ABSTRACT

Epidemiological studies focused on public health have currently shown significant limitations regarding in-depth theoretical reports, overvaluing methodological aspects. The lack of theoretical explanation affects both the quality and reproducibility of studies. This study therefore reflected on the importance of in-depth theoretical reports considering the theoretical foundation used by researchers in the main sections of the manuscript (title, abstract, introduction, methodology, results, discussion, and conclusion) based on a review of the scientific literature on the subject. We believe that this article can help understand the importance and the development of in-depth theoretical reports in scientific articles, contributing to assessments, interpretations, and criticisms of reviewers and editors regarding the explanation and reporting of theoretical foundation in manuscripts submitted to scientific journals.

Epidemiologic Studies; Grounded Theory; Measurements, Methods and Theories; Publications

INTRODUCTION

Theory and methodology are considered essential to the scientific doing since they give rigor and quality to research. Although the literature describes the importance of combining these two elements, they are often applied unequally¹1. Cabrera Arana GA. Uso de teorías y modelos en artículos de una revista latinoamericana de salud pública, 2000-2004. Rev Saude Publica. 2007;41(6):963-9. https://doi.org/10.1590/S0034-8910200700060001
https://doi.org/10.1590/S0034-8910200700... . Reporting failures (theoretical or methodological) can also reduce the validity of findings and negatively affect the reproducibility of studies²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... .

In reports of epidemiological studies, methodological aspects are increasingly overlapping theoretical aspects. Pressure for productivity and demands for publications in high-impact journals often guide research leaders to methodological preferences, limiting the range of studies to be developed³3. Borsoi ICF. Trabalho e produtivismo: saúde e modo de vida de docentes de instituições públicas de Ensino Superior. Cad Psicol Soc Trab. 2012;15(1):81-100..

Journals also reinforce this attitude by requiring specific instruments to measure potential methodological bias or reporting guidelines developed for specific designs (e.g., PRISMA, STROBE, CONSORT), which do not concern theoretical issues. Moreover, journals offer no guidelines for reporting theoretical foundation and authors have few instruments that help conduct an in-depth theoretical report.

All studies must be related to a theory and/or theoretical model that supports and guides the stages of the research⁴4. Rocco TS, Plakhotnik MS. Literature reviews, conceptual frameworks, and theoretical frameworks: terms, functions, and distinctions. Hum Resour Dev Rev. 2009;8(1):120-30. https://doi.org/10.1177/1534484309332617
https://doi.org/10.1177/1534484309332617... . The in-depth report of such theory should facilitate the study’s identification and guide both the research team and the reader. In epidemiological studies, the absence of citations and explanation of theories or theoretical models can affect the understanding of the study, limit critical evaluation, and compromise quality and reproducibility²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... ,⁵5. Heale R, Noble H. Integration of a theoretical framework into your research study. Evid Based Nurs. 2019;22(2):36-7. https://doi.org/10.1136/ebnurs-2019-103077
https://doi.org/10.1136/ebnurs-2019-1030... ,⁶6. Adom D, Hussein EK, Agyem JA. Theoretical and conceptual framework: mandatory ingredients of a quality research. Int J Sci Res. 2018;7(1):438-41. since reproducibility does not depend on methodological quality alone, but on the combination between methodological, theoretical, and reporting qualities²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... .

Cabrera¹1. Cabrera Arana GA. Uso de teorías y modelos en artículos de una revista latinoamericana de salud pública, 2000-2004. Rev Saude Publica. 2007;41(6):963-9. https://doi.org/10.1590/S0034-8910200700060001
https://doi.org/10.1590/S0034-8910200700... considers that rigorous scientific communication should quote the adopted theory and describe its variables and constructs, explain how the theoretical foundation guided the methodology and its analyses, and, finally, discuss the conclusions or thematic issues addressed based on the explanatory components of the theory or descriptions of the theoretical models. A theoretical report should not focus on mechanically and exhaustively repeating the theoretical framework, but on understanding its importance in all stages of research and manuscript.

Thus, quoting “... this study was based on the theory/theoretical model x” in each part of the text is insufficient. The author must explain the theory’s contributions to each section of the article according to its function in the text and the possible effects of the study on the Theory/Model. Our study therefore reflected about the importance of an in-depth theoretical report in each section of a scientific article.

TITLE

The title should briefly reflect the essence of the manuscript and its novelty and relevance to science⁷7. Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int. 2011;31(11):1409-17. https://doi.org/10.1007/s00296-011-1999-3
https://doi.org/10.1007/s00296-011-1999-... , but the literature is yet to agree on an ideal title size⁸8. Habibzadeh F, Yadollahie M. Are shorter article titles more attractive for citations? Cross-sectional study of 22 scientific journals. Croat Med J. 2010;51(2):165-70. https://doi.org/10.3325/cmj.2010.51.165.
https://doi.org/10.3325/cmj.2010.51.165... ,⁹9. Letchford A, Moat HS, Preis T. The advantage of short paper titles. R Soc Open Sci. 2015;2(8):150266. https://doi.org/10.1098/rsos.150266
https://doi.org/10.1098/rsos.150266... . It should summarize the main idea of the manuscript in a simple and stylish way, identifying key variables, theories adopted, and the relationship between them¹⁰10. American Psychological Association, organizer. Publication manual of the American Psychological Association. 6. ed. Washington, DC: APA; 2010.while being sufficiently informative, descriptive, and precise to attract interest and favor the study’s identification¹¹11. Cals JWL, Kotz D. Effective writing and publishing scientific papers, part II: title and abstract. J Clin Epidemio. 2013;66(6):585. https://doi.org/10.1016/j.jclinepi.2013.01.005
https://doi.org/10.1016/j.jclinepi.2013.... .

Studies that do not have the theory/theoretical model in the title might not be selected in literature reviews and bibliographic searches on the theory and its use. Title-reading is often suggested as an initial stage of bibliographic search and selection. Titles that do not mention the adopted theory could thus hinder bibliographic findings, decreasing the range of literature reviews¹²12. Vries BBLP, Smeden M, Rosendaal FR, Groenwold RHH. Title, abstract, and keyword searching resulted in poor recovery of articles in systematic reviews of epidemiologic practice. J Clin Epidemiol. 2020;121:55-61. https://doi.org/10.1371/journal.pntd.0006559
https://doi.org/10.1371/journal.pntd.000... .

Therefore, mentioning the theory in the title can help researchers identify the article and promptly show readers the theoretical approach adopted. After all, determining the factor that makes the article unique in the field is important, and emphasizing it on title could stimulate interest and the potential access of readers¹¹11. Cals JWL, Kotz D. Effective writing and publishing scientific papers, part II: title and abstract. J Clin Epidemio. 2013;66(6):585. https://doi.org/10.1016/j.jclinepi.2013.01.005
https://doi.org/10.1016/j.jclinepi.2013.... .

ABSTRACT

The abstract seeks to help readers select appropriate articles more quickly, allowing more accurate searches and facilitating peer review¹³13. Bordage G, McGaghie WC. Title, authors, and abstract. Acad Med. 2001;76(9):945-7.. They can be “structured” or “unstructured”, in which content can be the same, but in different presentation formats¹⁴14. Pereira MG. O resumo de um artigo científico. Epidemiol Serv Saude. 2013;22(4):707-8. https://doi.org/10.5123/S1679-49742013000400017
https://doi.org/10.5123/S1679-4974201300... . Many journals recommend structured abstracts since they have shown to be more effective and systematic¹⁵15. Sharma S, Harrison JE. Structured abstracts: do they improve the quality of information in abstracts? Am J Orthod Dentofacial Orthop. 2006;130(4):523-30. https://doi.org/10.1016/j.ajodo.2005.10.023
https://doi.org/10.1016/j.ajodo.2005.10.... .

Abstracts offer reviewers an immediate and general meaning of the study, helping them structure the analysis and review the article¹⁵15. Sharma S, Harrison JE. Structured abstracts: do they improve the quality of information in abstracts? Am J Orthod Dentofacial Orthop. 2006;130(4):523-30. https://doi.org/10.1016/j.ajodo.2005.10.023
https://doi.org/10.1016/j.ajodo.2005.10.... . However, despite their advantages¹³13. Bordage G, McGaghie WC. Title, authors, and abstract. Acad Med. 2001;76(9):945-7., abstracts often have missing information which are only present in the text¹⁶16. Froom P, Froom J. Deficiencies in structured medical abstracts. J Clin Epidemiol. 1993;46(7):591-4. https://doi.org/10.1016/0895-4356(93)90029-z
https://doi.org/10.1016/0895-4356(93)900... , especially information related to the theoretical foundation and its contribution in sections of the manuscript¹⁷17. Soares CB, Yonekura T. Revisão sistemática de teorias: uma ferramenta para avaliação e análise de trabalhos selecionados. Rev Esc Enferm USP. 2011;45(6):1507-14. https://doi.org/10.1590/S0080-62342011000600033
https://doi.org/10.1590/S0080-6234201100... .

An abstract must contain preliminary information about the theoretical framework, explaining how the variables were evaluated, the main findings, potential limitations, and conclusions related to the theory/theoretical model adopted, even if simplified¹⁰10. American Psychological Association, organizer. Publication manual of the American Psychological Association. 6. ed. Washington, DC: APA; 2010.,¹⁸18. Mack C. Implementing structured abstracts in JM. J Micro/Nanolith, MEMS MOEMS. 2018;17(3):030101. https://doi.org/10.1117/1.JMM.17.3.030101
https://doi.org/10.1117/1.JMM.17.3.03010... . Its synthetic explanation of the used methodology, results obtained, limitations identified, and conclusions – sections already commonly reported in studies and abstracts – considers the challenges and potentialities of the theory/model used, its contribution to the study, and how the research could strengthen or question it. This practice provides a coherent and cohesive report, increasing the article’s chance of selection, access, and evaluation.

INTRODUCTION

The introduction should briefly explain the study’s subject according to the literature and the theoretical foundation adopted¹⁹19. Friedlander MR, Arbués-Moreira MT. Análise de um trabalho científico: um exercício. Rev Bras Enferm. 2007;60(5):573-8. https://doi.org/10.1590/S0034-71672007000500017
https://doi.org/10.1590/S0034-7167200700... , presenting current knowledge, recent insights and developments on the subject, and possible gaps to justify theoretical and methodological choices²⁰20. Sharma A. How to write an article: an introduction to basic scientific medical writing. J Minim Access Surg. 2019;15(3):242-8. https://doi.org/10.4103/jmas.JMAS_91_18
https://doi.org/10.4103/jmas.JMAS_91_18... . This section gives authors greater freedom to explain the study’s context and basis broadly and descriptively.

However, it is often described succinctly, seeking to convince the reader of the value of its product²¹21. Sanes JR. Tell me a story. eLife. 2019;8:e50527. https://doi.org/10.7554/eLife.50527
https://doi.org/10.7554/eLife.50527... . This attitude – popularly known as “selling fish” in Brazil – should be combated, since it often overvalues methodological aspects from the pressure for increased scientific productivity over quality²²22. Babor TF, Ward JH. Caveat emptor: predatory publishers, rogue journals, and the potential corruption of addiction science [editorial]. J Stud Alcohol Drugs. 2018;79(4):509-13.,²³23. Souza ASR, Silva Junior JR, Agra KF. A política de incentivo e a qualidade da publicação científica no Brasil e no mundo [editorial]. Rev Bras Saude Mater Infant. 2016;16(1):3-4. https://doi.org/10.1590/1806-93042016000100001
https://doi.org/10.1590/1806-93042016000... .

The introduction should justify the theoretical methodological choices and present questions to be answered in the text, explaining and describing to the reader: the theoretical foundation; the reference used; their scientific appreciation or criticism; parallel theories or gaps in the literature; and reasons that guided their choice, based on hypotheses about how the theory/theoretical model can contribute to the studied phenomenon.

Moreover, this initial presentation can include more than consecrated theories and great canons of literature⁵5. Heale R, Noble H. Integration of a theoretical framework into your research study. Evid Based Nurs. 2019;22(2):36-7. https://doi.org/10.1136/ebnurs-2019-103077
https://doi.org/10.1136/ebnurs-2019-1030... . Many researchers innovate regarding causal relationships but lack literature to support their hypotheses, thus creating theoretical models based on the free connection between different themes and/or previous scientific findings. In this case, they must explain the theoretical model created, their variables and inclusion or exclusion criteria, their interrelations, and possibilities of defending the model as innovative for the theme.

METHODOLOGY

All knowledge carries theory, and all methods are guided by theories²⁴24. Tavallaei M, Abu Talib M. A general perspective on role of theory in qualitative research. J Int Soc Res. 2010;3(11):570-7.. Although the methodology section commonly presents only the research/intervention methods used, it should also report on the theoretical foundation that supports the methodological path, explaining how the theory/theoretical model guided the method and how the variables were classified and interrelated.

A profound explanation of the theoretical-methodological path adopted includes justifying the exclusion and inclusion of variables in the analyses and the presence of bias. Authors should not only quote the chosen method – disconnected from the theoretical framework and the evidence on the subject – but explain, in depth, each point of importance for the analyses and if they correspond with the theoretical foundation.

We believe that the choice of variables is guided by the theory/theoretical model (existing, adapted or new, created by researchers) and not by arbitrary decisions such as ease/difficulty in obtaining data or even preferences of researchers. Authors should justify if they cannot obtain information on important variables.

Moreover, a graphic presentation of the theoretical model can better explain the variables involved and their relations²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... . Every theoretical model is a simplification of reality and so is its graphic representation²⁵25. Bunge M. Teoria e realidade. São Paulo: Perspectiva; 1974. (Debates; nº 72). However, researchers and readers might have difficulty visualizing the chosen theoretical model among the large textual volume produced, detailed descriptions of phenomena, and criticisms and considerations⁶6. Adom D, Hussein EK, Agyem JA. Theoretical and conceptual framework: mandatory ingredients of a quality research. Int J Sci Res. 2018;7(1):438-41..

The graphic representation of the theoretical model is essential for the communication of the research since it facilitates the visualization of the variables of interest and their interrelations, promotes significant learning about the studied phenomenon²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... , continuously improves the theoretical model by reviewing variables and observing relationships not initially considered, and helps create the model of analysis and minimize bias²2. Souza Filho BAB, Struchiner CJ. Uma proposta teórico-metodológica para elaboração de modelos teóricos. Cad Saude Coletiva. 2021;29(1). https://doi.org/10.1590/1414-462X202129010180
https://doi.org/10.1590/1414-462X2021290... ,²⁶26. Cortes TR, Faerstein E, Struchiner CJ. Utilização de diagramas causais em epidemiologia: um exemplo de aplicação em situação de confusão. Cad Saude Publica. 2016;32(8):e00103115. https://doi.org/10.1590/0102-311X00103115
https://doi.org/10.1590/0102-311X0010311... , thus improving the study.

RESULTS

The results section commonly explains the findings of each variable considered important, which are not always cohesively related to the theory/theoretical model adopted.

Changes in the initial conceptual variables can affect the study’s results, over or underestimating values and relationships according to the theoretical structure²⁷27. Jahn-Eimermacher A, Ingel K, Preussler S, Bayes-Genis A, Binder H. A DAG-based comparison of interventional effect underestimation between composite endpoint and multi-state analysis in cardiovascular trials. BMC Med Res Methodol. 2017;17(1):92. https://doi.org/10.1186/s12874-017-0366-9
https://doi.org/10.1186/s12874-017-0366-... . Moreover, a study with no defined theoretical framework could have difficulty determining causal mechanisms, generalizing for other populations, or even establishing the clinical meaning of the effects of the intervention²⁸28. Evans BC, Coon DW, Ume E. Use of theoretical frameworks as a pragmatic guide for mixed methods studies: a methodological necessity? J Mix Methods Res. 2011;5(4):276-92. https://doi.org/10.1177/1558689811412972
https://doi.org/10.1177/1558689811412972... . We therefore consider that presenting the findings for each variable related to the theoretical structure is important, including those in which no statistical relationship or significance was found, those excluded from the initial theoretical model, or even those unreported.

Such results can positively or negatively affect the initial theory/theoretical model or improve it by incorporating new variables, questioning existing variables, or questioning its scientific plausibility. Reporting the study’s innovations to the theory/theoretical model used can expand scientific knowledge and help new research on the subject.

Results can be described using graphic presentations, which show possible changes in the initial theoretical model and the theoretical impacts of the research²⁹29. Pearl J, Mackenzie D. The book of Why: the new science of cause and effect. New York: Basic Books; 2018..

DISCUSSION

This section opposes ideas and findings of the study with elements of the literature, gathering knowledge to find new propositions. The literature shows that any scientific finding should be assessed regarding the theoretical perspective from which it derives and to which it can contribute³⁰30. Silvermann D. Doing qualitative research. 5. ed. Singapore: SAGE Publications; 2018., indicating that discussion must be guided by the theoretical and conceptual processes that support the research.

The discussion section should therefore present the observed innovations, the confirmation – or not – of the initial hypothesis, how the chosen theoretical model contributed to the study, and important or needed modifications to the model. Discussing the chosen theory’s limitations is considered as good practice since it shows possible weaknesses of the theoretical approach adopted and of the study itself, helping improve new research.

This form of reporting improves the cohesion and coherence of the discussion, of reflections on the results, and of interpretations and comparisons with other existing theories/models for the same relationships observed.

CONCLUSION

Once authors understand the importance of the theory/theoretical model for guiding the study, they will instinctively conduct a general overview of the potentialities and gaps of the used model and its implications for future practice and research.

FINAL CONSIDERATIONS

The study’s theoretical foundation can be seen as its guiding thread. Reporting its specific contribution to each section of the manuscript can improve both the study and science overall.

We understand the challenges related to space limitations imposed by journals. However, available add-in files and/or electronic pages could be a viable alternative to favor robust and transparent reports.

Authors must use theory, methodology, and reporting together to construct scientific knowledge, without overlapping or overvaluing one over the other but understanding their combined importance for scientific doing.

After all, nothing is better than watching a movie or reading a book with a well-founded, well-directed, and well-reported story. We should expect the same from scientific publications. However, are all those involved (authors, reviewers, and editors) concerned with reporting theoretical foundation in scientific articles? Are you?

REFERENCES

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