research findings 2022

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The 10 biggest science stories of 2022 – chosen by scientists

From moon missions to fast-charging batteries and AI-sourced antibiotics, in no particular order, the year’s significant scientific developments

1. The Dart and Orion missions

The year opened with a bang. Or rather, it didn’t. The successful film Don’t Look Up , in which a comet is found to be on a collision course with Earth, had been released just before Christmas 2021. In the bleak days of post-festive gloom, the news media were on an adrenaline high, chasing any and every story about potential asteroid collisions to cheer us all up. Five asteroids were to pass close to the Earth in January alone! Happily for the health and wellbeing of humanity, none was predicted to come within a whisker of hitting the planet. Nonetheless, the possibility of an asteroid colliding with Earth is a reality – the globe is covered in craters from previous impacts, and it is well known that 65m years ago, dinosaurs became extinct following the impact of an asteroid about 10km across. Can anything be done about saving us from this existential extraterrestrial threat? Fortunately, the international space community has taken the first steps towards reducing the risk of an asteroid catching us unawares. The joint Nasa- Esa mission Dart (Double Asteroid Re-Direction Test) was an ambitious attempt to alter the trajectory of a small asteroid (Dimorphos) as it orbited a slightly larger asteroid (Didymos), by sending a spacecraft to crash into it. In October, we learned that the mission had been even more successful than anticipated, and that the orbit of Dimorphos had changed – showing that we could, if given sufficient time, alter the path of an asteroid if it were on a collision course with Earth.

As well as asteroid activity, our moon has been in the news, as a destination of choice for a new generation of astronauts. This year, it is 50 years since the Apollo 17 mission, the last time a human set foot on the moon. So it is a cause for celebration that Artemis, another joint Nasa-Esa programme, has started its operation to return people to the moon. The first phase of the mission, the Orion capsule, was launched in mid-November, and successfully returned to Earth last week. The capsule is designed to hold up to six astronauts – though there were none on board this maiden flight around the moon. We can now look forward to a series of increasingly complex flights of Orion – culminating in a crew of astronauts landing on the moon as soon as 2025.

Monica Grady

Monica Grady is professor of planetary and space sciences at Open University

2. Covid’s boost to immune research

Vaccine technology has seen an unprecedented acceleration in innovation that could soon be benefiting us in a host of ways. A vaccine works by delivering an “infection” signal (something from the germ) and an “alert” signal (to wake the immune response up). As our knowledge of immunology has increased, so too has our capacity to innovate in the vaccines that deliver those signals. Designing any new vaccine takes a long time, significant investment and a lot of eager volunteers, all of which was accelerated during the pandemic, resulting in a host of novel developments.

The autumn Covid-19 booster shots we have just been offered are one such example – these bivalent vaccines target the original strain of Sars-CoV-2 (the virus that causes Covid-19) alongside the Omicron variant. Bivalent vaccines have advantages over the original vaccines as they both top up and broaden our immunity . But what if you could broaden your immunity further – to not just two but multiple strains of virus? So-called multivalent vaccines for Covid-19 and flu are looking very promising. Another approach we could soon see is the use of sniffable or inhalable vaccines – mucosal vaccines . These are already used in China to tackle Covid-19 and may offer long-term protection against respiratory viruses. They are also much more appealing for those of us who are needle-phobic. If these new developments deliver on their promise, then one day soon the calls for annual shots could be a thing of the past. Sheena Cruickshank

Sheena Cruickshank is professor of biomedical sciences and public engagement at the University of Manchester

3. AI reveals new antibiotics

Over the course of the past few years, AI has transformed the field of molecular biology. The revolution started with the AlphaFold algorithm, which rapidly predicts the complex three-dimensional structures of proteins, thus aiding the understanding of protein functions and the identification of drug targets. This year, AI has achieved another breakthrough, this time at the other end of the drug discovery pipeline: several groups in 2022 have reported the first successful applications of AI to identify novel antibiotic drugs.

Antimicrobial resistance is a major global threat. This year, the global research on antimicrobial resistance report published in the Lancet indicated that, worldwide, 4.95m deaths were associated with drug-resistant bacteria in 2019, making untreatable infections one of the leading causes of death.

Developing new drugs that overcome resistance and replenish our arsenal of effective antimicrobials is a continuous struggle. And that is where AI is now beginning to make a major contribution. For example, Yue Ma and colleagues from the Chinese Academy of Sciences used machine-learning techniques originally developed for natural language processing to identify antimicrobial peptides encoded by the genome sequences of microbes in the human gut. The algorithm identified 2,349 potential antimicrobial peptide sequences. Of these, 216 peptides were synthesised by chemical methods, and 181 of them were shown to have antimicrobial activity. This is an impressive success rate, which would not have been possible without the aid of AI.

Even more strikingly, almost half of the peptides discovered were entirely new, without obvious sequence similarity to known antimicrobials, thus increasing the chances of circumventing existing resistance mechanisms. Animal experiments showed that three of the new peptides could be used for the safe and effective treatment of bacterial pneumonia in mice. Studies such as this are good news, promising an unprecedented rapid route towards novel treatment options for some of the scariest pathogenic threats we currently face. Eriko Takano

E riko Takano is professor of synthetic biology at the Manchester Institute of Biotechnology

4. Early weather warnings

In 2022, science was able to see a hurricane hitting the coast of the US before it even formed out at sea. We could visualise the Brisbane River spreading out into Australian homes before a drop of rain had fallen. And we put firefighters on action stations before the spark was lit that burned southern France. We now have the technology to see many of these natural hazards coming, days in advance.

And yet 2022 has been full of lethal events. In Europe, more than 20,000 people died from record-breaking heat this summer, hitting more than 40C (104F) across England for the first time. In August, one third of Pakistan was underwater during a monster monsoon season, killing 1,700 people . Global heating is making these types of disasters worse.

This is why the key scientific story from the past year is not cutting-edge research or hi-tech engineering, but the push by the UN secretary general António Guterres for the world to have equal access to early warnings . Alerting people to danger, so they can take action, is the best way to prevent tragedy. We need equal access to skills and systems that were pioneered years ago. Critical, too, is the leadership to share information and act on the warnings that ensue. Hannah Clo ke

Hannah Clo ke is professor of hydrology at Reading University

5. Inclusive inroads

This year saw a small but important advance in the treatment of sickle cell disease, a group of inherited disorders that cause red blood cells to become sickle shaped and can lead to anaemia. A drug developed to treat an enzyme deficiency (pyruvate kinase) was found to improve anaemia and reduced acute episodes of severe pain in sickle cell disease. While the research is still in its early phases, the researchers point out that their breakthrough came from looking at the characteristics of people with sickle cell disease rather than focusing only on their red blood cells. This development has been found to benefit people with other conditions and brings hope to millions of people worldwide, but predominantly in Africa, the Indian subcontinent and South America.

This was also the year when Nasa’s Artemis mission, which aims “to land the first woman and first person of colour on the moon” by 2025, put female torsos Helga and Zohar into space to test the effects of radiation on the grounds that women appear to be at a greater risk from space radiation than men. This may seem unremarkable, but it was only in 2022 that a Swedish research team designed a new crash test dummy representing an “average woman” , rather than a scaled-down version of the male dummy that is the size of a 12-year-old girl.

Developments such as these excite hope of inclusive science where gender, ethnicity and location neither privilege nor exclude. Ann Phoenix

Ann Phoenix is professor of psychosocial studies at the UCL Institute of Education

6. Elite mathematicians

The Fields medal recognises outstanding mathematical achievement for existing work. Often described as the Nobel prize of mathematics, it is awarded every four years to recipients under the age of 40.

Congratulation to Prof James Maynard, who was awarded a Fields medal this year for his “spectacular contributions” to analytic number theory, “which have led to major advances in the understanding of the structure of prime numbers and in Diophantine approximation”.

One of his standout proofs was to prove the following: there are infinitely many prime numbers whose decimal representation does not contain the digit 7.

Such a simple statement to understand but not very easy to prove. Maynard joins an elite list of British mathematicians who have won the medal.

Congratulations also to one of the other Fields medallists, the Ukrainian mathematician Maryna Viazovska , the second woman to win the award. The mathematician Henry Cohn stated: “Viazovska manages to do things that are completely non-obvious that lots of people tried and failed to do.” She was cited for many mathematical accomplishments, in particular her proof that an arrangement called the E8 lattice is the densest packing of spheres in eight dimensions. Nira Chamberlain

Prof Nira Chamberlain is president of the Institute of Mathematics and its Applications

7. Soft cell, hard cell…

When we think about what influences how the cells inside our bodies develop, we often think of biological or chemical factors. But physical forces – what’s known as the “mechanical” environment – can be just as critical to a cell’s journey. The ability of cells to sense and respond to their mechanical environment has been known for several decades: for example, stem cells grown on soft jelly-like gels will become different cell types compared with stem cells grown on stiff glass-like surfaces.

Early signs of diseases such as cancer and Alzheimer’s are often associated with changes in cell stiffness. However, it has been difficult to measure the stiffness of cells and organs inside our bodies, and how they change during development and disease. Tools to measure cell mechanical properties have relied on applying forces to the cell – essentially poking or cutting a cell and seeing how it responds. This is often invasive and damaging, and isn’t easily performed on living cells or organs inside animals, let alone humans.

This year, two research groups, one from Germany , and one from the US , published separate studies demonstrating groundbreaking improvements in a method to measure cell-stiffness, known as Brillouin microscopy. This optical method is non-damaging, allowing you to “see” the stiffness of a material without having to touch it. Developments in this technique this year have significantly advanced imaging speed and resolution, and reduced photo-damage, making the method now widely applicable for observing changes in cell mechanical properties in living animals.

This method will provide a powerful tool for early diagnosis of diseases such as cancer, atherosclerosis and Alzheimer’s. It will also revolutionise how scientists can measure and track the mechanical changes of our cells during normal development, and critically improve our understanding of the importance of mechanical forces in biology. Yanlan Mao

Yanlan Mao is professor of developmental biophysics at University College London

8. Quantum entanglement untangled

“Spooky action at a distance.” That’s what Albert Einstein called quantum entanglement, which is when two quantum particles have to be considered as a single entity, since influencing one of them affects the other even when they are far apart.

In October this year, the three pioneers of quantum information science, Alain Aspect of the University of Paris-Saclay, John Clauser of JF Clauser & Associates, and Anton Zeilinger of the University of Vienna were awarded the Nobel prize in physics for their contributions to understanding quantum entanglement.

There are many reasons to enjoy this long overdue award. For the sheer beauty of providing new insights into an exciting area of fundamental phenomena. For laying the groundwork for breakthroughs in quantum computers to carry out complex calculations that would be impossible on a conventional computer, and in quantum encryption that could allow secure communications. For spurring more experiments to address one of the great questions of science – how to reconcile quantum mechanics with Einstein’s general theory of relativity.

And finally, for demonstrating another example of the importance of curiosity-driven basic science leading to real-world applications that could change the way we live and work. Saiful Islam

Saiful Islam is professor of materials science at Oxford University

9. Nature positive

A huge moment for biodiversity is still ongoing as I write: the much-delayed 15th meeting of the parties to the Convention on Biological Diversity in Montreal, which will set a course for nature recovery from now until 2050. These international agreements feed into national legislation, such as the UK’s Environment Act. Alongside this, companies are making bold commitments to become “nature positive”, meaning that their activities should, overall, lead to nature being in a better state.

Nature-positive commitments need to translate into real, measurable – and attributable – recovery of nature. This is very challenging, though, partly because many products have tortuous supply chains so that the companies themselves don’t always know what the biodiversity impact of their activities is. For example, nickel is a crucial component of our daily lives, being used in the production of stainless steel. Yet how often do we stop and think about where the nickel in our cutlery or electric car batteries has come from, and how producing it has affected the environment?

One impact is the clearance of forests in areas where nickel ore is mined. Ambatovy nickel mine, the biggest mine in Madagascar, is one of a growing number of businesses to have made a commitment to leave nature in no worse a state as a result of its operations. The mine compensated for its forest clearance by putting measures in place to stop clearance of forest by local people for agriculture elsewhere. This year, Katie Devenish and colleagues at Bangor University published a paper looking at whether they had succeeded. Using sophisticated methods to separate out the effects of the mine’s activities from other factors leading to forest loss, the researchers demonstrated that the mine was on track to prevent at least as much deforestation as it had caused. The study is a model for how scientists can carry out thorough and independent evaluations of companies’ environmental commitments, reducing the temptation to greenwash.

We need many more studies like this, that link the esoteric world of high-level policy-making to realities on the ground, in all sectors from mining, to food, to transport and infrastructure. Then we will have a much better chance to hold our governments and companies to account, and reverse the loss of nature, wherever it takes place. E J Milner-Gulland

EJ Milner-Gulland is a professor of biodiversity at Oxford University

10. Battery charge

It’s one of the greatest unappreciated stories of our time: the incredibly rapid improvements in battery technology that will form the foundation of an electrified world as we wean ourselves off fossil fuels.

Of course there are questions. What about the costs? Will batteries ever really store enough energy for their size to power something like a large plane? And where will we get all the rare metals necessary to build them?

That’s why my story of the year is the October Nature paper by Chao-Yang Wang and co-authors , describing a way to charge energy-dense batteries incredibly quickly – in just a few minutes. It really highlights the phenomenal speed at which battery chemists, engineers and technologists are rising to the challenge. If you can charge a car battery in 10-12 minutes, charging more frequently becomes much less of a problem, allowing for smaller batteries that are cheaper and less resource-intensive to make.

We are also seeing huge progress in battery technologies based on cheap, abundant sodium instead of expensive and relatively rare lithium, as well as methods to make all these batteries far easier to recycle.

The basic principles of a battery haven’t changed, but the potential of the newest versions is astonishing and getting better all the time. Helen Czerski

Helen Czerski is a research fellow at the department of mechanical engineering , University College London

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Resultados científicos revolucionarios en la estación espacial de 2023

What we learned from scientific investigations on the space station in 2022, melissa l. gaskill.

Lee esta historia en español aquí .

The International Space Station, in its third decade of continuous human presence, has far-reaching impact as a microgravity lab hosting technology demonstrations and scientific investigations from a range of fields. Between Oct. 1, 2021 and Sept. 30, 2022, researchers published more than 400 scientific papers based on studies conducted aboard the space station.

Read highlights of some of the groundbreaking space station science published this past year below. For more space station research achievements and additional information about the findings mentioned here, check out the 2022 Annual Highlights of Results .

Tracking unique strains of microbes

Microbial Observatory-1 monitored the microbes present on the space station, identifying hundreds of microbial species. Researchers report finding three novel strains of Agrobacterium , a genus known for disease-causing characteristics. Results suggest that these strains could colonize habitats with fewer nutrients, giving them an advantage over those that need richer environments. The study of microbes offers insight to support development of mitigation strategies for maintaining safe living spaces for astronauts in spaceflight and for humans on Earth.

Protecting crew members’ brains

ISS Medical Monitoring regularly collects crew member health data that measures spaceflight’s effects on the human body. This information also is used for additional research studies. Researchers from ESA (European Space Agency) and State Space Corporation ROSCOSMOS used crew member blood samples taken before and after extended exposure to microgravity to assess brain tissue biomarkers. They report an increase in blood-based biomarkers of inflammation that could indicate potential risk to long-duration spaceflight crews. Additional studies with larger samples are needed to clarify these findings.

Measuring magnetars

NICER studies the extraordinary physics of neutron stars, which are glowing cinders left behind by supernovas, or the explosions of massive stars. Researchers report the classification of a recently discovered astronomical object, Swift J1555.2-5402, as a magnetar. Magnetars are highly magnetized neutron stars that release an enormous amount of magnetic energy through irregular outbursts of X- and gamma-rays. Observations of these outbursts help scientists address a wide range of astronomical topics, increasing understanding of some of the most extreme conditions in the universe.

Cyanobacteria rock extreme environments

EXPOSE R-2 BIOMEX, an investigation from ESA, measures the survival of terrestrial organisms in extreme environments, which could provide insight into the characteristics that extraterrestrial life would need to survive in space. Researchers exposed the desert cyanobacterium Chroococcidiopsis to simulated Mars-like conditions in space and on the ground. They report no increased genetic variants in the space strain, suggesting that the strain retained its ability to repair accumulated DNA lesions caused by radiation exposure. Cyanobacteria have potential for use in artificial bioregenerative life support systems to provide oxygen and food in space and for fuel, fertilizers, marine farming, and pharmaceuticals on Earth.

How plants sense gravity

Gravity acts as an important influence on plant development on Earth. Plant Gravity Sensing, an investigation from the Japan Aerospace Exploration Agency (JAXA), studies whether plants grown in microgravity can sense changes in gravity. Researchers report that Arabidopsis seeds cultured on a nylon lace mesh in microgravity had coiled roots and increased root entanglement with the mesh compared to those in Earth’s gravity. This observation suggests that gravity influences root coiling. Understanding how gravity affects plant growth could help scientists develop new ways to grow plants in space and lead to development of new plant varieties on Earth.

Archaeology in orbit

More than 332,000 items have been sent to the space station during its 20-plus years of human habitation. SQuARE, an investigation sponsored by the ISS National Lab, examined what happened to these objects and their possible symbolic and social meanings for crew members. Researchers report their observations on the processes developed to return research, commercial, and personal items to Earth and the meanings and associations of the objects that return. This research provides insights into the nature of life on the station and could inform design of future space habitats by expanding our understanding of how different objects and spaces are used over time. The paper’s authors received an Award for Outstanding Work in Digital Archaeology from the Archaeological Institute of America.

Microanalysis of Martian meteorite

Mochii is a miniature scanning electron microscope (SEM) that conducts real-time imaging and measurements of specimens on the space station. Such particles can interfere with equipment or affect crew health. To test the accuracy of the technology, researchers analyzed a fragment of a Martian meteorite found in Antarctica in 1984. They compared results using a standard SEM on the ground and Mochii on the space station, noting good agreement between the results that indicates accurate functioning of the microscope in space. Mochii could support novel, real-time scientific investigations and technology testing in microgravity to benefit space travelers and humans on Earth.

Watching water use from above

ECOSTRESS measures the temperature of the surface of Earth to help answer questions about water availability, vegetation water stress, and agricultural water use. Researchers used data from the investigation to study the water use efficiency (WUE) values within and among regions with different plant functional types, such as grassland and forest. WUE provides a direct measure of the link between plant carbon uptake and water loss and shows how ecosystem function varies with climate.

Ultracold bubbles

The space station’s Cold Atom Lab (CAL) produces clouds of chilled atoms that allow scientists to study fundamental behaviors and quantum characteristics that are difficult to probe at higher temperatures on Earth. Researchers report creation and measurements of bubbles of these ultracold atoms. Their observations could inform future microgravity studies exploring the fundamental nature of the condensed bubble state and advancing understanding of quantum systems.

Radio program notches 7th continent

The ISS Ham Radio program reached every continent on Earth when astronaut Kjell Lindgren spoke via amateur radio with students at a school in Argentina’s Esperanza Base in Antarctica. These sessions engage students, teachers, parents, and other members of the community and help inspire interest in science, technology, engineering, and math. Esperanza Base is a permanent, year-round Argentine research station in Hope Bay on the Trinity Peninsula, one of only two civilian settlements in Antarctica.

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MIT’s top research stories of 2022

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The dizzying pace of research and innovation at MIT can make it hard to keep up. To mark the end of the year, MIT News is looking back at 10 of the research stories that generated the most excitement in 2022.

We’ve also rounded up the year’s  top MIT community-related stories .

• Designing a heat engine with no moving parts . In April, engineers at MIT and the National Renewable Energy Laboratory (NREL) designed a heat engine that might someday enable a fully decarbonized power grid. In demonstrations, the engine was able to convert heat to electricity with over 40 percent efficiency — a performance better than that of traditional steam turbines.
• Creating a lightweight material stronger than steel . In February, MIT chemical engineers used a new polymerization process to form a material that that is stronger than steel and as light as plastic, and can be easily manufactured in large quantities. The material could be used as a coating for car parts or as a building material for bridges and other structures.
• Enabling portable desalination at the push of a button . MIT researchers developed a suitcase-sized device that can remove particles and salts to generate drinking water. Unlike other desalination units that rely on filters, this device uses electrical power to purify the water. It requires less power to operate than a cell phone charger and can be driven by a small solar panel. Just push start.
• Linking human genes to function . A team of researchers created the first map tying every gene expressed in human cells to its job in the cell. The map, which is available for other scientists to use, makes it easier to study a range of biological questions. The map was created using a CRISPR-based single-cell sequencing method known as Perturb-seq.
• Improving supercomputing with a new programming language . A team of researchers based mainly at MIT invented a faster and more reliable programming language for high-performance computing. The language, which was tested on a number of small programs, could one day help computers with a number of deep learning tasks like image processing.
• Lifting people out of extreme poverty . A study co-authored by an MIT economist showed that a one-time capital boost (in this case, a cow) helped poor people in rural Bangladesh improve their lives in the long run. The study suggests the very poor are in a poverty trap, in which an initial lack of resources prevents them from improving their circumstances, and implies that large asset transfers are an effective way to reduce global poverty.
• Helping robots fly . Inspired by fireflies, MIT researchers created tiny actuators that emit light to allow insect-scale robots to communicate. Weighing barely more than a paper clip, the robots are too small to make use of traditional means of sensing and communication. Instead, the actuators that control the robots’ wings light up in different colors and patterns, which could enable them to do things like share their location and call for help.
• Detecting a radio signal in a far-off galaxy . In July, astronomers at MIT and elsewhere were surprised to find a periodic fast radio burst (FRB) originating billions of light-years from Earth. It is the longest lasting FRB pattern detected to date and is made up of intensely strong radio waves that repeat every 0.2 seconds, similar to a heartbeat. Astronomers suspect the signal is coming from a neutron star.
• Proposal for a new, low-cost battery design . Researchers at MIT developed a battery made from abundant, inexpensive materials to complement the rise of lithium-ion batteries. The new battery uses aluminum and sulfur as its two electrode materials and a molten salt electrolyte in between. It could be ideal for powering single homes or small to medium sized businesses, producing a few tens of kilowatt-hours of storage capacity.
• Immigrants as job creators . A study co-authored by an MIT economist found that compared to native-born citizens, immigrants are about 80 percent more likely to found a firm. The study, which looked at registered businesses of all types across the country, suggests that immigrants act more as "job creators" than "job takers" and play outsized roles in high-growth entrepreneurship in the U.S.

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The 10 Most Significant Education Studies of 2022

In our annual ritual, we pored over hundreds of educational studies and pulled out the most impactful—from a new study on the sneaky power of sketchnotes to research that linked relationships and rigor.

This past year didn’t feel normal, exactly, but compared with the last few trips around the sun, well—it sufficed. In 2021, when we sat down to write our annual edition of the research highlights, we were in the throes of postpandemic recovery and wrote about the impact of a grueling year in which burnout and issues of mental and physical health affected educators everywhere.

This year, we crossed our fingers and turned to best practices once again, reviewing hundreds of studies to identify the most impactful and insightful educational strategies we could find.

What turned up?

We found evidence that sheds new light on the misunderstood power of brain breaks, took a close look at research that finds a surprising—even counterintuitive—rationale for teachers to focus on relationships, and located both the humor and the merit in asking kids to slither like a snake as they learn about the “sss” sound of the letter S .

All that, and a lot more too, in our once-a-year roundup that follows.

1. There’s No Conflict Between Relationships and Rigor

Observers sometimes assume that teachers who radiate empathy, kindness, and openness are “soft” and can be taken advantage of by students. But new research shows that when you signal that you care about kids, they’re willing to go the extra mile, giving you the flexibility to assign more challenging school work.

That’s the main takeaway from a 2022 study that examined teaching practices in 285 districts, comparing relationship-building strategies with the flexibility that teachers had in assigning challenging and complex work. The researchers found that the most effective teachers build their classrooms by getting to know their students, being approachable, and showing that they enjoy the work—and then deftly translate emotional capital into academic capital.

“When students feel teachers care about them, they work harder, engage in more challenging academic activities, behave more appropriately for the school environment, are genuinely happy to see their teacher, and meet or exceed their teacher’s expectations,” the researchers conclude.

2. Highlighting Isn’t Very Effective Until Teachers Step In

Students often highlight the wrong information and may rely on their deficient highlighting skills as a primary study strategy, leading to poor learning outcomes, a new analysis of 36 studies suggests. As little as two hours of tutoring, however, can dramatically improve their capabilities.

The researchers determined that “learner-generated highlighting” tended to improve retention of material, but not comprehension. When students were taught proper highlighting techniques by teachers, however—for example, how to distinguish main ideas from supporting ideas—they dramatically improved their academic performance. Crucially, “when highlighting is used in conjunction with another learning strategy” like “graphic organizers or post-questions,” its effectiveness soars, the researchers said.

The need for explicit teaching may be linked to changing reading habits as students graduate from stories and fables to expository texts, which require them to navigate unfamiliar text formats, the researchers note. To bring kids up to speed, show them “examples of appropriate and inappropriate highlighting,” teach them to “highlight content relatively sparingly,” and provide examples of follow-on tactics like summarizing their insights to drive deeper comprehension.

3. A Landmark Study Strikes a Resounding Note for Inclusion

When the Individuals with Disabilities Education Act called for greater inclusion—mandating that students with disabilities receive support in the “least restrictive environment”—one goal was to ensure that educational accommodations didn’t interfere with the students’ social and emotional development in classrooms full of their peers. The law also confronted age-old prejudices and established a binding legal obligation in favor of inclusion.

But thus far, rigorous evidence of the academic benefits has been thin.

Now a new large-scale study appears to put the matter beyond dispute. When researchers tracked nearly 24,000 adolescents who qualified for special education, they discovered that spending a majority of the day—at least 80 percent—in general education classes improved reading scores by a whopping 24 points and math scores by 18 points, compared with scores of their more isolated peers with similar disabilities.

“Treat the general education classroom as the default classroom,” the researchers firmly state, and push for separate accommodations only when all other options have been exhausted.

4. Sketchnotes and Concept Maps Work—Even Better Than You Might Think

Simple concept maps, sketchnotes, and other annotated jottings—akin to doodling with a purpose—can facilitate deeper comprehension of materials than more polished drawings, a new study finds.

Representational drawings, such as a simple diagram of a cell, may help students remember factual information, the researchers explain, but they “lack features to make generalizations or inferences based on that information.” Organizational drawings that link concepts with arrows, annotations, and other relational markings give students a clearer sense of the big picture, allow them to visualize how ideas are connected, and provide a method for spotting obvious gaps in their understanding. On tests of higher-order thinking, fifth graders who made organizational drawings outperformed their peers who tried representational drawings by 300 percent.

To reap the benefits in class, have students start with simple diagrams to help remember the material, and then move them up to sketchnotes and concept maps as they tease out connections to prior knowledge.

5. Brain Breaks Are Misunderstood (and Underutilized)

Conventional wisdom holds that the development of a skill comes from active, repeated practice: It’s the act of dribbling a basketball that ultimately teaches the basketball star.

But recent studies reveal that the intervals between practice sessions are at least as crucial. In 2021, researchers used brain scans to observe neural networks as young adults learned how to type. During breaks, the brains of the participants appeared to head back to the keyboards, unconsciously replaying the typing sequences over and over again at high rates of speed as they flipped the material between processing and memory centers dozens of times in the span of 10 seconds. The researchers concluded that brain breaks play “just as important a role as practice in learning a new skill.”

In 2022, we learned that the kinds of breaks make a difference, too. One study compared in-classroom breaks like drawing or building puzzles with outdoor breaks like running or playing in sandboxes. In a nod to the power of movement—and free time—it was the kids playing outside who returned to class ready to learn, probably because indoor games, like indoor voices, required children to engage in more self-regulation, the researchers speculated. Meanwhile, an analysis examining “green breaks” —brief strolls in a park or visits to a school garden—concluded that students who partook in the activities performed better on tests of attention and working memory.

Depriving kids of regular breaks, it turns out, is a threat to the whole proposition of learning. To commit lessons to memory, the brain demands its own time—which it sets aside to clean up and consolidate new material.

6. On Classroom Design, an Argument for Caution—and Common Sense

When it comes time to decorate their classrooms, teachers often find themselves on the horns of a dilemma: Should they aim for Pinterest-worthy interior design or opt for blank walls on the strength of research that emphasizes the risks of distracting students?

A study published in February this year argues for minimalism. Researchers tracked the on-task behavior of K–2 students and concluded that visually ”streamlined” classrooms produced more focused students than “decorated” ones. During short read-alouds about topics like rainbows and plate tectonics, for example, young kids in classrooms free of “charts, posters, and manipulatives” were paying attention at significantly higher rates.

But it might not be a simple question of more or less. A 2014 study confirmed that posters of women scientists or diverse historical figures, for example, can improve students’ sense of belonging. And a recent study that observed 3,766 children in 153 schools concluded that classrooms that occupied a visual middle ground—neither too cluttered nor too austere—produced the best academic outcomes. A 2022 study reached similar conclusions.

Classroom decoration can alter academic trajectories, the research suggests, but the task shouldn’t stress teachers out. The rules appear to be relatively straightforward: Hang academically relevant, supportive work on the walls, and avoid the extremes—working within the broad constraints suggested by common sense and moderation.

7. For Young Children, the Power of Play-Based Learning

Children aren’t miniature adults, but a bias toward adult perspectives of childhood, with its attendant schedules and routines, has gradually exerted a stranglehold on our educational system nonetheless, suggests the author and early childhood educator Erika Christakis.

How can we let little kids be little while meeting the academic expectations of typical schools? A new analysis of 39 studies spanning several decades plots a middle path for educators, highlighting the way that play gently guided by adults, often called play-based learning, can satisfy both objectives.

Teachers of young students can have a “learning goal” in mind, but true play-based learning should incorporate wonder and exploration, be child-led when possible, and give students “freedom and choice over their actions and play behavior,” the researchers assert. Interrupt the flow of learning only when necessary: gently nudge students who might find activities too hard or too easy, for example. The playful approach improved early math and task-switching skills, compared with more traditional tactics that emphasize the explicit acquisition of skills, researchers concluded.

To get the pedagogy right, focus on relationships and ask questions that prompt wonder. “Rich, open-ended conversation is critical,” Christakis told Edutopia in a 2019 interview —children need time "to converse with each other playfully, to tell a rambling story to an adult, to listen to high-quality literature and ask meaningful questions.”

8. A Better Way to Learn Your ABCs

Getting young kids to match a letter to its corresponding sound is a first-order reading skill. To help students grasp that the letter c makes the plosive “cuh” sound in car , teachers often use pictures as scaffolds or have children write the letter repeatedly while making its sound.

A new study suggests that sound-letter pairs are learned much more effectively when whole-body movements are integrated into lessons. Five- and 6-year-olds in the study spent eight weeks practicing movements for each letter of the alphabet, slithering like a snake as they hissed the sibilant “sss” sound, for example. The researchers found that whole-body movement improved students’ ability to recall letter-sound pairings and doubled their ability to recognize hard-to-learn sounds—such as the difference between the sounds that c makes in cat and sauce —when compared with students who simply wrote and spoke letter-sound pairings at their desks.

The approach can make a big difference in the acquisition of a life-changing skill. Educators should “incorporate movement-based teaching” into their curricula, giving special consideration to “whole-body movement,” the researchers conclude.

9. Why Learners Push the Pause Button

Some of the benefits of videotaped lessons are so self-evident that they hide in plain sight.

When teaching students foundational concepts, a video lesson equipped with a simple pause button, for example, may allow students to reset cognitively as they reach their attentional limits, a 2022 study concluded. Pause buttons, like rewind buttons, are also crucial for learners who encounter “complex learning materials,” have “low prior knowledge,” or exhibit “low working memory capacities.”

Increasingly, the intrinsic value of targeted video lessons is borne out in research. In a feature on Edutopia , we looked at research suggesting that video learning supported self-pacing and flexible, 24/7 access to lessons; that questions embedded in videos improved academic performance, increased note-taking, and reduced stress (see these 2015 and 2020 studies); and that video versions of lectures tended to “make content more coherent ” to students.

To modernize their classrooms, teachers might record their most important lessons and make them available to students as study aids so they can pause, rewind, and review to their hearts’ content.

10. An Authoritative Study of Two High-Impact Learning Strategies

Spacing and retrieval practices are two of the most effective ways to drive long-term retention, confirms an authoritative 2022 review spanning hundreds of studies on the topic—and students should know how and why the strategies are effective.

In the review, researchers explain that students who prefer techniques like reading and rereading material in intense cram sessions are bound to fail. Instead, students should think of learning as a kind of “fitness routine” during which they practice recalling the material from memory and space out their learning sessions over time. Teaching kids to self-quiz or summarize from memory—and then try it again—is the crucial first step in disabusing students of their “false beliefs about learning.”

The effect sizes are hard to ignore. In a 2015 study , for example, third-grade students who studied a lesson about the sun and then reread the same material scored 53 percent on a follow-up test, the equivalent of a failing grade, while their peers who studied it once and then answered practice questions breezed by with an 87 percent score. And in a 2021 study , middle school students who solved a dozen math problems spread out across three weeks scored 21 percentage points higher on a follow-up math test than students who solved all 12 problems on the same day.

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As populations age, Alzheimer’s and dementia are becoming more prevalent. A new drug could offer hope

As populations age, the number of cases of dementia rises. Image:  Unsplash/centelm

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• A new drug, lecanemab, has been shown to reduce the decline in memory and thinking associated with Alzheimer's.
• As populations age, dementia cases are on the rise, with 10 million new people diagnosed each year.
• Dementia is a collective term for a group of diseases or brain injuries that can lead to a change in cognitive functioning as well as other symptoms like lack of emotional control.

It is one of the biggest diseases of our time: 10 million new cases of dementia are diagnosed every year, according to the World Health Organization (WHO). More than 55 million people worldwide live with a form of dementia and it is the seventh leading cause of death among all diseases.

Now a new drug is offering a glimmer of hope after years of searching for a treatment. In clinical trials, lecanemab has been shown to slow the cognitive decline associated with the disease. The drug attacks the protein clumps in the brain that many think are the cause of the disease.

Although dementia patients are currently offered drugs, none of them affect the progression of the disease which is why scientists in the field are so excited about this latest development. Alzheimer's Research UK called the findings "a major step forwards" .

But while this is undoubtedly positive news, the body also points out that the benefits of the drug were small and came with significant side effects. In addition, lecanemab has been proven to work in the early stages of the disease, so would rely on doctors spotting it before it had progressed too far.

With the number of dementia cases expected to rise to 78 million by 2030 and 139 million in 2050, according to the WHO, the race is on for scientific developments and research that will help us understand, treat and possibly prevent the disease.

A global impact

As populations age, the number of cases of dementia rises. While the deterioration of cognitive functioning is not caused by age itself, it does primarily affect the older generation. For many elderly people it also results in disability and loss of independence - which can have psychological, social and economic implications for them and their families, carers and society more broadly.

The estimated global cost of dementia to society was placed at $1.3 trillion in 2019, and is expected to rise to $2.8 trillion by 2030, WHO says.

Alzheimer’s Diesease, a result of rapid ageing that causes dementia, is a growing concern. Dementia, the seventh leading cause of death worldwide, cost the world $1.25 trillion in 2018, and affected about 50 million people in 2019. Without major breakthroughs, the number of people affected will triple by 2050, to 152 million.

To catalyse the fight against Alzheimer's, the World Economic Forum is partnering with the Global CEO Initiative (CEOi) to form a coalition of public and private stakeholders – including pharmaceutical manufacturers, biotech companies, governments, international organizations, foundations and research agencies.

The initiative aims to advance pre-clinical research to advance the understanding of the disease, attract more capital by lowering the risks to investment in biomarkers, develop standing clinical trial platforms, and advance healthcare system readiness in the fields of detection, diagnosis, infrastructure and access.

What is dementia?

Dementia is a collective term for a group of diseases or injuries which primarily or secondarily affect the brain. Alzheimer’s is the most common of these and accounts for around 60-70% of cases. Other types include vascular dementia , dementia with Lewy bodies (abnormal protein clumps) and a group of diseases that contribute to frontotemporal dementia. It can also be triggered by strokes, excessive use of alcohol, repetitive head injuries, nutritional deficiencies, or follow some infections like HIV, the Alzheimer’s Society explains.

The different forms of dementia can often be indistinct and can co-exist.

Different people are affected in different ways, depending on the underlying cause. But the syndrome is usually progressive and can affect a range of functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement.

Changes in mood and ability to control emotions often accompany these cognitive variations.

Can it be treated?

There is no cure for dementia, although there are numerous treatments being worked on and at clinical trial phase. Dementia care currently focuses on early diagnosis, optimizing health and wellbeing and providing long-term support to carers.

Besides age, there are a number of other risk factors, which if avoided, can decrease the chances of dementia and slow its progression. Preventative steps include being physically active, not smoking, avoiding the harmful use of alcohol, as well as maintaining a healthy diet, weight, blood pressure, cholesterol and blood sugar levels.

Other risk factors associated with dementia include depression, social isolation, low educational attainment, cognitive inactivity and even air pollution .

What is the impact?

People with dementia rely heavily on informal care - i.e., friends and family. These carers spent on average five hours a day looking after people living with dementia in 2019, according to WHO figures. Informal care is thought to cover half of the overall financial burden of dementia.

There is also a disproportionate impact on women. They account for 65% of all dementia-related deaths, and also have a greater number of years affected by the disease. Women also typically provide the majority of informal care - covering over two-thirds of the carer hours for people living with dementia.

What are the latest developments?

The fact that dementia is only diagnosed once symptoms appear means that by the time people take part in clinical trials the disease is often quite well advanced. This can hamper the development of drugs. However, research analyzing data from the UK Biobank has indicated there are a collection of signals that could indicate a problem years before dementia is currently being diagnosed .

Other scientists postulate that, rather than being a disease of the brain, Alzheimer’s is in fact a disorder of the immune system within the brain . They believe research should instead focus on drugs targeting auto-immune pathways .

On a less positive note, researchers found that people who have recently received a dementia diagnosis, or diagnosed with the condition at a younger age, are at an increased risk of suicide . This underlines the importance of a strong support network, particularly among those newly diagnosed.

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• Research Themes and Findings

The DHR program funds research that demonstrates how digital healthcare solutions can be designed and implemented to improve healthcare system performance and patient health outcomes. Our funded research focuses on advancing patient safety, care, and shared decision making without placing excessive burden on users, including patients, physicians, and other members of care teams.

This report highlights research stories that showcase significant findings and impact under each theme. The research stories are identified as completed or emerging (newly funded) research.

• Completed research: 28 grants and 3 contracts recently ended.
• Emerging research: 23 grants recently awarded.

In 2022, the DHR program managed 108 grants and seven research contracts across the three main themes:

• Engaging and Empowering Patients

Engaging and empowering patients in their own healthcare leads to improvements in safety, quality, and satisfaction of care. Use of digital healthcare tools, like patient portals, smartphones, or mobile apps, can facilitate patient engagement and empower patients and their caregivers to participate more actively in their own health self-management, chronic care management, and wellness at the many points of interaction with the healthcare system.

In 2022, DHR invested $72.3 million in grants and contracts across the lifetime of the projects to help patients, families, and health professionals work together as partners in promoting care improvements over the duration of the projects.

Research Stories by Subtheme

Below are research stories told in the investigator’s own words organized by subtheme.

Using digital healthcare tools in chronic disease self-management

A mobile application designed to facilitate asthma self-management and shared decision making through patient-reported outcomes can improve care, asthma control, and knowledge, as well as decrease healthcare utilization

A patient-facing app simplifying the information patients and caregivers receive has the potential to better engage patients and families in their healthcare post-discharge and reduce adverse events.

Using digital shared decision-making tools to support personalized decision making

Enhancing personalized care decisions, using technology designed with human factors engineering approaches, can improve breast cancer care quality.

Other Research by Subtheme

The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research related to Engaging and Empowering Patients that was either completed or newly awarded in 2022. To search the entire portfolio of research, please visit AHRQ Funded Projects .

Mobile health applications adapted with automated learning algorithms can target specific health conditions, such as improving the management of diabetes and depression while delivering adaptive messages based on patients' behaviors.

The use of a mobile health application can improve chronic disease self-management and medication adherence for people with HIV.

Expansion of an evidence-based digital health intervention for attention deficit hyperactivity disorder in children that is focused on improving communication and care coordination across multiple points of care has the potential to improve outcomes for this group of individuals.

While “cold” texting of patients to suggest screening for diabetes is feasible from a technological and governance perspective, more research is needed to inform how to better engage patients.

The use of Support-Engage-Empower-Diabetes (SEE-Diabetes), a user-centered shared decision-making module, may improve self-care behaviors and outcomes for older adults with diabetes.

Use of a standards-based shareable, interoperable patient-facing clinical decision support tool for high blood pressure management has the potential to improve outcomes by empowering patients and providing them the tools to better engage in the self-management of their high blood pressure.

Using patient-facing applications to empower patients in their care

Identifying and characterizing the factors differentiating patient portal users from nonusers within population subgroups can inform clear design guidelines to represent the diverse needs of patients to increase access and utilization of patient portals.

The use of Substitutable Medical Applications Reusable Technologies (SMART®) on Fast Healthcare Interoperability Resources (FHIR®) standards has the potential to improve guideline-directed medication therapy in those with heart failure, and if successful, the approach could reduce heart failure hospital admissions and be applied to other chronic conditions.

A multicomponent digital health solution has the potential to improve glycemic control and outcomes in Medicaid-enrolled pregnant individuals with type 2 diabetes.

A family-centered multi-component digital tool with an innovative communication approach may reduce childhood obesity risk, as well as contribute to the limited evidence base of effective, culturally relevant mHealth tools for minority, at-risk populations.

Using CareHeroes, an application to support caregivers of those living with dementia, has the potential to support caregivers by making information on dementia readily available and creating the ability to track and share information about the impacted person between caregivers and providers.

Using technology solutions to optimize pain management

Measuring patient-reported outcomes for pain management after certain dental procedures with a mHealth platform is feasible and improves patient-provider communication, patient-provider relationship, and the ability to manage pain medication prescribing.

The use of a virtual reality app has the potential to be a cost-effective way to alleviate pain, reduce the need for opioids, and improve outcomes for children needing at-home dressing changes for burn injuries.

• Optimizing Care Delivery for Clinicians

Supporting clinicians and other healthcare professionals by maximizing their ability to provide high-quality and safe healthcare to patients leads to improved health outcomes. For example, using digital health research to optimize clinical decision making by delivering the right information to the right people at the right times, allows clinicians to make the best treatment decisions, while also ensuring that technology is designed in a way that supports cognitive work and does not introduce or increase provider burden.

In 2022, the DHR program invested $55.2 million over the duration of research on projects that focused on optimizing care delivery for clinicians, including research on using effective clinical decision support (CDS) interventions to improve care, using real-time digital healthcare data to improve timely treatment or diagnosis, and technology solutions to improve medication safety.

Improving medication safety using digital healthcare solutions

Implementing CancelRx, an e-prescribing tool to electronically communicate medication discontinuation orders between electronic health records and pharmacies, showed an immediate and persistent reduction in prescriptions that were dispensed after discontinuation.

Scaling effective and interoperable CDS to improve care and decision making

Tools like ASPIRE that integrate fall prevention clinical decision support and patient resources may better support patient self-care and adoption of evidence-based recommendations.

A methodology for scaling patient-centered outcomes research into interoperable, shareable clinical decision support tools that are actively maintained with current evidence has the potential to close the evidence-into-practice gap, leading to better patient outcomes.

Using real-time digital healthcare data to improve timely treatment or diagnosis

Use of an artificial intelligence algorithm that would allow for screening mammography interpretation and same-day diagnostic imaging has the potential to vastly shorten the time from an abnormal screening mammogram to diagnostic workup, resolving false positives in a timelier fashion, and reducing the anxiety incurred in patients by long wait times for diagnostic evaluation.

An artificial intelligence digital health tool that identifies patients on the verge of clinical deterioration may allow for faster intervention and a reduction in morbidity and mortality.

Using the clinical decision support system Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department significantly reduces the prescribing of potentially inappropriate medications in the emergency department setting.

The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research related to Optimizing Care Delivery for Clinicians that was either completed or newly awarded in 2022. To search the entire portfolio of research, please visit AHRQ Funded Projects .

Computerized alerts can prevent errors and improve clinical documentation by prompting prescribers to double check the patient, the drug, and the diagnosis whenever a drug being ordered does not match any diagnosis in the patient’s problem list.

A perioperative clinical decision software platform outperformed the standard medication administration and documentation workflow by improving efficiency and quality of care while receiving higher usability ratings from clinicians.

Innovations in drug allergy picklists, particularly using enhanced dynamic picklists, are a promising solution to support real-time allergy reconciliation, improve documentation among providers, and reduce cognitive burden.

Using interoperable standards to create a reusable, shareable, and scalable system for patient shared decision aids has the potential to scale these important shared decision-making tools widely and improve patient-centered outcomes.

CDS Connect offers a public platform for authoring and sharing interoperable clinical decision support resources. Health information technology developers, clinical informaticists, and healthcare system leaders can leverage each other’s experiences and tools to reduce the burden of developing and implementing CDS, thus making it easier overall to advance evidence into clinical practice through CDS.

Creating clinical decision support artifacts that are shareable, interoperable, and scalable may allow for wider dissemination of patient-centered outcomes research related guidelines.

Clinical decision support embedded within a provider’s workflow combined with a continuing medical education program increases a provider’s awareness of medications and conditions that increase the risk of Torsades des Pointes, an uncommon, but life-threatening cardiac arrhythmia.

The design, development, and implementation of the app Tapering And Patient Reported outcomes for Chronic Pain Management (TAPR-CPM) led to the identification of strategies, facilitators, and barriers to implementation that provide insight for future digital healthcare interventions.

Using digital healthcare tools in improving chronic disease care

The use of clinical decision support for adults with prediabetes improves clinical processes and may lead to improved outcomes.

Applying novel machine learning methodologies in real time to readily available risk and prognostic data in electronic health records could contribute to the development of a timely, accurate, and scalable approach to inform personalized childhood asthma treatment at the point of care.

A clinical decision support system that uses machine learning combined with clinician perspectives to identify and manage patients with acute respiratory distress syndrome is feasible and outperforms clinician recognition.

Using clinical decision support to alert clinicians about potential factors impacting a patient’s ability to adhere with a care plan leads to the improvement of contextualized care plans that account for those factors.

Several electronic health record (EHR) communication network structures, including network size and betweenness centralization, impacts patients’ survival time such that smaller and more centralized EHR networks are associated with longer survival time.

Using technology to improve provider capacity to provide optimal care

A training solution using artificial intelligence can be tailored to allow providers to quickly and actively address inadequate training, and thus improving their ability to elicit from patients their own motivations to make healthy behavior changes.

Examining the relationship between nursing documentation patterns and patient outcomes during the COVID-19 pandemic can support better optimization of electronic health record configurations to support nurses to provide better care for patients.

The use of order sets in patients with sepsis reduces order variation and improves outcomes and may be a strategy to adhere to best practices and improve clinical management.

• Supporting Health Systems in Advancing Care Delivery

Advancing care delivery at the health systems or organization level, including scaling effective interventions across different platforms, promoting interoperability, and leveraging data and technologies can strengthen healthcare systems and the care they deliver.

In 2022, the DHR program invested $45.4 million across the lifetime of projects on research to advance care delivery and to scale effective digital healthcare intervention across healthcare systems.

Improving equity in healthcare with digital healthcare solutions

A machine learning, predictive analytic intervention has the potential to improve healthcare, making it more equitable for patients with a non-English language preference and complex care needs by supporting timely interpreter use to facilitate decision making and promote patient-centered care.

Scaling effective digital healthcare interventions across healthcare systems

A shared decision-making tool to support the appropriate use of low-dose computed tomography screening has the potential to prevent 10,000 or more lung cancer deaths annually in the United States.

Clinical decision support that can be implemented in different types of electronic health records has the potential to scale evidence-based practice across healthcare systems.

Development of a toolkit to facilitate the scale and spread of using patient-reported outcomes among rheumatoid arthritis patients fills an existing gap in national resources to provide support to rheumatologists.

Using digital healthcare tools to improve patient safety

New measures to identify near-miss medication errors are a major advancement in patient safety and can help healthcare systems make ordering even safer.

An enhanced health information exchange platform that improves workflow, interoperability, and visualization of data for inter-hospital transfers may reduce the morbidity and mortality seen today during inter-hospital transfers.

Using machine learning- and artificial intelligence-developed tools in the intensive care unit has the potential to optimize critical care pharmacist resources and improve patient safety by reducing adverse drug events.

The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research related to Supporting Health Systems in Advancing Care Delivery that was either completed or newly awarded in 2022. To search the entire portfolio of research, please visit AHRQ Funded Projects .

Bringing together States’ Medicaid medical directors to understand undiscovered challenges facing Medicaid consumers and Medicaid programs in identified areas that may be amenable to improvement through technology innovation.

The use of automated speech recognition and automated machine translation technologies integrated in an asynchronous telepsychiatry application may be a viable language interpretation option for those with limited English proficiency.

The dissemination of a low-cost, user-friendly, culturally competent, evidence-based, scalable intervention to improve the health of young African American women is critical to improving maternal and child health outcomes.

Improving shared decision making for lung cancer screening by adapting and disseminating an interoperable clinical decision support tool and patient-facing app has the potential to reduce lung cancer deaths—the leading cause of cancer-related deaths in the United States.

E-care plan applications that use interoperability standards have the potential to improve care management and care coordination for people with multiple chronic conditions across different healthcare settings.

Applying improved methods to handle missing and misclassified data across databases without the need to share data on the individual level will lead to improvements in data used for population-level research.

Creating tools to automate the assessment and improvement of representational semantic integrity of terminologies in electronic health record databases will lead to improved databases with less redundancy and ambiguity and more robustness for research purposes.

Analyzing electronic health record metadata may help health systems identify gaps, inconsistencies, and inefficiencies in discharge planning to inform improvements in transitions of care.

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• Ulster Med J
• v.91(2); 2022 May

The Role of Visual Abstracts in the Dissemination of Medical Research

Beverley c. millar.

1 School of Medicine, Dentistry and Biomedical Sciences, The Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK

2 School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA

3 Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AD, UK

Michelle Lim

4 James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

Medical research within the UK has continued to grow, most notably during the COVID-19 pandemic over the last two years, which highlights the importance of disseminating relevant research findings. For all researchers involved in clinical trials and scientific research, the end goal of success is not completed following the publication of the research findings, but ultimately true impact and significance is achieved when such research has a role in developing clinical practice. Each year between 2.5 - 3 million scientific papers are published and the number continues to rise, therefore it is becoming increasingly difficult to ensure that published research has such a targeted impact as it must first get noticed. Increasing time commitments result in difficulties for clinicians keeping up-to-date with the current literature and in order to address this, journals and researchers have developed approaches to share peer-reviewed research with the wider research community in an effective and efficient manner. One such approach has been the introduction of the visual abstract which comprises of an infographic style format, coupled with a shortened, limited word summary of the research abstract detailing the key question, methodology, findings and take home message of the research study. The visual abstract has characteristics which enable it to be shared on social media platforms and in turn increase the interest and impact within the research community. Visual abstracts are being increasingly introduced within medical journals and organisations to help disseminate valuable research findings. This review focuses on visual abstracts, what they are, their history, structure and role within research dissemination and medical education.

INTRODUCTION

“If a tree falls in a forest and no one is around to hear it, does it make a sound?” (Henriksen and Mishra, 2019) 1

The ultimate goal of medical research is to have impact on clinical practice and as reported by the National Institute for Health Research, “ clinically research-active hospitals have better patient care outcomes ”. 2 However, increasing numbers of high quality medical research although published, may never be disseminated, cited or read, other than by the authors, the peer-reviewers and the editor of the accepting journal, thus questioning the significance and value of such research. 1 It is therefore fundamentally important to disseminate research to a wide audience to facilitate and promote the implementation of research findings into clinical practice. 1

The impact of research, particularly in academia, has traditionally been measured quantitatively in terms of number of publications, the impact factors of journals where the research has been published, the number of citations and the h -index. 3 This form of assessment has been viewed by some as outdated and it has been suggested that the validity of the traditional form of assessment has been compromised due to a number of issues, such as, the increased numbers on author lists, the volume of papers published, self-citations, extensive reference lists and papers published in high impact journals by common groups of authors 3 . More recently, due to the advancements in digital technology, additional complementary research evaluation, attention and dissemination metrics have been introduced by institutional repositories and journal websites, such as Altmetric 4 and PlumX Metrics 5 . These metrics aim to provide a more comprehensive indication of the impact of research outputs, within the online environment and complement the traditional bibliometrics. 6 These additional indices reflect digital footprints and provide a more comprehensive overview of the interest that the published research has had in terms of citations including clinical, patent and policy documents, usage, captures, mentions and social media 6 . Currently, however, traditional citation bibliometrics still remain the most recognised for impact evaluation of peer-reviewed publications and researcher activity within academia.

Irrespective of which bibliometrics are favoured, it is important that for peer-reviewed published research to have educational or clinical impact such research must be first noticed and subsequently read by the appropriate and varied target communities within research, education, government as well as healthcare policy makers and discipline specific groups providing guidelines.

“ What information consumes is rather obvious: it consumes the attention of its consumers. Hence a wealth of information creates a poverty of attention and a need to allocate that attention efficiently among the overabundance of information sources that might consume it .” (Simon, 1971) 7

The concept of attention and various aspects of attention have been discussed and researched extensively amongst psychologists for centuries 8 , however with the ever increasing demands on individuals’ time, attention is currently globally seen as a valuable commodity which is required to be captured. The term “ attention economy ” was originally devised in 1971 by the psychologist, economist and Nobel Laureate, Herbert Alexander Simon, who believed that an abundance of information would result in the consumption of attention 7 . Attention economy is not only important to organisations and business but also to publishers and authors of clinical and scientific research. Investment must be given to design approaches to capture the attention of readers and other researchers to facilitate the communication of research findings to key stakeholders whether that be service users, multidisciplinary healthcare teams or other researchers, by a variety of dissemination approaches to ensure attention and understanding in a resourceful manner 9 .

It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it. (Osler,1904) 10 .

It is essential that all clinicians, healthcare staff, researchers and students, can adapt and draw upon the current research knowledge to deliver safe, quality evidence based-practice for patient care and successful outcomes 11 . Developments within medicine are constantly and rapidly evolving and it is common practice to consult clinical journals to keep informed of recent research and reflect on such literature, which could impact or change clinical practice. Reviewing and reflecting on current medical literature, not only in relation to specific speciality disciplines, but in general terms, contributes to personal learning and continuing professional development in terms of keeping knowledge skills up-to-date, as well as identifying centres of excellence which could potentially be sources of clinical guidance in the future 11 , 12 . Importantly, the construction of clinical practice guidelines is built upon a solid evidence-base by systematic review of the published literature. 13 It has been calculated that the growth in publication outputs from scientific research in the field of Life Sciences has an annual growth rate of 5.07% and a doubling time of 14 years 14 . The time required to navigate through the oceans of articles published each month, filter and subsequently read, result in individuals facing challenges of how to allocate their time to focus on the articles which are significant in terms of their personal interests and those whose findings could impact on their clinical practice. As such, recently a variety of strategies have been documented to keep abreast with such medical literature through journal surveillance, manuscript review, rounds/seminars, amongst other approaches 11 .

‘With half an hour’s reading in bed every night as a steady practice, the busiest man can get a fair education before the plasma sets in the periganglionic spaces of his grey cortex’ (Osler, 1909) 15 .

Visual abstracts are a communication approach increasingly being used by authors and journals to stimulate selective attention and disseminate research findings to a broad audience both within and outside the readership of a particular journal in a concise manner and shared via social media. 16 Such image-focused summaries provide clinicians and researchers with a snapshot of current research findings and help guide which articles to select for further in-depth examination, whether for educational or research purposes. Visual abstracts, what they are, their history, role and structure are discussed in this article to complement their introduction within the Ulster Medical Journal .

THE PURPOSE OF VISUAL ABSTRACTS

“Visualisation lays the foundation of new modes of thought and dissemination of scientific ideas and information” (Ostergren, 2013) 17

Visualisation of key research outcomes offers the advantage of using a common language, thereby permitting global dissemination in a format which is accessible and understandable. 17 , 18 Such visual representations not only improve memorability in comparison to verbal representation but also help to persuade the viewer to examine the research in greater depth by retrieving the article. 17 , 18 The routine use of visualisation to communicate research findings not only allows scientists to develop competency in relation to visual literacy skills but more importantly, leads to the enhancement of cognition by means of visual thinking. 17 , 18

Nearly six years ago, Professor Andrew Ibrahim, Creative Director of Annals of Surgery , wished to improve how researchers could disseminate their research findings visually and the result was the introduction and sharing by the journal of the first visual abstract in July 2016 via social media using the hashtag #VisualAbstract. 19 The concept of visual representations of scientific research findings was not novel as many journals since the 1980s have used other visual formats such as central illustrations and graphic summaries to convey such information. Central illustrations and graphic summaries are used to convey the primary message or the most important findings detailed in a paper by means of a single illustration or graphical image. Unlike visual abstracts, they do not contain any details on methodology and generally appear at the end of the paper or at the end of the results section, the beginning of the discussion or as a thumbnail linked to the article. 20 In contrast, a visual abstract is generally presented at the beginning of the article after the scientific abstract. The purpose of the unique layout of the visual abstract is to provide a visual summary of research studies using visual icons in a format where scientific abstract meets infographic. Historically visual abstracts have used single or dual coloured icons and a limited text to convey the main outcomes of studies accompanied with a citation to the full article and credit to the visual abstract constructor. 21 The purposes of the visual abstracts are multi-fold namely to (i) assist readers scan recent research articles to acquire a flavour and comprehension for what is new and current in clinical research, (ii) engage and entice the reader to retrieve and read complete articles, which is fundamentally important prior to changing or influencing decisions relating to clinical practice 19 , 21 , (iii) promote a deeper engagement and discussion regarding the study findings 21 , (iv) help facilitate the establishment of scientific communities 22 , (v) increase a broader readership and (vi) provide a preview output which lends itself to dissemination particularly via social media. Since 2016, over one hundred medical journals and organisations, initially many nephrology and surgical journals and subsequently other various specialisms, including, but not limited to, the New England Journal of Medicine , The British Medical Journal, Stroke, Academic Psychiatry, Medical Education and JAMA Open , have adopted visual abstract formats, with several journals including Bone and Joint Research and the British Journal of Sports Medicine , dedicating sections to this aspect. 23 Some examples of the varied visual abstract designs are shown in Figure 1 .

(A) Taken from Costa RLD, Sória TC, Salles EF, Gerecht AV, Corvisier MF, Menezes MAM, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality. J Bras Nefrol . 202; 43(3) :349-358, under a Creative Commons Attribution (CC BY) License. ( https://creativecommons.org/licenses/by/4.0/deed.en ). 24

(B) Taken from Abbar M, Demattei C, El-Hage W, Llorca PM, Samalin L, Demaricourt P, et al. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ . 2022 Feb 2; 376 :e067194, under a Creative Commons Attribution-Non-Commercial (CC BY-NC 4.0) License ( http://creativecommons.org/licenses/by-nc/4.0/ ). 25

(C) Taken from Tummalapalli SL, Mendu ML, Struthers SA, White DL, Bieber SD, Weiner DE, et al. Nephrologist Performance in the Merit-Based Incentive Payment System. Kidney Med . 2021; 3(5) :816-826.e1, under a Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) License. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ). 26

(D) Visual Abstract used in conjunction with the full article by Ali B, Jiang Y, Agbim U, Kedia SK, Satapathy SK, Barnes M, et al. Effect of opioid treatment on clinical outcomes among cirrhotic patients in the United States. Clin Transplant . 2020; 34(6) :e13845. 27

RESOURCES AND SKILLS TO PREPARE A VISUAL ABSTRACT

There is much variation in the style and structure of visual abstracts currently shared on social media and as such, journals have provided guidelines to help standardise these outputs based on current published evidence to ensure consistency and validity of the visual abstracts associated with their journal. There are three main valuable resources which help guide in the construction of a visual abstract and which have been consulted when designing the templates for use in the Ulster Medical Journal , namely (i) Visual Abstract Primer (edited by Andrew Ibrahim) 21 which covers topics such as creating a visual abstract and leveraging a visual abstract for dissemination, (ii) Andrew Ibrahim’s Guidelines to Standardise Visual Abstracts for Scientific Research 19 and (iii) Michelle Lim’s short course on designing and the design process of visual abstracts. 28 The guidance detailed below and in Figure 2 and Figure 3 has been taken from these three resources.

The top ten tips for preparing an effective visual abstract

Key resources relating to the preparation of visual abstracts

In order to prepare an effective and informative visual abstract, it is not essential to use costly and complicated illustrative software or to possess extensive artistic or graphic design skills. It is important however, to be able to condense information and represent such information logically and coherently into three main sections encompassing the methodology, the main findings and conclusions of the research study. Additional skills which are required include creativity in thought of how to represent these findings using visual icons and the ability to organise information into bite size sections. 28

VISUAL ABSTRACT STRUCTURE

PowerPoint is the preferred digital tool to construct visual abstracts and used extensively by numerous journals and as such, the UMJ have prepared PowerPoint templates which will be used when visual abstracts accompany clinical papers. All template formats consist of four main areas as detailed below and examples of visual abstracts relating to previous articles published in the UMJ are shown alongside their paired scientific abstract, which is the primary source of the most important content prioritised in the visual abstract ( Figures 4 - ​ -6). 6 ). Details relating to the four areas of the visual abstract are detailed below and general guidelines are provided in Figure 2 .

Paired (a) written abstract and (b) visual abstract of a clinical paper previously published in the Ulster Medical Journal entitled “Antibiotic Prophylaxis Protocols and Surgical Site Infection Rates in Trauma Surgery” . 29

Paired (a) written abstract and (b) visual abstract of a clinical paper previously published in the Ulster Medical Journal entitled “Diagnostic accuracy of ultrasound in the paediatric population with acute right iliac fossa pain, our District General Hospital experience” . 31

Central to the construction of a visual abstract which is aesthetically pleasing and which contributes to promoting attention and further cognitive pursuit, is to ensure that its individual elements are discernible and there is a clear relationship between these sections with a logical flow. 17 , 18 Research has suggested several key tips to ensure that there is a minimum pressure on the working memory namely by minimising clutter, avoidance of prolixity and information overload and ensuring that images and text are germane to the key messages which need to be conveyed. 18

4a WRITTEN ABSTRACT

Introduction.

Prophylactic antibiotics have been shown to reduce the rate of surgical site infection (SSI), however there is little evidence supporting the effectiveness of one antibiotic over another. We have studied SSI rates and antibiotic prophylaxis protocols in Northern Ireland trauma surgery over a 10-year period to identify the most effective antibiotic protocol associated with lowest rate of SSI.

Antibiotic prophylaxis protocols from 2004-2014 were sought from each of the region’s 4 trauma hospitals and their dates of introduction recorded. For the same period, the number of trauma procedures carried out quarterly and the number of SSIs were recorded for each hospital from the return of prospectively collected SSI surveillance forms.

26849 trauma procedures were included with an overall SSI rate of 1.34% (95% Confidence interval [CI] 1.21 to 1.49). Single dose flucloxacillin (2 grams) with single dose gentamicin (3mg/kg) was the most commonly used protocol used in 3 different hospitals for a combined 13.5 years covering 11445 procedures. The SSI rate was 0.72% (95% CI 0.58-0.89). Triple dose cefuroxime (1.5 grams) was used in 2 different hospitals for a combined 10 years covering 8864 procedures. The SSI rate for this regime was 2.46% (95% CI 2.16-2.80). Single dose cefuroxime (1.5 grams) was used in 2 different hospitals for a combined 8 years covering 6540 procedures. The SSI rate was 0.92% (95% CI 0.71-1.18).

In this prospective observational cohort study prophylaxis using flucloxacillin and gentamicin was associated with the lowest SSI rate. Single dose cefuroxime was associated with a lower rate of SSI compared to triple dose (p<0.001). Identification of antibiotic regimes associated with the lowest SSI rates will promote the judicious use of antibiotics, improve antibiotic stewardship while allowing for continued benefit in the prevention of SSI in an era of ever-increasing antibiotic resistance.

4b VISUAL ABSTRACT

5a written abstract.

The delivery of cataract surgery during the COVID-19 pandemic is challenging because of the risk of nosocomial SARS-CoV-2 infection when patients attend hospital for elective care. In order to ascertain the risk to patients awaiting cataract surgery, this study aimed to identify the presence of systemic comorbidities that are associated with a high risk of severe disease or death due to COVID-19.

A prospective study of 315 patients (630 eyes) was conducted from 3rd June to 31st July 2020. An electronic health record was used to identify any systemic comorbidities that would render a patient ‘clinically extremely vulnerable’ to COVID-19, as outlined by the Department of Health for Northern Ireland. Patient demographics, best-corrected visual acuity (VA) and risk of postoperative anisometropia were also recorded.

The median age of patients awaiting cataract surgery was 76 years (range 22-97). Of the 315 patients, 72% were aged over 70 and 16% were aged over 85. A systemic comorbidity that would confer high risk status was identified in 21% of patients. This high risk status was attributable to severe respiratory disease, cancer, and immunosuppression therapies in the majority of cases. The high risk group were younger than those deemed non-high risk, but there were no significant differences with respect to gender, anticipated degree of surgical difficulty, VA, or whether the patient was undergoing first or second eye surgery. Of those patients awaiting first eye cataract surgery, the mean VA in the listed eye was 0.84 logMAR and 39% (70/179) had a VA <0.3 logMAR (6/12 Snellen acuity) in their fellow eye. 57% of patients were awaiting first eye surgery, and 32% of those patients would be at risk of symptomatic anisometropia postoperatively.

One-fifth of patients awaiting cataract surgery were found to be at high risk of severe disease or death from COVID-19 and these patients may experience delays in their surgical care. Additional planning is required in order to minimise the morbidity associated with delayed cataract surgery.

5b VISUAL ABSTRACT

Paired (a) written abstract and (b) visual abstract of a clinical paper previously published in the Ulster Medical Journal entitled “Surgical planning during a pandemic: Identifying patients at high risk of severe disease or death due to COVID-19 in a cohort of patients on a cataract surgery waiting list” . 30

6a WRITTEN ABSTRACT

This project aimed to evaluate the role of ultrasound scan (USS) in children presenting with acute onset right iliac fossa (RIF) pain and suspected appendicitis

We retrospectively studied 100 consecutive children undergoing USS for RIF pain. Children with low to moderate clinical probability of appendicitis were seen by the surgical team and subsequently underwent USS by a radiologist or a sonographer with a special interest in paediatric USS. The clinical findings, blood tests, and radiological diagnosis led to a decision to operate, observe or discharge. USS findings were subsequently verified with the final histology. The six-month follow-up data of these patients were also analysed.

35 males, median age of 11 years (range 4-17), and 65 females, median age of 14 years (range 6-18) were included. A total of 23 appendicectomies were performed. On histology appendicitis was confirmed in 20, including 16 pre-operatively diagnosed on USS. 6 of these appendicectomies were performed on clinical suspicion with normal USS. 1 patient was diagnosed with neuroendocrine tumour of the appendix. Only 2 negative appendicectomies were performed. 62 patients were discharged without intervention. USS sensitivity was 74%, and specificity was 92% for appendicitis. An additional 16 patients were identified with alternate pathology including 5 ovarian cysts.

Appendicitis was more common in male patients; however, there was no difference in overall disease prevalence in male or female paediatric patients. Thus, USS is a valuable tool to exclude appendicitis in children with low to moderate probability.

6a VISUAL ABSTRACT

Area 1: title.

In order to gain the readers’ initial attention and provide a clear context for the research study, it is recommended that the title should be framed as a question, rather than the same title of the original article. In other words, what question did the study set out to address?

AREA 2: METHODS & COHORT

To ensure that the quality of the evidence, the research design should be described e.g., randomised controlled trial, retrospective cohort study, in vitro study, etc., and the time frame and any follow-up periods should be stated.

AREA 3: FINDINGS

The findings or outcomes of studies are varied and as such it is difficult to definitively state how this section should be formatted. It is important to think of the findings as discrete points and in the case of most studies, short comparative phrases can be included in text box headings, relating to each end point evaluated. Numeric values should be provided for each of the findings detailed including units and values relating to statistical significance, as this will not only highlight the validity of the research findings but also allow readers to interpret the findings themselves.

AREA 4: CONCLUSION/TAKE HOME MESSAGE

It is important that the conclusion aligns with the question in the title and the key take home message the authors wish to convey. Although the original article may have numerous outcomes, it is important to select between one to three main take home messages. Stating numerous outcomes may distract from the key message which the authors wish to convey. It is important, that the primary outcome of the study is presented to minimise reporting conclusions which are not intentionally or non-intentionally biased.

On a cautionary note, although the primary aim of a visual abstract is to present research findings clearly in a simplified manner, if over simplified the outcomes could be potentially misleading with respect to the strength and significance of the study. Furthermore, due to space limitations, authors may only focus on the positive outcomes of the study and overlook findings which were not significant, inconclusive or negative. The visual abstract should be a true reflection of the manuscript content and that they are not used to promote authors’ own biases or self-promotion which in turn could impact on research groups’ credibility. 17 It is therefore important that where visual abstracts are a formal adjuvant published alongside the peer-reviewed article, that they are included in the peer-review process to ensure validity and quality, prior to the dissemination.

THE PREPARATION OF ICONS

Icons, are graphical interphases which have meaning and have the ability to rapidly convey information which can be remembered effortlessly. 32 Icons, are a central to the preparation of an engaging and successful visual abstract as they have the potential to draw the attention of the reader and in turn enhance their understanding and visual learning of the content displayed. 32 Studies involving eye trackers to measure visual attention and subjective evaluations have shown that the composition of icons and backgrounds have an effect on user’s attention to the viewed icons with solid single colour icons composed of planes resulting in greater fixation, in terms of duration and frequency, as well as subjective evaluation of attention compared to line-based icons, which appear as outlined figures. 32 It is therefore recommended that solid fill icons are the preferred format of icons used in visual abstracts. When choosing icons the use of 2-D icons is advised for clarity as 3-D icons may distract the reader and clutter the visual abstract. Where possible chose .svg or .emf formats as these can be re-coloured in packages such as PowerPoint.

As a rule of thumb, one icon should be used to illustrate one key point. Icons used should be free of copyright restrictions and negate the requirement for attribution and such sources which are freely available include PowerPoint and Pixabay ( https://pixabay.com/ ). The Noun Project ( https://thenounproject.com/ ) offers an extensive catalogue of over two million icons, however the use of icons without attribution requires a small yearly payment, although educator and student licences are available with a discount. Flaticon ( https://www.flaticon.com/ ) is a valuable resource for coloured icons which is free to use with attribution and without attribution with associated costs.

DISSEMINATION OF VISUAL ABSTRACTS

Visual abstracts have a propensity to be shared and disseminated using social media platforms such a Twitter, Facebook, LinkedIn and Research Gate and in turn encourage the full articles to be downloaded. 33 Twitter as of the January 2022 has 396.5 million users with 206 million daily active users. 34 This social media platform permits the “tagging” of organisations, fellow researchers and educators, who may be interested in the research topic and tweets or posts encompassing visual abstracts which have been advocated to encourage engagement with the research studies. The twitter platform has been described as shifting the dissemination of research from a “pull” model i.e., requiring individuals to search for research articles themselves to a ”push model” which translates to researchers actively transmitting information in a more direct approach to potentially interested audiences. 35 A recent article in the Journal of Urology which has published visual abstracts since 2016, reported visual abstract tweets significantly improved overall reader engagement by 65%, compared to tweets without visual abstracts. 36 This finding highlights the potential positive impact that the sharing of visual abstracts via Twitter may have in terms of subsequent citations, as it has been previously concluded from a systematic review, on the use of Twitter by medical journals, that using such social media communication improves citation based and alternative bibliometrics for academic medical journals when used in combination with strategies such as tweeting titles, links to articles, infographics or podcasts. 37 The Journal of the American Geriatrics Society has also examined the dissemination of research articles via social media and compared standard tweets correlating to published articles with tweets that also contained a visual abstract. Interestingly, the standard tweet received 24,984 impressions (i.e. times content was displayed) and 17 tweets (posts) and 36 likes over a period of eight days, whereas the visual abstract tweet received 168,447 impressions, 81 tweets and 100 likes over four days, highlighting a wider interest. 38 Numerous other studies have reported a similar significant greater research dissemination, social media engagement and clicks on links to the full articles, particularly by healthcare professionals, further emphasising the need for open access journals to capitalise on this increase in footfall. 16 , 39 , 40 These findings highlight the potential that visual abstracts have in disseminating research when used in conjunction with social media and the impact that this communication combination approach has on audience engagement, the alternative bibliometrics relating to impact of research publications as well as academic citation. 38 , 41

OTHER USES OF VISUAL ABSTRACTS WITHIN MEDICINE

Education, journal clubs, scientific conferences.

Social media as a platform for electronic communication within medical education has been thrust into the use of alternative approaches to aid in building educational online communities during the COVID-19 pandemic. 42 Such digital sharing of education information, including visual abstracts has provided valuable approaches to increase the reach of research articles within disciplines as recently reported in surgical education. 43

The use of visual abstracts in conjunction with social media has not been limited to their formal publication alongside the full journal article. As healthcare professionals have indicated that they have a preference for visual infographic formats rather than conventional written abstracts when communicating via social media and when viewing online journals, 44 it is not surprising that visual abstracts have been used as educational tools within journal clubs and rounds. Presenting and sharing visual infographics has been shown to engage and enhance understanding as assessed by comprehension and recall when used in a weekly orthopaedic journal club. 45 - 47 Medical Schools have promoted the use of visual abstracts in education programmes to share and showcase educational innovation and scholarship by means of a visual abstract poster format thereby permitting presenters to have more time to engage in interactive discussion with interested individuals. 48

Conferences have used visual abstracts to covey the current research has highlighted by The World Congress of Nephrology (WCN) which is an annual scientific, educational, and networking meeting of the International Society of Nephrology. 49 Recently the 2021 The Developing Excellence in Medical Education Conference (DEMEC) offered two mechanisms for authors to present their posters on a virtual platform either in the form of a visual abstract or a pre-recorded translational talk about their abstract in a “pitch” format. 50

Live visual abstracts coupled with tweeting have started to trend at conferences to promote the central messages from presentations freely to a wider audience. Such live visual abstracts have the potential to increase the visibility of the conference as well as the presenters and their research. 51

Key guidance for those who wish to use visual abstracts in this manner has been prepared within the Visual Abstract Primer (edited by Andrew Ibrahim). 51 The use of visual; abstracts were examined during an annual conference of Association of Vascular Access & inTerventionAl Renal Physicians (AVATAR 2018). 52 The findings of this study indicated that such live visual abstracts tweeted using the handle #LiveVisualAbstract received significantly more impressions and engagements than other popular media tweets which covered the same session. 52 This highlights the potential that this approach can have on delivering information to a wide audience to encourage discussion online and enhancing medical education.

Visual abstracts have been predominantly constructed for and shared with the scientific research community, however more recently, a similar visual abstract format has been used to raise public, policy makers, news and media outlets awareness of important research findings. One such example is the Centers for Disease Control and Prevention journal, The Morbidity and Mortality Week Report (MMWR), which publishes current research related to important public health issues. 53 Such visual abstracts are more akin to lay or plain language summaries and although not the focus of this review may offer an informative visual communication route between patients and healthcare providers ( Figure 7 ).

An example of a visual abstract for the lay community published by the Centers for Disease Control and Prevention journal in relation to the published article by McKnight-Eily LR, Okoro CA, Turay K, Acero C, Hungerford D. Screening for Alcohol Use and Brief Counseling of Adults - 13 States and the District of Columbia, 2017. MMWR Morb Mortal Wkly Rep. 2020 Mar 13;69(10):265-270. 53 , 54

CONCLUSIONS

We live in a society where communication and information rely on embedded visual imagery. As researchers, the communicative power of visual abstracts, particularly when used in conjunction with social media, should be harnessed to disseminate research findings. Although not a replacement for the full article, visual abstracts act as a “taster” to entice a wide audience to examine, retrieve and read the full article in greater depth. Visual abstracts may be used to highlight current research findings and promote individual researchers and research groups through a variety of mechanisms. The primary formal approach is by means of independent review and inclusion alongside the peer-reviewed manuscript in the accepting journal, which is increasingly being used as a communicating strategy and subsequently shared on social media platforms. A less formal use of visual abstracts, is through journal clubs, blog posts and conference highlights providing educational value and personal knowledge development, as well as offering a mechanism and encouragement of discussion and debate. As the Ulster Medical Journal embarks on its visual abstract journey, it is intended that these will enhance interest in the published articles, increase awareness of the valuable research published in this journal and help to stimulate discussions and collaborations within medical research locally, nationally and internationally.

UMJ is an open access publication of the Ulster Medical Society ( http://www.ums.ac.uk ).

Overview and key findings of the 2022 Digital News Report

Last year’s report contained some positive signs for the news industry, with higher consumption and rising trust amidst a second wave of Coronavirus lockdowns. Many traditional news brands seemed to benefit not just from greater attention, but also financially, with more people taking out online subscriptions and advertisers looking to associate themselves with reliable content.

A year on and we find a slightly less optimistic picture. While a break-out group of primarily upmarket news publishers across the world report record digital subscription numbers and growing revenues, more broadly, we find that interest in news and overall news consumption has declined considerably in many countries while trust has fallen back almost everywhere – though it mostly remains higher than before the Coronavirus crisis began. We’re also seeing news fatigue setting in – not just around COVID-19 but around politics and a range of other subjects – with the number of people actively avoiding news increasing markedly.

Since our main data set was collected in early February, a new threat to global security has emerged in the form of Russia’s invasion of Ukraine. This event clearly increased news consumption across all news sources, but a second Digital News Report survey in five countries undertaken in early April saw further levels of selective avoidance, even in countries like Poland and Germany that have been directly impacted by the conflict. We devote a special chapter to the impact of the Ukraine crisis and attitudes towards media coverage.

An episode on the report

A clear throughline in this year’s report is the changing habits of younger groups, specifically those under 30, whom news organisations often struggle to reach. Throughout this Executive Summary, and in a separate chapter, we find that this group that has grown up with social media is not just different but more different than they were in the past. We also explore their use of newer visual networks for news such as TikTok and Instagram, with support from a detailed qualitative study in three countries (UK, US, and Brazil).

More widely, this year’s data confirm how the various shocks of the last few years, including the Coronavirus pandemic, have further accelerated structural shifts towards a more digital, mobile, and platform-dominated media environment, with further implications for the business models and formats of journalism.

In our country and market pages, which combine industry developments with key local data points, we see how different media companies are coping with these various headwinds. We find a mixed picture of downsizing and layoffs in some places, but optimism around business models, industry cooperation, and format innovation in others. And everywhere we find growing concerns about a looming cost-of-living crisis that could be making people rethink how much they can afford to spend on news media.

This eleventh edition of our Digital News Report , based on data from six continents and 46 markets, aims to cast light on the key issues that face the industry. Our more global sample, which since 2021 has included India, Indonesia, Thailand, Nigeria, Colombia, and Peru, provides some understanding of how differently the news environment operates outside the United States and Europe. The overall story is captured in this Executive Summary, followed by Section 1, with chapters containing additional analysis, and then individual country and market pages in Section 2 with extra data and context.

A summary of some of the most important findings from our 2022 research.

Trust in the news has fallen in almost half the countries in our survey, and risen in just seven, partly reversing the gains made at the height of the Coronavirus pandemic. On average, around four in ten of our total sample (42%) say they trust most news most of the time. Finland remains the country with the highest levels of overall trust (69%), while news trust in the USA has fallen by a further three percentage points and remains the lowest (26%) in our survey.

Consumption of traditional media, such as TV and print, declined further in the last year in almost all markets (pre-Ukraine invasion), with online and social consumption not making up the gap. While the majority remain very engaged, others are turning away from the news media and in some cases disconnecting from news altogether. Interest in news has fallen sharply across markets, from 63% in 2017 to 51% in 2022.

Meanwhile, the proportion of news consumers who say they avoid news, often or sometimes, has increased sharply across countries. This type of selective avoidance has doubled in both Brazil (54%) and the UK (46%) over the last five years, with many respondents saying news has a negative effect on their mood. A significant proportion of younger and less educated people say they avoid news because it can be hard to follow or understand – suggesting that the news media could do much more to simplify language and better explain or contextualise complex stories.

In the five countries we surveyed after the war in Ukraine had begun, we find that television news is relied on most heavily – with countries closest to the fighting, such as Germany and Poland, seeing the biggest increases in consumption. Selective news avoidance has, if anything, increased further – likely due to the difficult and depressing nature of the coverage.

Global concerns about false and misleading information remain stable this year, ranging from 72% in Kenya and Nigeria to just 32% in Germany and 31% in Austria. People say they have seen more false information about Coronavirus than about politics in most countries, but the situation is reversed in Turkey, Kenya, and the Philippines, amongst others.

Despite increases in the proportion paying for online news in a small number of richer countries (Australia, Germany, and Sweden), there are signs that overall growth may be levelling off. Across a basket of 20 countries where payment is widespread, 17% paid for any online news – the same figure as last year. Persuading younger people to pay remains a critical issue for industry, with the average age of a digital news subscriber almost 50.

A large proportion of digital subscriptions go to just a few big national brands – reinforcing the winner takes most dynamics that we have reported in the past. But in the United States and Australia we are now seeing the majority of those paying taking out more than one  subscription. This reflects the increased supply of differentiated paid news products in areas such as political opinion, local news, and a range of specific niches – holding out hope that more people will ultimately pay for multiple titles.

But in the face of rapidly rising household bills, we find some respondents rethink the number of media subscriptions they can afford this year – which include news, television, music, and books. While most say they expect to retain the same number of media subscriptions, others say they expect to take out fewer , as they look to save money on non-essential items.

With first-party data collection becoming more important for publishers with the imminent demise of third-party cookies, we find that most consumers are still reluctant to register their email address with news sites. Across our entire sample, only around a third (32%) say they trust news websites to use their personal data responsibly – comparable to online retailers such as Amazon – and the figure is even lower in the United States (18%) and France (19%).

Access to news continues to become more distributed. Across all markets, less than a quarter (23%) prefer to start their news journeys with a website or app, down nine points since 2018. Those aged 18–24 have an even weaker connection with websites and apps, preferring to access news via side-door routes such as social media, search, and mobile aggregators.

Facebook remains the most-used social network for news but users are more likely to say they see too much news in their feed compared with other networks. While older groups remain loyal to the platform, we show how the youngest generation has switched much of its attention to more visual networks over the last three years.

TikTok has become the fastest growing network in this year’s survey, reaching 40% of 18–24s, with 15% using the platform for news. Usage is much higher in parts of Latin America, Asia, and Africa than it is in the United States or Northern Europe. Telegram has also grown significantly in some markets, providing a flexible alternative to Meta-owned WhatsApp.

While social media have increased the profile of many digital journalists, we find that the most well-known journalists are still TV anchors and presenters in most countries. When asked to name journalists they pay attention to, few people can name foreign correspondents, while newspaper columnists have higher name recognition in the UK and Finland than in Brazil, the United States, or France.

The smartphone has become the dominant way in which most people first access news in the morning, though we find different patterns across countries. In Norway, Spain, Finland, and the UK, the smartphone is now accessed first ahead of television, while radio retains an important role in Ireland. Morning newspaper reading is still surprisingly popular in the Netherlands; television still dominates in Japan.

After last year’s slowdown in part caused by restrictions on movement during the COVID-19 pandemic, growth in podcasts seems to have resumed, with 34% consuming one or more podcasts in the last month. Our data show Spotify continuing to gain ground over Apple and Google podcasts in a number of countries and YouTube also benefiting from the popularity of video-led and hybrid podcasts.

Consumption patterns reveal disconnection and disengagement with news – amongst some news consumers

While a succession of crises including the pandemic and the invasion of Ukraine demonstrates the importance of independent professional journalism, and significant growth for some individual media brands, we find that many people are becoming increasingly disconnected from news – with falling interest in many countries, a rise in selective news avoidance, and low trust further underlining the critical challenge news media face today: connecting with people who have access to an unprecedented amount of content online and convincing them that paying attention to news is worth their while.

We now have solid data spanning ten years that enable us to see consistent and relentless falls across countries in the reach of traditional channels such as print, radio, and television news. At the same time, we find that online reach is flat or, at best, increasing slightly – but certainly not making up the gap. Digital and social media offer a much wider range of stories, but this environment can often be overwhelming and confusing. While many people remain extremely active and engaged with online news, the abundance of choice in an online context may be leading others to engage far less regularly than they did in the past.

In the chart below, which shows weekly access in the United States between 2013 and 2022, we have added an extra line for those who say they accessed none of the listed options in the week they completed our survey. This has grown from 3% in 2013 to 15% in 2022.

While the United States seems to have the largest group of disconnected news users, we see similarly high figures in Japan (15%) the United Kingdom (9%), France (8%), and Australia (8%). Even Germany, a country with often very traditional media habits, is not immune. Since 2013, weekly print consumption has fallen from 63% to 26% and TV news usage from 82% to 65%. Although online and social media have grown a little, overtaking television for the first time, we also find growing numbers who seem to be disconnecting from news altogether – this proportion reaching 5% in 2022.

It is important to note that high levels of disconnection are not evident everywhere. The proportion consuming none of our listed news sources weekly is limited in Portugal (2%) and Finland (2%) and extremely rare in South Africa (1%), Nigeria (<1%), and Kenya (<1%), even though we also see growing pressure on traditional sources of news such as print and television news in these countries.

Falling interest in the news

Disconnection is just one sign of the difficulties of engaging some audiences in a more digital environment. At the same time we find that the proportion that says they are very or extremely interested in news has fallen sharply over time across markets – a trend that has accelerated despite the continuing COVID-19 pandemic. This year we find news interest lower in the vast majority of countries in our survey. In some countries, such as Argentina, Brazil, Spain, and the United Kingdom, these falls have been going on for some time, while in the United States we see a slightly different pattern. Interest remained high during the Trump years but seems to have declined significantly since Joe Biden became president. Today, less than half of our sample (47%) say they are very or extremely interested in news compared with 67% in 2015.

Again, it is important to note that there are some countries that buck these trends or where declines are happening more slowly. These include richer Central/Western European nations where there has been less political or economic turmoil over the past few years.

Proportion who are very or extremely interested in news (2015-2022) Selected countries with largest falls

Selected countries with more stable levels

Q1c. How interested, if at all, would you say you are in news? Base: Total 2015–22 samples (n ≈ 2000).

These data suggest two different but related problems. First, the emergence of a minority of people who are active online, many of them younger or less well educated, but who have become largely disconnected from the news, perhaps because they don’t feel that it is relevant to their lives. And then, separately, we find a more generalised decline in news interest and consumption affecting a much bigger group, which may relate to structural changes in the way the news is distributed, such as the shift to online, the nature of the news cycle itself, or both.

Selective news avoidance and its implications

While the majority of people across countries remain engaged and use the news regularly, we find that many also increasingly choose to ration or limit their exposure to it – or at least to certain types of news. We call this behaviour selective news avoidance and the growth of this activity may help to explain why consumption levels have mostly not increased, despite the uncertain times in which we live. The proportion that says they avoid the news, sometimes or often, has doubled in Brazil (54%) and the UK (46%) since 2017 – and also increased in all other markets (see next chart). This type of selective avoidance seems to be less widespread in Northern European countries such as Germany (29%), Denmark, and Finland (20%), as well as in some Asian countries such as Japan (14%).

Selective news avoiders give a variety of reasons for their behaviour. Across markets, many respondents say they are put off by the repetitiveness of the news agenda – especially around politics and COVID-19 (43%), or that they often feel worn out by the news (29%). A significant proportion say they avoid news because they think it can’t be trusted (29%). Around a third (36%), particularly those who are under 35, say that the news brings down their mood. Others say the news leads to arguments they would rather avoid (17%), or leads to feelings of powerlessness (16%). A small proportion say they don’t have enough time for news (14%) or that it is too hard to understand (8%).

Most common reasons for news avoidance

All markets

say there is too much politics and COVID-19

say news has negative effect on mood

say they are worn out by amount of news

say the news is untrustworthy or biased

say it leads to arguments I'd rather avoid

say there is nothing I can do with the information

Q1di_2017ii. Why do you find yourself actively trying to avoid the news? Base: All who avoid the news often, sometimes, or occasionally. All markets = 64,120.

Concerns about the news having a negative effect on their mood are higher amongst avoiders in the United Kingdom (55%) and United States (49%) than they are elsewhere.

Political allegiances can also make a striking difference to why people choose to avoid news. In the United States, those who self-identify on the right are far more likely to avoid news because they think it is untrustworthy or biased, but those on the left are more likely to feel overwhelmed, carry feelings of powerlessness, or worry that the news might create arguments.

These findings will be particularly challenging for the news industry. Subjects that journalists consider most important, such as political crises, international conflicts, global pandemics, and climate catastrophes, seem to be precisely the ones that are turning some people away from news – especially amongst those who are younger or harder to reach.

Many news organisations are embracing approaches such as solutions journalism around subjects like climate change, that aim to give people a sense of hope or personal agency. Others are looking to find ways to widen the agenda to softer subjects or make news more relevant at a personal level, but there will be a limit to how far journalists can go – or should go – to make the news more palatable.

News is too hard for many people to work out

One other important data point relates to the difficulty that many younger audiences, and less educated groups, have in understanding journalism as currently practised. In countries such as Australia, the United States, and Brazil, around 15% of younger avoiders say they find news hard to follow – a much higher proportion than older news consumers.

This could relate to the complexity of the language or assumed knowledge often contained in news reports. But the increase in news consumption via social media or word of mouth through friends and family, may also be playing a part. News is often accessed by young people in more fragmented ways, meaning that people sometimes miss key context that was previously carefully packaged into linear narratives by the mainstream media.

During the COVID-19 crisis (and now Ukraine) we saw many news organisations using explainer and Question & Answer formats to try to address these issues on websites and via social media to engage younger and less educated audiences. Our data suggest this process needs to go much further.

Trust falls back after COVID-19 bumps

This year we find lower levels of overall trust in 21 of our 46 markets, partly reversing the gains made at the height of the Coronavirus pandemic. Eighteen markets are at a similar level, with just seven on an upward path. The average level of trust (42%) is also a little lower than last year and trust in individual news brands is on a downward trend in most countries.

Finland remains the country with the highest levels of overall trust (69%) – up four points on last year and 13 points on 2020. At the other end of the scale, news trust in the USA (26%) has fallen by a further three percentage points and remains the lowest level in our survey along with Slovakia (26%). Notable changes in Europe include falls in Romania (-9), Croatia (-7), Poland (-6), Switzerland (-5), Austria (-5), Greece (-5), Italy (-5), and Spain (-4). In Latin America, trust is down in Brazil (-6) and Colombia (-3), but level or slightly up elsewhere. It is a mixed picture in Africa, with a fall in Kenya (-4) but strong growth in South Africa (+9) and Nigeria (+4). Finally, in Asia, trust has risen in the Philippines (+5) and Japan (+2) but is down in Malaysia (-5) and Taiwan (-4).

In some regions we find a widening gap between markets with the highest levels of trust and those with the lowest. We also find that those markets with the most trust – such as Finland – also tend to have higher interest in news and lower levels of active news avoidance. By contrast, low trust countries, such as the United States, France, the United Kingdom, and Slovakia, see some of the highest levels of selective avoidance, as well as news disconnection, with declining interest in news.

It is important to put this year’s trust changes in context. In most cases the headline trust level is still higher than it was before the Coronavirus pandemic reinforced the importance of reliable media for many people. On the other hand, the chart below also reminds us that, in many countries, trust had been on a downward trajectory for some time – partly driven by a series of polarising events like Brexit in the UK, the turmoil of the Trump years in the United States, and the Gilets Jaunes protests in France. In this context, last year’s COVID-19 optimism looks more like a short-term rally rather than any kind of longer-term renaissance. In all the examples below, apart from Finland, trust is still considerably lower than in 2015.

Across our data set, and in wider research on this issue (Toff et al. 2021; Ross Arguedas et al. 2022), we find that indifference to news and its value, along with widespread perception of political and other biases by the media, are two of the main reasons for low trust. In the United States, politics is particularly central, and those who self-identify on the right are more than twice as likely to distrust the news compared with those on the left. In early 2021 only 14% of those on the political right said they trusted the news, which helps to explain how the false and misleading ‘stolen election’ narrative promoted by some politicians, activists, and partisan media personalities got so much traction, not least after President Donald Trump’s talk about a liberal mainstream media peddling ‘fake news’. By contrast, in Finland we see almost no difference in news trust based on politics, though even here the cut and thrust of a parliamentary election in late 2019 may have contributed to a slight dip in trust.

In other cases, lack of trust in the news is less about ideological political divides and more about a split between the ‘haves’ and the ‘have-nots’. In France, for example, we find that divisions are more about income and education rather than party allegiance. During the Gilets Jaunes protests, for example, the news media was often seen as aligning itself with the elites, while journalists were also targeted in Canada during trucker protests this year. In both countries, we find significant trust gaps over income or education.

In other parts of the world, lack of trust is closely related to the issue of interference by politicians, businesspeople, or both. This is a particular issue in Central and Eastern Europe where oligarchs close to ruling parties control much of the media, or where governments regularly withhold advertising from publications they don’t like. Only a small minority think the news is free from undue political influence in Greece (7%), Hungary (15%), Bulgaria (15%), Slovakia (16%), Czech Republic (17%), Croatia (18%), and Poland (19%). We see similarly low levels in some Southern European countries, such as Italy (13%) and Spain (13%), where there is also a strong tradition of party-political influence over the media. Compare this with Finland (50%), where people have much higher confidence in the independence of the journalism they see from undue political influence.

It is a similar story when it comes to perceptions of undue business influence, with almost identical scores in most markets. This suggests that consumers either have a clear-eyed view of the connections between politicians and businesspeople, or that they have a more generalised lack of trust about those in power and the relations they have with the news media.

However, a large minority also question the priorities of news organisations themselves. Across all markets, just 19% say all or most news organisations put what’s best for society ahead of their own commercial or political interests. In fact, many more people say that all or most put their own political views (40%) or commercial interests (42%) ahead of society. These views are held by around 20% in countries with high trust in news, such as Finland, but are held by around 45% in the US, the UK, and a majority in parts of Southern Europe, Eastern Europe, and Latin America. This may reflect cynicism about the underlying motivations of many publishers, or perhaps hardened realism about what many commercial news organisations must do to survive. Either way it reminds us that, although people often recognise the pressures they face, few people think that most news organisations fight powerful interests on behalf of society in practice.

Trust in news brands: the particular case of public service media

Underpinning news trust in many Northern and Western European countries, as well as Canada and Australia, we find a number of public service broadcasting organisations with a strong track record of independence. These generally appear at the top of our brand trust lists in each country and are often the first port of call for audiences when looking for reliable news around important stories such as COVID-19 and the Ukraine conflict. These institutions have a very different reputation to public and state broadcasters in Southern and Eastern Europe that often take a more partisan editorial line.

But independent public media are under increasing pressure in a number of countries, with attacks on funding, questions about impartiality, and challenges in reaching younger audiences who are increasingly turning to digital and social media. The BBC faces another round of cuts after a difficult licence settlement while DR, the Danish public broadcaster, recently cut three linear channels as part of a wider restructuring after a narrow parliamentary majority imposed a major cut in funding. Against this background, it is interesting to see how well trust is holding up, with some very notable exceptions. Nordic PSBs as well as those of other smaller countries like Ireland and Portugal have retained or even increased trust since 2018, but it has been a very different story in the UK, Australia, and Canada, with significant falls for the main public broadcasters.

The BBC, which remains the most widely used news source in the UK, reported record audiences in the first weeks of the Ukraine crisis, 1 but it has also come under intense criticism for its reporting of a range of more divisive issues – notably Brexit but also immigration, race, gender identity, and attitudes to COVID-19 vaccinations. In many cases, these criticisms of the BBC have been amplified on social media, with senior correspondents exposed to physical attacks along with personal abuse on social media. 2

Trust in BBC News has fallen 20 percentage points in the last five years, from 75% to 55%. Equally telling is the proportion who say they distrust the BBC, which has grown from 11% to 26% (see next chart). The majority of these are from the political right, echoing criticism from Boris Johnson’s government about an alleged anti-Brexit and liberal bias, but we also find that low trust in the BBC also comes from those who are less interested in news altogether. It is important to note that other big brands in the UK (e.g. the Guardian and the Mail ) have been affected by growing levels of distrust, though not as severely. Declining trust is a particular challenge for public media organisations, as they try to fulfil their mission to appeal to all audiences.

The continued audience success of some European public media makes them a particular target for those who want to influence the debates on politics and wider issues around culture. Our survey shows that journalists from these organisations are often first to be recognised by the public. The outgoing BBC political editor Laura Kuenssberg is by far the most well-known journalist in the UK, according to respondents to our survey, even when it comes to digital news. Broadcasters with a commitment to impartiality, including the BBC, make up 62% of all mentions. Journalists from public media also feature strongly in data from Finland, France, and Germany. But it is a very different story in the United States, where partisan cable TV hosts Tucker Carlson, Rachel Maddow, and Sean Hannity attract the most attention.

Best known journalists in Northern/Western Europe have reputation for impartiality

Laura Kuenssberg BBC Political Editor (outgoing), UK

Marietta Slomka ZDF TV Anchor, Germany

Matti Rönkä Yle TV Anchor, Finland

Best known journalists in USA have reputation for strong opinions

Tucker Carlson TV Anchor, Fox News

Sean Hannity Fox News

Rachel Maddow MSNBC

Should journalists remain impartial when on social media?

With more journalists building channels and direct relationships on social media, there is a growing debate about how they should interact when on platforms such as Facebook and Twitter. These are informal spaces where social media users can let their hair down and show more personality. But how compatible is this with the impartial or objective approaches still practised by many media brands (and that last year we found many members of the public value)?

In our survey, around half of respondents or more in most countries feel that journalists should stick to reporting the news, but a sizeable minority believed they should be allowed to express their personal opinions on social media at the same time. Brazil and Japan seem to be outliers here, showing opposite views.

But as we also found in last year’s Digital News Report study on impartiality (Vir 2021), there are clear generational differences, with younger groups holding a stronger preference for journalists being able to express their personal opinions freely on social media. As some media organisations tighten social media guidelines, they are facing resistance from younger journalists who take a different view, and are trying to push the boundaries. This is just another way in which journalistic norms are being challenged by social and digital media.

Paying for news, subscription fatigue, and the battle for registration

In the last few years, many publishers have been increasing efforts to get audiences to pay for content online via subscription, membership, or donations – to reduce their reliance on advertising revenue, which online tends to flow towards the big platforms such as Google and Meta (formerly Facebook). These are now worldwide trends, and our country pages document how leading publishers in Argentina, Colombia, Japan, Nigeria, and Kenya, for example, have recently launched or consolidated paywalls.

This year’s data show mixed progress, with significant increases in a small number of wealthier countries, though there are signs elsewhere that growth may be levelling off. Across a basket of 20 countries where payment is relatively widespread, 17% paid for any online news – the same figure as last year. Norway continues to lead the way (41%), followed by Sweden (33%), Finland (19%), and the United States (19%). Australia (18%) and Germany (14%) showed the biggest increases this year at five percentage points in each case. By contrast, our survey data in Norway and the United States show a slight decline this year, though in both cases industry figures suggest that there has still been some progress. Either way, longer term trends do suggest a slowing down in some of these early-mover markets – raising questions about whether they might be reaching a more mature phase.

This year we asked those paying for online news to name the brands they subscribed to. In some countries, we find a high degree of market concentration, with around half the subscriptions in the US going to the New York Times , Washington Post , and Wall Street Journal . In Finland, half of subscribers (50%) pay for just one publication – Helsingin Sanomat , the country’s paper of record – sometimes in combination with a local publication. Over half (53%) pay for a local or regional title in Norway, with high numbers in all the other Nordic countries as well as Germany (35%) and the United States (27%). By contrast, just 5% of subscribers pay for a local title in the UK and 3% in Portugal.

Another striking finding is that, across countries, the vast majority of those paying are older, with an average age of 47 across countries. Persuading younger people to pay remains a critical issue for industry, with just 8% of news subscribers in the UK being under 30 and just 17% in the United States. This quote from our focus groups sums up the attitude of many of those who grew up in an era with mostly free online sources.

In almost all of the listed countries, the majority of subscribers pay for one publication. But in the United States and Australia, around half (56% and 51% respectively) now pay for two or more – often a national and local paper combination. Second subscriptions in the United States include political and cultural magazines such as The Atlantic and The New Yorker , partisan digital outlets such as Blaze Media and Epoch Times, or passion-based titles such as the Athletic (sports). We also see growing levels of payment for platform-based news subscription products Apple+ and Twitter Blue. In Australia, second subscriptions include a relatively high proportion (9%) from US or UK publications such as the New York Times and The Times of London.

The influence of individual journalist brands may be overstated

Some news brands continue to have the reputation, scale, and technical capability to charge for their services, but in parallel the emergence of low-cost subscription and membership platforms, like Substack and Patreon, has enabled some individual journalists, podcasters, or other creators to also convince people to pay for their work. Substack says that there are now around a million paying subscribers to its premium content emails. 3

Despite this, our data show the number of these individual subscriptions is still relatively modest, certainly when compared with established news brands. Even in the United States, we find that just 7% of news subscribers in the United States pay for one or more journalist emails – around 1% of our overall sample. The proportions are even lower elsewhere, though we do see some emerging payment for individual email writers or podcasters in parts of Europe and Australia.

Over time, it is possible that these solo or small businesses, mostly operating in closely defined niches, could make up a far bigger part of the overall pie, expanding the market but also creating more competition for big news brands. If nothing else, they have already made the value of some individual journalists more explicit, pushing up wages of top talent.

These data also highlight the growing importance of formats like email and podcasts, both of which have become much more important in driving regular engagement for all publishers – from general news to specialist information and entertainment.

In the vast majority of markets in our survey, people say they still identify most with traditional news brands rather than individual journalists. This is especially true in Nordic countries but less true in the United States, Southern Europe, Latin America, and parts of Asia. Perhaps the greater affinity with journalists in these countries offers a different opportunity to monetise content than brand-led subscription.

The impact of wider media subscriptions and prospects for subscription fatigue

With rising energy prices and inflation, and with many different types of online media (TV, music, books) now competing for a share of household budgets, there are genuine fears in the industry about whether recent growth in news subscriptions can continue. Against this backdrop, we explored the characteristics of different media subscriptions and asked respondents whether they were thinking of taking out more – or cutting back.

Taking the UK as an example of an advanced subscription market (chart below), we find almost two-thirds of our sample (65%) have taken out at least one subscription to a TV or film service like Netflix, 37% have a music subscription to Spotify or similar, 22% pay for a premium sports service, and 7% have a news subscription or other ongoing payment such as a donation. Because premium content is spread across TV platforms, many people feel the need to take out more than one subscription, with 19% taking out three or more. By contrast, one music or news service is normally enough, as rival services often offer broadly similar content. But as we noted earlier, in some countries we are seeing more differentiated news services and a consequent rise in the number of subscriptions per person. The other big difference is the age profile, with TV, music, and audio books skewing younger, while sport has an equal age split and news skews much older. People who subscribe to news are more likely to subscribe to other services and vice versa.

Thinking about the year ahead, most respondents say the number of media subscriptions they have (across TV, music, sports, books, and news) will stay the same, but there is an appetite to take out more in Germany, Austria, and Switzerland. By contrast, the Portuguese are most likely to be looking to reduce their media subscriptions this year, while respondents in the UK and US are evenly split.

This overall picture is perhaps more optimistic than might be expected, with relatively low subscription churn, providing publishers with a more stable and secure income than the frequent ups and downs of the advertising market. On the other hand, the cost-of-living crisis has been building since our survey in January and will clearly be a significant factor for those on lower incomes.

It’s not entirely clear whether news will be treated in the same bucket as entertainment subscriptions that could be seen as more of a luxury. The news demographic tends to be older and richer, perhaps making the group less affected by rising prices. On the other hand, the sector is unlikely to be immune from these trends and a number of respondents said they would be cancelling subscriptions to news sites because they were too expensive. Others say they are planning to increase the number of subscriptions this year, with some seeing the current national and international instability as a good reason to invest more in high-quality information.

Investment in new products may encourage further take-up and much of the news industry remains confident about longer-term trends. But some publishers, notably CNN, recently reversed its much-hyped online paywall strategy (CNN+) amid doubts from its new owners about the viability of yet another stand-alone subscription. 4 Uncertainty remains about how far and fast the market can grow, especially in more troubled economic times.

Audiences reluctant to give up their data for news sites

Beyond concerns about subscription diets, media companies face another challenge in maintaining advertising revenues in the face of the imminent phasing out of third-party cookies. 5 Without these cross-platform trackers, media companies are looking to build up their own first-party data that can give them more leverage with advertising companies – and increase the rates they can charge. News companies now routinely ask for an email address before people can see content or access additional features such as commenting. In some countries (Portugal, Finland, and Switzerland), publishers have collaborated to provide a single login system that works across multiple online websites and apps. But how do audiences view these issues?

Across countries we find that only around a quarter (28%) have registered for one or more news websites in the last year. Those in Portugal (44%) are most likely to have given their details, but people in Germany (19%), the UK (16%), and Japan (14%) are least likely to have parted with their information for access. These differences may relate to the extent to which registration walls are being pushed by publishers in each country, but the relatively low levels in general reflect a continuing reluctance amongst consumers to give up email addresses or other personal details – especially if content is available elsewhere. Most news websites simply do not have a clear enough value proposition to persuade people to do so.

We also compared willingness to give data to news sites with other digital services such as online retailers and social media apps. Across our entire sample, only around a third (32%) say they trust news websites to use personal data responsibly – ahead of social media sites (25%), but at a similar level to trust in online retailers (33%). This does vary considerably by country, with 49% of Finns prepared to trust news organisations with data, but only 18% in the United States.

Proportion who trust each to use their data responsibly

Online retailers

Highest in Poland (44%)

Lowest in France (18%)

News websites

Highest in Finland (49%)

Lowest in USA (18%)

Social media

Less trust in social platforms to use data responsibly

REGISTER2_1/2/3 I trust most news websites/social media sites/online retailers to use my data responsibly. Base: Total sample: All markets = 44,924.

We find a clear link between general trust and people’s willingness to trust publishers with their data. Those with the highest levels of trust (48%) are more than twice as likely to give up their data than those with the lowest (19%). In this respect, building trust will be critical not just for those pursuing subscription models but for any publisher looking to engage and connect with audiences more deeply in the future.

Devices and access points to news

The smartphone continues to be the most important digital device for accessing news across countries, though our data suggest the first decline in weekly access since our survey began – reflecting falling news consumption across all devices after COVID-19 highs.

This year, we revived a question about how different groups access news first thing in the morning to give a sense of how news habits have changed since 2019. The next chart shows striking differences between countries. In Norway, Spain, Finland, and the UK, the smartphone is now the go-to route to news in the morning, with dependence on it growing substantially in the last three years. Radio remains an important part of morning routines in Ireland – even though it has been overtaken by the smartphone for the first time. Morning newspaper reading is still surprisingly popular in the Netherlands and Finland. Television remains a key influence in the US, France, and Italy and is the dominant medium in Japan.

Across countries, almost half of under 35s (47%) say they accessed news first using a smartphone, compared with just a quarter (28%) of those aged 35 and older and just 15% of those aged 65 and older. Japan’s older population may explain why it is bucking wider trends.

But what channels do people use when accessing news on a smartphone at the start of each day? Since 2019, we find that, across countries, social media (39%) have overtaken websites and apps (31%), followed by the smartphone home screen (12%) and aggregator apps like Apple News (9%).

Main gateways to digital news

We continue to monitor the main access points to online news, not just via a smartphone and not just first thing in the morning. Across all devices, our data show direct access to apps and websites becoming less important over time and social media becoming more important, partly due to their ubiquity and convenience. At an aggregate level, we have reached something of a tipping point this year, with social media preference (28%) surging ahead of direct access (23%). But these are cross-market averages and there are major differences between markets. Audiences in Nordic countries and the UK still have strong direct connections, while people in Japan and South Korea tend to access news via powerful aggregators and search engines – relying less on direct access. These differences, which we can perhaps treat as a proxy for the strength of news brands in a digital world, help explain why it may be easier to charge for online news in some countries and not others.

These changes are in large part driven by the emerging habits of a new generation of social natives as they come into adulthood, rather than by shifts in behaviour by older groups. In the next chart, which shows main access by age in the UK, we find that millennials within our 25–34 group (orange line) and those older than 35 (magenta line) have only slightly changed preferences over time, but the 18–24 group (turquoise line) has become significantly less likely to use a news website or app.

This is another illustration that this youngest generation, which has grown up with social media, is not just different but is more different than the one that came before – with a much weaker connection to traditional brands.

Is Facebook losing its sheen?

Each year since 2014, we have tracked the different social networks used for any purpose and for news across 12 countries. Facebook usage for any purpose (60%) is down five percentage points since its peak in 2017 and is now at a similar level to YouTube. Instagram (40%), TikTok (16%), and Telegram (11%) are the only networks to have grown in the last year.

Once again, most of these changes – such as the decline in Facebook use over the last few years – result from shifts in behaviour of the youngest cohort of social natives, not older respondents, who tend to have more entrenched habits. In the following chart from the UK we illustrate how the attention of this group has gradually shifted – from Facebook, to Instagram, and now to TikTok.

When it comes to news usage specifically, Facebook remains the most important network across our basket of 12 countries, but has dropped by 12 percentage points since 2016. Twitter has largely stagnated over the last decade in terms of its user base, though it remains hugely influential with journalists and politicians. Confusion over its future direction is likely to persist following the attempt to take over the company by Elon Musk 6 and the subsequent loss of senior executives. Meta-owned Instagram is now more widely used for news, while TikTok has overtaken Snapchat from a low base.

Outside Western countries – especially in Latin America and Africa – we find a much higher proportion of our sample using social media for news, but we also find different networks in play. In African countries such as Nigeria, South Africa, and Kenya, WhatsApp (55%) and Telegram (18%) combined are more important for finding, sharing, and discussing news than Facebook (59%). Latin Americans tend to use a combination of all the main networks, while it is a mixed picture in Asia, with almost three-quarters (73%) using Facebook for news in the Philippines but just 5% in Japan, where Twitter (18%) and Line (16%) are more popular. YouTube (44%) is the main social network for news in South Korea, along with home-grown app KakaoTalk (24%) and KakaoStory (5%).

TikTok emerges as a significant new player in the news ecosystem

In our data, we find significant and rapidly growing usage of TikTok, especially in Africa, Asia, and Latin America as well as across Eastern Europe. Usage is mostly still with under 25s, but is extending into all age brackets in countries with higher levels of usage, such as Kenya, South Africa, Thailand, Indonesia, Brazil, and Peru. This quote from our Brazil qualitative research sums up how perceptions of content on TikTok have changed in the last year or so.

The Russia-Ukraine conflict has increased the profile of the network globally. Ukrainians have been documenting their experience of the war, including leaving their homes as refugees, clocking up millions of views in the process (see picture). As we noted last year, many publishers have been increasing their investment, but some worry that a platform where entertainment content is so sought-after may not be the most effective place for news. BBC News originally decided to avoid TikTok, but has now set up channels in Russian and English after seeing misleading information being shared on the platform around the war in Ukraine.

of 18-24s use TikTok for any purpose

of 18-24s use TikTok for news

In contrast to traditional networks such as Facebook or Twitter, the content of the main TikTok feed is driven less by who you follow and more by an algorithm that takes into account what you like and what others are watching.

But others remain sceptical about the value of very short videos designed for popularity.

How much news do people see on each platform?

Facebook tells us that about 4% of the content of the average person’s feed comes from news outlets, though for some that proportion will be much higher. 7 Twitter does not provide equivalent data, but our survey shows that across markets it has a high proportion (56%) who use it for news weekly. By contrast, only around four in ten (39%) Instagram users access news via the platform weekly and just a third of TikTok users do the same (33%). But do people think they are seeing too much or too little news in these networks? 8

More than a fifth of UK respondents (21%) feel that they see too much news on Facebook and only 3% would like to see more. Facebook has been trying to reduce the amount of news on the platform partly for reputational reasons but also because, as previous research shows, people are mainly there to connect with friends and family rather than consume news. On the other hand, Twitter is seen as having more of a reputation for news so it is somewhat surprising to find one in ten (11%) saying they see too much. There is a clear link with news avoidance: those who often avoid the news are twice as likely to say they see too much news on both Facebook and Twitter when compared with the average user.

These data suggest the ambivalent relationship many people have with news on social media. It drives much of the conversation and engagement but can also interrupt other activities and create arguments. This dilemma may be one of the factors behind Facebook’s recent decision to create a separate tab in five countries (Facebook News) with content from a selection of partner publishers, in parallel with an ongoing string of decisions in recent years to reduce the amount of news in the main ‘Feed’ (recently renamed from ‘News Feed’). Platforms like Twitter might also need to think about why even some people who love the news want to see less of it, given the network’s reputation for often abusive debate. TikTok and Instagram will also be aware, as they grow, of the careful balance they need to strike if they are not to put people off.

Misinformation

In this year’s survey we find a link between online misinformation fears and the widespread use of social media. Across markets, just over half (54%) say they worry about identifying the difference between what is real and fake on the internet when it comes to news, but people who say they mainly use social media as a source of news are more worried (61%) than people who don’t use it at all (48%). Additionally, regions with the highest levels of concern – Africa and Latin America – correspond closely with high levels of social media news use. This is not to say that social media use causes misinformation, but that usage may generate awareness of and potential exposure to false information, including giving voice to extreme perspectives that previously would not have been widely heard.

When looking at the types of misinformation that people claim to see, we find that dubious health claims around COVID-19, including from anti-vaccination groups, are, as in 2021, still most widespread across most regions, ahead of politics. Notable exceptions are in Kenya – where political misinformation is more widely seen – as well as Colombia and the Philippines, both countries where elections were held this year.

Levels of perceived misinformation around climate change and the environment are around three times higher in the United States (34%) than they are in Taiwan (10%) or Denmark (13%). Despite pledges to crack down, social media posts and videos denying climate change or disputing its causes remain widespread on Twitter, Facebook, YouTube, and TikTok, according to recent research. 9

In this year’s report we find increased polarisation around climate change in a number of countries, including the United States, and identify the most important sources for climate change news with different groups.

Text is still king but what role for online video?

Since the emergence of the internet, consumption on news websites (and apps) has primarily been about reading text articles. But that has begun to change with the growing supply of video news formats on social media.

Against this background, it is surprising to find that all age groups, on average, say they still prefer to read news online rather than watch it – and we have seen little change in underlying preferences since we last asked the question in 2019. Younger audiences, however, are significantly more likely to say they watch the news, perhaps because they are more exposed to networks like Facebook, Instagram, and TikTok.

We do find significant market-level differences in preferences around reading or watching, partly conditioned by consumption patterns offline. We find markets with historic patterns of high newspaper consumption such as Finland and Japan near the top of the list in terms of reading preference, with low-newspaper-circulation countries like Thailand and Brazil near the bottom. But other factors are also likely to be at play. Higher use of social media in general in Latin America (Mexico, Peru, Colombia, and Chile) as well as in parts of Asia-Pacific (Philippines and Taiwan) may be encouraging more video news use in these markets.

These preferences are closely linked to video consumption through platforms such as YouTube, the most widely used video-based platform in our survey. We see extremely high levels of consumption in the Philippines and India, for example. Meanwhile, in Thailand, the combination of low data charges, and greater freedom to speak openly online, has led to a spate of independent TV-style shows that are widely consumed on mobile phones. In other countries such as the UK and Denmark, by contrast, there is comparatively little mainstream news consumed on YouTube, though some alternative or partisan channels and conspiracy theorists do have a presence.

Overall, respondents say they prefer reading online because it is quicker (50%) or gives them more control (34%). Around a third (35%) say they are put off by pre-roll ads that sometimes appear ahead of videos. Almost a fifth (17%) say videos don’t add to anything that would otherwise be in a text story, 13% struggle with technical issues when trying to watch videos, and 8% worry about cost or data charges – much higher in African countries such as Kenya (35%) and Nigeria (35%).

Main reasons why people read rather than watch online news

say it is a quicker way to access information

2. Poor video experience

say pre-roll adverts tend to put me off (Finland 55%, Germany 43%)

say reading gives more control than playing videos

OptQ11ai. You say you prefer to read news in text rather than watch online video … What are the main reasons for this? Base: All who prefer to read news. All markets = 59, 258.

By contrast, people who prefer to watch news online say that this is because they find it an easier (42%) and more engaging (41%) way to access the news. Some like to see the people making or reporting the news (20%), as it brings stories to life, while others say video tells a more complete story (29%), making it easier to follow. Finally, many prefer video because they are using social media anyway (24%) and it appears, conveniently, in their feeds.

Main reasons why people watch rather than read online news

say it is a quicker way to consume news

2. Engaging

say moving pictures are more engaging than text

3. Convenient

say they come across videos often (e.g. via social media) – especially younger groups

OptQ11bi. You say you prefer to watch news video rather than read it in text … What are the main reasons for this? Base: All who prefer to watch news. All markets = 11,449.

Podcast usage growing again after COVID-19 pause

Podcasts have been another format that publishers have invested in heavily over the last few years (Newman and Gallo 2019 and 2020). Podcasts tend to reach younger audiences via their smartphones, and many subscription publishers are looking to use habit-building products, such as The Daily from the New York Times , to attract younger customers. Podcast growth has resumed this year in more than half of our markets after COVID-19 had disrupted the commute to work, negatively affecting news consumption. Looking at an average of 20 countries where we are confident that the term ‘podcast’ is well understood, we find 34% (+3) consumed one or more podcasts in the last month, with 12% accessing a news podcast. Ireland, a country with a strong audio tradition, heads our list, along with Sweden, the home of Spotify.

Platform mix is changing

Spotify, Amazon, and Google have been investing in podcasts over the last few years as they seek to capitalise on surging demand and break Apple’s historic audio dominance. The battle for talent has intensified, as evidenced by Spotify’s willingness to pay around $200m for exclusive rights to the Joe Rogan podcast, and to stand by him after rows over controversial guests and accusations of spreading of false information. 10 In our qualitative research in both the UK and US, it was striking how many younger people regularly listen to The Joe Rogan Experience, even as they worry about some of the content.

Spotify has continued to gain ground this year, overtaking BBC Sounds in the UK as the main podcast platform. It is also leading in Germany, but not in Spain, where YouTube is ahead and where the audio platform iVoox – which focuses on Spanish and Latin American markets – has a substantial share. In our qualitative research, we find some clues as to why these long news shows with diverse perspectives on Spotify and YouTube seem to appeal to young multitaskers.

YouTube is increasing its publisher focus on podcasting this year – partly to bring more reputable content onto the platform – and has revealed plans for a discovery hub and better monetisation and analytics. 11

Big tech platforms are investing in content and bringing programming to a wider and more mainstream audience but this is also raising familiar questions for publishers about monetisation, distribution, and access to data. The New York Times is launching its own app for audio this year in a bid to build more direct traffic, while Schibsted in Norway and Prisa Media in Spain, the publishers of El País , have also been investing in podcast platforms to create more critical mass and ultimately more control.

Meanwhile, the wider shift to audio continues to be driven by new voice interfaces and devices such as smart speakers and in-car entertainment systems. Amazon and Google are the key market makers in this respect, though South Korea has its own set of device manufacturers. Smart speakers now reach almost a quarter of the UK adult population (24%), 17% in Canada and Korea, 15% in Germany, and 13% in the US. But news use remains disappointing: only a minority use these devices for any kind of news (6% in the UK and 4% in the US).

While some individual news media have clearly been very successful at building online reach or convincing people to subscribe, and developed new offers across podcast, video, and newsletters, this year’s data show many publishers are still struggling to come to terms with structural changes that have been ravaging the industry for more than a decade. These challenges are compounded by the fraying connection that journalism and news media have with much of the public in many countries. More people are disconnected, interest in news is down, selective news avoidance up, and trust far from a given. The Ukraine crisis, and before it the COVID-19 pandemic, have reminded people of the value of accurate and fair reporting that gets as close to the truth as possible, but we also find evidence that the overwhelming and depressing nature of the news, feelings of powerlessness, and toxic online debates are turning many people away – temporarily or permanently. Paywalls and registration gates may not be helping either, putting further barriers in the way of the content that audiences want to consume, even as they are creating more sustainable businesses for some.

Although many publishers have had a relatively good year with increased revenue, future growth is likely to be challenged by the combined impact of inflation and rising energy prices, squeezing household budgets currently devoted to news media, but also potentially hitting advertising revenues, too. In this context, publishers will need to be even more focused on meeting the needs of specific audiences and demonstrating value to users. Internet users have access to an unprecedented amount of content, products, and services competing for their attention and hard-earned money, and news needs to stand out, connect, and create value, if it is to convince them to pay.

They will also need to keep an eye on the needs of the next generation, who this report has shown are exhibiting very different behaviours and attitudes than the one that went before. These social natives , who have come into adulthood in the last five or ten years, are much less likely to visit a traditional news website or to pay for online news – and they are often wary of giving up their data. Deeply networked, they are increasingly accessing news in video or audio on networks like Instagram, TikTok, YouTube, or Spotify.

The world feels increasingly uncertain, with war in Europe and a major refugee crisis adding to the impact of the pandemic, not to mention the looming threat of climate change. The need for reliable information, careful context, and considered debate has rarely been greater, but so too has the desire for stories that inspire and give hope of a better tomorrow. The global shocks of the last few years have galvanised publishers to refocus on digital, embracing new business models, storytelling, and distribution. But there will be no single route to success in this often confusing and increasingly complex media environment.

1 During the first week of the conflict, the BBC estimated 280 million people used its news output in the UK and around the world. https://www.independent.co.uk/news/uk/bbc-ukraine-tim-davie-nadine-dorries-bbc-news-b2047209.html ↩

2 https://www.theguardian.com/uk-news/2022/feb/17/bbcs-sarah-smith-relieved-to-escape-scottish-bile-and-hatred ↩

3 https://www.forbes.com/sites/marisadellatto/2021/11/15/substack-announces-one-million-paid-subscribers/ ↩

4 https://edition.cnn.com/2022/04/21/media/cnn-shutting-down/index.html ↩

5 In January 2022 Google announced it will stop the use of third-party cookies in its popular Chrome web browser by the end of 2023, joining a growing list of browsers and platforms that are stopping support for this tracking technology. ↩

6 https://www.cnbc.com/2022/04/26/elon-musks-twitter-takeover-sets-up-a-potential-clash-with-europe.html ↩

7 https://www.cnbc.com/2018/01/19/facebooks-news-feed-survey-users-to-find-high-quality-news.html ↩

8 We did ask respondents directly to estimate how much news they saw in each of their social media feeds, partly to prime them for this subsequent question about too much/too little. We have preferred to use data on the proportion who say they use each network for any purpose/for news as they show similar trends and are data we collect every year. ↩

9 https://eu.usatoday.com/story/tech/2022/01/21/climate-change-misinformation-facebook-youtube-twitter/6594691001/ ↩

10 ‘Joe Rogan: Four Claims from his Spotify Podcast Fact-Checked’, https://www.bbc.co.uk/news/60199614 ↩

11 https://podnews.net/update/youtube-podcasting-plans ↩

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The dawn of the FemTech revolution

Women’s healthcare enables better outcomes for women patients and consumers, 1 The authors acknowledge the importance of healthcare to the transgender, nonbinary, and gender-fluid communities and that not all people who identify as women are born biologically female and vice versa. The focus of this paper is on women’s health support as related to a market segment specific to a certain biological sex. We recognize the need for future research into health issues that is inclusive of the transgender, nonbinary, and gender-fluid communities. Indeed, we intend to explore these needs in much greater detail in the months and years ahead. investors and other stakeholders across the value chain, and society at large. We explore many of these opportunities, and the broader context in which they have developed, in a related article, “ Unlocking opportunities in women’s healthcare .” In this article, we focus specifically on FemTech: defining what it means, taking the measure of its already impressive growth, and exploring its potential to help better match resources, talent, and capital to women’s unmet health needs.

Understanding FemTech

The term “FemTech” was first coined in 2016 by entrepreneur Ida Tin. In the course of just a few years, it has grown to encompass a range of technology-enabled, consumer-centric products and solutions.

About the authors

This article is a collaborative, global effort by Emma Kemble, Lucy Pérez , Valentina Sartori , Gila Tolub , and Alice Zheng, representing views from McKinsey’s Healthcare Systems & Services Practice.

For purposes of this research, we analyzed 763 FemTech companies, designated as largely tech-enabled, consumer-centric solutions addressing women’s health, excluding biopharma and incumbent medical devices. We included select nondigital consumer products (with materials science innovations), devices (that are patient friendly), and health clinics (that are consumer-centric). We excluded companies that are more than 20 years old or are not focused exclusively on women’s health (diagnostics, supplements, telemedicine). Companies with both men’s and women’s health solutions were included in the data set but were excluded from funding calculations.

In the course of just a few years, FemTech has grown to encompass a range of technology-enabled, consumer-centric products and solutions.

FemTech provides a wide range of solutions to improve healthcare for women across a number of female-specific conditions, including maternal health, menstrual health, pelvic and sexual health, fertility, menopause, and contraception, as well as a number of general health conditions that affect women disproportionately or differently (such as osteoporosis or cardiovascular disease). While it’s still early days, our research indicates that the dynamics underlying FemTech are accelerating: public awareness, company formation, and funding are surging (Exhibit 1).

FemTech companies are already validating their investment hypotheses. Among others, Progyny, which manages fertility benefits for employers, went public in 2019 at a valuation in excess of $1 billion; its current market capitalization is about $4 billion. And Maven Clinic, a virtual clinic for women’s and family health, was valued at more than $1 billion in a recent Series D investment. In fact, the opportunities for multiple players, including investors, researchers, providers, payers, and legacy pharmaceutical and medical-device companies, are becoming increasingly evident.

A market of opportunity

Depending on scope, estimates for FemTech’s current market size range from $500 million to $1 billion. Forecasts suggest opportunities for double-digit revenue growth. On the digital health front, FemTech companies currently receive 3 percent of all digital health funding . In our scan of hundreds of FemTech companies, we found concentration in maternal health patient support, consumer menstrual products, gynecological devices, and solutions in fertility. Funding reached $2.5 billion by early December 2021. In some cases, FemTech companies are filling gaps not yet addressed by biopharma and device incumbents, such as in the area of maternal health. Yet this is clearly, and promisingly, only the beginning of what FemTech can address. There are still significant white spaces (Exhibit 2).

On the cusp of disruption

FemTech companies could disrupt healthcare in a number of ways. Initial breakthroughs are already being achieved across a range of areas, including the following:

• Improving care delivery: Virtual clinics such as Tia, innovative brick-and-mortar clinics such as Kindbody, and direct-to-consumer prescription delivery services like those of The Pill Club, all enable women to access care in a more convenient, consumer-centric manner.
• Enabling self-care: Trackers and wearables offered by companies such as Bloomlife, and at-home diagnostics like those provided by Modern Fertility, are among the FemTech solutions that are helping women take greater charge of their health and health-related data.
• Improving diagnoses: Clinical diagnostics companies are pushing the scientific frontier to address unmet medical needs in areas such as endometriosis (DotLab) and preterm birth (Sera Prognostics).
• Addressing stigmatized areas: Companies are addressing what had been considered to be stigmatized topics head on, such as menstrual health (Thinx), sexual health (Rosy Wellness), pelvic care (Elvie), and menopause (Elektra Health).
• Delivering culturally sensitive and tailored care: Solutions tailored for subpopulations are emerging for Black women (such as Health in Her HUE), LGBTQ+ populations (FOLX Health), and women in low- and middle-income countries (Kasha).

The categories in which FemTech is having an impact are increasing—and also, in some cases, starting to evolve, overlap, and redefine themselves as FemTech companies begin to scale up and seek new ways to expand. For instance, Maven started in maternity care and then expanded across the reproductive life cycle. Peppy, which was founded to offer a solution for organizations to better support their people once they had brought their new babies home, now also addresses challenges around menopause. Other businesses, among them models that were launched on a direct-to-consumer model , are now seeking to obtain regulatory approval and reimbursement, as they build upon their experiences and real-world data to provide improved solutions for a broader set of stakeholders who benefit from better women’s healthcare.

Looking forward, early movers can stake out opportunities in prominent white spaces, including by leveraging technology to address women’s health issues beyond reproduction, and by helping to meet the needs of underserved populations such as low-income or minority communities. FemTech also presents significant partnership opportunities for legacy players in traditional sectors. Cosmetics leader L’Oréal, for example, recently unveiled a partnership with the period-tracking app Clue to deepen knowledge on the relationship between skin health and the menstrual cycle. As FemTech companies increasingly gain traction and change the competitive landscape, stakeholders within and beyond the healthcare ecosystem could well provide additional momentum.

Moreover, FemTech—and indeed, improved women’s healthcare overall—could help catalyze positive social changes across the healthcare ecosystem and beyond. Consider menopause, which frequently occurs when women are most likely to step into senior roles . Its effects can have an impact on the number of women in top positions and the quality of women’s experiences throughout organizations. 2 Jeneva Patterson, “It’s time to start talking about menopause at work,” Harvard Business Review , February 24, 2020. Deploying technological and consumer-centric solutions to address menopause can serve as a model and an enabler for future female leaders.

Along those lines, FemTech is powered to a significant extent by female entrepreneurs—more than 70 percent of FemTech companies we analyzed had at least one female founder, compared with a 20 percent norm for new companies. Indeed, across the value chain, a more inclusive, gender-aware healthcare system could help support more women to become inventors, investors, physicians, founders—and healthier human beings, solving for the health conditions of other human beings. Research has shown that when inventors set out to solve a health problem, male inventors are more likely to solve for a male-oriented condition; women-led teams solve for both. 3 John-Paul Ferguson, Rembrand Koning, and Sampsa Samila, “Who do we invent for? Patents by women focus more on women’s health, but few women get to invent,” Science , June 18, 2021, Volume 372, Number 6548, pp. 1345–48.

Increasing female representation among researchers, inventors, investors, and founders can create more consumer-centric products and solutions that recognize and target women’s specific healthcare needs. Indeed, the market is not just women consumers but also payers and providers that seek better products and tools to engage more effectively with women end consumers. FemTech solutions are not only achieving commercial success; they are contributing to the conditions for continued innovation. Because women are not just consumers but the primary healthcare decision-makers for themselves and often for their families, better health outcomes for women can lead to better outcomes for society.

As women’s healthcare becomes an increasing priority, FemTech is rising to meet the challenge as it matches capital and talent with unmet needs. In a short period of time, FemTech has already demonstrated impressive early wins. An even greater disruption could be ahead.

Emma Kemble is a consultant in McKinsey’s New Jersey office, Lucy Pérez is a senior partner in the Boston office, Valentina Sartori  is a partner in the Zurich office, Gila Tolub is a partner in the Tel Aviv office, and Alice Zheng is an alumna of the Silicon Valley office.

The authors wish to thank Angie Cui, Arshiya Fazal, Kat Guillen, Prithvi Kamadana, Peter Pfeiffer, Nikhil Sahni, Josh Sternberg, Nicole Szlezak, and Eli Weinberg for their contributions to this article.

References to companies presented as examples in this article do not represent an endorsement from McKinsey & Company.

This article was edited by David Schwartz, an executive editor in the Tel Aviv office.

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Broad Public Support for Legal Abortion Persists 2 Years After Dobbs

By more than 2 to 1, americans say medication abortion should be legal, table of contents.

• Other abortion attitudes
• Overall attitudes about abortion
• Americans’ views on medication abortion in their states
• How statements about abortion resonate with Americans
• Acknowledgments
• The American Trends Panel survey methodology

Pew Research Center conducted this study to understand Americans’ views on the legality of abortion, as well as their perceptions of abortion access. For this analysis, we surveyed 8,709 adults from April 8 to 14, 2024. Everyone who took part in this survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for the report and its methodology .

Nearly two years after the Supreme Court overturned the 1973 Roe v. Wade decision guaranteeing a national right to abortion, a majority of Americans continue to express support for abortion access.

About six-in-ten (63%) say abortion should be legal in all or most cases. This share has grown 4 percentage points since 2021 – the year prior to the 2022 decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe.

The new Pew Research Center survey, conducted April 8-14, 2024, among 8,709 adults, surfaces ongoing – and often partisan – divides over abortion attitudes:

• Democrats and Democratic-leaning independents (85%) overwhelmingly say abortion should be legal in all or most cases, with near unanimous support among liberal Democrats.
• By comparison, Republicans and Republican leaners (41%) are far less likely to say abortion should be legal in all or most cases. However, two-thirds of moderate and liberal Republicans still say it should be.

Since before Roe was overturned, both parties have seen a modest uptick in the share who say abortion should be legal.

As in the past, relatively few Americans (25%) say abortion should be legal in all cases, while even fewer (8%) say it should be illegal in all cases. About two-thirds of Americans do not take an absolutist view: 38% say it should be legal in most cases, and 28% say it should be illegal in most cases.

Related: Americans overwhelmingly say access to IVF is a good thing

Women’s abortion decisions

A narrow majority of Americans (54%) say the statement “the decision about whether to have an abortion should belong solely to the pregnant woman” describes their views extremely or very well. Another 19% say it describes their views somewhat well, and 26% say it does not describe their views well.

Views on an embryo’s rights

About a third of Americans (35%) say the statement “human life begins at conception, so an embryo is a person with rights” describes their views extremely or very well, while 45% say it does not describe their views well.

But many Americans are cross-pressured in their views: 32% of Americans say both statements about women’s decisions and embryos’ rights describe their views at least somewhat well.

Abortion access

About six-in-ten Americans in both parties say getting an abortion in the area where they live would be at least somewhat easy, compared with four-in-ten or fewer who say it would be difficult.

However, U.S. adults are divided over whether getting an abortion should be easier or harder:

• 31% say it should be easier for someone to get an abortion in their area, while 25% say it should be harder. Four-in-ten say the ease of access should be about what it is now.
• 48% of Democrats say that obtaining an abortion should be easier than it is now, while just 15% of Republicans say this. Instead, 40% of Republicans say it should be harder (just 11% of Democrats say this).

As was the case last year, views about abortion access vary widely between those who live in states where abortion is legal and those who live in states where it is not allowed.

For instance, 20% of adults in states where abortion is legal say it would be difficult to get an abortion where they live, but this share rises to 71% among adults in states where abortion is prohibited.

Medication abortion

Americans say medication abortion should be legal rather than illegal by a margin of more than two-to-one (54% vs. 20%). A quarter say they are not sure.

Like opinions on the legality of abortion overall, partisans differ greatly in their views of medication abortion:

• Republicans are closely split but are slightly more likely to say it should be legal (37%) than illegal (32%). Another 30% aren’t sure.
• Democrats (73%) overwhelmingly say medication abortion should be legal. Just 8% say it should be illegal, while 19% are not sure.

Across most other demographic groups, Americans are generally more supportive than not of medication abortion.

Across demographic groups, support for abortion access has changed little since this time last year.

Today, roughly six-in-ten (63%) say abortion should be legal in all (25%) or most (38%) cases. And 36% say it should be illegal in all (8%) or most (28%) cases.

While differences are only modest by gender, other groups vary more widely in their views.

Race and ethnicity

Support for legal abortion is higher among Black (73%) and Asian (76%) adults compared with White (60%) and Hispanic (59%) adults.

Compared with older Americans, adults under 30 are particularly likely to say abortion should be legal: 76% say this, versus about six-in-ten among other age groups.

Those with higher levels of formal education express greater support for legal abortion than those with lower levels of educational attainment.

About two-thirds of Americans with a bachelor’s degree or more education (68%) say abortion should be legal in all or most cases, compared with six-in-ten among those without a degree.

White evangelical Protestants are about three times as likely to say abortion should be illegal (73%) as they are to say it should be legal (25%).

By contrast, majorities of White nonevangelical Protestants (64%), Black Protestants (71%) and Catholics (59%) say abortion should be legal. And religiously unaffiliated Americans are especially likely to say abortion should be legal (86% say this).

Partisanship and ideology

Democrats (85%) are about twice as likely as Republicans (41%) to say abortion should be legal in all or most cases.

But while more conservative Republicans say abortion should be illegal (76%) than legal (27%), the reverse is true for moderate and liberal Republicans (67% say legal, 31% say illegal).

By comparison, a clear majority of conservative and moderate Democrats (76%) say abortion should be legal, with liberal Democrats (96%) overwhelmingly saying this.

Views of abortion access by state

About six-in-ten Americans (58%) say it would be easy for someone to get an abortion in the area where they live, while 39% say it would be difficult.

This marks a slight shift since last year, when 54% said obtaining an abortion would be easy. But Americans are still less likely than before the Dobbs decision to say obtaining an abortion would be easy.

Still, Americans’ views vary widely depending on whether they live in a state that has banned or restricted abortion.

In states that prohibit abortion, Americans are about three times as likely to say it would be difficult to obtain an abortion where they live as they are to say it would be easy (71% vs. 25%). The share saying it would be difficult has risen 19 points since 2019.

In states where abortion is restricted or subject to legal challenges, 51% say it would be difficult to get an abortion where they live. This is similar to the share who said so last year (55%), but higher than the share who said this before the Dobbs decision (38%).

By comparison, just 20% of adults in states where abortion is legal say it would be difficult to get one. This is little changed over the past five years.

Americans’ attitudes about whether it should be easier or harder to get an abortion in the area where they live also varies by geography.

Overall, a decreasing share of Americans say it should be harder to obtain an abortion: 33% said this in 2019, compared with 25% today.

This is particularly true of those in states where abortion is now prohibited or restricted.

In both types of states, the shares of Americans saying it should be easier to obtain an abortion have risen 12 points since before Roe was overturned, as the shares saying it should be harder have gradually declined.

By comparison, changes in views among those living in states where abortion is legal have been more modest.

While Americans overall are more supportive than not of medication abortion (54% say it should be legal, 20% say illegal), there are modest differences in support across groups:

• Younger Americans are somewhat more likely to say medication abortion should be legal than older Americans. While 59% of adults ages 18 to 49 say it should be legal, 48% of those 50 and older say the same.
• Asian adults (66%) are particularly likely to say medication abortion should be legal compared with White (55%), Black (51%) and Hispanic (47%) adults.
• White evangelical Protestants oppose medication abortion by about two-to-one (45% vs. 23%), with White nonevangelicals, Black Protestants, Catholics and religiously unaffiliated adults all being more likely than not to say medication abortion should be legal.
• Republicans are closely divided over medication abortion: 37% say it should be legal while 32% say it should be illegal. But similar to views on abortion access overall, conservative Republicans are more opposed (43% illegal, 27% legal), while moderate and liberals are more supportive (55% legal, 14% illegal).

Just over half of Americans (54%) say “the decision about whether to have an abortion should belong solely to the pregnant woman” describes their views extremely or very well, compared with 19% who say somewhat well and 26% who say not too or not at all well.

Democrats (76%) overwhelmingly say this statement describes their views extremely or very well, with just 8% saying it does not describe their views well.

Republicans are more divided: 44% say it does not describe their views well while 33% say it describes them extremely or very well. Another 22% say it describes them somewhat well.

Fewer Americans (35%) say the statement “human life begins at conception, so an embryo is a person with rights” describes their views extremely or very well. Another 19% say it describes their views somewhat well while 45% say it describes them not too or not at all well.

(The survey asks separately whether “a fetus is a person with rights.” The results are roughly similar: 37% say that statement describes their views extremely or very well.)

Republicans are about three times as likely as Democrats to say “an embryo is a person with rights” describes their views extremely or very well (53% vs. 18%). In turn, Democrats (66%) are far more likely than Republicans (25%) to say it describes their views not too or not at all well.

Some Americans are cross-pressured about abortion

When results on the two statements are combined, 41% of Americans say the statement about a pregnant woman’s right to choose describes their views at least somewhat well , but not the statement about an embryo being a person with rights. About two-in-ten (21%) say the reverse.

But for nearly a third of U.S. adults (32%), both statements describe their views at least somewhat well.

Just 4% of Americans say neither statement describes their views well.

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Support for legal abortion is widespread in many places, especially in Europe

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H5N1 virus from 2022 mink outbreak capable of inefficient airborne transmission

Highly pathogenic H5N1 avian influenza was detected in dairy cattle for the first time in the United States in March, with nine states reporting outbreaks by May. While the method of transmission among cattle is currently unknown, new research published today (May 15) in Nature Communications demonstrates that a related strain of H5N1, subtype clade 2.3.4.4b, which caused an outbreak in farmed mink in 2022, transmitted through the air to a limited number of ferrets. This is the first time that a member of the group of H5N1 clade 2.3.4.4b viruses has been shown to exhibit this ability. According to the Penn State researchers who led the study, the findings suggest these viruses are evolving to infect mammals and with potentially increased risk to humans.

"While there is no evidence that the strain of H5N1 that is presently affecting dairy cattle is capable of airborne transmission, our study suggests that another member of this family of viruses has evolved some degree of airborne transmissibility," said Troy Sutton, associate professor of veterinary and biomedical sciences, Penn State, and corresponding author on the paper. "This finding underscores the importance of continued surveillance to monitor the evolution of these viruses and their spillover into other mammals, including humans."

According to the researchers, assessing a virus's potential for airborne transmission in mammals could inform the understanding of its potential risk to humans. Since virus samples could not be readily obtained after the outbreak in mink had been controlled, the team reconstructed the virus using publicly available genetic sequences.

Next, the researchers evaluated the ability of the virus to transmit in ferrets, which have respiratory tracts that are more similar to humans in their susceptibility to viral infection and transmission than other model organisms, such as mice. The team measured both direct transmission of the virus by placing infected ferrets in cages with uninfected ferrets and indirect airborne transmission by placing infected and uninfected ferrets in cages that enabled shared airspace but prevented physical contact. To assess disease severity, the team examined the ferrets' weight loss and signs of clinical illness.

The researchers found that the virus transmitted by direct contact to 75% of exposed ferrets and by respiratory droplets to 37.5% of exposed ferrets after about nine days of exposure. The team also found that the virus had a low infectious dose, meaning that even small amounts of virus caused an infection.

Sutton noted that the mink strain of the virus contained a mutation, called PB2 T271A. To test the influence of this mutation on viral transmission and disease severity, the team engineered the virus without the mutation and found that mortality and airborne transmission in the ferrets infected with this version of the virus was reduced.

"These findings suggest that the PB2 T271A mutation is enhancing viral replication of the virus, contributing to both virulence and transmission in ferrets," Sutton said. "Understanding the role that this mutation plays means we can monitor for it or for similar mutations to arise in the currently circulating strains of H5N1."

Sutton added that the ferrets that the team used in its studies had no preexisting immunity to influenza, whereas the majority of humans have been exposed to H1N1 and H3N2 seasonal influenza viruses.

"This exposure would likely offer some degree of cross-protection against H5N1 if humans are exposed to another H5N1 variant," he said.

Furthermore, he said that the transmission rate the team observed in the mink virus is lower than is typical for pandemic influenza viruses.

"Pandemic influenza viruses typically transmit via the airborne route to 75% to 100% of contacts within three to five days, whereas the mink virus we studied transmitted to fewer than 40% of contacts after nine days," Sutton said. "The transmission observed in our studies is indicative of increased pandemic potential relative to previously characterized strains of H5N1; however, the mink virus does not exhibit the same attributes as pandemic strains. The H5N1 strain affecting cattle also has not caused severe disease in cattle or humans, but the longer the virus circulates, and the more exposure humans have to it, the greater the chances that it will evolve to infect humans."

This research was conducted in Penn State's Eva J. Pell Advanced Biological Laboratory, a high-containment biosafety level 3 enhanced laboratory that is regularly inspected by the Centers for Disease Control and Prevention and the United States Department of Agriculture.

Other Penn State authors of the paper include Katherine Restori, assistant research professor in veterinary and biomedical sciences, as well as Kayla Septer, Cassandra Field and Devanshi Patel, all graduate students in veterinary and biomedical sciences. David VanInsberghe, postdoctoral fellow; Vedhika Raghunathan, graduate student; and Anice Lowen, professor of microbiology and immunology, all at Emory University, also are authors of the paper.

The National Institutes of Health and National Institute of Food and Agriculture supported this research.

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• Global spread of H5N1 in 2006
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Story Source:

Materials provided by Penn State . Original written by Sara LaJeunesse. Note: Content may be edited for style and length.

Journal Reference :

• Katherine H. Restori, Kayla M. Septer, Cassandra J. Field, Devanshi R. Patel, David VanInsberghe, Vedhika Raghunathan, Anice C. Lowen, Troy C. Sutton. Risk assessment of a highly pathogenic H5N1 influenza virus from mink . Nature Communications , 2024; 15 (1) DOI: 10.1038/s41467-024-48475-y

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