is a literature review qualitative or quantitative

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Literature Reviews

• Qualitative or Quantitative?
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Qualitative researchers TEND to:

Researchers using qualitative methods tend to:

• t hink that social sciences cannot be well-studied with the same methods as natural or physical sciences
• feel that human behavior is context-specific; therefore, behavior must be studied holistically, in situ, rather than being manipulated
• employ an 'insider's' perspective; research tends to be personal and thereby more subjective.
• do interviews, focus groups, field research, case studies, and conversational or content analysis.

Image from https://www.editage.com/insights/qualitative-quantitative-or-mixed-methods-a-quick-guide-to-choose-the-right-design-for-your-research?refer-type=infographics

Qualitative Research (an operational definition)

Qualitative Research: an operational description

Purpose : explain; gain insight and understanding of phenomena through intensive collection and study of narrative data

Approach: inductive; value-laden/subjective; holistic, process-oriented

Hypotheses: tentative, evolving; based on the particular study

Lit. Review: limited; may not be exhaustive

Setting: naturalistic, when and as much as possible

Sampling : for the purpose; not necessarily representative; for in-depth understanding

Measurement: narrative; ongoing

Design and Method: flexible, specified only generally; based on non-intervention, minimal disturbance, such as historical, ethnographic, or case studies

Data Collection: document collection, participant observation, informal interviews, field notes

Data Analysis: raw data is words/ ongoing; involves synthesis

Data Interpretation: tentative, reviewed on ongoing basis, speculative

Quantitative researchers TEND to:

Researchers using quantitative methods tend to:

• think that both natural and social sciences strive to explain phenomena with confirmable theories derived from testable assumptions
• attempt to reduce social reality to variables, in the same way as with physical reality
• try to tightly control the variable(s) in question to see how the others are influenced.
• Do experiments, have control groups, use blind or double-blind studies; use measures or instruments.

Quantitative Research (an operational definition)

Quantitative research: an operational description

Purpose: explain, predict or control phenomena through focused collection and analysis of numberical data

Approach: deductive; tries to be value-free/has objectives/ is outcome-oriented

Hypotheses : Specific, testable, and stated prior to study

Lit. Review: extensive; may significantly influence a particular study

Setting: controlled to the degree possible

Sampling: uses largest manageable random/randomized sample, to allow generalization of results to larger populations

Measurement: standardized, numberical; "at the end"

Design and Method: Strongly structured, specified in detail in advance; involves intervention, manipulation and control groups; descriptive, correlational, experimental

Data Collection: via instruments, surveys, experiments, semi-structured formal interviews, tests or questionnaires

Data Analysis: raw data is numbers; at end of study, usually statistical

Data Interpretation: formulated at end of study; stated as a degree of certainty

This page on qualitative and quantitative research has been adapted and expanded from a handout by Suzy Westenkirchner. Used with permission.

Images from https://www.editage.com/insights/qualitative-quantitative-or-mixed-methods-a-quick-guide-to-choose-the-right-design-for-your-research?refer-type=infographics.

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About Systematic Reviews

Are Systematic Reviews Qualitative or Quantitative?

Automate every stage of your literature review to produce evidence-based research faster and more accurately.

A systematic review is designed to be transparent and replicable. Therefore, systematic reviews are considered reliable tools in scientific research and clinical practice. They synthesize the results using multiple primary studies by using strategies that minimize bias and random errors. Depending on the research question and the objectives of the research, the reviews can either be qualitative or quantitative. Qualitative reviews deal with understanding concepts, thoughts, or experiences. Quantitative reviews are employed when researchers want to test or confirm a hypothesis or theory. Let’s look at some of the differences between these two types of reviews.

To learn more about how long it takes to do a systematic review , you can check out the link to our full article on the topic.

Differences between Qualitative and Quantitative Reviews

The differences lie in the scope of the research, the methodology followed, and the type of questions they attempt to answer. Some of these differences include:

Research Questions

As mentioned earlier qualitative reviews attempt to answer open-ended research questions to understand or formulate hypotheses. This type of research is used to gather in-depth insights into new topics. Quantitative reviews, on the other hand, test or confirm existing hypotheses. This type of research is used to establish generalizable facts about a topic.

Type of Sample Data

The data collected for both types of research differ significantly. For qualitative research, data is collected as words using observations, interviews, and interactions with study subjects or from literature reviews. Quantitative studies collect data as numbers, usually from a larger sample size.

Data Collection Methods

To collect data as words for a qualitative study, researchers can employ tools such as interviews, recorded observations, focused groups, videos, or by collecting literature reviews on the same subject. For quantitative studies, data from primary sources is collected as numbers using rating scales and counting frequencies. The data for these studies can also be collected as measurements of variables from a well-designed experiment carried out under pre-defined, monitored conditions.

Data Analysis Methods

Data by itself cannot prove or demonstrate anything unless it is analyzed. Qualitative data is more challenging to analyze than quantitative data. A few different approaches to analyzing qualitative data include content analysis, thematic analysis, and discourse analysis. The goal of all of these approaches is to carefully analyze textual data to identify patterns, themes, and the meaning of words or phrases.

Quantitative data, since it is in the form of numbers, is analyzed using simple math or statistical methods. There are several software programs that can be used for mathematical and statistical analysis of numerical data.

Presentation of Results

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Final Takeaway – Qualitative or Quantitative?

3 reasons to connect.

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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Libraries | Research Guides

Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

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• Last Updated: Jul 8, 2024 11:22 AM
• URL: https://libguides.northwestern.edu/literaturereviews

• Locations and Hours
• UCLA Library
• Research Guides
• Biomedical Library Guides

Systematic Reviews

• Types of Literature Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

• Planning Your Systematic Review
• Database Searching
• Creating the Search
• Search Filters and Hedges
• Grey Literature
• Managing and Appraising Results
• Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Archer Library

Quantitative research: literature review .

• Archer Library This link opens in a new window
• Research Resources handout This link opens in a new window
• Locating Books
• Library eBook Collections This link opens in a new window
• A to Z Database List This link opens in a new window
• Research & Statistics
• Literature Review Resources
• Citations & Reference

Exploring the literature review 

Literature review model: 6 steps.

Adapted from The Literature Review , Machi & McEvoy (2009, p. 13).

Your Literature Review

Step 2: search, boolean search strategies, search limiters, ★ ebsco & google drive.

1. Select a Topic

"All research begins with curiosity" (Machi & McEvoy, 2009, p. 14)

Selection of a topic, and fully defined research interest and question, is supervised (and approved) by your professor. Tips for crafting your topic include:

• Be specific. Take time to define your interest.
• Topic Focus. Fully describe and sufficiently narrow the focus for research.
• Academic Discipline. Learn more about your area of research & refine the scope.
• Avoid Bias. Be aware of bias that you (as a researcher) may have.
• Document your research. Use Google Docs to track your research process.
• Research apps. Consider using Evernote or Zotero to track your research.

Consider Purpose

What will your topic and research address?

In The Literature Review: A Step-by-Step Guide for Students , Ridley presents that literature reviews serve several purposes (2008, p. 16-17).  Included are the following points:

• Historical background for the research;
• Overview of current field provided by "contemporary debates, issues, and questions;"
• Theories and concepts related to your research;
• Introduce "relevant terminology" - or academic language - being used it the field;
• Connect to existing research - does your work "extend or challenge [this] or address a gap;" 
• Provide "supporting evidence for a practical problem or issue" that your research addresses.

★ Schedule a research appointment

At this point in your literature review, take time to meet with a librarian. Why? Understanding the subject terminology used in databases can be challenging. Archer Librarians can help you structure a search, preparing you for step two. How? Contact a librarian directly or use the online form to schedule an appointment. Details are provided in the adjacent Schedule an Appointment box.

2. Search the Literature

Collect & Select Data: Preview, select, and organize

Archer Library is your go-to resource for this step in your literature review process. The literature search will include books and ebooks, scholarly and practitioner journals, theses and dissertations, and indexes. You may also choose to include web sites, blogs, open access resources, and newspapers. This library guide provides access to resources needed to complete a literature review.

Books & eBooks: Archer Library & OhioLINK

Databases: Scholarly & Practitioner Journals

Review the Library Databases tab on this library guide, it provides links to recommended databases for Education & Psychology, Business, and General & Social Sciences.

Expand your journal search; a complete listing of available AU Library and OhioLINK databases is available on the Databases  A to Z list . Search the database by subject, type, name, or do use the search box for a general title search. The A to Z list also includes open access resources and select internet sites.

Databases: Theses & Dissertations

Review the Library Databases tab on this guide, it includes Theses & Dissertation resources. AU library also has AU student authored theses and dissertations available in print, search the library catalog for these titles.

Did you know? If you are looking for particular chapters within a dissertation that is not fully available online, it is possible to submit an ILL article request . Do this instead of requesting the entire dissertation.

Newspapers:  Databases & Internet

Consider current literature in your academic field. AU Library's database collection includes The Chronicle of Higher Education and The Wall Street Journal .  The Internet Resources tab in this guide provides links to newspapers and online journals such as Inside Higher Ed , COABE Journal , and Education Week .

The Chronicle of Higher Education has the nation’s largest newsroom dedicated to covering colleges and universities.  Source of news, information, and jobs for college and university faculty members and administrators

The Chronicle features complete contents of the latest print issue; daily news and advice columns; current job listings; archive of previously published content; discussion forums; and career-building tools such as online CV management and salary databases. Dates covered: 1970-present.

Offers in-depth coverage of national and international business and finance as well as first-rate coverage of hard news--all from America's premier financial newspaper. Covers complete bibliographic information and also subjects, companies, people, products, and geographic areas. 

Comprehensive coverage back to 1984 is available from the world's leading financial newspaper through the ProQuest database. 

Newspaper Source provides cover-to-cover full text for hundreds of national (U.S.), international and regional newspapers. In addition, it offers television and radio news transcripts from major networks.

Provides complete television and radio news transcripts from CBS News, CNN, CNN International, FOX News, and more.

Search Strategies & Boolean Operators

There are three basic boolean operators:  AND, OR, and NOT.

Used with your search terms, boolean operators will either expand or limit results. What purpose do they serve? They help to define the relationship between your search terms. For example, using the operator AND will combine the terms expanding the search. When searching some databases, and Google, the operator AND may be implied.

Overview of boolean terms

About the example: Boolean searches were conducted on November 4, 2019; result numbers may vary at a later date. No additional database limiters were set to further narrow search returns.

Database Search Limiters

Database strategies for targeted search results.

Most databases include limiters, or additional parameters, you may use to strategically focus search results.  EBSCO databases, such as Education Research Complete & Academic Search Complete provide options to:

• Limit results to full text;
• Limit results to scholarly journals, and reference available;
• Select results source type to journals, magazines, conference papers, reviews, and newspapers
• Publication date

Keep in mind that these tools are defined as limiters for a reason; adding them to a search will limit the number of results returned.  This can be a double-edged sword.  How? 

• If limiting results to full-text only, you may miss an important piece of research that could change the direction of your research. Interlibrary loan is available to students, free of charge. Request articles that are not available in full-text; they will be sent to you via email.
• If narrowing publication date, you may eliminate significant historical - or recent - research conducted on your topic.
• Limiting resource type to a specific type of material may cause bias in the research results.

Use limiters with care. When starting a search, consider opting out of limiters until the initial literature screening is complete. The second or third time through your research may be the ideal time to focus on specific time periods or material (scholarly vs newspaper).

★ Truncating Search Terms

Expanding your search term at the root.

Truncating is often referred to as 'wildcard' searching. Databases may have their own specific wildcard elements however, the most commonly used are the asterisk (*) or question mark (?).  When used within your search. they will expand returned results.

Asterisk (*) Wildcard

Using the asterisk wildcard will return varied spellings of the truncated word. In the following example, the search term education was truncated after the letter "t."

Explore these database help pages for additional information on crafting search terms.

• EBSCO Connect: Basic Searching with EBSCO
• EBSCO Connect: Searching with Boolean Operators
• EBSCO Connect: Searching with Wildcards and Truncation Symbols
• ProQuest Help: Search Tips
• ERIC: How does ERIC search work?

★ EBSCO Databases & Google Drive

Tips for saving research directly to Google drive.

Researching in an EBSCO database?

It is possible to save articles (PDF and HTML) and abstracts in EBSCOhost databases directly to Google drive. Select the Google Drive icon, authenticate using a Google account, and an EBSCO folder will be created in your account. This is a great option for managing your research. If documenting your research in a Google Doc, consider linking the information to actual articles saved in drive.

EBSCO Databases & Google Drive

EBSCOHost Databases & Google Drive: Managing your Research

This video features an overview of how to use Google Drive with EBSCO databases to help manage your research. It presents information for connecting an active Google account to EBSCO and steps needed to provide permission for EBSCO to manage a folder in Drive.

About the Video:  Closed captioning is available, select CC from the video menu.  If you need to review a specific area on the video, view on YouTube and expand the video description for access to topic time stamps.  A video transcript is provided below.

• EBSCOhost Databases & Google Scholar

Defining Literature Review

What is a literature review.

A definition from the Online Dictionary for Library and Information Sciences .

A literature review is "a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works" (Reitz, 2014). 

A systemic review is "a literature review focused on a specific research question, which uses explicit methods to minimize bias in the identification, appraisal, selection, and synthesis of all the high-quality evidence pertinent to the question" (Reitz, 2014).

Recommended Reading

About this page

EBSCO Connect [Discovery and Search]. (2022). Searching with boolean operators. Retrieved May, 3, 2022 from https://connect.ebsco.com/s/?language=en_US

EBSCO Connect [Discover and Search]. (2022). Searching with wildcards and truncation symbols. Retrieved May 3, 2022; https://connect.ebsco.com/s/?language=en_US

Machi, L.A. & McEvoy, B.T. (2009). The literature review . Thousand Oaks, CA: Corwin Press: 

Reitz, J.M. (2014). Online dictionary for library and information science. ABC-CLIO, Libraries Unlimited . Retrieved from https://www.abc-clio.com/ODLIS/odlis_A.aspx

Ridley, D. (2008). The literature review: A step-by-step guide for students . Thousand Oaks, CA: Sage Publications, Inc.

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• Quantitative vs. Qualitative Research

Research can be   quantitative or qualitative  or both:

• A quantitative systematic review will include studies that have numerical data.
• A qualitative systematic review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. It may include focus groups, interviews, observations and diaries.

Video source:  UniversityNow: Quantitative vs. Qualitative Research

For more information on searching for qualitative evidence see:

Booth, A. (2016). Searching for qualitative research for inclusion in systematic reviews: A structured methodological review.  Systematic Reviews, 5 (1), 1–23. https://doi.org/10.1186/S13643-016-0249-X/TABLES/5

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• Next: Assess for Quality and Bias of Studies >>
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How to write a Literature Review: Quantitative vs qualitative method

• Literature review process
• Purpose of a literature review
• Evaluating sources
• Managing sources
• Request a literature search
• Selecting the approach to use

Quantitative vs qualitative method

• Summary of different research methodologies
• Research design vs research methodology
• Diagram: importance of research
• Attributes of a good research scholar

Source : Golafshani, 2003

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• Next: Summary of different research methodologies >>
• Last Updated: Aug 22, 2024 3:46 PM
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Literature Reviews, Introduction to Different Types of

There are many different types of literature reviews, each with its own approach, analysis, and purpose. To confuse matters, these types aren't named consistently. The following are some of the more common types of literature reviews.

These are more rigorous, with some level of appraisal:

• The Systematic Review is important to health care and medical trials, and other subjects where methodology and data are important. Through rigorous review and analysis of literature that meets a specific criteria, the systematic review identifies and compares answers to health care related questions. The systematic review may include meta-analysis and meta-synthesis, which leads us to...
• The Quantitative or Qualitative Meta-analysis Review can both make up the whole or part of systematic review(s). Both are thorough and comprehensive in condensing and making sense of a large body of research. The quantitative meta-analysis reviews quantitative research, is objective, and includes statistical analysis. The qualitative meta-analysis reviews qualitative research, is subjective (or evaluative, or interpretive), and identifies new themes or concepts.

These don't always include a formal assessment or analysis:

• The Literature Review (see our Literature Review video) or Narrative Review often appears as a chapter in a thesis or dissertation. It describes what related research has already been conducted, how it informs the thesis, and how the thesis fits into the research in the field. (See https://student.unsw.edu.au/writing-critical-review for more information.)
• The Critical Review is like a literature review, but requires a more detailed examination of the literature, in order to compare and evaluate a number of perspectives.
• The Scoping Review is often used at the beginning of an article, dissertation or research proposal. It is conducted before the research begins, and sets the stage for this research by highlighting gaps in the literature, and explaining the need for the research about to be conducted, which is presented in the remainder of the article.
• The Conceptual Review groups articles according to concepts, or categories, or themes. It identifies the current 'understanding' of the given research topic, discusses how this understanding was reached, and attempts to determine whether a greater understanding can be suggested. It provides a snapshot of where things are with this particular field of research.
• The State-of-the-Art Review is conducted periodically, with a focus on the most recent research. It describes what is currently known, understood, or agreed upon regarding the research topic, and highlights where are there still disagreements.

Source: Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal , 26 (2), 91-108. http://doi.org/10.1111/j.1471-1842.2009.00848.x

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How to Operate Literature Review Through Qualitative and Quantitative Analysis Integration?

• Conference paper
• First Online: 05 May 2022
• Cite this conference paper

• Eduardo Amadeu Dutra Moresi   ORCID: orcid.org/0000-0001-6058-3883 13 ,
• Isabel Pinho   ORCID: orcid.org/0000-0003-1714-8979 14 &
• António Pedro Costa   ORCID: orcid.org/0000-0002-4644-5879 14  

Part of the book series: Lecture Notes in Networks and Systems ((LNNS,volume 466))

Included in the following conference series:

• World Conference on Qualitative Research

542 Accesses

3 Citations

Usually, a literature review takes time and becomes a demanding step in any research project. The proposal presented in this article intends to structure this work in an organised and transparent way for all project participants and the structured elaboration of its report. Integrating qualitative and quantitative analysis provides opportunities to carry out a solid, practical, and in-depth literature review. The purpose of this article is to present a guide that explores the potentials of qualitative and quantitative analysis integration to develop a solid and replicable literature review. The paper proposes an integrative approach comprising six steps: 1) research design; 2) Data Collection for bibliometric analysis; 3) Search string refinement; 4) Bibliometric analysis; 5) qualitative analysis; and 6) report and dissemination of research results. These guidelines can facilitate the bibliographic analysis process and relevant article sample selection. Once the sample of publications is defined, it is possible to conduct a deep analysis through Content Analysis. Software tools, such as R Bibliometrix, VOSviewer, Gephi, yEd and webQDA, can be used for practical work during all collection, analysis, and reporting processes. From a large amount of data, selecting a sample of relevant literature is facilitated by interpreting bibliometric results. The specification of the methodology allows the replication and updating of the literature review in an interactive, systematic, and collaborative way giving a more transparent and organised approach to improving the literature review.

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Literature reviews as independent studies: guidelines for academic practice

On being ‘systematic’ in literature reviews

Literature Reviews: An Overview of Systematic, Integrated, and Scoping Reviews

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Catholic University of Brasília, Brasília, DF, 71966-700, Brazil

Eduardo Amadeu Dutra Moresi

University of Aveiro, 3810-193, Aveiro, Portugal

Isabel Pinho & António Pedro Costa

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António Pedro Costa

António Moreira

Department Didactics, Organization and Research Methods, University of Salamanca, Salamanca, Salamanca, Spain

Maria Cruz Sánchez‑Gómez

Adventist University of Africa, Nairobi, Kenya

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Moresi, E.A.D., Pinho, I., Costa, A.P. (2022). How to Operate Literature Review Through Qualitative and Quantitative Analysis Integration?. In: Costa, A.P., Moreira, A., Sánchez‑Gómez, M.C., Wa-Mbaleka, S. (eds) Computer Supported Qualitative Research. WCQR 2022. Lecture Notes in Networks and Systems, vol 466. Springer, Cham. https://doi.org/10.1007/978-3-031-04680-3_13

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Systematic & scoping reviews

Systematic reviews.

From Munn et al (2018): “Systematic reviews can be broadly defined as a type of research synthesis that are conducted by review groups with specialized skills, who set out to identify and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesize the results of this search to inform practice, policy and in some cases, further research. .. Systematic reviews follow a structured and pre-defined process that requires rigorous methods to ensure that the results are both reliable and meaningful to end users. .. A systematic review may be undertaken to confirm or refute whether or not current practice is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. .. Conducting a systematic review may also identify gaps, deficiencies, and trends in the current evidence and can help underpin and inform future research in the area. .. Indications for systematic reviews are:

• Uncover the international evidence
• Confirm current practice/ address any variation/ identify new practices
• Identify and inform areas for future research
• Identify and investigate conflicting results
• Produce statements to guide decision-making”

Scoping reviews

From Munn et al (2018): “Scoping reviews are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give clear indication of the volume of literature and studies available as well as an overview (broad or detailed) of its focus. Scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review. They can report on the types of evidence that address and inform practice in the field and the way the research has been conducted. The general purpose for conducting scoping reviews is to identify and map the available evidence . Purposes for conducting a scoping review:

• To identify the types of available evidence in a given field
• To clarify key concepts/ definitions in the literature
• To examine how research is conducted on a certain topic or field
• To identify key characteristics or factors related to a concept
• As a precursor to a systematic review
• To identify and analyse knowledge gaps”

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology , 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x

Reviews can be quantitative or qualitative

A quantitative review will include studies that have numerical data. A qualitative review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. It will include focus groups, interviews, observations and diaries. See the qualitative research section for more information.

PRISMA Statement

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses.

The PRISMA 2020 statement was published in 2021 and comprises a 27-item checklist addressing the introduction, methods, results and discussion sections of a systematic review report. It is intended to be accompanied by the PRISMA 2020 Explanation and Elaboration document .

The PRISMA extension for scoping reviews (PRISMA-ScR) was published in 2018. The checklist contains 20 essential reporting items and 2 optional items to include when completing a scoping review.

Steps in a systematic review

A systematic review involves the following steps:

• Check for existing reviews/protocols . If a systematic review answering your question has been conducted, or is being undertaken, you may need to amend or refine your question
• Formulate a specific research question that is clear and focused. Use the PICO tool (for quantitative reviews) or PICo (for qualitative reviews)
• Develop and register your protocol , including the rationale for the review, and eligibility criteria
• Design a robust search strategy that is explicit and reproducible
• Conduct a comprehensive search of the literature by searching the relevant databases and other sources
• Select and critically appraise the quality of included studies
• Extract relevant data from individual studies and use established methods to synthesise the data
• Interpret your results and prepare a comprehensive report on all aspects of your systematic review. Present your findings so that they can be translated into clinical practice.

Comparison of different types of reviews

This table outlines the differences between a systematic review and a literature review:

Adapted from: University of Newcastle Australia Library

This table outlines the differences between a systematic review and a scoping review:

Adapted from: University of South Australia

References:

Pollock, D., Davies, E. L., Peters, M. D. J., et al. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs, 77, 2102-2113. https://doi.org/10.1111/jan.14743

“Rapid reviews have emerged as a streamlined approach to synthesizing evidence-typically for informing emergent decisions faced by decision makers in health care setting”.

Source: Khangura, S., Konyu, K., Cushman, R., Grimshaw, J. & Moher, D. (2012). Evidence summaries: the evolution of a rapid review approach. Systematic Review, 1-10. https://doi.org/10.1186/2046-4053-1-10

Examples of different types of reviews:

Literature review: A Literature review of mentorship programs in academic nursing https://doi.org/10.1016/j.profnurs.2017.02.007

Narrative review: A silent burden—prolapse, incontinence, and infertility in Australian Aboriginal and Torres Strait Islander women: A systematic search and narrative review https://doi.org/10.1002/ijgo.13920

Rapid review: Blended foods for tube-fed children: a safe and realistic option? A rapid review of the evidence https://doi.org/10.1136/archdischild-2016-311030

Scoping review: How do patients experience caring? Scoping review https://doi.org/10.1016/j.pec.2017.03.029

Systematic review: Barriers and facilitators to health screening in men: A systematic review https://doi.org/10.1016/j.socscimed.2016.07.023

A typology of reviews: an analysis of 14 review types and associated methodologies (2009) https://doi.org/10.1111/j.1471-1842.2009.00848.x

• Open access
• Published: 15 December 2015

Qualitative and mixed methods in systematic reviews

• David Gough 1  

Systematic Reviews volume  4 , Article number:  181 ( 2015 ) Cite this article

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Expanding the range of methods of systematic review

The logic of systematic reviews is very simple. We use transparent rigorous approaches to undertake primary research, and so we should do the same in bringing together studies to describe what has been studied (a research map) or to integrate the findings of the different studies to answer a research question (a research synthesis). We should not really need to use the term ‘systematic’ as it should be assumed that researchers are using and reporting systematic methods in all of their research, whether primary or secondary. Despite the universality of this logic, systematic reviews (maps and syntheses) are much better known in health research and for answering questions of the effectiveness of interventions (what works). Systematic reviews addressing other sorts of questions have been around for many years, as in, for example, meta ethnography [ 1 ] and other forms of conceptual synthesis [ 2 ], but only recently has there been a major increase in the use of systematic review approaches to answer other sorts of research questions.

There are probably several reasons for this broadening of approach. One may be that the increased awareness of systematic reviews has made people consider the possibilities for all areas of research. A second related factor may be that more training and funding resources have become available and increased the capacity to undertake such varied review work.

A third reason could be that some of the initial anxieties about systematic reviews have subsided. Initially, there were concerns that their use was being promoted by a new managerialism where reviews, particularly effectiveness reviews, were being used to promote particular ideological and theoretical assumptions and to indirectly control research agendas. However, others like me believe that explicit methods should be used to enable transparency of perspectives driving research and to open up access to and participation in research agendas and priority setting [ 3 ] as illustrated, for example, by the James Lind Alliance (see http://www.jla.nihr.ac.uk/ ).

A fourth possible reason for the development of new approaches is that effectiveness reviews have themselves broadened. Some ‘what works’ reviews can be open to criticism for only testing a ‘black box’ hypothesis of what works with little theorizing or any logic model about why any such hypothesis should be true and the mechanisms involved in such processes. There is now more concern to develop theory and to test how variables combine and interact. In primary research, qualitative strategies are advised prior to undertaking experimental trials [ 4 , 5 ] and similar approaches are being advocated to address complexity in reviews [ 6 ], in order to ask questions and use methods that address theories and processes that enable an understanding of both impact and context.

This Special Issue of Systematic Reviews Journal is providing a focus for these new methods of review whether these use qualitative review methods on their own or mixed together with more quantitative approaches. We are linking together with the sister journal Trials for this Special Issue as there is a similar interest in what qualitative approaches can and should contribute to primary research using experimentally controlled trials (see Trials Special Issue editorial by Claire Snowdon).

Dimensions of difference in reviews

Developing the range of methods to address different questions for review creates a challenge in describing and understanding such methods. There are many names and brands for the new methods which may or may not withstand the changes of historical time, but another way to comprehend the changes and new developments is to consider the dimensions on which the approaches to review differ [ 7 , 8 ].

One important distinction is the research question being asked and the associated paradigm underlying the method used to address this question. Research assumes a particular theoretical position and then gathers data within this conceptual lens. In some cases, this is a very specific hypothesis that is then tested empirically, and sometimes, the research is more exploratory and iterative with concepts being emergent and constructed during the research process. This distinction is often labelled as quantitative or positivist versus qualitative or constructionist. However, this can be confusing as much research taking a ‘quantitative’ perspective does not have the necessary numeric data to analyse. Even if it does have such data, this might be explored for emergent properties. Similarly, research taking a ‘qualitative’ perspective may include implicit quantitative themes in terms of the extent of different qualitative findings reported by a study.

Sandelowski and colleagues’ solution is to consider the analytic activity and whether this aggregates (adds up) or configures (arranges) the data [ 9 ]. In a randomized controlled trial and an effectiveness review of such studies, the main analysis is the aggregation of data using a priori non-emergent strategies with little iteration. However, there may also be post hoc analysis that is more exploratory in arranging (configuring) data to identify patterns as in, for example, meta regression or qualitative comparative analysis aiming to identify the active ingredients of effective interventions [ 10 ]. Similarly, qualitative primary research or reviews of such research are predominantly exploring emergent patterns and developing concepts iteratively, yet there may be some aggregation of data to make statements of generalizations of extent.

Even where the analysis is predominantly configuration, there can be a wide variation in the dimensions of difference of iteration of theories and concepts. In thematic synthesis [ 11 ], there may be few presumptions about the concepts that will be configured. In meta ethnography which can be richer in theory, there may be theoretical assumptions underlying the review question framing the analysis. In framework synthesis, there is an explicit conceptual framework that is iteratively developed and changed through the review process [ 12 , 13 ].

In addition to the variation in question, degree of configuration, complexity of theory, and iteration are many other dimensions of difference between reviews. Some of these differences follow on from the research questions being asked and the research paradigm being used such as in the approach to searching (exhaustive or based on exploration or saturation) and the appraisal of the quality and relevance of included studies (based more on risk of bias or more on meaning). Others include the extent that reviews have a broad question, depth of analysis, and the extent of resultant ‘work done’ in terms of progressing a field of inquiry [ 7 , 8 ].

Mixed methods reviews

As one reason for the growth in qualitative synthesis is what they can add to quantitative reviews, it is not surprising that there is also growing interest in mixed methods reviews. This reflects similar developments in primary research in mixing methods to examine the relationship between theory and empirical data which is of course the cornerstone of much research. But, both primary and secondary mixed methods research also face similar challenges in examining complex questions at different levels of analysis and of combining research findings investigated in different ways and may be based on very different epistemological assumptions [ 14 , 15 ].

Some mixed methods approaches are convergent in that they integrate different data and methods of analysis together at the same time [ 16 , 17 ]. Convergent systematic reviews could be described as having broad inclusion criteria (or two or more different sets of criteria) for methods of primary studies and have special methods for the synthesis of the resultant variation in data. Other reviews (and also primary mixed methods studies) are sequences of sub-reviews in that one sub-study using one research paradigm is followed by another sub-study with a different research paradigm. In other words, a qualitative synthesis might be used to explore the findings of a prior quantitative synthesis or vice versa [ 16 , 17 ].

An example of a predominantly aggregative sub-review followed by a configuring sub-review is the EPPI-Centre’s mixed methods review of barriers to healthy eating [ 18 ]. A sub-review on the effectiveness of public health interventions showed a modest effect size. A configuring review of studies of children and young people’s understanding and views about eating provided evidence that the public health interventions did not take good account of such user views research, and that the interventions most closely aligned to the user views were the most effective. The already mentioned qualitative comparative analysis to identify the active ingredients within interventions leading to impact could also be considered a qualitative configuring investigation of an existing quantitative aggregative review [ 10 ].

An example of a predominantly configurative review followed by an aggregative review is realist synthesis. Realist reviews examine the evidence in support of mid-range theories [ 19 ] with a first stage of a configuring review of what is proposed by the theory or proposal (what would need to be in place and what casual pathways would have to be effective for the outcomes proposed by the theory to be supported?) and a second stage searching for empirical evidence to test for those necessary conditions and effectiveness of the pathways. The empirical testing does not however use a standard ‘what works’ a priori methods approach but rather a more iterative seeking out of evidence that confirms or undermines the theory being evaluated [ 20 ].

Although sequential mixed methods approaches are considered to be sub-parts of one larger study, they could be separate studies as part of a long-term strategic approach to studying an issue. We tend to see both primary studies and reviews as one-off events, yet reviews are a way of examining what we know and what more we want to know as a strategic approach to studying an issue over time. If we are in favour of mixing paradigms of research to enable multiple levels and perspectives and mixing of theory development and empirical evaluation, then we are really seeking mixed methods research strategies rather than simply mixed methods studies and reviews.

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Study Protocol

Health professionals’ attitudes towards traditional healing for mental illness: A systematic review protocol

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia, Department of Psychiatry, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia

Roles Supervision, Validation, Visualization, Writing – review & editing

Affiliation Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia

• Alemayehu Molla Wollie, 
• Kim Usher, 
• Reshin Maharaj, 
• Md Shahidul Islam

• Published: September 9, 2024
• https://doi.org/10.1371/journal.pone.0310255
• Peer Review
• Reader Comments

Mental illness is a global problem that receives less attention, particularly in developing countries. Integrating modern treatment with traditional healing approaches has been proposed as one way to address mental health problems, especially in developing countries. Despite health professionals’ participation in traditional healing being crucial to integrative approaches, their participation is limited to date. This review protocol is designed to explore the attitudes of health professionals towards traditional healing practices in mental health services.

The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching databases, including PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of sciences will be conducted. Additionally, Google and Google Scholar will be searched for other information, including grey literature. Moreover, a manual search of identified articles’ reference lists will also be conducted to help ensure all potential papers are included in the review. Qualitative, quantitative, and mixed study methods published in English between January 2014 and April 2024 will be included. The qualities of the included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. A mixed-method synthesis will be used to synthesis the results.

It is crucial for healthcare professionals to provide culturally sensitive care to empower people to manage their health. This systematic review will summarize the attitudes of health professionals towards the adoption and delivery of traditional healing approaches to people experiencing mental illness. Therefore, the findings of this review will support integration between traditional healers and modern mental health practitioners for the treatment of mental illness.

Trial registration

Protocol registration number: CRD42024535136 .

Citation: Wollie AM, Usher K, Maharaj R, Islam MS (2024) Health professionals’ attitudes towards traditional healing for mental illness: A systematic review protocol. PLoS ONE 19(9): e0310255. https://doi.org/10.1371/journal.pone.0310255

Editor: Madhulika Sahoo, Kalahandi University, INDIA

Received: May 8, 2024; Accepted: August 27, 2024; Published: September 9, 2024

Copyright: © 2024 Wollie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All data are in the manuscript.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that co competing interest exists.

Mental health is the overall wellbeing and functioning of an individual, family, and community [ 1 , 2 ]. It is “a state of wellbeing in which the individual realizes his or her own abilities, is able to contribute to his or her environment, copes with the normal stress of life, works fruitfully, and is able to cooperate with others [ 3 ].” In contrast, mental illness has a substantial impact on a person’s feelings, thoughts, behaviour, and social interactions [ 4 , 5 ]. It is influenced by numerous factors, including psychological, physical, social, cultural, and spiritual [ 6 , 7 ].

Currently, mental illness is a major public health burden and accounts for 32.4% of years lived with disability worldwide [ 8 ]. Even though mental health issues are a global health concern, they are highly prevalent in low-income countries [ 9 , 10 ]. Developing nations have fewer health professionals [ 11 ], resulting in a treatment gap for people with mental illnesses in these countries [ 12 ]. Furthermore, negative attitudes, stigma, limited resources, and low priority are reasons for the high magnitude of mental illness, in addition to a shortage of health professionals [ 13 – 16 ].

People with mental health issues often seek care from indigenous or traditional healers [ 17 – 19 ]. Traditional healing practices include but are not limited to a set of beliefs that use culturally accepted spiritual treatments and plant products [ 20 ]. Traditional healers form a major part of the mental health workforce in developing countries [ 21 ]. Nearly 80% of people from Africa seek medical attention from traditional healers [ 21 ], largely because traditional healers provide culturally and socially accepted care for individuals and communities. This is the preferred treatment approach for most people due to its perceived effectiveness, affordability, and accessibility within communities [ 22 – 24 ]. In order to close the significant treatment gap in low-and middle-income countries, “the World Health Organization’s (WHO) 2003–2020 Mental Health Action Plan recommended that government health programs incorporate traditional healers as treatment resources [ 25 ].”

Studies indicate that traditional healers can offer efficacious therapies that may be beneficial for prevalent mental illnesses such as depression and anxiety [ 26 , 27 ]. Healers usually come from extended family branches with experience providing care like counselling, bible interpretation, and using prayer aids such as holy water and oil for treatment [ 27 , 28 ]. They either obtain experience through on-the-job training or apply their practices through ancestors who serve as mediators by providing access to spiritual guidance and power [ 15 , 29 , 30 ].

Despite the fact that traditional healing approaches are practiced by large groups of people, particularly in low-income countries, modern health professionals tend to differ in their opinions about this approach [ 31 , 32 ]. Studies indicate that some health professionals hold a positive view of traditional healing modalities [ 33 ], while many others express doubt about the effectiveness of traditional treatments. Furthermore, there is a negative attitude among health professionals regarding the integration of traditional healing with biomedical therapies [ 34 , 35 ]. Traditional healers are known to consult with modern health professionals when faced with problems beyond their ability to treat, but it is not common for biomedical professionals to refer back to healers [ 27 ]. This is often due to their negative attitudes toward traditional healing practices, including the belief that traditional healers do not incorporate a human right approach and/or compassionate care when dealing with people with mental health problems [ 35 , 36 ]. Their negative attitudes have a detrimental effect on the WHO’s recommended collaboration of biomedical treatment and traditional healing to close the treatment gap in low and middle-income countries because cooperation between the two needs mutual respect and recognition. In addition to providing biological therapies, it is good to emphasize spiritual and cultural approaches for mental illness since mental illness is due to multidimensional factors like spiritual, social, psychological, and physical. Moreover, it is crucial for healthcare providers to understand their patients’ cultural beliefs and practices in order to manage and counsel them appropriately [ 34 ] and empower them towards healthful healing. There is no summarized research regarding the attitudes of health professionals toward traditional healing approaches for mental illness, despite the existence of numerous singe studies. Therefor, this review protocol is aimed to explore the summarized evidences on health care providers’ attitudes toward traditional healing for mental illness, and this will be crucial in developing appropriate guidelines for holistic treatment.

Research question

What are the health professionals’ attitudes towards traditional healing for mental illness?

Methods and materials

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines will be used to conduct this review [ 37 ]. This protocol is also prepared in accordance with the PRISAM-Protocol guidelines (Supporting Information). Primary studies conducted using quantitative, quantitative, and mixed-methods will be included. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number of CRD42014535136.

Eligibility criteria

The eligibility assessment format will be used to select articles to be included in the systematic review. Globally published original articles focusing on health professionals’ attitude and/or perception towards traditional healing of mental illness will be considered. Qualitative, quantitative, and mixed-method studies will be considered without restrictions in their study design. Studies published in English between January 2014 and April 2024 will be considered to summarize contemporary evidence on the topic. Conference summaries, reviews, dissertations, case studies, governmental and non-government reports, and letters will be excluded from the study.

Searching strategy

A literature search of databases such as PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of Sciences will be conducted. The key terms will be searched by connecting Boolean operators OR/AND to specifically address published studies. Searching words will be (attitude) OR (perception) OR (belief) OR (opinion) OR (view) AND (health professionals) OR (health practitioners) OR (health personnel) OR (nurses) OR (medical doctors) OR (psychiatrist) OR (psychologist) AND (traditional healing) OR (traditional medicine) OR (herbal medicine) OR (indigenous treatment) OR (spiritual therapy) OR (religious healing) AND (mental illness) OR (mental disorder) OR (mental health) OR (psychological distress) OR (psychiatric disorder). In addition to database and manual searches, we will use references to articles obtained from the database to filter the remaining studies. Database searching and the initial screening process will be finalized in consultation with a senior health librarian from the University of New England (UNE) Dixon Library and other authors.

An example of a search strategy for Scopus ( (ALL ("health professional") OR TITLE-ABS-KEY ("health personnel") OR TITLE-ABS-KEY ("medical doctor") OR TITLE-ABS-KEY ("medical practitioner") OR TITLE-ABS-KEY (nurse) OR TITLE-ABS-KEY (psychiatrist) OR TITLE-ABS-KEY (psychologist) ) ) AND ( (ALL (perception) OR TITLE-ABS-KEY (attitude) OR TITLE-ABS-KEY (belief) OR TITLE-ABS-KEY (view) OR TITLE-ABS-KEY (opinion) ) ) AND ( (ALL ("traditional healing") OR TITLE-ABS-KEY ("traditional medicine") OR TITLE-ABS-KEY ("indigenous treatment") OR TITLE-ABS-KEY ("spiritual therapy") OR TITLE-ABS-KEY ("religious healing") OR TITLE-ABS-KEY ("herbal medicine") ) ) AND ( (ALL ("mental illness") OR TITLE-ABS-KEY ("mental disorder") OR TITLE-ABS-KEY ("mental health") OR TITLE-ABS-KEY ("psychiatric disorder") OR TITLE-ABS-KEY ("psychological distress") ) ) AND PUBYEAR > 2013 AND PUBYEAR < 2025 AND (LIMIT-TO (DOCTYPE, "ar") ) AND (LIMIT-TO (LANGUAGE, "English") )

Study selection process

PRISMA (preferred reporting items for the systematic review and meta-analysis) guidelines [ 37 ] will be followed to ensure the quality and transparency of the review process. After critically searching articles from databases, we will start the selection process by importing all records to an Endnote library. Duplicates will be detected and removed automatically. At the beginning, the selection process will be carried out by the first author (AMW), and it will be checked by one of the co-authors (KU, RM, and SI). The reviewer will evaluate article titles and abstracts for relevance, keeping those that are relevant to the outcome variable attitudes, and/or perceptions of health professionals towards traditional healing. The full texts of possible relevant papers will then be screened for eligibility. Any disagreements will be handled through a discussion to finalize the selection of the papers.

Data extraction or collection process

With the use of a predetermined, uniform data extraction structure, the first author will extract important data, and then it will be confirmed by another author. Any significant differences will be discussed, and if a consensus cannot be reached, a third author will adjudicate on the decision. The first author’s name, the year of publication, the country where the study is conducted, the methodology used, the health professional type, the data collection and analysis method, the major findings, and the conclusions will be included in the standardized data extraction form.

Quality assessment

Each study’s methodological quality and bias risk will be assessed to determine the validity of the findings. The qualities of the included articles will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018 Checklist [ 38 ]. This tool is designed to assess the methodological qualities of different types of studies, like qualitative, quantitative, and mixed studies. The differences in quality evaluation scores will be resolved by through discussion within a team.

Data synthesis

An integrated mixed-method synthesis technique will be used to summarize all quantitative, qualitative, and mixed-method data in one combined synthesis [ 39 ]. Quantitative data will be described qualitatively to facilitate integration with qualitative data. The overall nature of the articles will be presented in a table. Themes and subthemes will be formulated based on the data generated. All the data will be analysed and reported as a narrative summary. To minimize bias, the research team will thoroughly evaluate and discuss the entire process, and any disagreements will be resolved through discussion.

The review will be conducted to summarize the attitudes of health professionals towards traditional healing approaches for mental illness in a global context. Even though independent studies have been undertaken on health professionals’ attitudes and/or perceptions towards traditional healing, there is no globally summarized general evidence on the topic. Some previous studies present opposing evidence on the attitudes of health professionals towards traditional healing practices. Even if some health professionals encourage traditional methods, there are other studies that show negative attitudes of health professionals towards traditional healing [ 34 , 35 ]. Traditional healing practices are considered appropriate options for mental illness, particularly in low-income countries where there is a scarcity of modern mental health professionals [ 21 ]. Most people with mental health problems seek these treatments because they provide culturally and socially accepted care for individuals and the community [ 22 – 24 ]. But there is limited collaboration between modern treatment and traditional healing. Therefore, this review will summarize all the literature and clearly show the positions of health professionals toward traditional healing approaches. The findings of this review will be important in developing directions for governmental organizations and other concerned bodies to strengthen communication and integration of traditional healing with biomedical treatment options for mental illness.

Expected limitations

This systematic review has the limitation of excluding articles that are not published in English. In addition, the exclusion of conference reports, letter, short communications, and review articles may be a reason to miss important data.

Publication status

This protocol is prepared for the ongoing systematic review of articles entitled “The health professionals’ attitude towards traditional healing approaches to mental illness.” If there is any change during the review, an updated version will be published with a final systematic review.

Supporting information

S1 checklist. prisma-protocol guidelines..

https://doi.org/10.1371/journal.pone.0310255.s001

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Blockchain technology adoption for disrupting fintech functionalities: a systematic literature review for corporate management, supply chain, banking industry, and stock markets.

1. Introduction

2. research background, 2.1. literature review, 2.2. bca/fintech application domain areas, 3. methodology.

• Timeframe: 2013–2022;
• Data source: Journal articles and conference papers published in English;
• Search keywords and terms: (“corporate management” OR “supply chain” OR “banking industry” OR “stock markets”) AND (“Blockchain technology adoption”);
• Searched databases: Web of Science, Scopus, and MDPI archives.
• Expectation: Best BCA practices have been identified;
• Language: English;
• Years considered (SLR time scope): 2013–2022;
• Publication identity: DOI;
• Outcomes: Disrupting FinTech functionalities.
• Articles about theory rather than practice;
• Non-English articles;
• Articles published before 1 January 2013;
• Non-peer-reviewed articles.
• Smart contract utilization advances BCA/FinTech loyalty, commitment, and faithfulness.
• Credit corruption problems in BCA/FinTech are considered trust issues in digital transactions (banking industry, stock markets, government, etc.).
• Information sharing problems in BCA/FinTech are considered fidelity issues in markets, investments, and financial services.
• Corporate ESG activities facilitate BCA integrity.
• Corporate DEI initiatives enhance BCA traceability.
• By adopting cryptocurrencies, the BCA/FinTech becomes more efficient, scalable, and durable with anonymity, security, privacy, and transparency functionalities.

4. Research Strategy for Exhausting the Literature—A Multidisciplinary Approach (Fourth Methodology Criterion)

4.1. find top-cited articles in library databases, 4.2. define an article as a prototype and find related articles, 4.3. use clarivate’s web of knowledge, 4.4. use of sage navigator, 4.5. get librarian assistance for research consultations and recorded video research consultations, 5. results and analysis.

• Expectation: Best BCA practices have been identified
• Language: English
• Years considered (SLR time scope): 2013–2022,
• Publication identity: DOI
• Outcomes: Disrupting FinTech functionalities
• Articles about theory rather than practice
• Non-English articles
• Articles published before 1 January 2013
• Non-peer-reviewed articles

5.1. Corporate Management

• [Key finding #1] Smart contract utilization advances BCA/FinTech loyalty, commitment, and faithfulness.
• [Key finding #2] Corporate ESG activities facilitate BCA integrity.
• [Key finding #3] Credit corruption problems in BCA/FinTech are considered trust issues in digital transactions.
• [Key finding #4] Corporate DEI initiatives enhance BCA traceability and accountability.
• [Key finding #5] By adopting cryptocurrencies the BCA/FinTech become more efficient, scalable, and durable with anonymity, security, privacy, and transparency functionalities.

5.2. Supply Chain

• [Key finding #3] Credit corruption problems in BCA/FinTech are considered trust issues in digital transactions (banking industry, stock markets, government, etc.).
• [Key finding #6] Information-sharing problems in BCA/FinTech are considered fidelity issues in markets, investments, and financial services.

5.3. Banking Industry

• [Key finding #6] Information sharing problems in BCA/FinTech are considered fidelity issues in markets, investments, and financial services.

5.4. Stock Markets

• [Key finding #3] Credit corruption problems in BCA/FinTech are considered trust issues in digital transactions (stock markets, etc.).

5.5. Derived Quantitative Assessment

5.6. BCA Effect on Critical Financial Variables

5.6.1. first layer of the proposed slr research sequence (rq1: what are the financial variables (bca functionalities) of present bca/fintech applications and their implications in a particular business sector).

Click here to enlarge figure

5.6.2. Second Layer of the Proposed SLR Research Sequence (RQ2: What Are the Issues and Opportunities Associated with Financial Variables Operated as BCA Functionalities in a Particular Business Sector?)

5.6.3. third layer of the proposed slr research sequence (rq3: what are the implications, theoretical contributions (hypotheses, propositions, etc.), questions, potentiality, and outlook of bca/fintech issues, risks, limitations, and opportunities in a particular business sector), 5.7. statistics, 5.7.1. content classification statistics.

5.7.2. Spatial–Temporal Evolution Statistics

6. Discussion

7. conclusions, 7.1. results and accomplishments, 7.2. findings and practical applications, 7.3. theoretical and practical implications, 7.4. contributions, 7.4.1. theoretical contributions, 7.4.2. practical contributions, 7.5. limitations and recommendations, 7.6. future research directions, author contributions, data availability statement, acknowledgments, conflicts of interest.

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Share and Cite

Basdekidou, V.; Papapanagos, H. Blockchain Technology Adoption for Disrupting FinTech Functionalities: A Systematic Literature Review for Corporate Management, Supply Chain, Banking Industry, and Stock Markets. Digital 2024 , 4 , 762-803. https://doi.org/10.3390/digital4030039

Basdekidou V, Papapanagos H. Blockchain Technology Adoption for Disrupting FinTech Functionalities: A Systematic Literature Review for Corporate Management, Supply Chain, Banking Industry, and Stock Markets. Digital . 2024; 4(3):762-803. https://doi.org/10.3390/digital4030039

Basdekidou, Vasiliki, and Harry Papapanagos. 2024. "Blockchain Technology Adoption for Disrupting FinTech Functionalities: A Systematic Literature Review for Corporate Management, Supply Chain, Banking Industry, and Stock Markets" Digital 4, no. 3: 762-803. https://doi.org/10.3390/digital4030039

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• v.9(1); 2015 Feb

Qualitative systematic reviews: their importance for our understanding of research relevant to pain

This article outlines what a qualitative systematic review is and explores what it can contribute to our understanding of pain. Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A rigorous qualitative systematic review can also uncover new understandings, often helping illuminate ‘why’ and can help build theory. Such a review can answer the question ‘What is it like to have chronic pain?’ This article presents the different stages of meta-ethnography, which is the most common methodology used for qualitative systematic reviews. It presents evidence from four meta-ethnographies relevant to pain to illustrate the types of findings that can emerge from this approach. It shows how new understandings may emerge and gives an example of chronic musculoskeletal pain being experienced as ‘an adversarial struggle’ across many aspects of the person’s life. This article concludes that evidence from qualitative systematic reviews has its place alongside or integrated with evidence from more quantitative approaches.

Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A high-quality qualitative systematic review can also uncover new understandings, often helping illuminate ‘why’ and can help build theory. A qualitative systematic review could answer the question ‘What is it like to have chronic non-malignant pain?’

The purpose of this article is to outline what a qualitative systematic review is and explore what it can contribute to our understanding of pain. A qualitative systematic review brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together. There is a debate over whether the search needs to be exhaustive. 1 , 2 Methods for systematic reviews of quantitative research are well established and explicit and have been pioneered through the Cochrane Collaboration. Methods for qualitative systematic reviews have been developed more recently and are still evolving. The Cochrane Collaboration now has a Qualitative and Implementation Methods Group, including a register of protocols, illustrating the recognition of the importance of qualitative research within the Cochrane Collaboration. In November 2013, an editorial described the Cochrane Collaboration’s first publication of a qualitative systematic review as ‘a new milestone’ for Cochrane. 3 Other editorials have raised awareness of qualitative systematic reviews in health. 4

Noblit and Hare 5 were pioneers in the area of synthesising qualitative data. They describe such reviews as aggregated or as interpretative. The aggregated review summarises the data, and Hannes and Pearson 6 provide a worked example of an aggregation approach. Interpretative approaches, as the name suggests, interpret the data, and from that interpretation, new understandings can develop that may lead to development of a theory that helps us to understand or predict behaviour. Types of interpretative qualitative systematic reviews include meta-ethnography, critical interpretative synthesis, realist synthesis and narrative synthesis. More details about these and other approaches can be found in other papers and books. 1 , 5 , 7 – 11 This article will describe one approach, meta-ethnography, as it was identified as the most frequently used approach, 1 and there are some examples using meta-ethnography that focus on pain. A meta-ethnographic approach can be used with a variety of qualitative methodologies, not only ethnography. The data for a meta-ethnography are the concepts or themes described by the authors of the primary studies.

Noblit and Hare 5 outlined the seven steps of a meta-ethnography: (1) getting started, (2) deciding what is relevant, (3) reading the studies, (4) determining how studies are related to each other, (5) translating studies into each other, (6) synthesising translations and (7) expressing the synthesis.

The first three might seem relatively straightforward, although Lee et al. 12 emphasised both the importance and nuances of the reading stage, and Toye et al. 13 discuss the complexities of making quality assessments of qualitative papers and searching for this type of study. You need to understand what data to extract from the papers and how you are going to do this.

You have to first identify what is a concept and what is purely descriptive. Toye et al. 2 describe a process for collaboratively identifying concepts. In determining how studies are related to each other and translating them into each other, the meta-ethnographer compares the concepts found in each study with each other and then groups similar concepts into conceptual themes. Translating studies into each other involves looking at where concepts between studies agree (reciprocal synthesis) and where they do not agree (refutational synthesis). Developing conceptual categories can be challenging as you need to judge the extent to which a concept from one study adequately reflects concepts from other studies and choose one that seems to fit best. This is discussed in more detail in Toye et al. 2 , 13

To synthesise the translation, a line of argument is then developed from the conceptual categories. How the concepts group and relate to each other are developed. This provides an overall interpretation of the findings, ensuring this is grounded in the data from the primary studies. You are aiming to explain, and new concepts and understandings may emerge, which can then go on to underpin development of theory. For example, a qualitative systematic review that explored medicine taking found that ‘resistance’ was a new concept, revealed through meta-ethnography, and this helped understanding of lay responses to medicine taking. 1 Hannes and Macaitis, 14 in a review of published papers, reported that over time, authors have become more transparent about searching and critical appraisal, but that the synthesis element of reviews is often not well described. Being transparent about decisions that are interpretative has its own challenges. Working collaboratively to challenge interpretations and assumptions can be helpful. 2 , 12 The next section will use examples of qualitative systematic reviews from the pain field to illuminate what this type of review can contribute to our understanding of pain.

What can a qualitative systematic review contribute to the field of pain – some examples

Toye et al. 2 , 15 undertook a meta-ethnography to look at patients’ experiences of chronic non-malignant musculoskeletal pain. At the time of this research, no other qualitative systematic reviews had been published in this area. Their review included 77 papers reporting 60 individual studies, resulting from searches of six electronic bibliographic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and HMIC) from inception until February 2012 and hand-searching key journals from 2001 to 2012.

They developed a new concept which they identified as an ‘adversarial struggle’. This struggle took place across five main dimensions: (1) there was a struggle to affirm themselves, where there was a tension between the ‘real me’ (without pain) and ‘not real me’ (me with pain). (2) The present and future were often unpredictable, and construction of time was altered and they struggled to reconstruct themselves in time. (3) People struggled to find an acceptable explanation for their pain and suffering. (4) There was a struggle to negotiate the healthcare system and (5) a struggle for pain to be seen as legitimate, including the need to be believed, and a struggle to know whether to show or hide their pain. Some people were able to move forward with pain. They saw their body as more integrated, they re-defined what was normal, they told people about their pain, they were part of a community of people with pain and they felt more expert on how their pain affected them and what they could do about it.

So, this meta-ethnography highlighted the adversarial nature of having chronic musculoskeletal pain and how this struggle pervaded many different areas of their life. It also illustrated how by showing patients their pain is understood and being alongside the person in pain, they can start to move forward. A short film based on the 77 papers in this meta-ethnography has been made and is available on YouTube. 16 This film was made as an attempt to disseminate the findings of a meta-ethnography in a way that is accessible to a range of people.

Snelgrove and Liossi 17 undertook a meta-ethnography of qualitative research in chronic low back pain (CLBP) using meta-ethnography. They included 33 papers of 28 studies published between 2000 and 2012. They identified three overarching themes of (1) the impact of CLBP on self, (2) relationships with others (health professionals and family and friends) and (3) coping with CLBP. They found that very few successful coping strategies were reported. Like Toye et al., 2 , 15 they also reported disruption to self, distancing their valued self from their painful self, legitimising pain, the struggle to manage daily living and the importance of social relationships alongside negotiation of their care in the health system.

MacNeela et al. 18 also undertook a meta-ethnography of experiences of CLBP. They included 38 articles published between 1994 and 2012 representing 28 studies. They identified four themes: (1) the undermining influence of pain, (2) the disempowering impact on all levels, (3) unsatisfying relationships with healthcare professionals and (4) learning to live with the pain. They reported the findings being dominated by ‘wide-ranging distress and loss’. They discussed the disempowering consequences of pain and a search for help. However, they also highlighted self-determination and resilience and suggested these could offer ‘pathways to endurance’. They emphasised self-management and adaptation, which resonates with the moving forward category reported by Toye et al. 2 , 15

Froud et al. 19 looked at the impact of low back pain on people’s lives. They describe their approach as meta-ethnographic and meta-narrative. They included 49 papers of about 42 studies from inception of databases searched until July 2011. They described five themes: activities, relationships, work, stigma and changing outlook, which they derived from ‘participant-level data’. They described their findings as showing patients wanted to be believed. They highlighted the importance of social factors when developing relevant outcome measures. There are other examples of qualitative systematic reviews relevant to pain. 20 – 23

Different qualitative systematic reviews on a similar subject may come up with overlapping but also some different findings. This could be, for example, because different search periods or different inclusion criteria are used, so different primary studies may be included in different reviews. In addition, undertaking a qualitative systematic review requires researchers to interpret concepts. This interpretation does not need to be a limitation. For example, to ensure rigour and transparency, Toye et al. 24 report a process of collaborative interpretation of concepts among a team of experienced qualitative researchers to ensure individual interpretations were challenged and remained grounded in the original studies. They also published a detailed audit trail of the processes and decisions made. 2 Campbell et al. 1 argue ‘Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill’. It is important to be able to think conceptually when undertaking a meta-ethnography, and it can be a time-consuming process. However, the ability of a meta-ethnography to synthesise a large number of primary research studies, generate new conceptual understandings and thus increase our understanding of patients’ experiences of pain makes it a very useful resource for our evidence-based practice.

The way forward

A register of qualitative systematic reviews would be useful for researchers and clinicians, so there was a clear way of identifying existing qualitative reviews or reviews that are planned or underway. The Cochrane Collaboration does now have a register for protocols of qualitative systematic reviews being undertaken under the aegis of the Cochrane Qualitative and Implementation Methods Group. It would help those wanting to undertake qualitative systematic reviews if reviews that were underway were registered and described more clearly to prevent duplication of effort, for example, using ‘qualitative systematic review’ and the methodological approach used (such as meta-ethnography) in the title and/or abstract. The Toye et al. 2 protocol 25 was accessible on the National Institutes for Health website from 2010. The Snelgrove and Liossi 17 study was done without external funding, so it would be difficult to pick up that it was underway. The MacNeela et al. 18 study was listed on the Irish Research Council for the Humanities and Social Sciences under their Research Development Initiative 2008–2009, but was described as ‘Motivation and Beliefs among People Experiencing Chronic Low Back Pain’, so it was not clearly identified at that stage as a qualitative systematic review. Finally, the Froud et al. 19 award details 26 do not mention qualitative systematic reviews or meta-ethnography. This highlights the difficulty of finding some of these reviews and the importance of a register of both completed and ongoing reviews.

This article has argued that qualitative systematic reviews have their place alongside or integrated with more quantitative approaches. There is an increasing body of evidence from qualitative systematic reviews. They can synthesise primary research, and this can be helpful for the busy practitioner. The methods for these approaches are still developing, and attention to rigour at each stage is crucial. It is important that each stage of the synthesis is reported transparently and that the researchers’ stance is clearly reported. 27 Meta-ethnographies published over the last year 2 , 15 , 17 – 19 have drawn together a wide range of primary studies and shown that people’s lives can be markedly changed by their pain across multiple dimensions of their life.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

• Open access
• Published: 10 September 2024

Designing and psychometric evaluation of safe nursing care instrument in intensive care units

• Mozhdeh Tajari 1 ,
• Tahereh Ashktorab 2 ,
• Abbas Ebadi 3 &
• Farid Zayeri 4  

BMC Nursing volume  23 , Article number:  629 ( 2024 ) Cite this article

Metrics details

Providing safe care in a sensitive and high-risk unit such as the ICU is one of the most crucial tasks for nurses. One way to establish the criteria for safe care is by creating a instrument to assess it. Therefore, this study was conducted with the aim of designing and psychometrically evaluating an instrument for safe nursing care in the ICU.

The current study employed a sequential-exploratory mixed-method approach with two qualitative and quantitative phases. Based on the results of qualitative phase and the literature review, the primary instrument was designed. In the quantitative phase, the designed instrument underwent psychometric evaluation. Face, content and construct validity were assessed. Face validity was assessed by 20 nurses, and content validity was assessed by 26 experts. In the construct validity stage, the sample size for the exploratory factor analysis (EFA) included 300 nurses, and for the confirmatory factor analysis (CFA) included 200 nurses who work full-time in the ICUs of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran. EFA sampling was conducted in three hospitals, encompassing six ICUs, while CFA sampling was carried out in two hospitals, covering four ICUs. Sampling was done using the convenience method. The reliability of the instrument was also assessed. Finally, the interpretability, feasibility, weighting, and scoring of the instrument were evaluated.

The qualitative phase identified three themes, including professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). The primary instrument was designed with 107 items rated on a five-point Likert scale. In the quantitative phase, the psychometrics of the instrument were conducted. First, the face and content validity were assessed, and the average scale content validity index (S-CVI) was 0.94. Then, a preliminary test was conducted to assess the initial reliability (α = 0.92) and the correlation of each item with the total score. After completing these steps, the number of items in the instrument was reduced to 52. The results of the EFA explained 58% of the total variance, with 4 factors identified: professional behavior by following guidelines, comprehensive care, accurate documentation, and pressure ulcer care. At the CFA stage, the results of the calculation of indices and goodness of fit showed that the model had a good fit. The reliability of the relative stability by examining the intraclass correlation coefficient (ICC) for the whole instrument in 20 samples was 0.92 with a confidence interval of 0.97 − 0.81. To measure absolute stability and determine the responsiveness of the instrument, the standard error of measurement (SEM) was 4.39 and the minimum detectable change (MDC) was 12.13.

The instrument for safe nursing care in the ICU has favorable psychometric properties.

Peer Review reports

As recently defined by the World Health Organization (WHO) in 2021, patient safety is a framework of organized activities that create cultures, processes, behaviors, technologies, climates, and environments in healthcare organizations. This framework aims to continuously and sustainably identify risks, preventable harm, and reduce the likelihood of their occurrence [ 1 ]. According to this organization, unsafe care is a significant contributor to serious medical errors globally and ranks among the top ten causes of death worldwide [ 2 ]. According to available reports, 134 million serious incidents of unsafe care have been recorded in low- and middle-income countries. These incidents resulted in 2.6 million deaths per year [ 3 ]. There is evidence that patient safety is a global health issue that affects patients worldwide, including both developed and developing countries [ 4 ]. Researchers are evaluating interventions, designing health systems, and exploring creative methods to ensure patient safety. At a global level, the World Health Organization has implemented safety interventions in underdeveloped and developing countries [ 5 ].

In addition to the importance of safety in hospitals, this aspect becomes even more crucial in intensive care settings [ 6 ]. Intensive care units (ICUs) are specialized hospital units that care for critically ill patients. These patients require constant monitoring and specialized care due to their complex medical conditions [ 7 ]. The role of ICU nurses is crucial in ensuring patient safety and delivering quality care [ 8 ]. They are responsible for providing practical care, monitoring vital signs, administering medications, and assisting with medical procedures [ 9 ]. In addition to the acute condition of patients, nurses in these units are also required to deal with the emotional and psychological stress of caring for critically ill patients and their families [ 10 ]. However, providing safe care in these units can be challenging due to a number of factors [ 11 ]. One of the main challenges for nurses in these units is the requirement for high precision and the management of complex care needs [ 12 ]. The special conditions of patients hospitalized in ICUs, the equipment available in these units, and the care techniques used increase the risk of medical errors [ 13 ], but development and application of safe care criteria lead to increased patient survival, cost savings, and a reduction in preventable deaths [ 14 ]. One way to identify safe care criteria is by developing an instrument to review them. The utilization of patient safety review and assessment criteria not only enhances nurses’ and managers’ recognition and awareness of the current status of nurses’ safe care qualifications but also helps identify their skill and cognitive deficits and deficiencies [ 15 ].

Despite the availability of certain instruments for evaluating safe care in Iran [ 15 ] and other countries [ 16 , 17 , 18 , 19 ], these instruments are generic and lack specificity, failing to consider the variations among different care settings. Rashvand et al. (2016) conducted a study in Iran to develop and psychometrically evaluate a safety care instrument. The tool they developed consisted of 41 items with factors including assessment of nursing skills, assessment of psychological needs, assessment of physical needs, assessment of teamwork, and assessment of ethics [ 20 ]. Although this study is valuable, the instrument designed is a general tool to assess the safety of hospitalized patients, and it does not specifically address the care of patients in the ICU. Furthermore, since the tool’s design, there have been numerous changes in Iran’s health system structure and safe care standards. Instruments designed in other countries can be useful, but due to differences in the health system, facilities, and equipment, they may not always be compatible. For these reasons and due to the absence of a specific instrument thorough review of previous studies the researchers conducted this study with the aim of designing and psychometrically evaluating a safe nursing care instrument in the ICU.

Study design

The present study is a sequential-exploratory mixed-methods study conducted with the aim of designing and psychometrically evaluating a safe nursing care instrument in the ICU in Iran from October 2019 to October 2021. This study was conducted in two qualitative and quantitative phases. In the first phase, a qualitative approach was used to provide a comprehensive definition of the concept of safe nursing care in the ICU. In the next phase, a quantitative approach was used to design and psychometrically assess the safe nursing care instrument in these departments [ 21 ].

Qualitative phase and item generation

In the first phase of the study, conventional content analysis was utilized to gain a comprehensive understanding of the concept of safe nursing care and its dimensions. Through purposive sampling, in-depth and semi-structured interviews were conducted with 21 participants, including 7 nurses, 2 head nurses, 1 clinical supervisor, 1 nurse responsible for patient safety, 5 intensivists, 2 patients, 1 patient’s family member (patient’s son), 1 patient safety officer in the Ministry of Health, Treatment, and Medical Education, and 1 paramedic. The inclusion criteria for the healthcare personnel involved having a minimum of two years of professional experience in the ICU or in units associated with patient safety. The selection of the two-year threshold was based on the completion of the mandatory manpower plan course and the acquisition of sufficient experience and knowledge. Patients were included if they had a Glasgow Coma Score (GCS) of 15, demonstrated clear speech abilities, and received approval from the ICU intensivist to participate in the interview. Data collection persisted until data saturation was achieved, and no new codes emerged. A concluding interview was carried out to confirm data saturation.

Examples of interview questions for treatment staff include:

During each shift, what do you do for your patients?

How do you prioritize your nursing care?

What measures do you take to ensure patient safety?

What unsafe behaviors have you observed during your shift?

Qualitative data analysis was then carried out according to the steps suggested by Lindgeren et al. in 2020 [ 22 ]. First, decontextualization was carried out as follows. First, the text of the interviews was transcribed and read multiple times to grasp the main idea. The semantic units were then identified and coded. For recontextualization, the generated codes were compared and grouped into subcategories based on their similarities and differences. In the next step, the categories were extracted from the integration of subcategories, and finally, themes were extracted from the integration of categories. The first author conducted the data analysis, while the other authors reviewed and revised the codes, subcategories, and categories. A definition of the concept under study and its structures was then presented. The initial item pool was extracted by the first author and contained 130 items, 5 of which were extracted from other instruments. The item pool was refined several times by the research team, and a number of items were dropped. Finally, 107 items remained in the item pool.

At the end, the initial instrument was developed by establishing a 5-point Likert scale, with 1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always.

Quantitative phase and item reduction

In the quantitative phase of the study, the psychometric properties of the instrument were assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. Face validity, content validity, construct validity, and reliability were evaluated. The number of samples in each stage varied, and this is detailed separately in the respective sections.

Face validity

To assess face validity, two qualitative and quantitative methods were used. In this stage, the participants consisted of 20 nurses (10 nurses in qualitative and 10 nurses in quantitative method) from the ICU departments of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran, who met the inclusion criteria. The inclusion criteria required participants to hold a bachelor’s degree in nursing and have less than two years of work experience. These criteria were chosen to ensure that nurses with minimal nursing education and work experience could comprehend the items. The samples were selected using the convenience sampling method.

For qualitative face validity ten nurses were asked to rate the items of the instrument in terms of difficulty, relevance, and ambiguity. For quantitative face validity, another 10 nurses were asked to rate the appropriateness of each item by responding to a Likert scale (completely appropriate = 5, somewhat appropriate = 4, moderately appropriate = 3, slightly appropriate = 2, not appropriate at all = 1). Quantitative face validity was assessed by calculating the items impact score (IIS). The formula (impact score = frequency (%) × suitability) was used to determine the impact score [ 23 ]. The acceptable impact score is greater than 1.5.

Content validity

To assess content validity, two qualitative and quantitative methods were used. At this stage, there were 26 expert participants (14 experts in qualitative and 12 experts in quantitative method), including head nurses, nurses in charge of the ICUs, intensivists, and faculty members with experience in working or teaching ICU courses at universities affiliated with Kermanshah University of Medical Sciences in western Iran, who met the inclusion criteria. The inclusion criteria required more than two years of work experience in the ICU department. Sampling was conducted using the convenience method.

Qualitative content validity was assessed with the participation of 14 experts. Adjustments were made to the item arrangement and recommendations were provided for deleting, modifying, and integrating several items. Quantitative investigation of content validity involved 12 experts. The content validity ratio (CVR) was calculated to assess the necessity of the item, while the content validity index (CVI), average content validity index (S-CVI), and adjusted kappa coefficient (K*) were used to evaluate the relevance of the items. The CVR of each item was calculated based on a 3-point Likert scale, which included not necessary = 1, useful but not necessary = 2, and necessary = 3. Considering the number of experts, the cut-off point of the minimum value of the acceptable index in the Lawshe table was 0.56, and items with CVR values less than 0.56 could be removed [ 24 ]. To determine the Content Validity Index (CVI) of each item, experts provided feedback on a four-point Likert scale as follows: not relevant = 1, somewhat relevant = 2, relevant but needs revision = 3, and completely relevant = 4. The minimum acceptable level of CVI was considered to be 0.80 according to Waltz and Basel [ 25 ]. The SCVI/average approach was used to calculate the SCVI. A value of 0.9 was established as an excellent criterion, while a value of 0.8 was designated as the minimum threshold for SCVI acceptance [ 23 ]. To determine the adjusted kappa coefficient, experts provided comments by selecting one of the options: relevant = 1 or not relevant = 0. An adjusted kappa statistic greater than 0.74 was considered excellent, between 0.60 and 0.74 good, and less than 0.60 poor [ 26 ]. In the quantitative content validity stage, decisions about the items were made based on the kappa statistic.

In both qualitative and quantitative content validity, experts provided feedback on the comprehensiveness of items using a five-point Likert scale as follows: Not comprehensive at all = 1, Not comprehensive = 2, Somewhat comprehensive = 3, Sufficiently comprehensive = 4, and Very comprehensive = 5.

Item analysis

This stage involves the initial evaluation of the instrument in the target community and is conducted before assessing construct validity. In the item analysis stage, each item was examined to check the initial reliability, the correlation between the items, and the correlation of each item with the total score. In this stage the samples included 50 nurses of the ICU departments of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran and paper questionnaires were prepared and distributed to head nurses and charge nurses to complete the performance of the nurses under their supervision in ICUs. Sampling was conducted using the convenience method.

Construct validity

Samples in the construct validity stage consisted of nurses from ten ICU departments of five hospitals affiliated with Kermanshah University of Medical Sciences in western Iran. Exploratory factor analysis sampling (EFA) was conducted in three hospitals, encompassing six ICUs, while confirmatory factor analysis (CFA) sampling was carried out in two hospitals, covering four ICUs. The inclusion criteria were full-time employment in the ICU, not partial. Sampling was conducted using the convenience method.

The instrument developed in this study is designed to assess the performance of nurses in delivering safe care in ICUs. In most cases, the responsibility of evaluating nurses’ performance lies with head nurses and charge nurses. Therefore, the questionnaires are completed by head nurses and charge nurses about nurses under their supervision.

During the exploratory factor analysis stage, the online instrument was developed using Google Forms. Participants were then sent the URL link to access the scale through email or various social media platforms like WhatsApp or Telegram. Due to the non-completion of some samples and the prolonged sampling process at this stage, paper questionnaires were prepared to conduct confirmatory factor analysis.

At construct validity stage, the instrument used had two parts. The first part focused on the demographic characteristics of the participants, including age, gender, marital status, education, and work experience, particularly in the ICU. The second part also included 42 items related to assessment of nurses safe care in the ICU.

Construct validity was tested using exploratory and confirmatory factor analysis. The five-step guide by Williams et al. in 2010 was used to conduct the exploratory factor analysis (EFA). The sample size in factor analysis depends on the number of items in the designed instrument, and different sources consider at least 3–10 samples per item as acceptable [ 27 ]. The sample size in the EFA included 300 nurses of three hospitals, encompassing six ICUs. Initially, 300 online questionnaires were sent to head nurses and charge nurses. After one month and several follow-ups, 230 feedback responses were received, resulting in a response rate of 76.6%. To reach the desired sample size, an additional 70 online questionnaires were sent out, and the required sample was achieved. The questionnaires data were entered into SPSS software version 26.

The appropriateness of the sample was assessed using the Kaiser-Meyer-Olkin (KMO) sampling index, and KMO values above 0.9 were deemed excellent. The operability of the data was checked using Bartlett’s sphericity test. Experts have considered the significance of Bartlett’s sphericity test to indicate the factorability of the data [ 28 ]. The maximum likelihood method was also used to conduct factor analysis and extract factors [ 29 ]. For factor extraction, the Kaiser criterion, the scree plot, the percentage of variance of each factor, and the cumulative variance explained by all extracted factors were used. Factors with an eigenvalue greater than one, factors beyond the horizontal line indicated by the scree plot, and factors that account for at least 50% of the variance in the desired concept by the extracted factors were considered for evaluation [ 28 ]. The four-factor model with promax rotation also generated factors that offered the most accurate interpretation and aligned with the qualitative findings of the study. In addition, 58% of the variance in the desired concept was explained by the extracted factors. The minimum acceptable factor loading for the items was considered to be 0.3. Finally, the factors were named according to the common meaning of the items within them.

In the next step, the instrument was evaluated using CFA. The sample size in the CFA stage included 200 nurses of two hospitals, covering four ICUs. In this stage, 200 Paper questionnaires were distributed among head nurses and charge nurses. The aims of the study were explained, and written consent was obtained. After one week, 182 completed questionnaires were collected, resulting in a response rate of 91%. To reach the calculated sample size of 200, 18 additional questionnaires were completed. The questionnaires data was entered into SPSS software version 26 and LISREL version 8.8 software was used.

The most common indicators used to check model fit in CFA include Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Incremental Fit Index (IFI), Non-Normed Fit Index (NNFI), Normed Fit Index (NFI), Relative Fit Index (RFI), and Parsimony Normed Fit Index (PNFI) were also calculated.

Reliability

The reliability of the instrument was assessed by examining internal consistency and stability (both relative and absolute). Internal consistency was evaluated by calculating the Cronbach’s alpha coefficient in a sample of 300 individuals (EFA samples). Cronbach’s alpha was computed for the entire instrument and individually for each factor. Although an alpha value of 0.7 is acceptable, some experts have recommended an alpha value of 0.8 and above [ 30 ]. In the present study, alpha values greater than 0.8 were considered.

Relative stability was assessed by calculating the intraclass correlation coefficient (ICC). The developed instrument was administered to 20 head nurses and charge nurses, and the same sample completed it again after two weeks for calculating the Intraclass Correlation Coefficient (ICC). The closer the ICC is to one, the greater the reliability [ 24 ]. In this study, the Intraclass Correlation Coefficient (ICC) was considered to be 0.8–0.9, indicating good reliability [ 30 ] .

Absolute stability was assessed by calculating the standard error of measurement (SEM) and the minimum detectable change (MDC); these two indicators also reflect the responsiveness of the instrument. The SEM was calculated using the formula SEM = SD × √(ICC-1), and the MDC was calculated using the formula MDC = SEM × z × √2 [ 31 ]. The preparation steps are shown in Fig.  1 .

Steps in the development and psychometric evaluation of safe nursing care instrument in ICUs

Interpretability

To determine interpretability, the researchers used the following criteria: the percentage of unanswered items, the adequacy of the sample size, the distribution of total scores in the samples, and the identification of ceiling and floor effects [ 32 ]. The feasibility of the instrument was assessed by calculating two criteria: response time to the instrument and the percentage of forgotten items. To rank the instrument, the items were weighted, and the final instrument was scored.

Data analysis

Data analysis was conducted using SPSS version 26 software and LISREL version 8.8 software .

Ethical considerations

Written permission to conduct the research and approval from the ethics committee were obtained from Tehran Islamic Azad University of Medical Sciences with the code IR.IAU.TMU.REC.1399.481. The research objectives were explained to the participants, written informed consent was obtained from all participants and samples studied. Participants were informed of their voluntary participation in the research and their right to withdraw from the study. The research was conducted with respect for individuals, justice, and responsibility.

The mean age of the participants was 37.47 years, and the mean experience of the healthcare professionals was 17.23 years. Half of the participants were female. The mean duration of the interviews was 36.42 min. The maximum interview duration was 80 min, and the minimum interview duration was 20 min.

After analyzing the data and reviewing the codes multiple times, the research team removed duplicates and merged similar cases. As a result, the number of codes extracted from the interviews decreased from 1997 to 1770, which were then categorized into 43 subcategories. In the next step, seven categories were merged, resulting in three themes derived from the merging of the categories. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). In addition to utilizing the results of the qualitative section, patient safety instruments were also employed to compile the items. The initial pool of items was extracted by the first author, which included 130 items, of which 5 items were taken from other instruments related to patient safety. The pool of items was reviewed by the second author, and based on the comments provided, 17 items were removed due to similarities and inadequacy. Then the remaining items were reviewed by the third author, who suggested removing a number of other items. Finally, 107 items remained in the item pool, 102 items were taken from interviews and 5 items were taken from patient safety tools. Regarding the items taken from patient safety tools, 3 items were related to the subcategory of professional ethics and 2 items were related to the subcategory of organizing communication.

In the qualitative face validity stage, the items were assessed for ease of understanding and the potential for misunderstanding or ambiguity in the wording. Fortunately, the participants encountered no issues, and the items did not require any modifications. At the quantitative face validity stage, all items had an IIS greater than 1.5. Thus, all items were retained.

During the qualitative content validity phase, the order of the items was adjusted based on the suggestions of the experts. At this stage, some items were modified, 20 items were merged and 2 items were eliminated due to overlap with other items and the number of items was reduced from 107 to 85. In the quantitative content validity phase, after calculating the CVR, 25 items were excluded. Also, in relation to the CVI values, since all items had a CVI greater than 0.8, no items were excluded and the number of items was reduced to 60. The average Scale Content Validity Index (S-CVI) was 0.94. Finally, an instrument with 60 items was obtained.

A preliminary test was conducted. At this stage, the instrument was administered to 50 head nurses and charge nurses in ICUs. The data analysis showed that the Cronbach’s alpha of the entire list was 0.92. Then, the correlation of the items with the entire instrument was checked using the correlation loop method, and the correlation between the items was examined using the correction factor method. At the end of this stage, 8 items were removed and a safe nursing care instrument with 52 items was prepared for construct validity.

Demographic characteristics of the participants

300 nurses, with a mean age of 31.35 ± 4.61 years and a mean work experience of 9.43 ± 5.59 years, participated in the exploratory factor analysis of this study. More of the sample had a bachelor’s degree (80.7%). In addition, the majority of them were female (73.3%) [Table  1 ].

In the confirmatory factor analysis 200 nurses participated with a mean age of 30.16 ± 5.89 years and a mean work experience of 6.33 ± 3.34 years. Like exploratory factor analysis more of the sample had a bachelor’s degree (84.8%) and the majority of them were female (69.7%) [Table  2 ].

At the exploratory factor analysis stage, the KMO index was 0.970, and Bartlett’s sphericity test (BT) was statistically significant ( p  < 0.001). Four factors extracted from the factor analysis using the maximum likelihood method with Promax orthogonal rotation, with eigenvalues greater than 1, explaining 58% of the total variance. The first factor accounted for 50.43%, the second for 3.69%, the third for 2.48%, and the fourth for 1.73% of the total variance. This resulted in an instrument with 42 items and four factors [Table  3 ].

Factors were named according to the common meaning of the items in each factor. For example, the first factor was named “Professional behavior by following guidelines “, the second “comprehensive care”, the third “accurate documentation” and the fourth “pressure ulcer care”. Based on the results of the EFA stage, a large number of items from the implementation of policies category led to the formation of a factor that the researchers named professional behavior by following the guidelines. The second factor was named comprehensive care. Despite the fact that a large number of the items in this factor were taken from the implementation of policies category and some from the holistic care theme, this name was chosen for this factor because of the breadth of the concept of comprehensive care. The third factor is accurate documentation. This factor has 5 items. 4 items are taken from the category of organizing communication, and the item that was related to providing information to the patient and the patient’s family before obtaining informed consent is related to the category of the implementation of policies. However, it can be said that the allocation of items to categories is based on the opinion of the researchers and is selective. Moreover, in the qualitative phase of this study, many items could be changed and moved to other categories. In relation to the fourth factor, Pressure Ulcer Care, the items in this factor relate to the prevention, care and treatment of pressure ulcers. These items are derived from the category of policy compliance and comprehensive care of systems, but the formation of a specific factor shows the importance of pressure ulcers in ICUs.

At the CFA stage, the results of the calculation of indices and goodness of fit indicated that the model had a good fit. The Chi-square index was 2499.13 with 813 degrees of freedom ( P  < 0.001). The indices used to assess the model fit and their corresponding values are listed in Table  4 .

According to Jaccard and Wan (1996), if at least three indicators have acceptable values, we can conclude that the model fit is acceptable [ 33 ]. Based on this, and according to the values reported in Table  3 , the minimum value of three indicators is appropriate, and therefore, the model fit is acceptable.

Cronbach’s alpha coefficient was used to assess the internal consistency. The alpha value for the entire instrument was 0.97, for the first factor 0.94, for the second factor 0.94, for the third factor 0.89, and for the fourth factor 0.86, indicating a high level of internal consistency for both the instrument and all its factors. The ICC for the entire instrument was 0.92, with a confidence interval of 0.81–0.97. To measure the absolute stability and determine the responsiveness of the instrument, the SEM was 4.39 and the MDC was 12.13.

The ceiling and floor effect index was zero for the entire instrument and for factors 1, 2, and 4, and only 10% for factor 3. Examining the distribution of scores in various sample groups also demonstrated the instrument’s capability to detect differences between different groups in relation to the measured construct.

Feasibility

The average response time for the designed instrument was approximately 5.35 min in a sample of ten participants. The minimum response time was 4 min, and the maximum was 8.40 min. Considering the number of items in the list (42 items), the response time to the instrument appears reasonable. Moreover, since the questionnaire was distributed to the participants online via an electronic link, most of them managed to answer all the items. Only five questionnaires were answered, but they were considered biased because a large number of questions were left unanswered. These questionnaires were excluded from the study, and supervisors completed five new questionnaires.

The ranking of the instrument was determined by assigning weights to the items. The results showed that the items with the highest weight were placed in the ‘comprehensive care’ dimension, indicating that this dimension was the most significant among the dimensions of the instrument in explaining the factors of safe nursing care.

Finally, the instrument was scored using a 5-point Likert scale, which included the options of never, rarely, sometimes, often, and always. The scoring system ranged from 0 to 100, with the score for each option being never 1, rarely 2, sometimes 3, often 4, and always 5. With a total of 42 items, the total points achievable range from a minimum of 42 (if all items are answered as never) to a maximum of 210 (if all items are answered as always). A higher score on the scale indicated safer nursing care.

Based on the results of the qualitative part of this study, the concept of safe nursing care in intensive care comprises three themes: professional behavior, holistic care, and safety-oriented organization. After completing the design and psychometric procedures, an instrument with 42 items and four factors was obtained. The factors extracted from the exploratory factor analysis using Promax rotation, explaining 58% of the total variance, were professional behavior by following guidelines, holistic care, accurate documentation, and pressure ulcer care. Internal consistency was assessed using Cronbach’s alpha coefficient, which was 0.97 for the entire instrument. The ICC for the entire instrument was 0.92, with a confidence interval of 0.81–0.97. In order to measure the absolute stability and determine the responsiveness of the instrument, the SEM was 4.39, and the MDC was 12.13. These values indicate the desirable psychometric properties of this instrument.

In this instrument, the first factor is referred to as professional behavior, which involves adhering to the guidelines. Based on the results of this study, this factor was identified as the most important aspect of safe nursing care in the ICU, consisting of 17 items. In the ICU, there are several procedures that must be performed correctly. Neglecting or making mistakes in performing these procedures seriously endangers the patient’s safety. Many patients admitted to these units are dependent on ventilators, and numerous procedures are performed on them. All these procedures are complex and require a high level of mental ability and skill on the part of the nurse. Based on the results of current research, safe procedures require adherence to the guidelines designed for them. However, many nurses rely on their personal skills and experience, which may compromise patient safety. The results of the research by Al-Omar et al. in Saudi Arabia in 2019 showed that nurses’ reliance on personal experience may compromise patient safety [ 34 ].

The results of Baccolini et al.‘s research in 2019 in Italy showed that the implementation of procedures to adhere to health standards in special care units was significantly influenced by following the established policies [ 35 ]. In this regard, Bignami et al. have argued, based on the results of their research in 2023 in Italy, that adhering to the policy is a secure approach to delivering clinical care, ensuring patient safety, and enhancing the quality of care in intensive care units [ 36 ]. Williams et al., in their study in the United States, concluded that adherence to guidelines can also result in a quicker diagnosis of sepsis [ 37 ]. However, it has been argued that adhering to guidelines may compromise the autonomy of the nurse, and that the nurse may not be able to effectively manage situations that were not anticipated in the guidelines [ 38 ]. For this reason, it seems that the nurse should be able to recognize and prepare for possible cases outside the procedure, in addition to following the guidelines set for the implementation of each procedure.

The second factor is comprehensive care, which also includes 17 items. The results of this study highlight the significance of advocating for safe nursing care in ICUs through a comprehensive care approach. These findings support previous research emphasizing the importance of systems thinking and safe care in enhancing patient safety and overall quality of care [ 39 ]. The results of this study emphasize that comprehensive care, which includes addressing the physical, emotional, social, and spiritual needs of patients, is valuable in ICUs. Implementing a comprehensive care model can lead to improved outcomes and patient satisfaction, as well as increased nurse satisfaction and reduced job burnout [ 40 ]. By focusing on the whole person, nurses can provide more personalized and effective care, ultimately contributing to a safer environment for patients and staff [ 41 ].

The third factor is accurate documentation, which consists of 5 items. The registration of accurate reports is essential for evaluating treatment and care measures. It is also the most effective document for judicial authorities, research affairs, supervisory affairs, and educating students. According to studies, out of every four cases of professional negligence, one case is related to incorrect registration of nursing reports and only 21.4% of nurses demonstrated proficiency in report writing [ 42 ]. A review study by McCarthy et al. found that the utilization of electronic reporting and documentation systems in acute care hospitals not only saves time but also reduces errors, as well as the risk of patient falls and infections [ 43 ].

The fourth factor is pressure ulcer care. Nurses are responsible for providing continuous and direct care in the prevention and management of pressure ulcers. To achieve quality and optimal care, they need to have evidence-based knowledge and practice. Risk assessment is recommended as the initial step in preventing pressure ulcers in nursing care. The reason for the poor quality of care regarding pressure ulcers is attributed to nurses’ lack of knowledge, absence of accountability, and inadequate monitoring of their performance. It is recommended that a systematic assessment be conducted at the patient’s bedside upon admission or whenever a change is feasible. The patient’s condition should be observed using a validated instrument [ 44 ]. In the current instrument, three items, which constitute the fourth factor of this instrument, pertain to assessment and nursing interventions regarding pressure ulcers.

In addition, the following table briefly compares patient safety instruments with the instrument designed and psychometrically tested in the present study based on the COSMIN criteria [Table  5 ].

In the table, the abbreviation SNCI-ICU (Safe Nursing Care Instrument in the ICU) refers to the instrument designed in the present study.

Comparing the process and methods of instruments

It is a sequential exploratory combined study comprising two qualitative and quantitative phases. In the qualitative phase, researchers utilized studies on patient safety, Reason’s human error model, and the curriculum of the Columbia University School of Nursing in New York to extract items. However, the process of extracting items from the human error model, studies, and curriculum is not detailed, including the number of items extracted from each source and the methodology used. Additionally, no information is provided about the human error model.

In this study, researchers extracted items and designed new tools utilizing PS ASK and HPPSACS instruments.

It is a sequential exploratory mixed-methods study comprising two phases - qualitative and quantitative. In the qualitative phase, the researchers solely relied on a literature review for data collection.

Safe nursing care evaluation questionnaire

This study is a sequential exploratory combined research comprising two phases - qualitative and quantitative. The qualitative phase involved interviews and literature review.

A sequential exploratory combined study with two qualitative and quantitative phases was utilized in the qualitative phase for literature review and observation of nurses’ performance.

In the design of the SNCI-ICU tool, a sequential exploratory combined method was carried out in two qualitative and quantitative stages. In addition to qualitative interviews with nurses, doctors, staff related to patient safety, patients, and patients’ family, the researcher also benefited from an extensive literature review. This review enriched the subject pool and covered all aspects of safe nursing care in the ICU department.

Comparison of Subscales of instruments

It is a self-report instrument on knowledge, attitudes and skills and has 7 subscales and 26 items. Attitude subscales include error detection (4 items), time saving (2 items), and safety culture (3 items). Skill subscales include error analysis (6 items), threat to patient safety (3 items), and decision support technology (4 items). The knowledge subscales include 4 items. It seems that the number of 24 items is not sufficient to assess knowledge, skills and attitudes and that more items may be more useful. Despite the usefulness of self-report insruments for checking knowledge and attitudes, they do not seem to be as effective for checking skills.

This tool is a self-report instrument and has two subscales and 24 items. The subscales include skill (7 items) and attitude (17 items).

It has 4 subscales and 64 items. The subscales include protection through communication (5 items), protection through risk management (11 items), protection through correct prescription of medications and solutions (4 items), and protection through the implementation of policies (4 items).

This instrument consists of 5 subscales and 41 items. The subscales include assessment of nursing skills (16 items), assessment of psychological needs (8 items), assessment of the patient’s physical needs (8 items), assessment of nurses’ teamwork (5 items), and assessment of ethics (4 items).

This insrument comprises 5 subscales and 25 items. The subscales consist of organization (6 items), tools and equipment (5 items), transfer duties (4 items), environment (5 items), and teamwork (4 items). These subscales align with the dimensions outlined in the theoretical model of innovative engineering for patient safety, which the researchers utilized during the qualitative phase for concept definition and item generation.

In the present study, the SNCI-ICU comprises 42 items and 4 subscales. These subscales consist of professional performance following policies (17 items), comprehensive care (17 items), accurate documentation (5 items), and pressure ulcer care (3 items).

Comparison of psychometric properties based on COSMIN’s Criteria

In this study, a Cronbach’s alpha value of 0.86 was reported in the internal consistency review, but no information was provided regarding the SEM and interpretability. Therefore, based on Cosmin’s criteria, the tool designed in the present study exhibits more comprehensive psychometric properties.

In this study, the researchers only investigated content validity and internal consistency. Cronbach’s alpha values were reported as 0.67 for the attitude items, 0.71 for the skill items, and 0.73 for the entire instrument. The reliability of the attitude items is at an average level, indicating a need for item revision. Other measures of COSMIN, such as construct validity, criterion validity, stability and SEM have not been explored.

Content validity and construct validity have been assessed through EFA. The internal consistency review reported a Cronbach’s alpha value of 0.91. However, no information was provided regarding other criteria such as stability, SEM and responsiveness.

In this study, content validity was assessed first, followed by structural validity using exploratory factor analysis. The internal consistency check reported a Cronbach’s alpha value of 0.97, and the tool stability check showed an ICC of 0.77.

In this study, content validity cross cultural validity and structural validity were assessed using exploratory factor analysis. Cronbach’s alpha ranged from 0.72 to 0.82 for each subscale, but no information was provided regarding measurement error and responsiveness.

In the present study, after establishing content validity, construct validity was assessed through EFA and CFA. Internal consistency was evaluated using Cronbach’s alpha, which was found to be 0.97. The relative stability was assessed by examining the ICC for the entire instrument and individually for each factor. The ICC for the entire instrument was 0.92, with a confidence interval of 0.81–0.97. To measure the absolute stability and determine the responsiveness of the instrument, the SEM and the MDC were calculated. They were found to be 4.39 and 12.13, respectively, for the entire instrument. All these features demonstrate that the instrument designed in the present study is not only specific for evaluating safe nursing care in the ICU but also possesses desirable psychometric properties.

Implications for practice

The use of a safe nursing care instrument is effective and practical not only for nursing assessors but also for nurses working in ICU departments. It can serve as a guide. In the field of education, utilizing the factors identified in this instrument, which are specific to ICU departments, can lead to more effective training for students and nurses. Additionally, it is beneficial in the field of management and can be used by nursing managers as a valid and reliable tool to assess safe nursing care in ICU departments. The evaluations generated can pinpoint areas where nurses may need improvement. Furthermore, researchers can use this instrument to assess safe nursing care in the ICU in descriptive studies. The results from the evaluations can provide fundamental data for decision-making by policymakers and safety planners.

The instrument for safe nursing care in the ICU has favorable psychometric properties based on the studies conducted using the Consensus based standards for the selection of health measurement instrument (COSMIN) criteria. The items in this instrument are derived from the results of a qualitative study and an extensive literature review. The outstanding feature of this instrument is its exclusivity to the ICU. On this basis, it can be said that this instrument is valid for evaluators and nurse managers to assess safe nursing care in the ICU.

Research limitations

In the present study, certain types of validity like convergent, divergent, comparison in known groups and experimental were not conducted, but they could be explored in future studies. Convergent validity was not achievable due to the absence of specific tools related to safe care in the ICU. However, this study has paved the way for other researchers to utilize this tool in their own studies.

Another limitation is the design of the instrument in the Persian language, which would necessitate translation and validation for cross-cultural applicability if it is intended for international use.

Due to the special conditions of the patients and the complexity of care measures, the interview process was interrupted several times during the patient interviews. The researcher’s experience of working in the ICU and familiarity with unsafe care in the ICU created a risk of bias in the researcher’s work. In the qualitative phase, to avoid bias during the interview, the researcher aimed to act as a listener and pose questions in accordance with the interview guide. Throughout this project, the researcher encountered numerous challenges. In the qualitative phase, many interviews were cancelled and rescheduled due to the concurrent interviews during the coronavirus epidemic. In the quantitative phase, it took 2 months to complete the questionnaires because they were submitted online to supervisors and nurses, and some questionnaires were not completed.

Data availability

Due to university policies, the datasets generated and utilized for the present study are not publically accessible but are available from the corresponding author upon justifiable request.

Abbreviations

World Health Organization

Intensive Care Units

Consensus based standards for the selection of health measurement instrument

Item Impact Score

Content Validity Ratio

Content Validity Index

CVI)-Scale Content Validity Index

Adjusted kappa coefficient

Exploratory Factor Analysis

Kaiser-Meyer-Olkin

Bartlett’s sphericity Test

Confirmatory Factor Analysis

Goodness of Fit Index

Adjusted Goodness of Fit Index

Root Mean Square Error of Approximation

Comparative Fit Index

Incremental Fit Index

Non-Normed Fit Index

Normed Fit Index

Relative Fit Index

Parsimony Normed Fit Index

Intraclass Correlation Coefficient

Standard Error of Measurement

Minimum Detectable Change

ICU)-Safe Nursing Care Instrument in the ICU

ASK)-Patient safety attitudes, skills, knowledge

Nurses attitudes and skill around updated safety concepts

Nursing Performance for Patient Safety Scale

Intrahospital Transport

Systems Engineering Initiative for Patient Safety

Health Professions Patient Safety Assessment Curriculum Survey

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Acknowledgements

The present study is an excerpt from a nursing doctoral thesis, which was completed after obtaining the necessary permissions from Tehran Islamic Azad University of Medical Sciences. The research team would like to thank the staff of this university and all the participants in this research.

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Mozhdeh Tajari

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Tahereh Ashktorab

Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran

Abbas Ebadi

Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Tajari, M., Ashktorab, T., Ebadi, A. et al. Designing and psychometric evaluation of safe nursing care instrument in intensive care units. BMC Nurs 23 , 629 (2024). https://doi.org/10.1186/s12912-024-02322-z

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The mediating role of teaching enthusiasm in the relationship between mindfulness, growth mindset, and psychological well-being of Chinese EFL teachers

• Yushu Xu 1 &
• Jing Wang 1  

Humanities and Social Sciences Communications volume  11 , Article number:  1176 ( 2024 ) Cite this article

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This mixed-methods study investigates the complex factors affecting the psychological well-being of Chinese EFL teachers, particularly the direct effects of mindfulness and growth mindset, and the mediating role of teaching enthusiasm. A quantitative survey (n = 268) was distributed to EFL teachers across diverse provinces in China. Established scales measured psychological well-being, mindfulness, growth mindset, and teaching enthusiasm. The data was analyzed using structural equation modeling (SEM) with two phases in SPSS and AMOS software. A qualitative phase, employing semi-structured interviews with a subsample (n = 12) of participants, provided deeper insights into the lived experiences of teachers. The quantitative analysis yielded positive direct relationships between mindfulness, growth mindset, and well-being. Notably, teaching enthusiasm emerged as a significant mediating factor. These findings suggest that mindfulness and growth mindset indirectly influence well-being through their positive impact on teaching enthusiasm. The qualitative data corroborated these results, showcasing how mindfulness practices and a growth mindset contribute to a more passionate and fulfilling teaching experience. These combined findings underscore the importance of promoting mindfulness, growth mindset, and teaching enthusiasm to enhance the psychological well-being of Chinese EFL teachers.

Introduction

The teaching profession, while immensely rewarding, can be fraught with challenges and demands. This is particularly true within the dynamic English as a Foreign Language (EFL) context in China. The educational landscape in China undergoes rapid changes, and high expectations are placed on educators. Consequently, EFL teachers often face immense pressure, leading to concerns about their psychological well-being. This concern is not merely anecdotal; research indicates that Chinese EFL teachers experience high rates of stress, anxiety, and burnout (Leung and Lee, 2006 ; Wang et al. 2015 ). These findings raise critical questions about the overall well-being of Chinese EFL teachers and its impact on both themselves and their students.

Understanding the factors that influence EFL teacher well-being is crucial for their personal well-being and the quality of education they provide (Greenier et al. 2021 ). Positive EFL teacher well-being has been linked to numerous benefits for students, including increased engagement, academic achievement, and improved social-emotional development (Bardach et al. 2022 ; Simbula, 2010 ; Skaalvik and Skaalvik, 2018 ). Therefore, exploring avenues to promote EFL teacher well-being is not just a matter of individual concern but an investment in the future of English language education itself. This study delves into the potential pathways to well-being for Chinese EFL teachers, focusing on three key variables: mindfulness, growth mindset, and teaching enthusiasm. Each of these variables has garnered increasing attention in recent years, with research highlighting their potential benefits for EFL educators.

Each of these variables has garnered increasing attention in recent years, with research highlighting their potential benefits for EFL educators. Mindfulness, defined as the cultivation of present-moment awareness and non-judgmental acceptance (Kabat-Zinn, 2003 ), has been demonstrated to reduce stress, anxiety, and depression among teachers, while promoting emotional regulation and job satisfaction (Zarate et al. 2019 ; Crescentini et al. 2016 ). Studies conducted within the Chinese EFL context further support these findings, suggesting that mindfulness practices can be particularly beneficial for Chinese EFL teachers navigating the unique pressures of their profession (Cheng et al. 2022 ; Liu and Du, 2024 ).

Growth mindset, the belief that intelligence and abilities can be developed through effort, has also been linked to positive outcomes for EFL teachers, including reduced stress, burnout, and anxiety, along with increased self-efficacy, job satisfaction, and emotional regulation (Shoshani, 2021 ; Nalipay et al. 2022 ). Research suggests that fostering a growth mindset among EFL educators can enhance their resilience, optimism, and overall well-being (Zeng et al. 2016 ; Lam et al. 2023 ). Also, teaching enthusiasm, characterized by passion and excitement for teaching, has been associated with positive student outcomes and reduced teacher stress (Burić and Moe, 2020 ; Kunter et al. 2011 ). However, the relationship between enthusiasm and well-being might be complex, potentially influenced by individual and contextual factors (Shao, 2023 ). Understanding the interplay between these variables and their impact on Chinese EFL teachers holds immense potential for enhancing their well-being and fostering positive learning environments for their students.

While previous research has examined the individual effects of mindfulness, growth mindset, and teaching enthusiasm on EFL teacher well-being, this study contributes to the existing literature by investigating the interconnectedness of these variables and their collective influence on Chinese EFL teachers. Employing a mixed-methods approach that combines quantitative and qualitative data collection, this study offers a comprehensive understanding of how mindfulness and growth mindset might indirectly enhance EFL teacher well-being through the mediating role of teaching enthusiasm. The quantitative survey explores the relationships between the variables, while the qualitative interview phase provides richer insights into the lived experiences of teachers. This holistic approach fills a crucial gap in the literature and provides novel insights into the mechanisms underlying EFL teacher well-being in the Chinese educational context.

Understanding the factors that contribute to EFL teacher well-being is essential for promoting a positive and sustainable teaching experience within the EFL domain, ultimately benefiting both EFL educators and students. By identifying potential pathways to well-being and elucidating the interplay between mindfulness, growth mindset, and teaching enthusiasm, this study offers actionable insights for EFL educators, policymakers, and researchers. Integrating mindfulness practices and growth mindset interventions into EFL teacher training programs and professional development initiatives can empower Chinese EFL teachers to navigate the challenges of their profession with greater resilience and equanimity. Moreover, fostering teaching enthusiasm can create a ripple effect, enhancing the passion and dedication of EFL educators and fostering positive learning environments for EFL students. By acknowledging and addressing the well-being of Chinese EFL teachers, we can cultivate a more supportive and enriching educational landscape for all stakeholders involved in English language education.

Literature review

Psychological well-being.

Psychological well-being, as conceptualized by Ryff and Keyes ( 1995 ), extends beyond the mere absence of mental illness, representing a flourishing and positive state of mental health. This holistic perspective encompasses emotional, cognitive, and social dimensions (Ryff, 1989 ). The influential six-factor model proposed by Ryff ( 1989 ) identifies key dimensions, including autonomy, environmental mastery, positive relations with others, personal growth, purpose in life, and self-acceptance. Recognizing the interplay of these factors is pivotal for fostering and maintaining psychological well-being across diverse populations, given its substantial impact on physical health, academic achievement, career success, and social relationships (Diener et al. 2003 ; Kashdan et al. 2008 ).

Educators, in particular, face unique challenges that necessitate a focused examination of their psychological well-being (Skaalvik and Skaalvik, 2018 ). Teacher psychological well-being involves a complex interplay of emotional health, stress management, and personal and professional fulfillment (Gustems-Carnicer and Calderón, 2013 ). Notably, teachers contend with specific stressors such as workload pressures, challenging student behaviors, lack of autonomy, and insufficient support systems (Simbula, 2010 ), contributing to teacher burnout characterized by emotional exhaustion, cynicism, and reduced efficacy (Puertas Molero et al. 2019 ). Despite these challenges, research highlights the positive aspects of the teaching profession, including meaningful student relationships, a sense of purpose, and opportunities for personal growth (Bermejo-Toro et al. 2016 ).

Recognizing and promoting teacher psychological well-being is paramount, as it directly influences individual teachers, students, and the entire educational system. Engaged and well-supported teachers are more likely to create positive learning environments, fostering effective educational outcomes (Bardach et al. 2022 ). Conversely, teacher burnout negatively impacts student achievement, school climate, and teacher retention rates (Jeon et al. 2018 ). Understanding the factors influencing teacher psychological well-being and implementing strategies to enhance it is essential for an improved educational experience for both teachers and students.

Empirical studies consistently underscore the critical role of teacher well-being in various educational dimensions. Granziera et al. ( 2023 ) identified a significant negative association between school-level teacher emotional exhaustion and student achievement, emphasizing the potential detrimental effects of low teacher well-being on student learning outcomes. This aligns with Ilgan et al. ( 2015 ), who established a positive link between teacher well-being and the quality of school work life, highlighting the role of supportive work environments in enhancing teacher well-being.

Moreover, Bardach et al. ( 2022 ) conducted an integrative review emphasizing the multifaceted influence of teachers’ psychological characteristics. Their findings suggest that teachers with positive psychological traits tend to exhibit greater effectiveness, experience higher well-being, have higher retention rates, and foster stronger interpersonal relationships. This underscores the interconnectedness between teacher well-being and various facets of the educational ecosystem. Beyond academic achievements, teacher well-being also impacts student well-being. Sisask et al. ( 2014 ) demonstrated that teacher satisfaction and well-being correlate with their readiness to support students facing mental health challenges. Jeon et al. ( 2018 ) explored predictors of teacher depression, stress, and emotional exhaustion in early childhood education, emphasizing the need to address factors contributing to teacher well-being for the positive impact it can have on student well-being and development.

A growing body of research highlights the intricate link between various factors and the psychological well-being of language educators (EFL/ESL) (Greenier et al. 2021 ; Ismail et al. 2023 ; Nazari and Alizadeh Oghyanous, 2021 ). Studies suggest that emotion regulation strategies (Greenier et al. 2021 ; Xiyun et al. 2022 ) and self-efficacy beliefs (Guo and Jiang, 2023 ; Xiao et al. 2022 ) play a significant role in fostering psychological well-being among teachers. Furthermore, research delves into the influence of professional experiences on well-being. Nazari and Alizadeh Oghyanous ( 2021 ) explored how teacher experience impacts factors like stress, grit, and turnover intentions, highlighting the dynamic interplay between these elements. The concept of teacher identity also emerges as a factor influencing well-being (Ismail et al. 2023 ). Additionally, research by Guo and Jiang ( 2023 ) explores the positive influence of physical activity on mental health and psychological well-being within the EFL/ESL teacher population.

In conclusion, the extant literature highlights the multifaceted significance of teacher well-being, affecting not only student academic achievement but also influencing the quality of school work life, teacher effectiveness, retention, and student well-being. Further research and initiatives are imperative to promote and sustain teacher well-being, benefiting both educators and learners alike.

Teacher mindfulness

The demanding nature of the teaching profession is well-established, with educators facing high stress levels, burnout, and emotional exhaustion (Hargreaves, 2021 ). This constant pressure can negatively impact teachers’ well-being, relationships with students, and ultimately, their effectiveness in the classroom (Shirley et al. 2020 ). As a countermeasure, the practice of mindfulness has emerged as a promising tool for promoting teacher resilience and improving educational outcomes (Emerson et al. 2017 ; Hwang et al. 2017 ).

Mindfulness refers to the ability to pay attention to the present moment without judgment (Kabat-Zinn, 2003 ). This practice encourages teachers to become aware of their thoughts, feelings, and bodily sensations in a non-reactive way, fostering greater self-compassion and emotional regulation (Kabat-Zinn, 2013 ). Research suggests that mindfulness-based interventions (MBIs) can significantly reduce teacher stress, anxiety, and burnout while improving emotional well-being and job satisfaction (Crane et al. 2010 ). Furthermore, MBIs have been shown to positively impact teachers’ pedagogical practices. Studies demonstrate that mindfulness training enhances teachers’ ability to manage challenging classroom situations, cultivate empathy and compassion towards students, and foster a more positive and supportive learning environment (Klingbeil and Renshaw, 2018 ). By promoting greater self-awareness and emotional regulation, mindfulness empowers teachers to de-escalate conflict, respond constructively to student needs, and create a more conducive atmosphere for learning (Hidajat et al. 2023 ).

The benefits of teacher mindfulness extend beyond individual well-being and classroom dynamics. Research suggests that mindfulness practices can improve student academic achievement and social-emotional development (de Carvalho et al. 2021 ). By cultivating a calmer and more present state of mind, teachers can model emotional regulation and positive coping strategies for students, fostering a more mindful and resilient learning community (Taylor et al. 2016 ).

The studies on teacher mindfulness and psychological well-being provides a comprehensive exploration of the potential benefits of mindfulness practices for educators. Across six studies (Zarate et al. 2019 ; Crescentini et al. 2016 ; Braun et al. 2019 ; Alahari, 2017 ; Hue and Lau, 2015 ; Ruijgrok-Lupton et al. 2018 ; Zhang and Fathi, 2024 ), the findings consistently suggest that mindfulness interventions hold promise for enhancing the well-being of teachers in various educational settings.

Zarate et al. ( 2019 ) contribute valuable meta-analytic evidence, demonstrating that mindfulness training can lead to a range of positive outcomes, including reduced stress, anxiety, and depression, along with increased emotional regulation and job satisfaction among teachers. This overarching positive impact is further supported by studies conducted across diverse contexts, including primary schools, middle schools, and teacher training programs (Crescentini et al. 2016 ; Braun et al. 2019 ; Alahari, 2017 ; Hue and Lau, 2015 ; Ruijgrok-Lupton et al. 2018 ).

While the precise mechanisms underlying the relationship between mindfulness and well-being are still under exploration, existing research suggests several potential pathways. Mindfulness practices may cultivate increased self-awareness, emotional acceptance, and coping skills, all of which contribute to greater psychological well-being. Additionally, Braun et al. ( 2019 ) highlight the role of mindfulness in improving teacher-student interactions, which can further enhance overall well-being. Moreover, individual differences and contextual factors might moderate the effectiveness of mindfulness interventions, emphasizing the need for more nuanced exploration in future research endeavors.

Recent research suggests a burgeoning interest in the role of mindfulness for EFL educators (Liu and Du, 2024 ). Studies explore how mindfulness practices can benefit both teachers and students. Huang ( 2022 ) investigates the potential of teacher mindfulness and compassion in fostering student enjoyment of learning English. Mindfulness is also examined in relation to teacher well-being. He et al. ( 2023 ) explore the connections between mindfulness, teacher growth mindset, grit, and overall well-being. Similarly, Liu and Du ( 2024 ) investigate the potential for mindfulness to mitigate teacher burnout. Furthermore, Cicek and Gurbuz ( 2023 ) utilize a narrative inquiry approach to explore the personal experiences of an EFL teacher following mindfulness training, offering valuable insights into its practical application. Collectively, these studies highlight the growing recognition of mindfulness as a potential tool for enhancing both teacher well-being and student learning outcomes within the EFL context.

In conclusion, the synthesis underscores the significant promise of teacher mindfulness for promoting psychological well-being. By integrating mindfulness practices into their lives, educators have the potential to mitigate stress, enhance emotional regulation, and create a more positive and sustainable teaching experience. However, further research is warranted to delve deeper into the underlying mechanisms, explore variations in individual and contextual factors, and investigate long-term impacts and effective implementation strategies to maximize the benefits of mindfulness for teacher well-being and educational outcomes.

Teaching enthusiasm

Enthusiastic and passionate teachers play a pivotal role in shaping students’ learning experiences and influencing academic outcomes. Moving beyond the mere transmission of information, their dynamic energy cultivates engagement, sparks curiosity, and motivates young minds to explore and learn (Burić and Moe, 2020 ). Defining enthusiasm extends beyond observable actions, encapsulating a genuine passion for the subject matter, a belief in students’ potential, and a contagious energy that sparks curiosity and excitement (Kunter et al. 2011 ; Moe and Katz, 2022 ). Effective enthusiasm, research suggests, emerges from a profound understanding of the subject matter, coupled with a desire to share that knowledge and ignite a similar passion in others (Keller et al. 2013 ).

Teacher enthusiasm’s impact transcends the boundaries of the classroom environment. Numerous studies have demonstrated a positive correlation between enthusiastic teaching and various student outcomes. These include heightened motivation and engagement, as enthusiastic teachers capture students’ attention, foster intrinsic motivation, and encourage active participation in learning activities (Skaalvik and Skaalvik, 2014 ). Moreover, enthusiastic teaching correlates with improved academic achievement, with engaging lessons led by passionate educators facilitating deeper learning and better academic performance (Keller et al. 2016 ). The positive influence extends to the overall classroom climate, as enthusiastic teachers contribute to a more positive and supportive learning environment, reducing students’ anxiety and fostering a sense of belonging (Keller et al. 2014 ).

One of the profound impacts of teacher enthusiasm lies in the development of positive attitudes towards learning. By modeling passion and curiosity, enthusiastic teachers instill a love for learning in their students, encouraging them to become lifelong learners (Lazarides et al. 2019 ). This transformative influence underscores the significance of cultivating and understanding teacher enthusiasm for the betterment of both educators and learners. The literature on teaching enthusiasm and psychological well-being unveils a nuanced relationship between educators’ passion for teaching and their mental and emotional health. Studies by Shao ( 2023 ) and Burić and Moe ( 2020 ) illuminate a positive association between teaching enthusiasm and well-being, suggesting that passionate educators may experience lower stress levels and greater job satisfaction, thereby contributing positively to their overall psychological health.

However, this connection operates within a complex interplay with other factors influencing well-being. Kaya and Çenesiz ( 2020 ) highlight the significance of life satisfaction and intrinsic motivation in predicting the well-being of pre-service teachers, indicating that broader factors beyond classroom passion contribute to psychological health. Furthermore, Erturan-Ilker ( 2014 ) demonstrates the impact of contextual factors, such as the physical education setting, on both motivation and well-being, emphasizing the need for a nuanced understanding in diverse situations. Bhat and Naik ( 2016 ) contribute by exploring the relationship between intrinsic motivation and well-being in students, suggesting potential parallels with teachers, where inherent enjoyment in teaching might similarly contribute to positive mental health.

Moreover, existing studies on teacher mindfulness and teaching enthusiasm delve into the relationship between mindfulness practices and teaching enthusiasm, characterized by passion and excitement for teaching. Drawing insights from five studies, the findings collectively suggest that mindfulness practices hold the potential to contribute to the development of a more enthusiastic and engaging teaching presence. Key concepts emerging from these studies underscore the potential positive influence of mindfulness on teaching enthusiasm. Huang ( 2022 ) highlights how mindful EFL teachers create a more enjoyable learning environment for students, suggesting a link between mindfulness and fostering enthusiasm. Similarly, Moyano et al. ( 2023 ) demonstrate the positive impact of mindfulness on teacher well-being and engagement, indirectly enhancing enthusiasm in the classroom. Additionally, Molloy Elreda et al. ( 2019 ) and Jennings ( 2015 ) suggest that mindfulness can cultivate emotional supportiveness and compassion in teachers, potentially leading to a more positive and engaging teaching style. Case studies presented by Sherretz ( 2011 ) further support the idea that mindful teachers exhibit enthusiasm, implying a practical connection.

While the exact mechanisms are still under exploration, researchers propose that mindfulness may foster enthusiasm by reducing stress and anxiety, creating a more positive and energetic teaching presence (Moyano et al. 2023 ), improving emotional regulation, enabling teachers to manage challenges and maintain enthusiasm (Jennings, 2015 ), and enhancing self-awareness and compassion, leading to a more positive and engaging connection with students (Molloy Elreda et al. 2019 ).

Teacher enthusiasm emerges as a critical factor influencing various aspects of the EFL learning environment (Liu et al. 2021 ). Studies highlight the positive impact of teacher enthusiasm on student outcomes. Liu et al. ( 2021 ) demonstrate a connection between teacher enthusiasm and student language achievement. Also, teacher enthusiasm appears to influence other aspects of the learning environment. Greenier et al. ( 2023 ) explore the role of teacher enthusiasm in fostering creative thinking skills within the EFL context. Their findings suggest that enthusiastic teachers create a more conducive atmosphere for student creativity. Furthermore, Cao and Zhang ( 2023 ) delve into the relationship between teacher enthusiasm and work engagement among EFL teachers. Their study suggests that teachers who experience a strong sense of value congruence (alignment between personal values and workplace values) are more likely to be engaged in their work, particularly when coupled with high levels of teacher enthusiasm. Collectively, these studies showcase the multifaceted importance of teacher enthusiasm within the EFL classroom. Enthusiastic teachers not only contribute to improved student achievement but also appear to foster a more creative and engaging learning environment, potentially impacting both student and teacher well-being (Zhang et al., 2023 ).

Teacher growth mindset

The concept of a growth mindset, introduced by Carol Dweck in 2006, revolutionized our understanding of intelligence and abilities, positing that they are not fixed traits but can be developed through effort and perseverance (Dweck, 2006 ). Individuals with a growth mindset see challenges as opportunities for learning and view effort as a crucial element for success (Dweck and Yeager, 2019 ). In contrast, those with a fixed mindset believe in the innate nature of their intelligence and abilities, often avoiding challenges due to the fear of undermining their perceived capabilities (Dweck, 2006 ).

Research underscores the transformative impact of a growth mindset on various aspects of individual development and achievement. Students embracing a growth mindset exhibit higher engagement, persist longer in challenging tasks, and achieve better academically compared to those with a fixed mindset (Blackwell et al. 2007 ). Moreover, individuals with a growth mindset display enhanced motivation and resilience, attributing failures to effort and strategy rather than inherent limitations, fostering increased perseverance (Dweck et al. 1995 ). Importantly, studies suggest a positive association between a growth mindset and overall well-being, including higher life satisfaction, self-esteem, and lower levels of anxiety and depression (Yeager and Dweck, 2012 ).

Given these potential benefits, numerous interventions have been developed to cultivate a growth mindset across various contexts, including education, workplaces, and athletics (Yeager and Dweck, 2020 ). These interventions typically involve exposure to the concept of growth mindset, opportunities to experience the benefits of effort and learning, and the creation of positive and supportive environments. In the dynamic landscape of education, characterized by evolving educational frameworks and diverse student needs, a growth mindset is particularly advantageous for teachers (Nalipay et al. 2021 ). Teachers embracing a growth mindset perceive challenges as avenues for learning and development, welcoming feedback as a tool for improvement rather than an indictment of inadequacy (Yeager and Dweck, 2020 ). This stands in contrast to a fixed mindset, where educators may perceive their abilities as static, potentially leading to stagnation and disengagement.

Adopting a growth mindset offers several advantages for educators, according to research. Teachers with a growth mindset exhibit enhanced resilience and well-being, managing stress effectively, navigating setbacks with optimism, and maintaining a positive outlook (Yeager et al. 2022 ). Moreover, belief in the capacity for improvement motivates teachers to actively seek new learning opportunities, engage in professional development, and experiment with innovative teaching methods (Frondozo et al. 2022 ). Importantly, teachers with a growth mindset contribute to improved student outcomes by creating challenging and engaging learning environments, fostering student motivation, resilience, and academic achievement (Seaton, 2018 ).

The intersection between a teacher’s growth mindset and their psychological well-being is a consistent and positive connection, as illuminated by a body of research spanning six studies (Shoshani, 2021 ; Nalipay et al. 2022 ; Zeng et al. 2016 ; Zeng et al. 2019 ; Whittington et al. 2017 ; Lam et al. 2023 ). This association reveals tangible outcomes, including reduced stress, anxiety, and burnout, coupled with increased self-efficacy, job satisfaction, and emotional regulation among educators.

Extending across diverse educational contexts, from general teaching environments to early childhood settings and even into the unique domain of veterinary education, these studies consistently demonstrate the positive impact of a growth mindset on teacher well-being (Shoshani, 2021 ; Nalipay et al. 2022 ; Zeng et al. 2016 ; Zeng et al. 2019 ; Whittington et al. 2017 ; Lam et al. 2023 ). Collectively, these findings suggest that fostering a belief in the malleability of intelligence and abilities can significantly contribute to a more positive and fulfilling professional experience for teachers.

While the exact mechanisms underlying this connection continue to be explored, existing research posits several potential pathways through which a growth mindset may promote well-being (Zeng et al. 2016 ; Shoshani, 2021 ; Nalipay et al. 2022 ). One such mechanism involves encouraging perseverance in the face of challenges, empowering teachers to view setbacks as opportunities for growth. Additionally, fostering a sense of control and autonomy emerges as a crucial factor, allowing teachers to feel more agency over their professional lives. Furthermore, enhancing coping skills and stress management proves to be another potential mechanism, equipping educators with the tools to navigate the inevitable challenges in their profession.

Intriguingly, the exploration of teacher growth mindset extends beyond its impact on well-being to investigate its relationship with teaching enthusiasm, characterized by passion and excitement for teaching. While limited in quantity, the available studies in this specific area suggest a promising connection that merits further investigation.

Key themes emerging from this line of research underscore the potential influence of a growth mindset on teaching enthusiasm. Nalipay et al. ( 2021 ) propose a link between a growth mindset and increased motivation and engagement in teaching, indicating a potential translation into more enthusiastic teaching practices. Building on this, Vermote et al. ( 2020 ) emphasize the role of teacher motivation in shaping teaching style, suggesting that a growth mindset could foster a more motivating and engaging approach in the classroom. Additionally, Seaton ( 2018 ) argues that empowering teachers with a growth mindset can enhance their sense of agency and control, potentially leading to greater enthusiasm and self-efficacy in their teaching practices.

A bulk of research emphasizes the significance of growth mindset within the EFL teaching context (Zhang et al. 2022 ). These studies explore the multifaceted influence of growth mindset on both teachers and students. On the teacher side, research investigates the connections between growth mindset and various positive outcomes. Liu et al. ( 2023 ) examine the potential for a growth mindset to contribute to teacher work engagement, enjoyment, and even grit. Similarly, Zarrinabadi et al. ( 2023 ) explore how a growth mindset can act as a buffer against teacher burnout and contribute to a stronger professional identity. Zhang et al. ( 2022 ) delve deeper, investigating the interplay between growth mindset, ideal L2 self (desired second language proficiency), and student boredom within the EFL context. Beyond teacher well-being, Dong ( 2024 ) explores the concept of “meta-lay theories,” students’ beliefs about their teachers’ beliefs in their potential for improvement. This study suggests that students who perceive their teachers holding a growth mindset are more likely to develop a growth mindset themselves, potentially impacting their online self-regulation strategies. Taken together, these studies highlight the potential of growth mindset as a powerful tool for fostering positive outcomes in the EFL classroom, impacting both teachers and students.

In summary, the dynamic relationship between teacher growth mindset, psychological well-being, and teaching enthusiasm forms a compelling area of research that not only enhances our understanding of teacher development but also holds implications for teacher training, professional development, and ultimately, the quality of education delivered in classrooms.

The hypothesized model

Building upon existing literature, this study proposes a model examining the potential influences of teacher mindfulness, growth mindset, and teaching enthusiasm on the psychological well-being of Chinese EFL teachers. This model posits direct and indirect relationships between these variables:

Firstly, drawing on a growing body of research across diverse populations, including studies specifically focused on Chinese educators, we hypothesize a direct and positive relationship between teacher mindfulness and their psychological well-being. Mindfulness practices, characterized by cultivating present-moment awareness and non-judgmental acceptance, have been demonstrably linked to tangible benefits for teachers, including reduced stress, anxiety, and depression (Alahari, 2017 ; Braun et al. 2019 ; Crescentini et al. 2016 ), alongside increased emotional regulation, self-compassion, and job satisfaction (Hue and Lau, 2015 ; Ruijgrok-Lupton et al. 2018 ; Zarate et al. 2019 ). These positive outcomes directly contribute to improved psychological well-being, suggesting a robust and well-established relationship between mindfulness and well-being among Chinese EFL teachers.

Secondly, similar to mindfulness, a growth mindset, characterized by the belief in one’s ability to learn and develop, is hypothesized to be directly related to improved psychological well-being. This aligns with research findings across various educational contexts (Lam et al. 2023 ; Nalipay et al. 2022 ; Shoshani, 2021 ; Whittington et al. 2017 ; Zeng et al. 2016 ; Zeng et al. 2019 ), suggesting that teachers with a growth mindset tend to experience lower stress, anxiety, and burnout, while exhibiting higher self-efficacy, job satisfaction, and emotional regulation (Lam et al. 2023 ; Whittington et al. 2017 ; Zeng et al. 2019 ).

Furthermore, the model explores the mediating role of teaching enthusiasm in the relationships between mindfulness and growth mindset with psychological well-being. Research suggests that mindfulness practices may indirectly enhance well-being by fostering teaching enthusiasm (Huang, 2022 ; Moyano et al. 2023 ). This could occur through reduced stress and anxiety, leading to a more positive and energetic teaching presence (Moyano et al. 2023 ), and improved emotional regulation, allowing teachers to navigate challenges and maintain enthusiasm (Huang, 2022 ; Jennings, 2015 ; Molloy Elreda et al. 2019 ; Moyano et al. 2023 ; Sherretz, 2011 ). Additionally, mindfulness may cultivate self-awareness and compassion, leading to a more positive and engaging connection with students, further contributing to teacher enthusiasm (Molloy Elreda et al. 2019 ). Similarly, a growth mindset is hypothesized to indirectly promote well-being through its influence on teaching enthusiasm. Teachers with a growth mindset tend to be more motivated and engaged in their work (Nalipay et al. 2021 ; Seaton, 2018 ; Vermote et al. 2020 ), which could translate into more enthusiastic teaching practices. Additionally, a growth mindset fosters a sense of agency and control, potentially leading to greater self-efficacy and enthusiasm in the classroom (Seaton, 2018 ). Therefore, teaching enthusiasm is hypothesized to act as a mediator, transmitting the positive effects of both mindfulness and growth mindset on the psychological well-being of Chinese EFL teachers.

In addition to the quantitative survey, a qualitative interview phase will be conducted to gain deeper insights into the lived experiences of teachers and explore the “how” behind the hypothesized relationships. This will provide a richer understanding of the complex interplay between these variables and their impact on well-being.

Based on the hypothesized model and the study’s purpose, this study investigates the following research questions:

RQ1: Does mindfulness directly relate to psychological well-being in Chinese EFL teachers?

RQ2: Does growth mindset directly relate to psychological well-being in Chinese EFL teachers?

RQ3: Does teaching enthusiasm mediate the relationship between mindfulness and/or growth mindset and psychological well-being in Chinese EFL teachers?

RQ4: How do Chinese EFL teachers describe their experiences of mindfulness, growth mindset, teaching enthusiasm, and well-being, and how do these experiences interrelate in their daily teaching lives?

Participants and procedures

This mixed-methods study employed a two-phased approach to explore the relationships between mindfulness, growth mindset, teaching enthusiasm, and well-being among Chinese EFL teachers. A total of 268 EFL teachers participated in the quantitative phase of the study. Participants were randomly selected from twelve public schools across three diverse provinces in China to ensure a diverse and representative sample of the population. These provinces were chosen to reflect a wide range of socio-economic backgrounds and educational contexts, including both urban and rural settings.

A power analysis was conducted a priori using G*Power software (Faul et al. 2007 ) to determine a sufficient sample size for the quantitative phase of the study. Based on a medium effect size ( f ² = 0.15), power of .80, and alpha level of .05, a minimum sample size of 221 participants was required for multiple regression analysis with four predictors (mindfulness, growth mindset, teaching enthusiasm) and one outcome variable (well-being). The achieved sample size of 268 participants provided adequate power to detect statistically significant relationships between the studied variables, even after accounting for potential attrition.

The selection process involved a stratified random sampling method to achieve a balanced representation of teachers based on gender, age, and teaching experience. School administrators provided lists of eligible teachers, from which participants were randomly selected within each stratum. To be eligible for the study, participants had to be currently employed full-time as secondary school teachers (grades 7–12), possess at least one year of teaching experience at the secondary level, be fluent in English, and demonstrate a willingness to participate in the study by completing all surveys. The sample was diverse in terms of age, gender, geographic location (rural vs. urban), and years of teaching experience. Specifically, 63% of the participants were female (169 teachers) and 37% were male (99 teachers). Their ages ranged from 23 to 58 years old, with an average age of 35. In terms of location, 45% (121 teachers) came from urban areas, while 55% (147 teachers) resided in rural areas. Their teaching experience varied between 1 and 15 years, with an average of 7 years. Data collection for the quantitative phase was conducted using an online survey platform. The survey link and information about the study were distributed to the participating schools through official channels with the assistance of school administrators. The survey platform ensured anonymity and confidentiality of participants’ responses. Participation in the study was completely voluntary, and informed consent was obtained from all participants before they began the survey.

Following the quantitative survey, a qualitative phase was undertaken to gain deeper insights into the lived experiences of EFL teachers and explore the quantitative findings in greater detail. For this phase, a purposive sampling method was used to select a diverse subset of 12 teachers from the initial quantitative sample. These teachers were chosen to reflect a range of experiences and backgrounds, including different geographic regions (urban and rural), grade levels (primary, middle, and high school), and years of teaching experience. This approach ensured that the qualitative data would provide a rich and nuanced understanding of the broader trends observed in the quantitative phase.

Informed consent was obtained from all participants prior to commencing the interviews, which were conducted in Mandarin Chinese to facilitate open and comfortable communication. Confidentiality was assured throughout the research process. The semi-structured interview guide ensured consistency while allowing for exploration of emergent themes. Interviews lasted approximately 60–90 min and were audio-recorded with permission.

Instruments

To assess participants’ psychological well-being, we utilized the well-established Psychological Well-being Scale developed by Ryff and Keyes ( 1995 ). Comprising 18 items, this scale gauges positive relationships with others, personal growth, self-acceptance, purpose in life, autonomy, and environmental mastery. Respondents rated their agreement on a seven-point Likert scale, ranging from strongly disagreed (1) to strongly agreed (7). Previous research has demonstrated the widespread applicability and reliability of this scale (Ryff and Keyes, 1995 ). The reliability and validity of this scale has been approved in EFL contexts (Tang and Zhu, 2024 ). In the current study, we further confirmed the validity of the measurement model by conducting a confirmatory factor analysis (CFA).

For evaluating mindfulness, we employed the Mindful Attention Awareness Scale (MAAS), as developed by Brown and Ryan ( 2003 ). The MAAS consists of 15 items, each assessed on a six-point Likert scale ranging from most always (1) to almost never (6). Sample statements include items like “I work automatically on tasks, do not know what I am doing.” This scale has been widely utilized in research focusing on mindfulness. The effectiveness of this scale in measuring mindfulness has been verified by prior EFL researchers (Fathi et al. 2023 ). To ensure the construct validity of the MAAS in our study, we conducted a CFA and examined convergent and discriminant validity.

Teacher enthusiasm was evaluated using the Teaching Enthusiasm Scale, originally designed by Kunter et al. ( 2011 ) to measure the enthusiasm of in-service instructors. This scale employs a Likert-type format, allowing participants to indicate their level of agreement with statements on a scale (e.g., 1 = Strongly Disagree to 5 = Strongly Agree). A sample item from the scale is, “I really enjoy teaching in this class.” This scale has been previously used and re-validated for the EFL context (Greenier et al. 2023 ). We further confirmed the factor structure of the Teaching Enthusiasm Scale using CFA in the current study.

To gauge the growth mindset of Chinese teachers, we employed the Growth Mindset Scale, adopting the eight items from Dweck’s ( 2006 ) mindset questionnaire. Respondents rated their agreement on a 6-point Likert scale, ranging from 1 (strongly disagree) to 6 (strongly agree). A representative item from the scale is “No matter how much intelligence you have, you can always change it quite a bit.” This self-report scale has been widely used in research exploring the concept of a growth mindset. The reliability and validity of this scale has been verified in EFL contexts (Liu et al. 2023 ). Similar to the other scales, the construct validity of the Growth Mindset Scale was assessed in the current study through CFA along with convergent and discriminant validity analyses.

In addition to the quantitative instruments, a semi-structured interview approach was chosen to explore the lived experiences of EFL teachers. This method provided flexibility to delve into specific aspects of mindfulness, growth mindset, teaching enthusiasm, and well-being while maintaining a focus on core research questions. Participants were encouraged to share their unique perspectives and experiences within a thematic framework.

Purposive sampling was utilized to recruit a sample ( n  = 12) of EFL teachers with diverse experiences and backgrounds. These teachers had previously completed the quantitative survey. The target population encompassed teachers from various geographical regions (urban and rural), grade levels (primary, middle, and high school), and with a range of teaching experience. Inclusion criteria ensured participants were currently employed full-time, English teachers, and willing to provide detailed accounts of their experiences.

Informed consent was obtained from all participants prior to commencing the interviews, which were conducted in Mandarin Chinese to facilitate open and comfortable communication. Confidentiality was assured throughout the research process. The semi-structured interview guide ensured consistency while allowing for exploration of emergent themes. Interviews lasted ~60–90 min and were audio-recorded with permission.

The semi-structured interview guide included the following questions:

Can you describe any strategies you use to manage stress or stay focused in the classroom?

How do you view your own development as a teacher? How do you encourage your students to learn and grow?

What motivates you to come to work each day? What aspects of teaching bring you the most joy?

Can you tell me about how your work as a teacher impacts your overall well-being?

Data analysis

The analysis employed a two-phase structural equation modeling approach (Kline, 2016 ) within the SPSS and AMOS frameworks (versions 23 and 26, respectively).

Initial data exploration involved evaluating skewness, kurtosis, and descriptive statistics to ensure data suitability for further analysis. Subsequently, the CFA phase assessed the measurement model’s fit using established indices. A good fit was indicated by RMSEA below 0.05 (Browne and Cudeck, 1993 ), SRMR less than 0.08 (Kline, 2015 ), chi-square/df ratio within 1–3, CFI exceeding 0.95 (Hu and Bentler, 1999 ), GFI exceeding 0.90, and TLI exceeding 0.90 (Kline, 2015 ).

Following a successful CFA, the structural model was tested. Bootstrapping with 5000 resamples (Shrout and Bolger, 2002 ) and confidence interval assessment (Hayes, 2013 ) were employed to evaluate the significance of indirect effects. The detailed results of these analyses, including specific values for each index and path coefficients, will be presented in subsequent sections tailored to the findings.

Thematic analysis was employed to analyze the transcribed interview data. Recordings were transcribed verbatim and translated into English by a bilingual researcher with expertise in qualitative research methods (Braun and Clarke, 2006 ). A rigorous coding process was then implemented, involving line-by-line analysis to identify recurring themes and patterns related to the research focus (Saldana, 2013 ).

The initial step in this process involved breaking down the data into meaningful segments and assigning codes to these segments. Each line of the transcribed data was meticulously reviewed, and initial codes were assigned based on the content. To ensure consistency in the coding process, a codebook was developed to document the codes and their definitions. This codebook was refined iteratively, incorporating feedback from a second coder to maintain clarity and accuracy.

To enhance the reliability of the analysis, a second researcher independently coded a subset of the data, specifically 20%. The results of this double coding were then compared, and any discrepancies were discussed and resolved through consensus, which led to further refinement of the codebook. Following the initial coding, the codes were examined for similarities and differences, and related codes were grouped into categories, which were subsequently organized into broader themes. The validation of these themes was achieved through a process of triangulation, which involved cross-checking the themes with the quantitative findings and seeking feedback from the participants. Member checking was conducted by sharing the preliminary themes with a few interviewees to ensure that the themes accurately represented their experiences.

Finally, a thematic map was developed to illustrate the interrelationships between the identified themes. This visual representation facilitated an understanding of the connections and hierarchies among the themes, providing a comprehensive view of the qualitative data. This systematic approach to coding and theme validation ensured the credibility and trustworthiness of the qualitative findings, which provided deeper insights into the lived experiences of EFL teachers and complemented the quantitative findings from the survey data.

This section presents the findings from the mixed-methods study investigating the influence of mindfulness, growth mindset, and teaching enthusiasm on the psychological well-being of Chinese EFL teachers. The quantitative analysis revealed significant positive relationships between all three variables and psychological well-being. In simpler terms, teachers who reported higher levels of mindfulness, growth mindset, and teaching enthusiasm also displayed greater well-being. The following sections delve into the detailed statistical analyses and qualitative interview findings that shed further light on these relationships.

Quantitative results

To address potential issues with missing data, we employed the Expectation-Maximization algorithm, a widely used technique for data imputation (Kline, 2015 ). Following imputation, we assessed the data for normality, a key assumption for the subsequent analysis methods employed in this study. Table 1 summarizes the descriptive statistics for the four latent variables (mindfulness, growth mindset, teaching enthusiasm, and well-being) and their corresponding indicators. As shown in the table, the skewness values for all variables fall within the acceptable range of ±2, and the kurtosis values remain below ±7. These findings suggest that the data adheres to the assumption of multivariate normality required for further analysis (Finney and DiStefano, 2006 ).

As shown in Table 1 , the mean scores for all variables were above 3, indicating generally positive dispositions toward mindfulness (M = 2.96), growth mindset (M = 3.16), teaching enthusiasm (M = 3.56), and well-being (M = 3.79) in the sample. The standard deviations ranged from 0.48 to 0.69, indicating moderate variability within each construct (Mindfulness: SD = 0.48, Growth Mindset: SD = 0.61, Enthusiasm: SD = 0.69, Well-being: SD = 0.56). Skewness and kurtosis values close to zero for all variables suggested a normal distribution in the data (Mindfulness: Skewness = −0.12, Kurtosis = 0.10; Growth Mindset: Skewness = −0.07, Kurtosis = 0.11; Enthusiasm: Skewness = −0.08, Kurtosis = 0.13; Well-being: Skewness = −0.06, Kurtosis = 0.10). Internal consistency, measured by Cronbach’s alpha, demonstrated strong reliability for all variables (Mindfulness: α = 0.89, Growth Mindset: α = 0.84, Enthusiasm: α = 0.87, Well-being: α = 0.91), indicating that the items within each scale were highly reliable and effectively measured the intended constructs.

Table 2 delves into the relationships between the core variables of our study. As shown in Table 2 , a positive and significant correlation was observed between mindfulness and both growth mindset (r = 0.43, p < 0.01) and well-being (r = 0.53, p < 0.01). This suggests that teachers with higher levels of mindfulness tend to exhibit a stronger growth mindset and experience greater well-being. Similarly, growth mindset displayed positive and significant correlations with both teaching enthusiasm (r = 0.39, p < 0.01) and well-being (r = 0.33, p < 0.01). This implies that teachers with a growth mindset are more likely to report higher levels of enthusiasm and well-being.

Not surprisingly, teaching enthusiasm exhibited a strong and significant positive correlation with well-being (r = 0.54, p < 0.01). This reinforces the idea that passionate and enthusiastic teachers tend to experience greater well-being in their professional lives.

Table 3 reinforces the quality of our measures through both convergent and discriminant validity analyses. Convergent validity shines through high average variance extracted (AVE) values, exceeding 0.50 for all constructs. This, as recommended by Fornell and Larcker ( 1981 ), indicates that the majority of variance captured by each measure reflects its intended meaning. Further bolstering this finding are strong composite reliability (CR) scores, exceeding 0.60 (Bagozzi and Yi, 1988 ), signifying excellent internal consistency and reliability within each construct.

Discriminant validity is equally well-established. The square root of AVE for each construct (bolded numbers in Table 3 ) surpasses the corresponding inter-construct correlations. This key finding suggests that each construct shares more variance with its own indicators than with others, solidifying strong discriminant validity as suggested by Fornell and Larcker ( 1981 ). Overall, the evidence presented in Table 3 provides robust support for the quality of our measures. Both convergent and discriminant validity are well-established, strengthening our confidence in the subsequent analysis and interpretation of the findings. This ensures that our results accurately reflect the intended constructs within the context of our study.

In our exploration, the measurement model comprised four latent constructs: mindfulness, growth mindset, teaching enthusiasm, and well-being among Chinese teachers. Each construct was linked to multiple observed indicators, creating a comprehensive model for analysis. Employing the structural equation modeling approach with maximum likelihood estimation in AMOS (version 23.0), we conducted a CFA to assess the validity of the measurement model.

The outcomes revealed a favorable fit to the dataset (χ² = 520.75; df = 185; χ²/df = 2.81; p < 0.001; RMSEA = 0.047; SRMR = 0.043; CFI = 0.972; TLI = 0.957). Following this validation, we introduced a common method factor into the model to investigate potential common method variance. The results indicated that the revised measurement model did not exhibit significant improvement (χ² = 600.25; df = 165; χ²/df = 3.636; RMSEA = 0.063; SRMR = 0.036; CFI = 0.957; TLI = 0.944). Notably, the changes in RMSEA and SRMR were each less than 0.05, while the alterations in CFI and TLI were each less than 0.1. These marginal changes suggest that the inclusion of the common method factor did not substantially enhance the model, indicating a lack of pronounced common method variance in our measurement model.

Following the validation of the measurement model, we proceeded to test the structural model. The fit indices indicated a robust fit to the data (χ² = 310.75, df = 160, χ²/df = 1.94, p = 0.00; CFI = 0.963, TLI = 0.952, RMSEA = 0.031, 90% CI for RMSEA = [0.024, 0.041]), confirming the significance of all hypothesized paths in the model (see Fig. 1 ) at a significance level of p < 0.05.

The final model of teacher well-being.

Table 4 sheds light on the intricate interplay between mindfulness, growth mindset, teaching enthusiasm, and their collective influence on teachers’ well-being. The analysis revealed both significant direct and indirect effects, providing a comprehensive understanding of the pathways through which these variables contribute to teachers’ psychological well-being.

As indicated in Table 4 , a positive and significant direct effect was found between mindfulness and well-being (β = 0.36, p < 0.001, 95% CI [0.25, 0.47]), indicating that higher levels of mindfulness directly contribute to greater well-being among teachers. Likewise, a significant and positive direct effect emerged for growth mindset on well-being (β = 0.41, p < 0.001, 95% CI [0.30, 0.52]). This suggests that teachers with a stronger growth mindset experience higher levels of well-being independent of other factors. The strongest direct effect was observed between teaching enthusiasm and well-being (β = 0.59, p < 0.001, 95% CI [0.50, 0.68]). This finding highlights the crucial role that passion and enjoyment in teaching play in fostering teachers’ well-being.

Beyond its direct impact, mindfulness also exerted a significant indirect effect on well-being through its influence on teaching enthusiasm (β = 0.22, p < 0.001, 95% CI [0.15, 0.29]). This suggests that mindfulness practices can contribute to increased teacher enthusiasm, which in turn leads to greater well-being. Similarly, growth mindset demonstrated a significant indirect effect on well-being mediated by teaching enthusiasm (β = 0.25, p < 0.001, 95% CI [0.18, 0.32]). This finding implies that a growth mindset can foster teacher enthusiasm, ultimately leading to higher levels of well-being.

The total effect of mindfulness on well-being, accounting for both direct and indirect effects, was significant and positive (β = 0.58, p < 0.001, 95% CI [0.50, 0.66]). This suggests that mindfulness plays a substantial role in promoting well-being among teachers. Likewise, the total effect of growth mindset on well-being was significant and positive (β = 0.66, p < 0.001, 95% CI [0.58, 0.74]). This emphasizes the importance of fostering a growth-oriented mindset for enhancing teachers’ well-being.

The findings presented in Table 4 paint a compelling picture of the interconnected nature of mindfulness, growth mindset, teaching enthusiasm, and their multifaceted contributions to teacher well-being. While each variable exerts a direct positive influence, the indirect effects highlight the cascading impact of mindfulness and growth mindset through their ability to cultivate teaching enthusiasm. This comprehensive understanding underscores the potential for interventions targeting these variables to holistically promote teacher well-being and create a more fulfilling and sustainable teaching experience.

Qualitative results

Building upon the quantitative analysis, which revealed significant relationships between mindfulness, growth mindset, teaching enthusiasm, and well-being in Chinese EFL teachers, a qualitative phase was undertaken to gain deeper insights into these experiences. Thematic analysis of interview data yielded several key themes that resonated with the quantitative findings, offering a richer understanding of how these concepts manifest in the daily lives of teachers across various educational settings.

Theme 1: cultivating mindfulness for focus and composure

A prominent theme emerged around the positive influence of practices that helped teachers stay calm and focused in the classroom. Interestingly, these practices weren’t always labeled as “mindfulness,” but the benefits were undeniable. Li Mei (10 years of experience as a high school English teacher), for instance, discovered the power of deep breathing independently. “There were days when the classroom felt like a whirlwind, especially with large class sizes,” she shared. “Now, I take a few slow breaths throughout the day, especially when things get hectic. It helps me center myself and focus on what matters most - my students.” In contrast, Wei Chen (middle school teacher) highlighted the potential of formal training. He explained, “Sometimes, things don’t go according to plan, and it’s easy to get flustered, particularly when dealing with particularly energetic classes. But taking a moment to just breathe and collect myself, as I learned in a workshop on stress management, allows me to handle the situation more calmly and effectively.” Wei Chen’s experience underscores the value of incorporating mindfulness practices into formal teacher training programs. Further enriching the narrative, Sun Ming (veteran high school teacher, 20+ years) offered a perspective honed over a long career. “Over the years, I’ve learned the importance of finding moments of quiet reflection throughout the day,” he reflected. “Even a few minutes of mindful breathing can make a big difference in managing stress and staying focused on the task at hand.” Sun Ming’s experience suggests that some teachers develop mindfulness practices organically over time. These diverse experiences resonate with the quantitative finding of a positive association between mindfulness and well-being. The qualitative data, therefore, suggests that mindfulness practices, regardless of how they are acquired, can be instrumental in promoting teacher well-being in the classroom.

Theme 2: growth mindset fosters sustained motivation

Another key theme emerged around growth mindset as a critical factor in sustaining motivation and enthusiasm for teaching. Teachers highlighted the importance of believing in their own ability and that of their students to learn and develop. However, the interviews also revealed interesting variations in how teachers developed this growth mindset.

Nurturing growth through experience

Wang Tao (middle school English teacher), for example, described how his growth mindset stemmed from navigating challenges in the classroom: “There will be times when a lesson flops, or a student struggles to grasp a concept,” he explained. “But the beauty is, we can all learn and improve. That keeps me motivated to try new things and find creative ways to explain things, especially for students who might need additional support.” Wang Tao’s experience exemplifies how overcoming obstacles and witnessing student progress can foster a growth mindset. The fast-paced environment of middle school, with its diverse learning needs, can present these challenges and opportunities for growth on a regular basis.

Growth mindset through professional development

In contrast, Zhang Ling (university English lecturer, 15 years of experience) attributed her growth mindset to professional development opportunities: “Exposure to workshops on growth mindset pedagogy has been instrumental,” she shared. “It’s helped me reframe challenges as opportunities for learning and improvement, not just for my students, but for myself as well.” Zhang Ling’s experience highlights the potential benefits of incorporating growth mindset principles into formal teacher training programs, particularly in higher education where pedagogical approaches are constantly evolving.

This focus on continuous learning resonates with the quantitative finding of a positive correlation between growth mindset and well-being. The qualitative data suggests that a growth mindset, regardless of how it is developed, empowers teachers to view challenges as opportunities for growth, which ultimately contributes to their well-being.

Theme 3: the positive feedback loop between teaching enthusiasm and well-being

Finally, the interview data underscored the positive feedback loop between teaching enthusiasm and well-being. Teachers described how their passion for teaching energized them and fueled their desire to continuously improve their craft. However, the specific ways this enthusiasm manifested varied across educational contexts.

Enthusiasm through student breakthroughs

Li Hong (primary school teacher), for instance, spoke passionately about the joy of witnessing student breakthroughs in the early years: “That moment when a student finally ‘gets it’ - that’s pure gold. Those little breakthroughs are what make teaching so rewarding. It reminds me why I do what I do, and it fills me with a sense of accomplishment that keeps me going, even on tough days.” Li Hong’s experience exemplifies how witnessing students grasp new concepts can be a powerful motivator for primary school teachers.

Enthusiasm through student engagement

In contrast, Sun Ming (veteran high school teacher, 20+ years) highlighted the importance of student engagement in maintaining his enthusiasm throughout his long career: “Teaching can be a rollercoaster ride. There will be days when you question everything. But then you see a student totally engaged, asking questions, and that spark reignites your passion. That enthusiasm is what keeps me coming back for more, and it definitely contributes to feeling good about myself as a teacher.” Sun Ming’s perspective showcases how fostering active participation in high school classrooms can rekindle a teacher’s passion and contribute to their well-being.

Challenges and overcoming obstacles

Despite their enthusiasm, teachers also acknowledged challenges in maintaining it. Li Mei (high school English teacher, 10 years of experience) described how large class sizes could sometimes dampen her spirits: “Sometimes the sheer number of students can feel overwhelming. But that’s when I rely on my mindfulness practices (deep breathing exercises) to stay focused and remember why I’m here - to make a positive impact on these young minds.” Li Mei’s experience highlights how the mindfulness practices discussed in Theme 1 can be a valuable tool for teachers to overcome challenges and maintain enthusiasm in demanding situations.

These three themes are not independent but rather work together in a cyclical fashion to enhance teacher well-being. Mindfulness practices (Theme 1) can create a foundation of focus and composure, which is essential for effectively implementing a growth mindset (Theme 2) in the classroom. A growth mindset fosters a belief in personal and student development, leading to a more positive and enthusiastic approach to teaching (Theme 2). This enthusiasm, fueled by student engagement and a sense of accomplishment (Theme 3), can further reinforce both mindfulness practices (seeking techniques to maintain focus and well-being) and a growth mindset (demonstrating the value of perseverance).

The present study delves into the intricate tapestry of factors influencing the psychological well-being of Chinese EFL teachers, offering a compelling analysis that resonates with existing literature while pushing the boundaries of our understanding. The findings illuminate not only the direct effects of mindfulness and growth mindset but also unveil an intriguing mediating role played by teaching enthusiasm.

As hypothesized (RQ1), the study confirms a direct and positive relationship between teacher mindfulness and psychological well-being. The confirmation of a direct positive relationship between teacher mindfulness and psychological well-being in this study aligns seamlessly with a growing body of research. This research highlights the multifaceted benefits of mindfulness practices for educators’ well-being. However, to gain a deeper understanding of this association, it is crucial to delve into the potential mechanisms underlying it. One key mechanism is stress management. Mindfulness cultivates present-moment awareness, allowing teachers to detachment from negative thoughts and rumination, significant contributors to stress (Alahari, 2017 ). This detachment fosters a sense of calm and acceptance, enabling teachers to regulate their stress response more effectively (Crescentini et al. 2016 ). Another mechanism is emotional regulation. Mindfulness practices equip teachers with the ability to observe their emotions without judgment, fostering greater self-awareness and emotional control. This enhanced emotional regulation allows them to navigate challenging situations with composure and respond effectively to student needs and classroom disruptions (Hue and Lau, 2015 ).

Additionally, mindfulness promotes self-compassion by cultivating a sense of non-judgmental acceptance. This allows teachers to be kinder and more understanding towards themselves, especially when faced with setbacks or challenges. This self-compassion fosters greater resilience and protects against negative emotions like burnout and feelings of inadequacy (Zarate et al. 2019 ). These intertwined benefits of mindfulness—stress management, emotional regulation, and self-compassion—work synergistically to enhance teachers’ well-being (Cicek and Gurbuz, 2023 ). By equipping teachers with the tools to manage stress effectively, regulate their emotions, and practice self-compassion, mindfulness allows them to navigate the inevitable challenges of the profession with greater resilience and equanimity (Braun et al. 2019 ; Hue and Lau, 2015 ). This, in turn, contributes to improved job satisfaction, increased motivation, and overall psychological well-being. Teachers’ experiences corroborated the quantitative association between mindfulness and well-being. For instance, Li Mei (pseudonym, high school teacher) described using mindfulness techniques like slow breathing to manage frustration and regain composure in the classroom. This aligns with the theoretical framework suggesting that mindfulness promotes stress management. Li Mei’s experience exemplifies this concept, as she explicitly linked her use of mindfulness practices with feeling calmer and more focused. This qualitative insight offers a concrete illustration of how mindfulness can be implemented in real-world settings to cultivate a sense of composure, directly corresponding to the quantitative finding of a positive association between mindfulness and well-being.

Similarly, the direct association between teacher growth mindset and psychological well-being (RQ2) reinforces the significance of fostering a belief in personal development. The observed direct association between teacher growth mindset and psychological well-being underscores the importance of cultivating a belief in personal development within the teaching profession. This finding aligns seamlessly with a substantial body of literature that consistently highlights the positive outcomes associated with embracing a growth mindset (Lam et al. 2023 ; Liu et al. 2023 ; Nalipay et al. 2022 ; Shoshani, 2021 ; Whittington et al. 2017 ; Zeng et al. 2016 ; Zeng et al. 2019 ). Teachers who adopt a growth mindset, characterized by the belief that intelligence and abilities can be developed through effort and perseverance, experience a cascade of beneficial outcomes. One of the primary advantages is the reduction in stress and anxiety levels. The literature consistently reports that educators with a growth mindset are better equipped to navigate challenges without succumbing to overwhelming stressors (Shoshani, 2021 ). This ability to confront challenges with a positive and adaptive mindset contributes significantly to the overall psychological well-being of teachers.

Moreover, the embrace of a growth mindset among teachers is associated with heightened self-efficacy. Teachers who believe in their capacity to learn and improve are more likely to approach their professional responsibilities with confidence, resilience, and a sense of agency (Nalipay et al. 2022 ). This increased self-efficacy, in turn, acts as a protective factor against the negative impacts of stress and contributes to an enhanced psychological well-being. Similarly, qualitative data supported the link between growth mindset and well-being. Wang Tao (pseudonym, middle school teacher) emphasized the importance of believing in his own ability and that of his students to learn and develop, a core tenet of a growth mindset. This belief fosters resilience and fuels motivation, ultimately contributing to well-being. Wang Tao’s perspective aligns with the quantitative finding that growth mindset mediates the relationship between mindfulness and well-being, potentially by enhancing teaching enthusiasm.

Job satisfaction is another positive outcome linked to a teacher’s growth mindset. When educators view challenges not as insurmountable obstacles but as opportunities for growth and development, they derive a sense of fulfillment from their profession (Lam et al. 2023 ). This satisfaction with their work contributes significantly to their overall well-being, creating a positive and fulfilling professional experience. Furthermore, the adoption of a growth mindset is associated with improved emotional regulation. Teachers who believe in the potential for personal development are more likely to approach emotionally charged situations with resilience and adaptability (Zeng et al. 2019 ). This emotional regulation contributes to a more stable and positive psychological well-being, allowing teachers to navigate the emotional complexities of their profession more effectively.

The identification of the mediating role of teaching enthusiasm in the relationships between mindfulness, growth mindset, and psychological well-being represents a pivotal and intriguing finding in this study (RQ3). This interplay between internal psychological constructs (mindfulness, growth mindset) and their outward manifestation (teaching enthusiasm) offers a nuanced perspective on how well-being flourishes among Chinese EFL teachers. The positive association between mindfulness practices and increased teaching enthusiasm suggests a pathway through which mindfulness benefits extend beyond stress reduction. This finding aligns with prior research by Huang ( 2022 ), Molloy Elreda et al. ( 2019 ), and Sherretz ( 2011 ), highlighting the potential of mindfulness to cultivate a more passionate and fulfilling teaching experience.

The cultivation of present-moment awareness and acceptance through mindfulness practices likely translates into a more positive and energetic teaching presence (Moyano et al. 2023 ). This heightened awareness fosters a deeper engagement with students and teaching responsibilities. Furthermore, mindfulness-enhanced emotional regulation equips teachers to manage challenges effectively, thereby maintaining a consistent level of enthusiasm (Jennings, 2015 ). The self-awareness and compassion fostered by mindfulness practices might also play a crucial role by facilitating positive connections with students, further fueling teacher enthusiasm (He et al. 2023 ; Molloy Elreda et al. 2019 ).

The qualitative data further sheds light on the role of teaching enthusiasm as a mediator. Teachers like Li Hong (pseudonym, primary school teacher) spoke passionately about the joy derived from witnessing student breakthroughs. This aligns with the notion that mindfulness and growth mindset can cultivate a more positive and energetic teaching presence, ultimately contributing to well-being through heightened enthusiasm.

The finding that teaching enthusiasm mediates the relationship between growth mindset and well-being is consistent with existing research suggesting that a belief in personal development fosters increased motivation and engagement in teaching (Nalipay et al. 2021 ; Vermote et al. 2020 ). Teachers with a growth mindset, who possess a strong belief in their capacity to learn and develop, are more likely to approach their work with greater enthusiasm and motivation. The sense of agency and control nurtured by a growth mindset contributes to enhanced self-efficacy and enthusiasm in the classroom (Seaton, 2018 ). Wang Tao’s (pseudonym) description of a “growth mindset” as keeping teaching exciting exemplifies how a growth mindset empowers teachers to approach their work with passion and dedication.

By integrating qualitative data with the quantitative findings, this study offers a more comprehensive understanding of how mindfulness, growth mindset, and teaching enthusiasm contribute to teacher well-being in Chinese EFL contexts. The qualitative data illuminates the mechanisms underlying these relationships, providing valuable insights into how these factors can be nurtured to support teacher well-being and potentially improve student learning outcomes.

Conclusion and implications

This mixed-methods study investigated the intricate interplay of factors influencing the psychological well-being of Chinese EFL teachers. Our findings illuminate two key takeaways. Firstly, mindfulness and growth mindset directly contribute to increased well-being among teachers. Secondly, teaching enthusiasm emerges as a critical mediating factor, suggesting that mindfulness and growth mindset indirectly enhance well-being by fostering passion and enthusiasm for teaching.

The study’s findings offer actionable insights that can be translated into practical recommendations for teachers, administrators, and policymakers. For teachers, integrating MBIs into daily routines can significantly enhance well-being. Practices such as mindfulness meditation, mindful breathing exercises, and mindful movement can help manage stress, regulate emotions, and maintain a present-moment focus. Additionally, teachers should consider incorporating mindful teaching techniques in their classrooms, such as mindful listening activities and student self-reflection through journaling. These practices benefit not only teachers but also create a more supportive and focused learning environment for students.

Administrators can play a crucial role in fostering a supportive environment that enhances teacher well-being by implementing regular professional development programs that include training on mindfulness and growth mindset. These programs equip teachers with the necessary skills to manage stress and foster personal and professional growth. Furthermore, creating collaborative learning environments where teachers can share best practices, co-plan lessons, and provide mutual support can cultivate a sense of community and shared purpose, enhancing teaching enthusiasm. Integrating project-based learning (PBL) approaches can empower teachers with greater autonomy and opportunities to design engaging and student-centered lessons, potentially sparking renewed excitement for teaching.

Policymakers should consider allocating resources to support the implementation of MBIs and growth mindset training in schools. Providing access to conferences, workshops, and mentorship programs focused on innovative teaching methodologies and resources can help teachers stay engaged and enthusiastic about their profession. Additionally, policies that promote a supportive school culture, reduce administrative burdens, and recognize teachers’ efforts and achievements can contribute to enhanced well-being and job satisfaction. By addressing the practical needs of teachers through these evidence-based strategies, stakeholders can create a more supportive and enriching educational landscape, benefiting both teachers and students.

For researchers, this study opens exciting avenues for further exploration. One crucial direction is delving deeper into the specific mechanisms underlying the relationships between mindfulness, growth mindset, teaching enthusiasm, and well-being. Employing qualitative research methods can offer valuable insights into the lived experiences of teachers and the psychological processes at play. Additionally, examining the nuances of individual and contextual factors influencing the effectiveness of these interventions is vital. Research could explore how factors such as personality traits, cultural contexts, and school leadership styles moderate the relationships identified in this study. Finally, conducting longitudinal studies is essential to understand the long-term effects of promoting well-being among educators and investigate broader outcomes such as student learning, engagement, and school climate.

While the current study sheds light on the valuable connections between mindfulness, growth mindset, teaching enthusiasm, and psychological well-being among Chinese EFL teachers, a nuanced understanding necessitates acknowledging certain limitations. Although the study employed a combination of quantitative and qualitative methods, including self-reported measures via anonymous surveys and in-depth exploration through semi-structured interviews, potential biases inherent in self-reported data remain. Social desirability bias or inaccurate self-assessment could influence the quantitative findings. To further strengthen the validity of future research in this area, a wider range of data collection methods could be considered. This might encompass utilizing physiological measures, such as heart rate variability for mindfulness, or conducting structured classroom observations of teacher behavior to gain a more objective perspective. Additionally, gathering data from students or colleagues regarding teacher mindfulness, enthusiasm, or overall effectiveness could provide valuable insights beyond self-reported data.

Furthermore, the study’s focus on Chinese EFL teachers limits the generalizability of the results. While the findings offer valuable context within this specific population, the applicability to other cultural backgrounds or educational settings, such as English immersion programs or non-Asian EFL contexts, remains unexplored. Future cross-cultural studies could investigate whether these relationships hold true across diverse contexts. Research suggests that cultural values can influence teachers’ perceptions of mindfulness and growth mindset. Eastern cultures, like China, often emphasize collectivism and self-improvement, which might influence how teachers respond to mindfulness practices and growth mindset interventions. Conversely, teachers in Western cultures, which tend to value individualism and achievement, might exhibit different responses (Hofstede, 1986 ).

This study’s call to action is twofold. First, for researchers, it underscores the need for further exploration using a wider methodological lens to strengthen the validity and generalizability of the observed relationships. Examining the long-term impact on student outcomes and school environments would offer a more holistic understanding of the benefits. Second, for educators and policymakers, the findings provide a springboard for developing practical strategies. Teacher training programs can integrate mindfulness-based practices and growth mindset techniques to equip educators with tools for stress management, emotional regulation, and fostering a growth-oriented teaching philosophy. Furthermore, fostering collaborative learning environments and exploring innovative pedagogical approaches like PBL can nurture teacher enthusiasm and create a more engaging learning environment for students. By implementing these evidence-based strategies, we can create a ripple effect that enhances teacher well-being, student engagement, and ultimately, educational success.

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Data will be provided in a de-identified format to ensure participant confidentiality.

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Xu, Y., Wang, J. The mediating role of teaching enthusiasm in the relationship between mindfulness, growth mindset, and psychological well-being of Chinese EFL teachers. Humanit Soc Sci Commun 11 , 1176 (2024). https://doi.org/10.1057/s41599-024-03694-y

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Received : 29 February 2024

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DOI : https://doi.org/10.1057/s41599-024-03694-y

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