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Online Guide to Writing and Research

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• Online Guide to Writing

Supporting with Research and Examples

“Okay, prove it.” Have you ever said that? Have you ever thought it? People, it seems, make wild claims all the time. The internet, the media, social media - they are full of them. College students, graduate students, and even professors, are expected to move beyond mere claims and support their assertions. You can do this by using source material (found during research) and examples. Providing these can lend credibility and credence to your claims.

Integrating sources into your work is a type of synthesis . A writer can also use sources to evaluate, and using sources is also a way to employ ethos, the effort to persuade by appealing to authority. 

Although sources can offer general support and examples can be hypothetical rather than source-based, a source can function as both support and an example. The following shows how one economics student integrated references into an informal assignment.

Reference Integration Example

Why i believe in enterprise zones.

Because they can recover lost tax revenue and generate growth, enterprise zones are a viable method for creating growth sectors in urban economies where growth would not otherwise appear.

Enterprise zones are specially protected areas of a city reserved for business growth. They are traditionally created in areas of low growth and offer incentives to businesses locating there. The critics’ argument that the loss of potential tax revenue negates their value is specious. Enterprise zones offer the potential for growth where it had not previously been realized, thereby offering real, as opposed to speculative, opportunity for growth.

Last week’s Post article on growth in Washington, D.C.’s, Adams Morgan neighborhood offers tangible proof that the concept of enterprise zones can work for cities. The Post related that this area, once inhabited by prostitutes and drug dealers, was set aside as an enterprise zone after the 1960s riots and has continued to attract small businesses and entrepreneurs. Enterprise zone status has spurred a new wave of investment there and has attracted many middle-class residents.

Key Takeaways

• Providing support for your assertions lends credibility and credence to your claims.
• When you research a topic, you will need to determine who the reliable sources are in the area of study involved.

Mailing Address: 3501 University Blvd. East, Adelphi, MD 20783 This work is licensed under a  Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License . © 2022 UMGC. All links to external sites were verified at the time of publication. UMGC is not responsible for the validity or integrity of information located at external sites.

Table of Contents: Online Guide to Writing

Chapter 1: College Writing

How Does College Writing Differ from Workplace Writing?

What Is College Writing?

Why So Much Emphasis on Writing?

Chapter 2: The Writing Process

Doing Exploratory Research

Getting from Notes to Your Draft

Introduction

Prewriting - Techniques to Get Started - Mining Your Intuition

Prewriting: Targeting Your Audience

Prewriting: Techniques to Get Started

Prewriting: Understanding Your Assignment

Rewriting: Being Your Own Critic

Rewriting: Creating a Revision Strategy

Rewriting: Getting Feedback

Rewriting: The Final Draft

Techniques to Get Started - Outlining

Techniques to Get Started - Using Systematic Techniques

Thesis Statement and Controlling Idea

Writing: Getting from Notes to Your Draft - Freewriting

Writing: Getting from Notes to Your Draft - Summarizing Your Ideas

Writing: Outlining What You Will Write

Chapter 3: Thinking Strategies

A Word About Style, Voice, and Tone

A Word About Style, Voice, and Tone: Style Through Vocabulary and Diction

Critical Strategies and Writing

Critical Strategies and Writing: Analysis

Critical Strategies and Writing: Evaluation

Critical Strategies and Writing: Persuasion

Critical Strategies and Writing: Synthesis

Developing a Paper Using Strategies

Kinds of Assignments You Will Write

Patterns for Presenting Information

Patterns for Presenting Information: Critiques

Patterns for Presenting Information: Discussing Raw Data

Patterns for Presenting Information: General-to-Specific Pattern

Patterns for Presenting Information: Problem-Cause-Solution Pattern

Patterns for Presenting Information: Specific-to-General Pattern

Patterns for Presenting Information: Summaries and Abstracts

Writing Essay Examinations

Writing Essay Examinations: Make Your Answer Relevant and Complete

Writing Essay Examinations: Organize Thinking Before Writing

Writing Essay Examinations: Read and Understand the Question

Chapter 4: The Research Process

Planning and Writing a Research Paper

Planning and Writing a Research Paper: Ask a Research Question

Planning and Writing a Research Paper: Cite Sources

Planning and Writing a Research Paper: Collect Evidence

Planning and Writing a Research Paper: Decide Your Point of View, or Role, for Your Research

Planning and Writing a Research Paper: Draw Conclusions

Planning and Writing a Research Paper: Find a Topic and Get an Overview

Planning and Writing a Research Paper: Manage Your Resources

Planning and Writing a Research Paper: Outline

Planning and Writing a Research Paper: Survey the Literature

Planning and Writing a Research Paper: Work Your Sources into Your Research Writing

Research Resources: Where Are Research Resources Found? - Human Resources

Research Resources: What Are Research Resources?

Research Resources: Where Are Research Resources Found?

Research Resources: Where Are Research Resources Found? - Electronic Resources

Research Resources: Where Are Research Resources Found? - Print Resources

Structuring the Research Paper: Formal Research Structure

Structuring the Research Paper: Informal Research Structure

The Nature of Research

The Research Assignment: How Should Research Sources Be Evaluated?

The Research Assignment: When Is Research Needed?

The Research Assignment: Why Perform Research?

Chapter 5: Academic Integrity

Academic Integrity

Giving Credit to Sources

Giving Credit to Sources: Copyright Laws

Giving Credit to Sources: Documentation

Giving Credit to Sources: Style Guides

Integrating Sources

Practicing Academic Integrity

Practicing Academic Integrity: Keeping Accurate Records

Practicing Academic Integrity: Managing Source Material

Practicing Academic Integrity: Managing Source Material - Paraphrasing Your Source

Practicing Academic Integrity: Managing Source Material - Quoting Your Source

Practicing Academic Integrity: Managing Source Material - Summarizing Your Sources

Types of Documentation

Types of Documentation: Bibliographies and Source Lists

Types of Documentation: Citing World Wide Web Sources

Types of Documentation: In-Text or Parenthetical Citations

Types of Documentation: In-Text or Parenthetical Citations - APA Style

Types of Documentation: In-Text or Parenthetical Citations - CSE/CBE Style

Types of Documentation: In-Text or Parenthetical Citations - Chicago Style

Types of Documentation: In-Text or Parenthetical Citations - MLA Style

Types of Documentation: Note Citations

Chapter 6: Using Library Resources

Finding Library Resources

Chapter 7: Assessing Your Writing

How Is Writing Graded?

How Is Writing Graded?: A General Assessment Tool

The Draft Stage

The Draft Stage: The First Draft

The Draft Stage: The Revision Process and the Final Draft

The Draft Stage: Using Feedback

The Research Stage

Using Assessment to Improve Your Writing

Chapter 8: Other Frequently Assigned Papers

Reviews and Reaction Papers: Article and Book Reviews

Reviews and Reaction Papers: Reaction Papers

Writing Arguments

Writing Arguments: Adapting the Argument Structure

Writing Arguments: Purposes of Argument

Writing Arguments: References to Consult for Writing Arguments

Writing Arguments: Steps to Writing an Argument - Anticipate Active Opposition

Writing Arguments: Steps to Writing an Argument - Determine Your Organization

Writing Arguments: Steps to Writing an Argument - Develop Your Argument

Writing Arguments: Steps to Writing an Argument - Introduce Your Argument

Writing Arguments: Steps to Writing an Argument - State Your Thesis or Proposition

Writing Arguments: Steps to Writing an Argument - Write Your Conclusion

Writing Arguments: Types of Argument

Appendix A: Books to Help Improve Your Writing

Dictionaries

General Style Manuals

Researching on the Internet

Special Style Manuals

Writing Handbooks

Appendix B: Collaborative Writing and Peer Reviewing

Collaborative Writing: Assignments to Accompany the Group Project

Collaborative Writing: Informal Progress Report

Collaborative Writing: Issues to Resolve

Collaborative Writing: Methodology

Collaborative Writing: Peer Evaluation

Collaborative Writing: Tasks of Collaborative Writing Group Members

Collaborative Writing: Writing Plan

General Introduction

Peer Reviewing

Appendix C: Developing an Improvement Plan

Working with Your Instructor’s Comments and Grades

Appendix D: Writing Plan and Project Schedule

Devising a Writing Project Plan and Schedule

Reviewing Your Plan with Others

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How To Write A Research Paper

Step-By-Step Tutorial With Examples + FREE Template

By: Derek Jansen (MBA) | Expert Reviewer: Dr Eunice Rautenbach | March 2024

For many students, crafting a strong research paper from scratch can feel like a daunting task – and rightly so! In this post, we’ll unpack what a research paper is, what it needs to do , and how to write one – in three easy steps. 🙂 

Overview: Writing A Research Paper

What (exactly) is a research paper.

• How to write a research paper
• Stage 1 : Topic & literature search
• Stage 2 : Structure & outline
• Stage 3 : Iterative writing
• Key takeaways

Let’s start by asking the most important question, “ What is a research paper? ”.

Simply put, a research paper is a scholarly written work where the writer (that’s you!) answers a specific question (this is called a research question ) through evidence-based arguments . Evidence-based is the keyword here. In other words, a research paper is different from an essay or other writing assignments that draw from the writer’s personal opinions or experiences. With a research paper, it’s all about building your arguments based on evidence (we’ll talk more about that evidence a little later).

Now, it’s worth noting that there are many different types of research papers , including analytical papers (the type I just described), argumentative papers, and interpretative papers. Here, we’ll focus on analytical papers , as these are some of the most common – but if you’re keen to learn about other types of research papers, be sure to check out the rest of the blog .

With that basic foundation laid, let’s get down to business and look at how to write a research paper .

Overview: The 3-Stage Process

While there are, of course, many potential approaches you can take to write a research paper, there are typically three stages to the writing process. So, in this tutorial, we’ll present a straightforward three-step process that we use when working with students at Grad Coach.

These three steps are:

• Finding a research topic and reviewing the existing literature
• Developing a provisional structure and outline for your paper, and
• Writing up your initial draft and then refining it iteratively

Let’s dig into each of these.

Need a helping hand?

Step 1: Find a topic and review the literature

As we mentioned earlier, in a research paper, you, as the researcher, will try to answer a question . More specifically, that’s called a research question , and it sets the direction of your entire paper. What’s important to understand though is that you’ll need to answer that research question with the help of high-quality sources – for example, journal articles, government reports, case studies, and so on. We’ll circle back to this in a minute.

The first stage of the research process is deciding on what your research question will be and then reviewing the existing literature (in other words, past studies and papers) to see what they say about that specific research question. In some cases, your professor may provide you with a predetermined research question (or set of questions). However, in many cases, you’ll need to find your own research question within a certain topic area.

Finding a strong research question hinges on identifying a meaningful research gap – in other words, an area that’s lacking in existing research. There’s a lot to unpack here, so if you wanna learn more, check out the plain-language explainer video below.

Once you’ve figured out which question (or questions) you’ll attempt to answer in your research paper, you’ll need to do a deep dive into the existing literature – this is called a “ literature search ”. Again, there are many ways to go about this, but your most likely starting point will be Google Scholar .

If you’re new to Google Scholar, think of it as Google for the academic world. You can start by simply entering a few different keywords that are relevant to your research question and it will then present a host of articles for you to review. What you want to pay close attention to here is the number of citations for each paper – the more citations a paper has, the more credible it is (generally speaking – there are some exceptions, of course).

Ideally, what you’re looking for are well-cited papers that are highly relevant to your topic. That said, keep in mind that citations are a cumulative metric , so older papers will often have more citations than newer papers – just because they’ve been around for longer. So, don’t fixate on this metric in isolation – relevance and recency are also very important.

Beyond Google Scholar, you’ll also definitely want to check out academic databases and aggregators such as Science Direct, PubMed, JStor and so on. These will often overlap with the results that you find in Google Scholar, but they can also reveal some hidden gems – so, be sure to check them out.

Once you’ve worked your way through all the literature, you’ll want to catalogue all this information in some sort of spreadsheet so that you can easily recall who said what, when and within what context. If you’d like, we’ve got a free literature spreadsheet that helps you do exactly that.

Step 2: Develop a structure and outline

With your research question pinned down and your literature digested and catalogued, it’s time to move on to planning your actual research paper .

It might sound obvious, but it’s really important to have some sort of rough outline in place before you start writing your paper. So often, we see students eagerly rushing into the writing phase, only to land up with a disjointed research paper that rambles on in multiple

Now, the secret here is to not get caught up in the fine details . Realistically, all you need at this stage is a bullet-point list that describes (in broad strokes) what you’ll discuss and in what order. It’s also useful to remember that you’re not glued to this outline – in all likelihood, you’ll chop and change some sections once you start writing, and that’s perfectly okay. What’s important is that you have some sort of roadmap in place from the start.

At this stage you might be wondering, “ But how should I structure my research paper? ”. Well, there’s no one-size-fits-all solution here, but in general, a research paper will consist of a few relatively standardised components:

• Introduction
• Literature review
• Methodology

Let’s take a look at each of these.

First up is the introduction section . As the name suggests, the purpose of the introduction is to set the scene for your research paper. There are usually (at least) four ingredients that go into this section – these are the background to the topic, the research problem and resultant research question , and the justification or rationale. If you’re interested, the video below unpacks the introduction section in more detail. 

The next section of your research paper will typically be your literature review . Remember all that literature you worked through earlier? Well, this is where you’ll present your interpretation of all that content . You’ll do this by writing about recent trends, developments, and arguments within the literature – but more specifically, those that are relevant to your research question . The literature review can oftentimes seem a little daunting, even to seasoned researchers, so be sure to check out our extensive collection of literature review content here .

With the introduction and lit review out of the way, the next section of your paper is the research methodology . In a nutshell, the methodology section should describe to your reader what you did (beyond just reviewing the existing literature) to answer your research question. For example, what data did you collect, how did you collect that data, how did you analyse that data and so on? For each choice, you’ll also need to justify why you chose to do it that way, and what the strengths and weaknesses of your approach were.

Now, it’s worth mentioning that for some research papers, this aspect of the project may be a lot simpler . For example, you may only need to draw on secondary sources (in other words, existing data sets). In some cases, you may just be asked to draw your conclusions from the literature search itself (in other words, there may be no data analysis at all). But, if you are required to collect and analyse data, you’ll need to pay a lot of attention to the methodology section. The video below provides an example of what the methodology section might look like.

By this stage of your paper, you will have explained what your research question is, what the existing literature has to say about that question, and how you analysed additional data to try to answer your question. So, the natural next step is to present your analysis of that data . This section is usually called the “results” or “analysis” section and this is where you’ll showcase your findings.

Depending on your school’s requirements, you may need to present and interpret the data in one section – or you might split the presentation and the interpretation into two sections. In the latter case, your “results” section will just describe the data, and the “discussion” is where you’ll interpret that data and explicitly link your analysis back to your research question. If you’re not sure which approach to take, check in with your professor or take a look at past papers to see what the norms are for your programme.

Alright – once you’ve presented and discussed your results, it’s time to wrap it up . This usually takes the form of the “ conclusion ” section. In the conclusion, you’ll need to highlight the key takeaways from your study and close the loop by explicitly answering your research question. Again, the exact requirements here will vary depending on your programme (and you may not even need a conclusion section at all) – so be sure to check with your professor if you’re unsure.

Step 3: Write and refine

Finally, it’s time to get writing. All too often though, students hit a brick wall right about here… So, how do you avoid this happening to you?

Well, there’s a lot to be said when it comes to writing a research paper (or any sort of academic piece), but we’ll share three practical tips to help you get started.

First and foremost , it’s essential to approach your writing as an iterative process. In other words, you need to start with a really messy first draft and then polish it over multiple rounds of editing. Don’t waste your time trying to write a perfect research paper in one go. Instead, take the pressure off yourself by adopting an iterative approach.

Secondly , it’s important to always lean towards critical writing , rather than descriptive writing. What does this mean? Well, at the simplest level, descriptive writing focuses on the “ what ”, while critical writing digs into the “ so what ” – in other words, the implications . If you’re not familiar with these two types of writing, don’t worry! You can find a plain-language explanation here.

Last but not least, you’ll need to get your referencing right. Specifically, you’ll need to provide credible, correctly formatted citations for the statements you make. We see students making referencing mistakes all the time and it costs them dearly. The good news is that you can easily avoid this by using a simple reference manager . If you don’t have one, check out our video about Mendeley, an easy (and free) reference management tool that you can start using today.

Recap: Key Takeaways

We’ve covered a lot of ground here. To recap, the three steps to writing a high-quality research paper are:

• To choose a research question and review the literature
• To plan your paper structure and draft an outline
• To take an iterative approach to writing, focusing on critical writing and strong referencing

Remember, this is just a b ig-picture overview of the research paper development process and there’s a lot more nuance to unpack. So, be sure to grab a copy of our free research paper template to learn more about how to write a research paper.

You Might Also Like:

Can you help me with a full paper template for this Abstract:

Background: Energy and sports drinks have gained popularity among diverse demographic groups, including adolescents, athletes, workers, and college students. While often used interchangeably, these beverages serve distinct purposes, with energy drinks aiming to boost energy and cognitive performance, and sports drinks designed to prevent dehydration and replenish electrolytes and carbohydrates lost during physical exertion.

Objective: To assess the nutritional quality of energy and sports drinks in Egypt.

Material and Methods: A cross-sectional study assessed the nutrient contents, including energy, sugar, electrolytes, vitamins, and caffeine, of sports and energy drinks available in major supermarkets in Cairo, Alexandria, and Giza, Egypt. Data collection involved photographing all relevant product labels and recording nutritional information. Descriptive statistics and appropriate statistical tests were employed to analyze and compare the nutritional values of energy and sports drinks.

Results: The study analyzed 38 sports drinks and 42 energy drinks. Sports drinks were significantly more expensive than energy drinks, with higher net content and elevated magnesium, potassium, and vitamin C. Energy drinks contained higher concentrations of caffeine, sugars, and vitamins B2, B3, and B6.

Conclusion: Significant nutritional differences exist between sports and energy drinks, reflecting their intended uses. However, these beverages’ high sugar content and calorie loads raise health concerns. Proper labeling, public awareness, and responsible marketing are essential to guide safe consumption practices in Egypt.

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Home » Research Paper – Structure, Examples and Writing Guide

Research Paper – Structure, Examples and Writing Guide

Table of Contents

Research Paper

Definition:

Research Paper is a written document that presents the author’s original research, analysis, and interpretation of a specific topic or issue.

It is typically based on Empirical Evidence, and may involve qualitative or quantitative research methods, or a combination of both. The purpose of a research paper is to contribute new knowledge or insights to a particular field of study, and to demonstrate the author’s understanding of the existing literature and theories related to the topic.

Structure of Research Paper

The structure of a research paper typically follows a standard format, consisting of several sections that convey specific information about the research study. The following is a detailed explanation of the structure of a research paper:

The title page contains the title of the paper, the name(s) of the author(s), and the affiliation(s) of the author(s). It also includes the date of submission and possibly, the name of the journal or conference where the paper is to be published.

The abstract is a brief summary of the research paper, typically ranging from 100 to 250 words. It should include the research question, the methods used, the key findings, and the implications of the results. The abstract should be written in a concise and clear manner to allow readers to quickly grasp the essence of the research.

Introduction

The introduction section of a research paper provides background information about the research problem, the research question, and the research objectives. It also outlines the significance of the research, the research gap that it aims to fill, and the approach taken to address the research question. Finally, the introduction section ends with a clear statement of the research hypothesis or research question.

Literature Review

The literature review section of a research paper provides an overview of the existing literature on the topic of study. It includes a critical analysis and synthesis of the literature, highlighting the key concepts, themes, and debates. The literature review should also demonstrate the research gap and how the current study seeks to address it.

The methods section of a research paper describes the research design, the sample selection, the data collection and analysis procedures, and the statistical methods used to analyze the data. This section should provide sufficient detail for other researchers to replicate the study.

The results section presents the findings of the research, using tables, graphs, and figures to illustrate the data. The findings should be presented in a clear and concise manner, with reference to the research question and hypothesis.

The discussion section of a research paper interprets the findings and discusses their implications for the research question, the literature review, and the field of study. It should also address the limitations of the study and suggest future research directions.

The conclusion section summarizes the main findings of the study, restates the research question and hypothesis, and provides a final reflection on the significance of the research.

The references section provides a list of all the sources cited in the paper, following a specific citation style such as APA, MLA or Chicago.

How to Write Research Paper

You can write Research Paper by the following guide:

• Choose a Topic: The first step is to select a topic that interests you and is relevant to your field of study. Brainstorm ideas and narrow down to a research question that is specific and researchable.
• Conduct a Literature Review: The literature review helps you identify the gap in the existing research and provides a basis for your research question. It also helps you to develop a theoretical framework and research hypothesis.
• Develop a Thesis Statement : The thesis statement is the main argument of your research paper. It should be clear, concise and specific to your research question.
• Plan your Research: Develop a research plan that outlines the methods, data sources, and data analysis procedures. This will help you to collect and analyze data effectively.
• Collect and Analyze Data: Collect data using various methods such as surveys, interviews, observations, or experiments. Analyze data using statistical tools or other qualitative methods.
• Organize your Paper : Organize your paper into sections such as Introduction, Literature Review, Methods, Results, Discussion, and Conclusion. Ensure that each section is coherent and follows a logical flow.
• Write your Paper : Start by writing the introduction, followed by the literature review, methods, results, discussion, and conclusion. Ensure that your writing is clear, concise, and follows the required formatting and citation styles.
• Edit and Proofread your Paper: Review your paper for grammar and spelling errors, and ensure that it is well-structured and easy to read. Ask someone else to review your paper to get feedback and suggestions for improvement.
• Cite your Sources: Ensure that you properly cite all sources used in your research paper. This is essential for giving credit to the original authors and avoiding plagiarism.

Research Paper Example

Note : The below example research paper is for illustrative purposes only and is not an actual research paper. Actual research papers may have different structures, contents, and formats depending on the field of study, research question, data collection and analysis methods, and other factors. Students should always consult with their professors or supervisors for specific guidelines and expectations for their research papers.

Research Paper Example sample for Students:

Title: The Impact of Social Media on Mental Health among Young Adults

Abstract: This study aims to investigate the impact of social media use on the mental health of young adults. A literature review was conducted to examine the existing research on the topic. A survey was then administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO (Fear of Missing Out) are significant predictors of mental health problems among young adults.

Introduction: Social media has become an integral part of modern life, particularly among young adults. While social media has many benefits, including increased communication and social connectivity, it has also been associated with negative outcomes, such as addiction, cyberbullying, and mental health problems. This study aims to investigate the impact of social media use on the mental health of young adults.

Literature Review: The literature review highlights the existing research on the impact of social media use on mental health. The review shows that social media use is associated with depression, anxiety, stress, and other mental health problems. The review also identifies the factors that contribute to the negative impact of social media, including social comparison, cyberbullying, and FOMO.

Methods : A survey was administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The survey included questions on social media use, mental health status (measured using the DASS-21), and perceived impact of social media on their mental health. Data were analyzed using descriptive statistics and regression analysis.

Results : The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO are significant predictors of mental health problems among young adults.

Discussion : The study’s findings suggest that social media use has a negative impact on the mental health of young adults. The study highlights the need for interventions that address the factors contributing to the negative impact of social media, such as social comparison, cyberbullying, and FOMO.

Conclusion : In conclusion, social media use has a significant impact on the mental health of young adults. The study’s findings underscore the need for interventions that promote healthy social media use and address the negative outcomes associated with social media use. Future research can explore the effectiveness of interventions aimed at reducing the negative impact of social media on mental health. Additionally, longitudinal studies can investigate the long-term effects of social media use on mental health.

Limitations : The study has some limitations, including the use of self-report measures and a cross-sectional design. The use of self-report measures may result in biased responses, and a cross-sectional design limits the ability to establish causality.

Implications: The study’s findings have implications for mental health professionals, educators, and policymakers. Mental health professionals can use the findings to develop interventions that address the negative impact of social media use on mental health. Educators can incorporate social media literacy into their curriculum to promote healthy social media use among young adults. Policymakers can use the findings to develop policies that protect young adults from the negative outcomes associated with social media use.

References :

• Twenge, J. M., & Campbell, W. K. (2019). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive medicine reports, 15, 100918.
• Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., … & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in Human Behavior, 69, 1-9.
• Van der Meer, T. G., & Verhoeven, J. W. (2017). Social media and its impact on academic performance of students. Journal of Information Technology Education: Research, 16, 383-398.

Appendix : The survey used in this study is provided below.

Social Media and Mental Health Survey

• How often do you use social media per day?
• Less than 30 minutes
• 30 minutes to 1 hour
• 1 to 2 hours
• 2 to 4 hours
• More than 4 hours
• Which social media platforms do you use?
• Others (Please specify)
• How often do you experience the following on social media?
• Social comparison (comparing yourself to others)
• Cyberbullying
• Fear of Missing Out (FOMO)
• Have you ever experienced any of the following mental health problems in the past month?
• Do you think social media use has a positive or negative impact on your mental health?
• Very positive
• Somewhat positive
• Somewhat negative
• Very negative
• In your opinion, which factors contribute to the negative impact of social media on mental health?
• Social comparison
• In your opinion, what interventions could be effective in reducing the negative impact of social media on mental health?
• Education on healthy social media use
• Counseling for mental health problems caused by social media
• Social media detox programs
• Regulation of social media use

Thank you for your participation!

Applications of Research Paper

Research papers have several applications in various fields, including:

• Advancing knowledge: Research papers contribute to the advancement of knowledge by generating new insights, theories, and findings that can inform future research and practice. They help to answer important questions, clarify existing knowledge, and identify areas that require further investigation.
• Informing policy: Research papers can inform policy decisions by providing evidence-based recommendations for policymakers. They can help to identify gaps in current policies, evaluate the effectiveness of interventions, and inform the development of new policies and regulations.
• Improving practice: Research papers can improve practice by providing evidence-based guidance for professionals in various fields, including medicine, education, business, and psychology. They can inform the development of best practices, guidelines, and standards of care that can improve outcomes for individuals and organizations.
• Educating students : Research papers are often used as teaching tools in universities and colleges to educate students about research methods, data analysis, and academic writing. They help students to develop critical thinking skills, research skills, and communication skills that are essential for success in many careers.
• Fostering collaboration: Research papers can foster collaboration among researchers, practitioners, and policymakers by providing a platform for sharing knowledge and ideas. They can facilitate interdisciplinary collaborations and partnerships that can lead to innovative solutions to complex problems.

When to Write Research Paper

Research papers are typically written when a person has completed a research project or when they have conducted a study and have obtained data or findings that they want to share with the academic or professional community. Research papers are usually written in academic settings, such as universities, but they can also be written in professional settings, such as research organizations, government agencies, or private companies.

Here are some common situations where a person might need to write a research paper:

• For academic purposes: Students in universities and colleges are often required to write research papers as part of their coursework, particularly in the social sciences, natural sciences, and humanities. Writing research papers helps students to develop research skills, critical thinking skills, and academic writing skills.
• For publication: Researchers often write research papers to publish their findings in academic journals or to present their work at academic conferences. Publishing research papers is an important way to disseminate research findings to the academic community and to establish oneself as an expert in a particular field.
• To inform policy or practice : Researchers may write research papers to inform policy decisions or to improve practice in various fields. Research findings can be used to inform the development of policies, guidelines, and best practices that can improve outcomes for individuals and organizations.
• To share new insights or ideas: Researchers may write research papers to share new insights or ideas with the academic or professional community. They may present new theories, propose new research methods, or challenge existing paradigms in their field.

Purpose of Research Paper

The purpose of a research paper is to present the results of a study or investigation in a clear, concise, and structured manner. Research papers are written to communicate new knowledge, ideas, or findings to a specific audience, such as researchers, scholars, practitioners, or policymakers. The primary purposes of a research paper are:

• To contribute to the body of knowledge : Research papers aim to add new knowledge or insights to a particular field or discipline. They do this by reporting the results of empirical studies, reviewing and synthesizing existing literature, proposing new theories, or providing new perspectives on a topic.
• To inform or persuade: Research papers are written to inform or persuade the reader about a particular issue, topic, or phenomenon. They present evidence and arguments to support their claims and seek to persuade the reader of the validity of their findings or recommendations.
• To advance the field: Research papers seek to advance the field or discipline by identifying gaps in knowledge, proposing new research questions or approaches, or challenging existing assumptions or paradigms. They aim to contribute to ongoing debates and discussions within a field and to stimulate further research and inquiry.
• To demonstrate research skills: Research papers demonstrate the author’s research skills, including their ability to design and conduct a study, collect and analyze data, and interpret and communicate findings. They also demonstrate the author’s ability to critically evaluate existing literature, synthesize information from multiple sources, and write in a clear and structured manner.

Characteristics of Research Paper

Research papers have several characteristics that distinguish them from other forms of academic or professional writing. Here are some common characteristics of research papers:

• Evidence-based: Research papers are based on empirical evidence, which is collected through rigorous research methods such as experiments, surveys, observations, or interviews. They rely on objective data and facts to support their claims and conclusions.
• Structured and organized: Research papers have a clear and logical structure, with sections such as introduction, literature review, methods, results, discussion, and conclusion. They are organized in a way that helps the reader to follow the argument and understand the findings.
• Formal and objective: Research papers are written in a formal and objective tone, with an emphasis on clarity, precision, and accuracy. They avoid subjective language or personal opinions and instead rely on objective data and analysis to support their arguments.
• Citations and references: Research papers include citations and references to acknowledge the sources of information and ideas used in the paper. They use a specific citation style, such as APA, MLA, or Chicago, to ensure consistency and accuracy.
• Peer-reviewed: Research papers are often peer-reviewed, which means they are evaluated by other experts in the field before they are published. Peer-review ensures that the research is of high quality, meets ethical standards, and contributes to the advancement of knowledge in the field.
• Objective and unbiased: Research papers strive to be objective and unbiased in their presentation of the findings. They avoid personal biases or preconceptions and instead rely on the data and analysis to draw conclusions.

Advantages of Research Paper

Research papers have many advantages, both for the individual researcher and for the broader academic and professional community. Here are some advantages of research papers:

• Contribution to knowledge: Research papers contribute to the body of knowledge in a particular field or discipline. They add new information, insights, and perspectives to existing literature and help advance the understanding of a particular phenomenon or issue.
• Opportunity for intellectual growth: Research papers provide an opportunity for intellectual growth for the researcher. They require critical thinking, problem-solving, and creativity, which can help develop the researcher’s skills and knowledge.
• Career advancement: Research papers can help advance the researcher’s career by demonstrating their expertise and contributions to the field. They can also lead to new research opportunities, collaborations, and funding.
• Academic recognition: Research papers can lead to academic recognition in the form of awards, grants, or invitations to speak at conferences or events. They can also contribute to the researcher’s reputation and standing in the field.
• Impact on policy and practice: Research papers can have a significant impact on policy and practice. They can inform policy decisions, guide practice, and lead to changes in laws, regulations, or procedures.
• Advancement of society: Research papers can contribute to the advancement of society by addressing important issues, identifying solutions to problems, and promoting social justice and equality.

Limitations of Research Paper

Research papers also have some limitations that should be considered when interpreting their findings or implications. Here are some common limitations of research papers:

• Limited generalizability: Research findings may not be generalizable to other populations, settings, or contexts. Studies often use specific samples or conditions that may not reflect the broader population or real-world situations.
• Potential for bias : Research papers may be biased due to factors such as sample selection, measurement errors, or researcher biases. It is important to evaluate the quality of the research design and methods used to ensure that the findings are valid and reliable.
• Ethical concerns: Research papers may raise ethical concerns, such as the use of vulnerable populations or invasive procedures. Researchers must adhere to ethical guidelines and obtain informed consent from participants to ensure that the research is conducted in a responsible and respectful manner.
• Limitations of methodology: Research papers may be limited by the methodology used to collect and analyze data. For example, certain research methods may not capture the complexity or nuance of a particular phenomenon, or may not be appropriate for certain research questions.
• Publication bias: Research papers may be subject to publication bias, where positive or significant findings are more likely to be published than negative or non-significant findings. This can skew the overall findings of a particular area of research.
• Time and resource constraints: Research papers may be limited by time and resource constraints, which can affect the quality and scope of the research. Researchers may not have access to certain data or resources, or may be unable to conduct long-term studies due to practical limitations.

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• How to write a research paper

Last updated

11 January 2024

Reviewed by

With proper planning, knowledge, and framework, completing a research paper can be a fulfilling and exciting experience. 

Though it might initially sound slightly intimidating, this guide will help you embrace the challenge. 

By documenting your findings, you can inspire others and make a difference in your field. Here's how you can make your research paper unique and comprehensive.

• What is a research paper?

Research papers allow you to demonstrate your knowledge and understanding of a particular topic. These papers are usually lengthier and more detailed than typical essays, requiring deeper insight into the chosen topic.

To write a research paper, you must first choose a topic that interests you and is relevant to the field of study. Once you’ve selected your topic, gathering as many relevant resources as possible, including books, scholarly articles, credible websites, and other academic materials, is essential. You must then read and analyze these sources, summarizing their key points and identifying gaps in the current research.

You can formulate your ideas and opinions once you thoroughly understand the existing research. To get there might involve conducting original research, gathering data, or analyzing existing data sets. It could also involve presenting an original argument or interpretation of the existing research.

Writing a successful research paper involves presenting your findings clearly and engagingly, which might involve using charts, graphs, or other visual aids to present your data and using concise language to explain your findings. You must also ensure your paper adheres to relevant academic formatting guidelines, including proper citations and references.

Overall, writing a research paper requires a significant amount of time, effort, and attention to detail. However, it is also an enriching experience that allows you to delve deeply into a subject that interests you and contribute to the existing body of knowledge in your chosen field.

• How long should a research paper be?

Research papers are deep dives into a topic. Therefore, they tend to be longer pieces of work than essays or opinion pieces. 

However, a suitable length depends on the complexity of the topic and your level of expertise. For instance, are you a first-year college student or an experienced professional? 

Also, remember that the best research papers provide valuable information for the benefit of others. Therefore, the quality of information matters most, not necessarily the length. Being concise is valuable.

Following these best practice steps will help keep your process simple and productive:

1. Gaining a deep understanding of any expectations

Before diving into your intended topic or beginning the research phase, take some time to orient yourself. Suppose there’s a specific topic assigned to you. In that case, it’s essential to deeply understand the question and organize your planning and approach in response. Pay attention to the key requirements and ensure you align your writing accordingly. 

This preparation step entails

Deeply understanding the task or assignment

Being clear about the expected format and length

Familiarizing yourself with the citation and referencing requirements 

Understanding any defined limits for your research contribution

Where applicable, speaking to your professor or research supervisor for further clarification

2. Choose your research topic

Select a research topic that aligns with both your interests and available resources. Ideally, focus on a field where you possess significant experience and analytical skills. In crafting your research paper, it's crucial to go beyond summarizing existing data and contribute fresh insights to the chosen area.

Consider narrowing your focus to a specific aspect of the topic. For example, if exploring the link between technology and mental health, delve into how social media use during the pandemic impacts the well-being of college students. Conducting interviews and surveys with students could provide firsthand data and unique perspectives, adding substantial value to the existing knowledge.

When finalizing your topic, adhere to legal and ethical norms in the relevant area (this ensures the integrity of your research, protects participants' rights, upholds intellectual property standards, and ensures transparency and accountability). Following these principles not only maintains the credibility of your work but also builds trust within your academic or professional community.

For instance, in writing about medical research, consider legal and ethical norms , including patient confidentiality laws and informed consent requirements. Similarly, if analyzing user data on social media platforms, be mindful of data privacy regulations, ensuring compliance with laws governing personal information collection and use. Aligning with legal and ethical standards not only avoids potential issues but also underscores the responsible conduct of your research.

3. Gather preliminary research

Once you’ve landed on your topic, it’s time to explore it further. You’ll want to discover more about available resources and existing research relevant to your assignment at this stage. 

This exploratory phase is vital as you may discover issues with your original idea or realize you have insufficient resources to explore the topic effectively. This key bit of groundwork allows you to redirect your research topic in a different, more feasible, or more relevant direction if necessary. 

Spending ample time at this stage ensures you gather everything you need, learn as much as you can about the topic, and discover gaps where the topic has yet to be sufficiently covered, offering an opportunity to research it further. 

4. Define your research question

To produce a well-structured and focused paper, it is imperative to formulate a clear and precise research question that will guide your work. Your research question must be informed by the existing literature and tailored to the scope and objectives of your project. By refining your focus, you can produce a thoughtful and engaging paper that effectively communicates your ideas to your readers.

5. Write a thesis statement

A thesis statement is a one-to-two-sentence summary of your research paper's main argument or direction. It serves as an overall guide to summarize the overall intent of the research paper for you and anyone wanting to know more about the research.

A strong thesis statement is:

Concise and clear: Explain your case in simple sentences (avoid covering multiple ideas). It might help to think of this section as an elevator pitch.

Specific: Ensure that there is no ambiguity in your statement and that your summary covers the points argued in the paper.

Debatable: A thesis statement puts forward a specific argument––it is not merely a statement but a debatable point that can be analyzed and discussed.

Here are three thesis statement examples from different disciplines:

Psychology thesis example: "We're studying adults aged 25-40 to see if taking short breaks for mindfulness can help with stress. Our goal is to find practical ways to manage anxiety better."

Environmental science thesis example: "This research paper looks into how having more city parks might make the air cleaner and keep people healthier. I want to find out if more green spaces means breathing fewer carcinogens in big cities."

UX research thesis example: "This study focuses on improving mobile banking for older adults using ethnographic research, eye-tracking analysis, and interactive prototyping. We investigate the usefulness of eye-tracking analysis with older individuals, aiming to spark debate and offer fresh perspectives on UX design and digital inclusivity for the aging population."

6. Conduct in-depth research

A research paper doesn’t just include research that you’ve uncovered from other papers and studies but your fresh insights, too. You will seek to become an expert on your topic––understanding the nuances in the current leading theories. You will analyze existing research and add your thinking and discoveries.  It's crucial to conduct well-designed research that is rigorous, robust, and based on reliable sources. Suppose a research paper lacks evidence or is biased. In that case, it won't benefit the academic community or the general public. Therefore, examining the topic thoroughly and furthering its understanding through high-quality research is essential. That usually means conducting new research. Depending on the area under investigation, you may conduct surveys, interviews, diary studies , or observational research to uncover new insights or bolster current claims.

7. Determine supporting evidence

Not every piece of research you’ve discovered will be relevant to your research paper. It’s important to categorize the most meaningful evidence to include alongside your discoveries. It's important to include evidence that doesn't support your claims to avoid exclusion bias and ensure a fair research paper.

8. Write a research paper outline

Before diving in and writing the whole paper, start with an outline. It will help you to see if more research is needed, and it will provide a framework by which to write a more compelling paper. Your supervisor may even request an outline to approve before beginning to write the first draft of the full paper. An outline will include your topic, thesis statement, key headings, short summaries of the research, and your arguments.

9. Write your first draft

Once you feel confident about your outline and sources, it’s time to write your first draft. While penning a long piece of content can be intimidating, if you’ve laid the groundwork, you will have a structure to help you move steadily through each section. To keep up motivation and inspiration, it’s often best to keep the pace quick. Stopping for long periods can interrupt your flow and make jumping back in harder than writing when things are fresh in your mind.

10. Cite your sources correctly

It's always a good practice to give credit where it's due, and the same goes for citing any works that have influenced your paper. Building your arguments on credible references adds value and authenticity to your research. In the formatting guidelines section, you’ll find an overview of different citation styles (MLA, CMOS, or APA), which will help you meet any publishing or academic requirements and strengthen your paper's credibility. It is essential to follow the guidelines provided by your school or the publication you are submitting to ensure the accuracy and relevance of your citations.

11. Ensure your work is original

It is crucial to ensure the originality of your paper, as plagiarism can lead to serious consequences. To avoid plagiarism, you should use proper paraphrasing and quoting techniques. Paraphrasing is rewriting a text in your own words while maintaining the original meaning. Quoting involves directly citing the source. Giving credit to the original author or source is essential whenever you borrow their ideas or words. You can also use plagiarism detection tools such as Scribbr or Grammarly to check the originality of your paper. These tools compare your draft writing to a vast database of online sources. If you find any accidental plagiarism, you should correct it immediately by rephrasing or citing the source.

12. Revise, edit, and proofread

One of the essential qualities of excellent writers is their ability to understand the importance of editing and proofreading. Even though it's tempting to call it a day once you've finished your writing, editing your work can significantly improve its quality. It's natural to overlook the weaker areas when you've just finished writing a paper. Therefore, it's best to take a break of a day or two, or even up to a week, to refresh your mind. This way, you can return to your work with a new perspective. After some breathing room, you can spot any inconsistencies, spelling and grammar errors, typos, or missing citations and correct them. 

• The best research paper format 

The format of your research paper should align with the requirements set forth by your college, school, or target publication. 

There is no one “best” format, per se. Depending on the stated requirements, you may need to include the following elements:

Title page: The title page of a research paper typically includes the title, author's name, and institutional affiliation and may include additional information such as a course name or instructor's name. 

Table of contents: Include a table of contents to make it easy for readers to find specific sections of your paper.

Abstract: The abstract is a summary of the purpose of the paper.

Methods : In this section, describe the research methods used. This may include collecting data , conducting interviews, or doing field research .

Results: Summarize the conclusions you drew from your research in this section.

Discussion: In this section, discuss the implications of your research . Be sure to mention any significant limitations to your approach and suggest areas for further research.

Tables, charts, and illustrations: Use tables, charts, and illustrations to help convey your research findings and make them easier to understand.

Works cited or reference page: Include a works cited or reference page to give credit to the sources that you used to conduct your research.

Bibliography: Provide a list of all the sources you consulted while conducting your research.

Dedication and acknowledgments : Optionally, you may include a dedication and acknowledgments section to thank individuals who helped you with your research.

• General style and formatting guidelines

Formatting your research paper means you can submit it to your college, journal, or other publications in compliance with their criteria.

Research papers tend to follow the American Psychological Association (APA), Modern Language Association (MLA), or Chicago Manual of Style (CMOS) guidelines.

Here’s how each style guide is typically used:

Chicago Manual of Style (CMOS):

CMOS is a versatile style guide used for various types of writing. It's known for its flexibility and use in the humanities. CMOS provides guidelines for citations, formatting, and overall writing style. It allows for both footnotes and in-text citations, giving writers options based on their preferences or publication requirements.

American Psychological Association (APA):

APA is common in the social sciences. It’s hailed for its clarity and emphasis on precision. It has specific rules for citing sources, creating references, and formatting papers. APA style uses in-text citations with an accompanying reference list. It's designed to convey information efficiently and is widely used in academic and scientific writing.

Modern Language Association (MLA):

MLA is widely used in the humanities, especially literature and language studies. It emphasizes the author-page format for in-text citations and provides guidelines for creating a "Works Cited" page. MLA is known for its focus on the author's name and the literary works cited. It’s frequently used in disciplines that prioritize literary analysis and critical thinking.

To confirm you're using the latest style guide, check the official website or publisher's site for updates, consult academic resources, and verify the guide's publication date. Online platforms and educational resources may also provide summaries and alerts about any revisions or additions to the style guide.

Citing sources

When working on your research paper, it's important to cite the sources you used properly. Your citation style will guide you through this process. Generally, there are three parts to citing sources in your research paper: 

First, provide a brief citation in the body of your essay. This is also known as a parenthetical or in-text citation. 

Second, include a full citation in the Reference list at the end of your paper. Different types of citations include in-text citations, footnotes, and reference lists. 

In-text citations include the author's surname and the date of the citation. 

Footnotes appear at the bottom of each page of your research paper. They may also be summarized within a reference list at the end of the paper. 

A reference list includes all of the research used within the paper at the end of the document. It should include the author, date, paper title, and publisher listed in the order that aligns with your citation style.

10 research paper writing tips:

Following some best practices is essential to writing a research paper that contributes to your field of study and creates a positive impact.

These tactics will help you structure your argument effectively and ensure your work benefits others:

Clear and precise language:  Ensure your language is unambiguous. Use academic language appropriately, but keep it simple. Also, provide clear takeaways for your audience.

Effective idea separation:  Organize the vast amount of information and sources in your paper with paragraphs and titles. Create easily digestible sections for your readers to navigate through.

Compelling intro:  Craft an engaging introduction that captures your reader's interest. Hook your audience and motivate them to continue reading.

Thorough revision and editing:  Take the time to review and edit your paper comprehensively. Use tools like Grammarly to detect and correct small, overlooked errors.

Thesis precision:  Develop a clear and concise thesis statement that guides your paper. Ensure that your thesis aligns with your research's overall purpose and contribution.

Logical flow of ideas:  Maintain a logical progression throughout the paper. Use transitions effectively to connect different sections and maintain coherence.

Critical evaluation of sources:  Evaluate and critically assess the relevance and reliability of your sources. Ensure that your research is based on credible and up-to-date information.

Thematic consistency:  Maintain a consistent theme throughout the paper. Ensure that all sections contribute cohesively to the overall argument.

Relevant supporting evidence:  Provide concise and relevant evidence to support your arguments. Avoid unnecessary details that may distract from the main points.

Embrace counterarguments:  Acknowledge and address opposing views to strengthen your position. Show that you have considered alternative arguments in your field.

7 research tips 

If you want your paper to not only be well-written but also contribute to the progress of human knowledge, consider these tips to take your paper to the next level:

Selecting the appropriate topic: The topic you select should align with your area of expertise, comply with the requirements of your project, and have sufficient resources for a comprehensive investigation.

Use academic databases: Academic databases such as PubMed, Google Scholar, and JSTOR offer a wealth of research papers that can help you discover everything you need to know about your chosen topic.

Critically evaluate sources: It is important not to accept research findings at face value. Instead, it is crucial to critically analyze the information to avoid jumping to conclusions or overlooking important details. A well-written research paper requires a critical analysis with thorough reasoning to support claims.

Diversify your sources: Expand your research horizons by exploring a variety of sources beyond the standard databases. Utilize books, conference proceedings, and interviews to gather diverse perspectives and enrich your understanding of the topic.

Take detailed notes: Detailed note-taking is crucial during research and can help you form the outline and body of your paper.

Stay up on trends: Keep abreast of the latest developments in your field by regularly checking for recent publications. Subscribe to newsletters, follow relevant journals, and attend conferences to stay informed about emerging trends and advancements. 

Engage in peer review: Seek feedback from peers or mentors to ensure the rigor and validity of your research . Peer review helps identify potential weaknesses in your methodology and strengthens the overall credibility of your findings.

• The real-world impact of research papers

Writing a research paper is more than an academic or business exercise. The experience provides an opportunity to explore a subject in-depth, broaden one's understanding, and arrive at meaningful conclusions. With careful planning, dedication, and hard work, writing a research paper can be a fulfilling and enriching experience contributing to advancing knowledge.

How do I publish my research paper? 

Many academics wish to publish their research papers. While challenging, your paper might get traction if it covers new and well-written information. To publish your research paper, find a target publication, thoroughly read their guidelines, format your paper accordingly, and send it to them per their instructions. You may need to include a cover letter, too. After submission, your paper may be peer-reviewed by experts to assess its legitimacy, quality, originality, and methodology. Following review, you will be informed by the publication whether they have accepted or rejected your paper. 

What is a good opening sentence for a research paper? 

Beginning your research paper with a compelling introduction can ensure readers are interested in going further. A relevant quote, a compelling statistic, or a bold argument can start the paper and hook your reader. Remember, though, that the most important aspect of a research paper is the quality of the information––not necessarily your ability to storytell, so ensure anything you write aligns with your goals.

Research paper vs. a research proposal—what’s the difference?

While some may confuse research papers and proposals, they are different documents. 

A research proposal comes before a research paper. It is a detailed document that outlines an intended area of exploration. It includes the research topic, methodology, timeline, sources, and potential conclusions. Research proposals are often required when seeking approval to conduct research. 

A research paper is a summary of research findings. A research paper follows a structured format to present those findings and construct an argument or conclusion.

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How to Write a Research Paper

Use the links below to jump directly to any section of this guide:

Research Paper Fundamentals

How to choose a topic or question, how to create a working hypothesis or thesis, common research paper methodologies, how to gather and organize evidence , how to write an outline for your research paper, how to write a rough draft, how to revise your draft, how to produce a final draft, resources for teachers .

It is not fair to say that no one writes anymore. Just about everyone writes text messages, brief emails, or social media posts every single day. Yet, most people don't have a lot of practice with the formal, organized writing required for a good academic research paper. This guide contains links to a variety of resources that can help demystify the process. Some of these resources are intended for teachers; they contain exercises, activities, and teaching strategies. Other resources are intended for direct use by students who are struggling to write papers, or are looking for tips to make the process go more smoothly.

The resources in this section are designed to help students understand the different types of research papers, the general research process, and how to manage their time. Below, you'll find links from university writing centers, the trusted Purdue Online Writing Lab, and more.

What is an Academic Research Paper?

"Genre and the Research Paper" (Purdue OWL)

There are different types of research papers. Different types of scholarly questions will lend themselves to one format or another. This is a brief introduction to the two main genres of research paper: analytic and argumentative. 

"7 Most Popular Types of Research Papers" (Personal-writer.com)

This resource discusses formats that high school students commonly encounter, such as the compare and contrast essay and the definitional essay. Please note that the inclusion of this link is not an endorsement of this company's paid service.

How to Prepare and Plan Out Writing a Research Paper

Teachers can give their students a step-by-step guide like these to help them understand the different steps of the research paper process. These guides can be combined with the time management tools in the next subsection to help students come up with customized calendars for completing their papers.

"Ten Steps for Writing Research Papers" (American University)  

This resource from American University is a comprehensive guide to the research paper writing process, and includes examples of proper research questions and thesis topics.

"Steps in Writing a Research Paper" (SUNY Empire State College)

This guide breaks the research paper process into 11 steps. Each "step" links to a separate page, which describes the work entailed in completing it.

How to Manage Time Effectively

The links below will help students determine how much time is necessary to complete a paper. If your sources are not available online or at your local library, you'll need to leave extra time for the Interlibrary Loan process. Remember that, even if you do not need to consult secondary sources, you'll still need to leave yourself ample time to organize your thoughts.

"Research Paper Planner: Timeline" (Baylor University)

This interactive resource from Baylor University creates a suggested writing schedule based on how much time a student has to work on the assignment.

"Research Paper Planner" (UCLA)

UCLA's library offers this step-by-step guide to the research paper writing process, which also includes a suggested planning calendar.

There's a reason teachers spend a long time talking about choosing a good topic. Without a good topic and a well-formulated research question, it is almost impossible to write a clear and organized paper. The resources below will help you generate ideas and formulate precise questions.

"How to Select a Research Topic" (Univ. of Michigan-Flint)

This resource is designed for college students who are struggling to come up with an appropriate topic. A student who uses this resource and still feels unsure about his or her topic should consult the course instructor for further personalized assistance.

"25 Interesting Research Paper Topics to Get You Started" (Kibin)

This resource, which is probably most appropriate for high school students, provides a list of specific topics to help get students started. It is broken into subsections, such as "paper topics on local issues."

"Writing a Good Research Question" (Grand Canyon University)

This introduction to research questions includes some embedded videos, as well as links to scholarly articles on research questions. This resource would be most appropriate for teachers who are planning lessons on research paper fundamentals.

"How to Write a Research Question the Right Way" (Kibin)

This student-focused resource provides more detail on writing research questions. The language is accessible, and there are embedded videos and examples of good and bad questions.

It is important to have a rough hypothesis or thesis in mind at the beginning of the research process. People who have a sense of what they want to say will have an easier time sorting through scholarly sources and other information. The key, of course, is not to become too wedded to the draft hypothesis or thesis. Just about every working thesis gets changed during the research process.

CrashCourse Video: "Sociology Research Methods" (YouTube)

Although this video is tailored to sociology students, it is applicable to students in a variety of social science disciplines. This video does a good job demonstrating the connection between the brainstorming that goes into selecting a research question and the formulation of a working hypothesis.

"How to Write a Thesis Statement for an Analytical Essay" (YouTube)

Students writing analytical essays will not develop the same type of working hypothesis as students who are writing research papers in other disciplines. For these students, developing the working thesis may happen as a part of the rough draft (see the relevant section below). 

"Research Hypothesis" (Oakland Univ.)

This resource provides some examples of hypotheses in social science disciplines like Political Science and Criminal Justice. These sample hypotheses may also be useful for students in other soft social sciences and humanities disciplines like History.

When grading a research paper, instructors look for a consistent methodology. This section will help you understand different methodological approaches used in research papers. Students will get the most out of these resources if they use them to help prepare for conversations with teachers or discussions in class.

"Types of Research Designs" (USC)

A "research design," used for complex papers, is related to the paper's method. This resource contains introductions to a variety of popular research designs in the social sciences. Although it is not the most intuitive site to read, the information here is very valuable. 

"Major Research Methods" (YouTube)

Although this video is a bit on the dry side, it provides a comprehensive overview of the major research methodologies in a format that might be more accessible to students who have struggled with textbooks or other written resources.

"Humanities Research Strategies" (USC)

This is a portal where students can learn about four methodological approaches for humanities papers: Historical Methodologies, Textual Criticism, Conceptual Analysis, and the Synoptic method.

"Selected Major Social Science Research Methods: Overview" (National Academies Press)

This appendix from the book  Using Science as Evidence in Public Policy , printed by National Academies Press, introduces some methods used in social science papers.

"Organizing Your Social Sciences Research Paper: 6. The Methodology" (USC)

This resource from the University of Southern California's library contains tips for writing a methodology section in a research paper.

How to Determine the Best Methodology for You

Anyone who is new to writing research papers should be sure to select a method in consultation with their instructor. These resources can be used to help prepare for that discussion. They may also be used on their own by more advanced students.

"Choosing Appropriate Research Methodologies" (Palgrave Study Skills)

This friendly and approachable resource from Palgrave Macmillan can be used by students who are just starting to think about appropriate methodologies.

"How to Choose Your Research Methods" (NFER (UK))

This is another approachable resource students can use to help narrow down the most appropriate methods for their research projects.

The resources in this section introduce the process of gathering scholarly sources and collecting evidence. You'll find a range of material here, from introductory guides to advanced explications best suited to college students. Please consult the LitCharts  How to Do Academic Research guide for a more comprehensive list of resources devoted to finding scholarly literature.

Google Scholar

Students who have access to library websites with detailed research guides should start there, but people who do not have access to those resources can begin their search for secondary literature here.

"Gathering Appropriate Information" (Texas Gateway)

This resource from the Texas Gateway for online resources introduces students to the research process, and contains interactive exercises. The level of complexity is suitable for middle school, high school, and introductory college classrooms.

"An Overview of Quantitative and Qualitative Data Collection Methods" (NSF)

This PDF from the National Science Foundation goes into detail about best practices and pitfalls in data collection across multiple types of methodologies.

"Social Science Methods for Data Collection and Analysis" (Swiss FIT)

This resource is appropriate for advanced undergraduates or teachers looking to create lessons on research design and data collection. It covers techniques for gathering data via interviews, observations, and other methods.

"Collecting Data by In-depth Interviewing" (Leeds Univ.)

This resource contains enough information about conducting interviews to make it useful for teachers who want to create a lesson plan, but is also accessible enough for college juniors or seniors to make use of it on their own.

There is no "one size fits all" outlining technique. Some students might devote all their energy and attention to the outline in order to avoid the paper. Other students may benefit from being made to sit down and organize their thoughts into a lengthy sentence outline. The resources in this section include strategies and templates for multiple types of outlines. 

"Topic vs. Sentence Outlines" (UC Berkeley)

This resource introduces two basic approaches to outlining: the shorter topic-based approach, and the longer, more detailed sentence-based approach. This resource also contains videos on how to develop paper paragraphs from the sentence-based outline.

"Types of Outlines and Samples" (Purdue OWL)

The Purdue Online Writing Lab's guide is a slightly less detailed discussion of different types of outlines. It contains several sample outlines.

"Writing An Outline" (Austin C.C.)

This resource from a community college contains sample outlines from an American history class that students can use as models.

"How to Structure an Outline for a College Paper" (YouTube)

This brief (sub-2 minute) video from the ExpertVillage YouTube channel provides a model of outline writing for students who are struggling with the idea.

"Outlining" (Harvard)

This is a good resource to consult after completing a draft outline. It offers suggestions for making sure your outline avoids things like unnecessary repetition.

As with outlines, rough drafts can take on many different forms. These resources introduce teachers and students to the various approaches to writing a rough draft. This section also includes resources that will help you cite your sources appropriately according to the MLA, Chicago, and APA style manuals.

"Creating a Rough Draft for a Research Paper" (Univ. of Minnesota)

This resource is useful for teachers in particular, as it provides some suggested exercises to help students with writing a basic rough draft. 

Rough Draft Assignment (Duke of Definition)

This sample assignment, with a brief list of tips, was developed by a high school teacher who runs a very successful and well-reviewed page of educational resources.

"Creating the First Draft of Your Research Paper" (Concordia Univ.)

This resource will be helpful for perfectionists or procrastinators, as it opens by discussing the problem of avoiding writing. It also provides a short list of suggestions meant to get students writing.

Using Proper Citations

There is no such thing as a rough draft of a scholarly citation. These links to the three major citation guides will ensure that your citations follow the correct format. Please consult the LitCharts How to Cite Your Sources guide for more resources.

Chicago Manual of Style Citation Guide

Some call  The Chicago Manual of Style , which was first published in 1906, "the editors' Bible." The manual is now in its 17th edition, and is popular in the social sciences, historical journals, and some other fields in the humanities.

APA Citation Guide

According to the American Psychological Association, this guide was developed to aid reading comprehension, clarity of communication, and to reduce bias in language in the social and behavioral sciences. Its first full edition was published in 1952, and it is now in its sixth edition.

MLA Citation Guide

The Modern Language Association style is used most commonly within the liberal arts and humanities. The  MLA Style Manual and Guide to Scholarly Publishing  was first published in 1985 and (as of 2008) is in its third edition.

Any professional scholar will tell you that the best research papers are made in the revision stage. No matter how strong your research question or working thesis, it is not possible to write a truly outstanding paper without devoting energy to revision. These resources provide examples of revision exercises for the classroom, as well as tips for students working independently.

"The Art of Revision" (Univ. of Arizona)

This resource provides a wealth of information and suggestions for both students and teachers. There is a list of suggested exercises that teachers might use in class, along with a revision checklist that is useful for teachers and students alike.

"Script for Workshop on Revision" (Vanderbilt University)

Vanderbilt's guide for leading a 50-minute revision workshop can serve as a model for teachers who wish to guide students through the revision process during classtime. 

"Revising Your Paper" (Univ. of Washington)

This detailed handout was designed for students who are beginning the revision process. It discusses different approaches and methods for revision, and also includes a detailed list of things students should look for while they revise.

"Revising Drafts" (UNC Writing Center)

This resource is designed for students and suggests things to look for during the revision process. It provides steps for the process and has a FAQ for students who have questions about why it is important to revise.

Conferencing with Writing Tutors and Instructors

No writer is so good that he or she can't benefit from meeting with instructors or peer tutors. These resources from university writing, learning, and communication centers provide suggestions for how to get the most out of these one-on-one meetings.

"Getting Feedback" (UNC Writing Center)

This very helpful resource talks about how to ask for feedback during the entire writing process. It contains possible questions that students might ask when developing an outline, during the revision process, and after the final draft has been graded.

"Prepare for Your Tutoring Session" (Otis College of Art and Design)

This guide from a university's student learning center contains a lot of helpful tips for getting the most out of working with a writing tutor.

"The Importance of Asking Your Professor" (Univ. of Waterloo)

This article from the university's Writing and Communication Centre's blog contains some suggestions for how and when to get help from professors and Teaching Assistants.

Once you've revised your first draft, you're well on your way to handing in a polished paper. These resources—each of them produced by writing professionals at colleges and universities—outline the steps required in order to produce a final draft. You'll find proofreading tips and checklists in text and video form.

"Developing a Final Draft of a Research Paper" (Univ. of Minnesota)

While this resource contains suggestions for revision, it also features a couple of helpful checklists for the last stages of completing a final draft.

Basic Final Draft Tips and Checklist (Univ. of Maryland-University College)

This short and accessible resource, part of UMUC's very thorough online guide to writing and research, contains a very basic checklist for students who are getting ready to turn in their final drafts.

Final Draft Checklist (Everett C.C.)

This is another accessible final draft checklist, appropriate for both high school and college students. It suggests reading your essay aloud at least once.

"How to Proofread Your Final Draft" (YouTube)

This video (approximately 5 minutes), produced by Eastern Washington University, gives students tips on proofreading final drafts.

"Proofreading Tips" (Georgia Southern-Armstrong)

This guide will help students learn how to spot common errors in their papers. It suggests focusing on content and editing for grammar and mechanics.

This final set of resources is intended specifically for high school and college instructors. It provides links to unit plans and classroom exercises that can help improve students' research and writing skills. You'll find resources that give an overview of the process, along with activities that focus on how to begin and how to carry out research. 

"Research Paper Complete Resources Pack" (Teachers Pay Teachers)

This packet of assignments, rubrics, and other resources is designed for high school students. The resources in this packet are aligned to Common Core standards.

"Research Paper—Complete Unit" (Teachers Pay Teachers)

This packet of assignments, notes, PowerPoints, and other resources has a 4/4 rating with over 700 ratings. It is designed for high school teachers, but might also be useful to college instructors who work with freshmen.

"Teaching Students to Write Good Papers" (Yale)

This resource from Yale's Center for Teaching and Learning is designed for college instructors, and it includes links to appropriate activities and exercises.

"Research Paper Writing: An Overview" (CUNY Brooklyn)

CUNY Brooklyn offers this complete lesson plan for introducing students to research papers. It includes an accompanying set of PowerPoint slides.

"Lesson Plan: How to Begin Writing a Research Paper" (San Jose State Univ.)

This lesson plan is designed for students in the health sciences, so teachers will have to modify it for their own needs. It includes a breakdown of the brainstorming, topic selection, and research question process. 

"Quantitative Techniques for Social Science Research" (Univ. of Pittsburgh)

This is a set of PowerPoint slides that can be used to introduce students to a variety of quantitative methods used in the social sciences.

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Writing a Research Paper

This page lists some of the stages involved in writing a library-based research paper.

Although this list suggests that there is a simple, linear process to writing such a paper, the actual process of writing a research paper is often a messy and recursive one, so please use this outline as a flexible guide.

Discovering, Narrowing, and Focusing a Researchable Topic

• Try to find a topic that truly interests you
• Try writing your way to a topic
• Talk with your course instructor and classmates about your topic
• Pose your topic as a question to be answered or a problem to be solved

Finding, Selecting, and Reading Sources

You will need to look at the following types of sources:

• library catalog, periodical indexes, bibliographies, suggestions from your instructor
• primary vs. secondary sources
• journals, books, other documents

Grouping, Sequencing, and Documenting Information

The following systems will help keep you organized:

• a system for noting sources on bibliography cards
• a system for organizing material according to its relative importance
• a system for taking notes

Writing an Outline and a Prospectus for Yourself

Consider the following questions:

• What is the topic?
• Why is it significant?
• What background material is relevant?
• What is my thesis or purpose statement?
• What organizational plan will best support my purpose?

Writing the Introduction

In the introduction you will need to do the following things:

• present relevant background or contextual material
• define terms or concepts when necessary
• explain the focus of the paper and your specific purpose
• reveal your plan of organization

Writing the Body

• Use your outline and prospectus as flexible guides
• Build your essay around points you want to make (i.e., don’t let your sources organize your paper)
• Integrate your sources into your discussion
• Summarize, analyze, explain, and evaluate published work rather than merely reporting it
• Move up and down the “ladder of abstraction” from generalization to varying levels of detail back to generalization

Writing the Conclusion

• If the argument or point of your paper is complex, you may need to summarize the argument for your reader.
• If prior to your conclusion you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to add your points up, to explain their significance.
• Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction.
• Perhaps suggest what about this topic needs further research.

Revising the Final Draft

• Check overall organization : logical flow of introduction, coherence and depth of discussion in body, effectiveness of conclusion.
• Paragraph level concerns : topic sentences, sequence of ideas within paragraphs, use of details to support generalizations, summary sentences where necessary, use of transitions within and between paragraphs.
• Sentence level concerns: sentence structure, word choices, punctuation, spelling.
• Documentation: consistent use of one system, citation of all material not considered common knowledge, appropriate use of endnotes or footnotes, accuracy of list of works cited.

Academic and Professional Writing

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Analysis Papers

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• Open access
• Published: 06 January 2022

Online student support: a framework for embedding support interventions into the online learning cycle

• O. Rotar   ORCID: orcid.org/0000-0001-7298-6444   nAff1  

Research and Practice in Technology Enhanced Learning volume  17 , Article number:  2 ( 2022 ) Cite this article

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Support is one of the crucial elements of online students’ success. Although many support strategies have been documented in the past, less is known at what stages of the learning cycle suggested interventions can be embedded into the online learning curriculum. This paper offers a systematic review of the 28 empirical studies on effective support strategies and interventions that are indexed by the SCOPUS database between 2010 and 2020. Following an Inclusive Student Services Process Model framework, identified strategies are allocated across different phases of student learning to indicate where and when they can be delivered to online students. The analysis suggests that the effectiveness of the support provision depends on the time when support is offered. Furthermore, it was found that two areas support delivery, namely support at transitions and measurement of support interventions, remain under-researched. Finally, the analysis showed two emerging trends in online students support: an increasing role of technology and social network sites to design support interventions and a shift to a more personalised yet holistic approach to student support.

Introduction

Successful learning at a distance requires students to possess specific skills and attributes. As Brindley ( 2014 ) emphasised, “studying at a distance requires maturity, a high level of motivation, the capacity to multi-task, goal-directedness, and the ability to work independently and cooperatively” (p. 278). Furthermore, she stated that,

Distance learners are expected to plan their academic programs, set their study schedules, balance their studies with other responsibilities (work/family), communicate proficiently in writing, find and use learning resources well, and read and synthesise efficiently. Those distance learners studying in cohorts are expected to collaborate effectively with their peers in virtual groups, and those studying in self-paced courses are often expected to create their own learning networks (Brindley, 2014 , p. 278).

However, mentioned above prerequisites may not be present in all students, and many online learners face challenges and barriers in their learning (Martin & Bolliger, 2018 ; Stone, 2017 ; Woodley & Simpson, 2014 ). It is widely recognised that student support is critical for overcoming barriers to learning and ensuring learner engagement, motivation and success in online higher education (see Rotar, 2020 ; Muljana & Luo, 2019 ). Although many support strategies are available for review, there were no attempts to systematically analyse them in relation to different stages of student learning. As a result, there is a lack of understanding of where and when student support can be embedded into the online learning curriculum (Rumble, 2000 ). To address limitations of the past research, this study poses the following research question: What support strategies and interventions can be offered to online students at different phases of the learning cycle?

By bringing together research on reported support strategies and interventions, this paper aims to generate insights into the development of a framework for embedding support interventions into the online learning cycle. In doing so, this paper offers a unique contribution to the research on student support within the field of online education.

Literature review

A provision of student support is a necessary element of online student success (Rumble, 2000 ) that has been recognised in the past (Woodley & Simpson, 2014 ) and continues to be relevant within the research on student’s attrition, retention, and dropout (Rotar, 2020 ). Different support models offer valuable conceptual frameworks for thinking about the approach to online student support (see Floyd & Casey-Powell, 2004 ; Ryan, 2004 ; Simpson, 2008 ). Ryan ( 2004 ) advocated a “centrality of student–student communication for retention and study success” (p. 131). He proposed a logical framework for maintaining support for online learners with a student as a centre of the model and argued that his framework “is best situated within the knowledge of the distance student’s lifecycle, from initial interest in distance education as a possible avenue for study, to inquiry at a particular institution, through academic counselling, to study and eventual graduation” (p. 127).

Floyd and Casey-Powell ( 2004 ) offered an Inclusive Student Services Process Model (ISSPM) where they summarised characteristics of successful support service and distinguished five phases of the learning cycle where support can be provided. Another model developed by Simpson ( 2008 ) advocates the need for proactive rather than reactive support interventions. Simpson’s Proactive Motivational Support model (Simpson, 2008 ) contains motivation and psychology elements and determines a proactive student outreach as an effective support intervention.

The models of online student support evolved since the invention of the Internet. The Internet facilitated the emergence of customised and automated services that can be delivered by computers rather than humans (Brindley, 2014 ; Dollingeret al., 2020 ; Walsh et al., 2020 ). It also enabled an opportunity to include social elements, e.g., online interactions and engagement, into support interventions. As Zawacki-Richter and Anderson ( 2014 ) emphasised, “the online world itself affords new tools for communication, knowledge and skill acquisition, and peer and group support that was not available to earlier generations of distance students” (p. 23).

Within the discourse on the affordances of the Internet, Moore and Kearsley ( 2012 ) introduced a theory of transactional distance that placed a significant emphasis on the development of an understanding of the very concept of online learner support. A new approach presented online student support as an intervention that intends to decrease a transactional distance between learners, a tutor, and an educational institution and helps the learner develop autonomy.

Whilst offering multiple benefits for providing new forms of student support via advanced technological and pedagogical tools, there has been a criticism of the potentially oppressive nature of online learning environments (Öztok, 2019 ; Rice et al., 2020 ). Such criticism resulted in the turn to the humanistic view on online student support, which placed a greater emphasis on personalised learner support. Research on online students’ experiences and perceptions also confirmed that embodied humanistic (as opposed to mechanistic) approaches for online learning support are critical for transformative learning experiences (Brown & Wilson, 2016 ; Sewart, 1993 ; Stone, 2019 ; Thorpe, 2002 ).

The reviewed literature highlights the evolution of support strategies from depersonalised and additional services into the more targeted and tailored to diverse student bodies’ needs, emphasises the increasing utilisation of the affordance of the Internet in offering support interventions. As Brindley ( 2014 ) states, “support systems for distance learners have become more proactive, more purposeful, and more effective in helping learners succeed in their studies”. (p. 305). Furthermore, the literature suggests that the consideration of the stage where support is offered is essential for the support strategy to be effective (Floyd & Casey-Powell, 2004 ; Ryan, 2004 ). However, little research has been done to systematically analyse specifically designed for online students support strategies or interventions in relation to the stages where they can be best implemented. By bringing together research on online student support strategies and interventions, this paper aims to generate insights into the development of the embedded support system that incorporates different phases of the learning cycle. In doing so, this paper offers a unique contribution to the research on student support within the field of online education.

Analytical frame

To analyse the identified support strategies and interventions, I employ an Inclusive Student Services Process Model (ISSPM) developed by Floyd and Casey-Powell ( 2004 ). The ISSPM is based loosely on Miller and Prince’s ( 1976 ) student development process model, which was intended to “meet the needs of all students, to plan for change rather than react to it, and to engage the full academic community in this collaborative effort” (p. 21).

In the ISSPM, Floyd and Casey-Powell ( 2004 ) summarised characteristics of successful support services and distinguished five phases of the learning cycle where support can be provided namely the student intake phase, student intervention phase, student support phase, the student transition phase, and a measurement phase. The focus during each phase is summarised in Table 1 .

The ISSPM framework is useful for the analysis as it identifies essential tasks for each stage of student learning and provides examples of support services that can be offered. The five stages of this multidimensional model offer a systemic and targeted approach to student support, placing the needs of students upfront. Furthermore, it suggests that the successfully support service holds the potential to benefit both learners and an educational institution. Thus, the application of the model as an analytical frame provides a wide angle for the analysis of the existing online student support strategies and interventions and assists in addressing the research question.

Methodology

This paper offers a systematic review of the online student support strategies and interventions reported over the last ten years. Furthermore, it provides a thematic analysis of recommendations for student support offered in the empirical studies in relation to the five stages of the learning cycle where identified strategies fit the best.

To examine online students’ support strategies and interventions, I considered studies published from 2010 to 2020 in peer-reviewed journals. To identify relevant studies, a set of inclusion and exclusion criteria has been set:

Due to the application of the ISSPM (Floyd & Casey-Powell, 2004 ) as an analytical frame, only research focused on the conception of online student support within the scope of five stages of the learning cycle: (1) intake stage, (2) orientation stage, (3) support stage, (4) transition stage and (5) measurement stage has been included into the analysis.

Only empirical studies have been considered. Non-empirical and opinion papers were excluded.

Only research that reported a concrete support strategy or support intervention within the scope of five stages of the learning cycle had been included in the further analysis.

Only peer-reviewed papers published in the English language between 2010 and 2020 have been considered. The ten-year period has been set to examine the most up-to-date literature on online students’ support.

Identification of the relevant studies

I adopted the identification process that involved three phases: searching, screening and analysis (Karabulut-Ilgu et al., 2018 ; Muljana & Luo, 2019 ).

Relevant studies were retrieved through a series of search efforts. Eligible research that meets the selection criteria were then identified. The search was carried out in two stages. First, an initial search was performed in the Scopus database. Keyword searches were conducted using the combinations of terms “support strateg*”, “support intervention*”, “student support” AND “online education”, “online higher education”, “online learning”, “distance learning”, “distance education”. Keywords have been selected to reflect the scope of this research and the research question. As a result, I identified 180 peer reviewed articles from this phase of searching.

The screening process aimed to identify relevant studies by reading the abstract of the paper and by application of the selected criteria. During this process, articles that did not meet the inclusion criteria (e.g., non-empirical articles, opinion papers, not peer-reviewed papers) were excluded from the further analysis. Additionally, duplicate reports of the same study were eliminated. The abstract screening yielded 38 peer-reviewed articles on the topic of interest for this paper, published between 2010 and 2020.

The analysis process consisted of full-text reading. At this stage, several non-empirical studies and studies that deviate from the focus of this paper (e.g., articles that reported support interventions that do not fall into any phase of the learning cycle) have been identified and excluded from the analysis. The process of analysis resulted in a pool of 28 articles. All articles were arranged in tabular form. Five phases of the learning cycle have been analysed applying the ISSPM framework (Floyd & Casey-Powell, 2004 ). During the analysis phase, I identified additional literature that did not meet inclusion criteria but was relevant for enhancing the analysis and discussion.

In the following part of the paper, I discuss the results of the systematic literature review of the studies that reported online student support strategies and interventions. The summary of the identified relevant studies is presented in Table 1 . The Table contains the details of selected studies, including author (s), publication date, considered strategy, and its effectiveness.

Following the ISSPM framework, the identified support strategies, recommendations and interventions are allocated across the five phases of the educational life cycle to indicate the areas where they can be embedded into the online learning curriculum.

Student Intake Phase

Advising prior to enrolment.

Past research advocates the provision of advising services on various aspects of learning prior to the enrolment (Cain & Lockee, 2002 ; Clay et al., 2008 ). It was found that the lack of comprehensive information about the chosen online programme was a main cause of misconceptions about requirements and a difficulty of the course (Clay et al., 2008 ). The review of the considered studies also supported the importance of the pre-enrolment advising. Gaytan ( 2015 ) believes that academic advisors must articulate study agreements regarding the credit transfer more clearly and provide advising strategies to ensure that students receive credit for previous coursework. Another example is a mandatory pre-enrolment initiative is an online readiness survey (Nichols, 2010 ). The author proposed that such a survey provide students with essential information needed for the decision-making process and decrease the mismatch in students’ expectations.

Orientation

Orientation programmes are proven to support student transition to the higher education (HE) and ensure the “scaffolded entry” (Stone, 2019 , p. 5) to the online learning environment (Horvath et al., 2019 ; Nichols, 2010 ; Walters-Archie, 2018 ). This support strategy implies a “greater emphasis at the front end” (Stone, 2019 , p. 5) and an establishment of an early connection with students (Gaytan, 2015 ). Through the orientation programme, students can also access “online tester experiences” (Kear et al., 2016 , p. 141) that allow them to evaluate their online learning skills and readiness to study in the online learning environment. As emphasised in the E-excellence framework, “students should be informed prior to registration about the skills they will need to develop, and the study skills support available to them” (Kear et al., 2016 , p. 141).

Orientation programmes also prepare students for their learning online after the enrolment. One example is a holistic pre-course orientation programme (see Walters-Archie, 2018 ) that consisted of four phases: an introduction to the online learning environment with the focus on navigation skills, an introduction to the structure and requirements of the programme, an introduction to the learning environment with the focus on practical activities (e.g. group discussions, quizzes), and an introduction to course facilitators. Walters-Archie ( 2018 ) reported that 94% of students found the orientation programme beneficial. Another example is orientation programme designed by Horvath et al. ( 2019 ) that include three modules, namely plan, prepare, and connect. Each module provides students with learning resources, video presentations, study guides, “Meet the experts” interactive Zoom seminars and “Getting Prepared for Study” quizzes that aim to clarify student expectations, present available support services and enhance students’ engagement.

Intervention phase

Identification of students at- risk and early interventions.

Netanda et al. ( 2019 ) found that novice online learners are also at a greater risk to face challenges when adjusting to the online learning environment than more experienced learners (p. 405). According to Purnell et al. ( 2010 ) “early intervention with weaker achieving student” enhance student retention (p. 78).

Identification of students at risk has been also emphasized in the past research (Gibbs et al., 2006 ; McKavanagh & Purnell, 2007 ). McKavanagh and Purnell ( 2007 ) pointed at distinctive features of those students such as lack of motivation, unrealistic time management expectations, and hesitation to reach for help (p. 79). In the United Kingdom Open University (UK OU) vulnerable or at-risk students have been identified based on the analysis institutional data (e.g. students’ sex, age, educational and professional experience) (Gibbs et al., 2006 ). A proposed support strategy involved contacting those students who have been identified as needing advice or support in order to offer them an appropriate help (Gibbs et al., 2006 ). Similarly, Simpson ( 2008 ) argued that in the situation of scarce recourses the most effective way to improve student retention is to focus on those students who require support and are most likely benefit from it. What makes a difference for at risk student retentions is the time between the student identification and a time of support intervention (Gibbs et al., 2006 ; Purnell et al., 2010 ).

Proactive support and student outreach

Empirical studies confirm the importance of proactive rather than reactive support for online distance learners. Robb and Sutton ( 2014 ) showed that motivational emails initiated by the educational institution significantly enhanced final course grade and course interest survey scores. Students reported that such emails encouraged them to put more effort into learning and eliminated discomfort in communication with their tutors. Core strategies for proactive tutor support in the UK OU included consideration of the students’ workload and pacing students’ learning against milestones, monitoring students’ learning outcomes in order to identify those who are at risk of falling behind and dropping out and getting in touch with students prior to the submission of the first assignment in order to identify those who struggle academically (Whitelock et al., 2015 ). Proactively contact students using learning analytics have been also advocated by Walsh et al. ( 2020 ).

Past research also emphasised the importance of prolonged proactive interventions at the early stage of the learning cycle (Anderson, 2003 ). Similarly, Simpson ( 2003 ) emphasised a positive impact of the motivational calls and postcards on UK OU students’ retention, speculating that motivational emails can have the same effect. Another example of proactive institutional support is an introduction of the possibility to re-submit an unsatisfactory assessment to individual students (Pinchbeck & Heaney, 2017 ). It is notable that online tutors play an invaluable part in the provision of the proactive support. According to Rendon ( 1994 ), a validation of the tutor in the form of encouragement or an interest in the students’ activities positively impacted students’ learning. Simpson ( 2004 ) found that online distance learners who have been approached by a tutor via phone call with an encouraging conversation had higher retention at the end of the programme than the students who did not received this support.

Addressing external factors

Online students require support not only with their learning, but with balancing external factors and commitments (Sorensen & Donovan, 2017 ; Stone, 2019 ; Whitelock et al., 2015 ). Whitelock et al. ( 2015 ) reported that the importance of the workload for online learners who have pressures with work and family responsibilities should be recognised and taken into consideration. Emerged from the overlap or clash of assignments with particularly busy periods of online students’ life may result in the heavy overload and a student may fall behind. Thus, it should not be assumed that students are always on track of their study schedules. Instead, an introduction of catch up or review weeks can enhance students’ motivation and contribute to their learning progress (Whitelock et al., 2015 ).

Support phase

Mentoring and peer support.

Mentoring and peer support proved to improve students’ adaptation to online learning environment (Kumar & Coe, 2017 ), contribute to the development of communication skills, and result in the better academic performance (Ashwin, 2003 ) and a higher persistence (Congos & Stout, 2003 ; McLean, 2004 ; Muldoon, 2008 ). Brindley ( 2014 ) argues that for educational institutions that have a constant enrolment in self passed learning an establishment of strong peer support networks in crucial for student success. Peer mentoring was the main mechanism in the designed by Horvath et al. ( 2019 ) orientation programme within which mentors helped new students to develop realistic expectations about their online learning, clarified the programme requirements, and overall served as learning models. Kumar and Coe ( 2017 ) too explained that through mentoring, new students can receive not only academic but also “socio-emotional support” (p. 15) since mentors play a mediating role for the knowledge and experience development. The participants of their study referred to the peer support as a paramount element for the development of community and persistence during the dissertation writing process.

Boyle et al. ( 2010 ) found that mentoring has a clear impact on student retention, offering a cost-efficient support strategy for the educational institution which is often underused in distance education. They proposed a “study dating” initiative designed to match students according to their characteristics, interests and other provided information (Boyle et al., 2010 , p. 129). Such use of technology and social network sites is a new turn in establishing student support networks. Indeed, Internet can offer additional affordances for online peer support and mentoring (Dollinger et al., 2020 ; Hsiao & Huang, 2019 ; Marineo & Shi, 2019 ).

The relative simplicity of peer mentoring, a cost-effective strategy considered earlier, as a support strategy embedded into the learning curriculum is also neglected (Boyle et al., 2010 ). Although it involves an establishment of initial connections between students and assistance in developing a peer network from the side of educational institution, this strategy takes less effort from academic and administrative staff than any other intervention. As, Brindley ( 2014 ) pointed out, “as institutions grapple with how to continue to provide quality support to greater numbers of students, it is likely that peer support will become much more important” (p. 297).

More attention has been paid to the indirect student support and caring. Robb and Sutton ( 2014 ) found that the student perception of a “caring instructor” (p. 6) or caring professor (Tippens, 2012 ) added a personal touch to the online class. Brown and Wilson ( 2016 ) proposed two initiatives, namely online caring groups and Caring connection website to facilitate students’ habits to care for themselves and care for others in an online learning environment. Prior research also recognised the value of indirect support. Jones ( 2010 ) argued that academic caring is an important factor for online students’ success. Similarly, Chen and Jang ( 2010 ) explain that students need to be surrounded by the atmosphere that allows a free expression of “feelings, thoughts, and concerns” (Chen & Jang, 2010 , p. 750), whereas the traditional form of depersonalised support can create barriers for expressing students concerns. Overall, an emphasis on care can facilitate genuine student connection with the educational institution and foster the development of the community of learners.

A provision of structure

Kumar and Johnson ( 2017 ) found that, from mentors’ perspective, the structure and scaffolding in online learning environment are the necessary strategies for students’ progress and elimination of the feeling of isolation. They found that organised group meetings and a provision of the peer feedback in a structured way assist students in being on top of their learning (p. 68). Smailes and Gannon-Leary ( 2011 ) also identified that a provision of scaffolding positively influenced students’ motivation. Educational scaffolding items mentioned by the students in their study are the well-organized structure of the courses, weekly email prompts and active learning tasks (Smailes & Gannon-Leary, 2011 ).

Fostering a strong sense of community

A community of learners is a “powerful motivator and a powerful mechanism” for supporting online students and their learning experience (Collins et al., 1987, in Boling et al., 2012 , p. 121). Hew ( 2015 ) argued that online learning experience can be enhanced by the reinforcement of the “social nature of learning” through the community where learners can socialise and support each other’s learning (p. 2).

Kumar and Coe ( 2017 ) supported a cohort model of learning that allows students to form meaningful interpersonal connections and be better supported in their learning challenges. In the past, “fostering sense of belonging” (p. 59) has been emphasised by Floyd and Casey-Powell ( 2004 ). Boyle et al. ( 2010 ) argued that feeling of belonging can be increased with the implementation of the peer support networks. Yet, individual institutions are recommended to identify communicative activities that work best for encouraging a greater sense of community among their students.

Interactions

Past research showed that well designed interactions improve students’ satisfaction, retention (Rienties & Toetenel, 2016 ) and learning outcomes (Kuo & Belland, 2016 ; Richardson et al., 2017 ). Boling et al. ( 2012 ) argue that online students’ connection with their tutors remains the most significant success factor. Among strategies to facilitate learner – content interactions Kuo and Belland ( 2016 ) suggested the use of technology enhanced tools (e.g., audio and video materials, multimedia, software that facilitates students’ learning) and a structured and easy to access online learning content. Interactions with the tutor can be enhanced by the provision of the encouragement and personalized guidance whereas the effectiveness of student communication can be facilitated through the guidance for interactions and collaborative work, with explanation of requirements, expectations, and online etiquette (Kuo & Belland, 2016 ).

Development of meaningful relationships

In online student support literature, there is a noticeable emphasis on the development of meaningful relationships. Scholars found that a teacher engagement and connection with online students has a positive effect on retention numbers (Glazier, 2016 ; Stone & O’Shea, 2019 ). Glazier ( 2016 ) identified that high-rapport relationship with the instructor is a key factor in student success and retention. To facilitate meaningful relationships, Glazier ( 2016 ) suggested implementing rapport-building teaching strategies, such as video updates, personal e-mails, and personalized electronic comments on assignments into online course.

Past research also indicate that the absence of the personal contact may result in the development of the feeling of loneliness (Sorensen & Donovan, 2017 ) and create communicative barriers especially for the less proactive learners (Brown et al., 2020 ; Paechter et al., 2010 ). To support the development of meaningful relationships, the teacher is expected to take onboard additional responsibilities (Russo-Gleicher, 2013 ).

Support with the development of necessary skills

Support with the development of skills necessary for online study may enhance students’ learning experience. Kuo and Belland ( 2016 ) found that pre-class training on the Internet-based technology facilitated students’ online interaction and overall learning experience and progress. In the study conducted by McLoughlin and Alam ( 2014 ), students were assisted in developing skills to work with social media and reported benefits of collaboration and peer networking of such support. Hsiao and Huang ( 2019 ) too suggested the use of wiki site as a strategy to support the development of the personal knowledge skills. Students found this support useful for a better personal knowledge management but not so for the purposes of socialisation. The concrete strategies for the development of student skills that the authors proposed are a provision of training, guidance, and examples of peer feedback and a peer reviewing process that enhances the development of the personal knowledge skills. In other works, despite the potential for enhancing students’ online learning experience the use of the Web.2.0. tools require guidance in how they are used by students and an ongoing evaluation of the effectiveness of their use.

Among interventions that support the development of online study skills reported in the past are time management and study management training for students with multiple priorities. Grant et al. ( 2011 ) designed an online study skills workshop aimed to develop students’ self-directedness and online learning skills. McLoughlin and Alam ( 2014 ) advocated scaffolded teaching as a way to increase collaborative learning interactions and to develop social media skills. In their study, they used Twitter as a tool for group interactions and found that twitter facilitated the development of a unique culture of peer communication and engagement.

For a diverse online student population, there is a need to re-think a meaningless and depersonalised provision of feedback. As Whitelock ( 2010 ) emphasised, timely and meaningful feedback influence online student progress as it is perceived as an “advice for action” (p. 323). Gaytan ( 2015 ) found that comprehensive feedback positively influences online students’ academic performance, resulting in an increase of student knowledge and decrease of the feeling of frustration. Uribe and Vaughan ( 2017 ) proposed a feedback cycle, suggesting two phases of potential frustration and difficulties: an encountering of the formative assessment feedback and a situation when a student does not seek a feedback clarification. The authors found that in these phases students may experience misunderstanding and confusion. Thus, as Whitelock et al. ( 2015 ) argued, affective and cognitive domains of the tutor feedback should be balanced in different ways for different learners, providing them with an adequate combination of “socio-emotive and cognitive support” (p. 171).

Personal advising and counselling

Although in the reviewed studies personal advising and counselling has not been differentiated as distinctive strategies, they were advocated as a part of the wholistic approach to supporting online students (Kelly et al., 2020 ; Zuhairi et al., 2019 ; Britto & Rush, 2013 ).

Research conducted in the past emphasises that the availability of advising services has direct impact on online students’ satisfaction and course retention (Cain & Lockee, 2002 ). Although such support is easily accessible for campus-based students, there is need for its provision for distance learners using multiple technological means, such as phone calls, emails, online conference tools. Furthermore, sufficient information about the personal support and counselling should be visible and available through the educational institution.

Transition phase

In the selected for analysis studies, there was no reference on concrete strategies or interventions at student transition points, apart from suggestions offered by Gibbs et al.( 2006 ) and Gibau, ( 2015 ). Yet, past research emphasises that those timely interventions at transition points, between different parts of the study and during the induction period, make a positive difference in students learning progress (Baxter, 2012 ). Following types of transitions have been identified in the past: transition to higher education, transition between different stages of learning, and transition to the labour market.

Transition to the higher education

Although the literature on the strategies for supporting students at transition points is scarce, past research focused on the transition to higher education, and especially the literature on socialisation, suggests that novice students benefit from guided transition (Gibau, 2015 ; Ward & Commander, 2011 ). Gibau ( 2015 ) explains that student transition often involves both social and physical adjustment (p. 6), which is in line with the models on students’ retention and progress (Tinto, 1975 ; Rovai, 2003 ). Pedagogical models presume that if a student cannot make a social and academic adaptation, then the result may be dropping out from the course of study.

To prepare students for the initial transition to the HE, such an early outreach and “intentional peer mentoring”- also discussed in other phases- have been suggested (Gibau, 2015 , p. 10) as strategies to support new students in their adjustment and transition to the higher education. Such activities contribute to the development of the kinship and can be arranged through matching different cohorts of students (Gibau, 2015 ).

Transitions between different stages of learning

The UK OU advocates focused support interventions in the periods of transition from one course to another to support students’ decision-making process (Gibbs et al., 2006 ). For some students, support in transition is a motivating factor, particularly if interventions from both tutors and support staff can address the lack of confidence- a common feeling reported by students in a new situation or environment. Baxter ( 2012 ) explained that if students are not supported at these ambiguous stages, they may experience exclusion and fail to progress.

Transition to the labour market

Another form of transition is the transitions from the university to the labour market (Dahlgren et al., 2006 ; Merrill, 2020 ). In the study conducted by Sisselman-Borgia and Torino ( 2017 ), students reported that “it was difficult to make a transition into a new field of work without ever having an experience in the new field” (p.). Learning experiences that aim to provide students with authentic experience in the field and evaluate their fitness (but also being flexible enough to fit into their current schedules) are among previously employed support strategies (see Sisselman-Borgia & Torino, 2017 ).

Measurement phase

Use of data analytics.

Learning analytics offered the potential to identify at-risk students based on predictor variables (Simpson, 2004 ). Moreover, institutional data allows matching the most appropriate strategies with students who may benefit from such support (Gibbs et al., 2006 ; Walsh et al., 2020 ). In the past, there were attempts to measure the effectiveness of student support strategies and interventions. For instance, Simpson ( 2004 ) proposed a “maximum possible increase in retention” indicator to measure the effectiveness of support strategies (p. 82). Using student data to conduct predictive models, educational institutions can develop targeted interventions and help learners make more informed decisions about available support services (Brindley, 2014 ).

Cost–benefit analysis

Although there was no data on the analysis of costs involved in the design of support interventions in the revised studies, prior research showed that employing the cost analysis can justify the concreate support strategy or intervention. In the UK OU, Gibbs et al. ( 2006 ) predicted a profit of $2,087,302 a year by implementing a new proactive support system for 35.000 online students that cost $1,085,000 per year (p. 371). Such evaluation allows implementing support strategy that is “backed by cost-effectiveness data based on evaluations of controlled experiments and driven by management information systems” (Gibbs et al., 2006 , p. 259). Furthermore, the cost–benefit may assist educational institutions in designing personalised, yet cost-effective support interventions based on the analysis of institutional data to identify vulnerable and at-risk students. However, the analysis of the research on support strategies and interventions showed that there are no embedded mechanisms to evaluate student support interventions in terms of their economic costs and benefits.

Surveys and interviews

Surveys of satisfaction with support services are most often used to measure quality and identify any unmet needs (Brindley, 2014 ). Nicholas et al. ( 2012 ) conducted pre-and post-intervention interviews with two groups of students, those who received support and those who did not. Qualitative interviews with intervention group participants proved to be helpful in identifying the beneficial impact of support. Specifically, the researchers were able to collect data on students’ decreased isolation, gain in knowledge, and normalisation of experience (Nicholas et al., 2012 ).

Self-evaluation tools

Higher educational institutions can use a variety of tools to assess the support services they offer. One assessment tool reported in the past is the Online Student Services Self-Assessment Tool, which helps educators review links to the support services and evaluate which areas of support are not addressed (Floyd & Casey-Powell, 2004 , p. 56). Among the considered studies, Boyle et al. ( 2010 ) also employed self-reports from online students to measure the effectiveness of the implemented peer support strategy. The data showed that mentored students had a higher persistence rate compare to the unsupported students. Analysis of such data helped to plan the further implementation of the peer-support strategy in the institution.

The analysis of support strategies, initiative and interventions using the MIPS framework aimed to answer the research question What support strategies and interventions can be offered to online students at different phases of the learning cycle ? Using Floyd and Casey-Powell ( 2004 )’ IMSS framework, I allocated identified support strategies for online students across different phases of the learning cycle. Figure  1 shows that various forms of support can be offered to students during the different stages of their learning.

Allocation of online student support strategies and intervention across different phases of the learning cycle

The results of this study support prior research on the positive effect of initial student support during the student intake phase (see studies on orientation programmes House & Kuchynka, 1997 ; Williford et al., 2001 ; Wilson, 2008 ).

At the student intervention phase, the analysis results appear to be in line with studies that advocate early and proactive interventions. Specifically, the findings support research on early measurement for identifying students' prior knowledge and behavioural characteristics that provide a clue for deciding on proactive intervention (Muljana & Luo, 2019 ; Nistor & Neubauer, 2010 ). The approaches to student outreach tend to utilise technologies and data analytics rather than the old form of proactive support such as telephone calls. Specifically, the use of learning analytics to identify at-risk students offers unlimited opportunities for targeted interventions (Simpson, 2004 ). This line of research holds the promise that predictor variables become more accurate in targeting students and the learner analytics approach more sophisticated.

In regard to the student support phase, there are multiple ways in which support can be offered (Tait, 2004 ). This study confirmed the importance of advising and counselling, the development of the sense of community and support with academic skills- essential elements of support emphasised by Floyd and Casey-Powell ( 2004 ). The analysis also found that there is a recognition of the positive impact of peer mentoring and support for online student progress and retention. Moreover, this strategy is suggested to be relatively cost-effective. However, in an online learning environment, peer support and mentoring remain under-researched domains, and there is "little evidence of the existence of UK programmes of peer mentoring in virtual formats" (Smailes & Gannon-Leary, 2011 ). Boyle et al. ( 2010 ) point out that "the key success factors consistently identified include appropriate mentor training and the inclusion of peer mentoring as part of the formal curriculum. (p.120). Thus, it is crucial to bear in mind that such conventional forms of student support may still have much to offer in enhancing student engagement and retention (Boyle et al., 2010 ).

The identified support interventions are in line with research that differentiates supports into academic, technological, and personal (Anderson, 2008 ; LaPadula, 2003 ). The study also recognises the importance to maintain a sense of belongingness to the community- key component that can combat student attrition and drop out (Lee & Choi, 2011 ).

Systematic literature review revealed that two phases of the learning cycle- transition and measurement- are not well supported by the existing research on online student support strategies and interventions. However, this does not minimise their importance but rather reveals the lack of research in those areas. The transition phase showed the aspect of students' transitions, such as a transition to the HE, transitions between different parts of study and during the induction period, and any other forms of transition that require student adjustment to the new environment or routine. This is in line with scholars who emphasised the multifaceted nature of the process of transition (Hussey & Smith, 2010 ; Maunder et al., 2013 ), which may involve not only educational adjustment but also personal adaptation and adjustment of the lifestyle. Past research suggests that there are different types of transition to which students require to adapt (Maunder et al., 2013 ). Maunder et al. ( 2013 ) emphasise that transitions not always associated with educational adaptation but may involve personal, lifestyle and identity adjustments (Cocquyt et al., 2017 ). Yet, most of the research on students' transitions have been predominantly focused on student transitions during the first year (Reay, 2003 ; Tett, 2000 ). Educators are invited to recognise the multifaceted nature of online students' transitions that can occur at different stages of their learning.

In regard to the measurement phase, the main finding of this study is that although attrition studies often conclude with recommendations for specific kinds of support interventions, relatively little evaluative research has been done to find out about their impact. Although, according to Rumble ( 2000 ), distance educational institutions are "more driven by concern for planning customer care and support than the traditional universities" (p. 219), mechanisms for measuring the suggested interventions are less developed. Tait (1995) emphasises that the rationale for online student support remains relatively weak and, therefore, continue to be "subject to wild fluctuations in terms of financial support" (Tait, 1995, in Rumble, 2000 , p. 216). Gibbs et al. ( 2006 ) agree that in the situation of scarce resources, evaluations of cost-effective cases should be done to gather evidence on the impact, effectiveness, and value of the support interventions. The issue that the authors emphasise is that the recommendations have been developed predominantly within a controlled environment rather than tested in real learning situations. Moreover, they argue, there is no comprehensive system that evaluates the effectiveness of the developed interventions (Gibbs et al., 2006 , p. 375). Therefore, more effective use of institutional data and data analytics is encouraged as they have proven its potential to evaluate the effect of support services. The impact of digital technologies on student support in distance and e-learning allows taking into accounts both internal and external factors and not only integrating student support with teaching and learning at different phases but also go gather data on their effectiveness automatically (Zuhairi et al., 2019 , p. 15). In other words, this research emphasised the need to not only understand the value of offered support for students but also to develop instruments for measuring the result of each intervention for educational institutions in order to effectively allocate scarce economic resources.

Finally, the analysis showed two emerging trends in online students support. The first one is the increase in the use of technology and social network sites to design support interventions (Dollinger et al., 2020 ; Hsiao & Huang, 2019 ; Marineo & Shi, 2019 ). Specifically, online tools and resources are used to increase communication and decrease transactional distance (Moore & Kearsley, 2012 ). Another interesting development is a shift to a more holistic approach to student support (Kelly et al., 2020 ; Zuhairi et al., 2019 ; Britto & Rush, 2013 ; Johns & Oestreich, 2019 ). Support strategies and services designed under a holistic approach and embrace all the aspects of the university experience, such as administrative, educational, pastoral, and personal, hold great potential for ensuring student success (Kear et al., 2016 ). As Brindley ( 2014 ) point out, a holistic approach to student support that is based on previous analyses of students' needs and demands, considering different learner groups and the specific characteristics of lifelong learners, will ensure that support is embedded at an institutional level. To embrace a holistic approach means to integrate different types of resources, coordinating staff to give support in academic, technical, administrative, and other relevant areas.

Limitations

Although this paper gathered valuable information on the effective support strategies and interventions, it has several limitations. First, this study did not intend to test employed IMMS model but rather used it as a frame for the analysis. As a result, some of the phases of the proposed framework are not supported by empirical evidence and discussed within the knowledge offered in the past research. This, however, allowed me to emphasise potential directions for the further research. Secondly, the study provides an analysis of the literature using a selected theoretical model which itself may need an empirical testing.

The reviewed literature provides a rather comprehensive set of online student support interventions and their allocation across the different phases of the learning cycle. It is suggested that the effectiveness of the implementation of these strategies and interventions depend on the time of student support provision, advocating the embedment of the support provision into the learning curriculum. Finally, this review indicates two under-investigated areas of student support, namely support at transition and a measurement of the effect from support interventions.

A widening participation agenda caused an emergence of the diverse online student body. Due to both the development of online learning technologies and diversification of the online student body, the provision of support services evolved, with significant variations among educational institutions. As Thorpe ( 2002 ) stated, “learner support” is the arena within which transformations in nature and the scale of activities made feasible by online teaching are generating widespread change in pedagogies and learning communities, and across institutions as a whole in ODL [online distance learning]” (p. 117).

A wide range of support interventions designed to support students at different stages suggests a need for an embedded, holistic approach to student support. Such a systemic approach may involve the development of specific policies and programmes and the integration of specialised support units and expertise across the institution. Furthermore, as the analysis showed, the time and relevancy of the provided support should not be neglected as in many cases, “support activity simply occurred too late in the course to be effective or after students had already decided to withdraw” (Gibbs et al., 2006 , p. 375).

Availability of data and materials

Data for the analysis was extracted from publications identified through the Scopus and Google Scholar databases and can be accessed online.

Analysed articles are marked with *.

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I would like to thank Professor Don Passey and two anonymous reviewers for their suggestions for improving this manuscript.

This research was supported by the FfWG of the British Federation of Women Graduates, Ref: GA-00764.

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Author contributions, declaration of interest, a systematic review of peer support interventions for student mental health and well-being in higher education.

Published online by Cambridge University Press:  15 December 2023

• Supplementary materials

Higher education institutions (HEIs) are seeking effective ways to address the rising demand for student mental health services. Peer support is widely considered a viable option to increase service capacity; however, there are no agreed definitions of peer support, making it difficult to establish its impact on student mental health and well-being.

This systematic review aims to better understand and evaluate peer support in HEIs.

Five databases, OpenGrey and Grey Matters were searched in May 2021. Included studies were quantitative, longitudinal (with and without a control) or cross-sectional with a control. The vote-counting method was used for synthesis. The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool.

Three types of peer support were represented in 28 papers: peer-led support groups, peer mentoring and peer learning. Peer learning and peer mentoring had more positive, significant results reported for the outcomes of anxiety and stress. Peer-led support groups were the only type targeting students with mental health difficulties.

The heterogeneity of measures and outcomes prevents firm conclusions on the effectiveness of peer support for mental health and well-being. Most studies were rated ‘poor’ or ‘fair’ in their risk of bias. There is not a solid evidence base for the effectiveness of peer support. Nonetheless, HEIs can use the terminology developed in this review for shared discussions that guide more robust research and evaluation of peer support as an intervention.

There are growing concerns for students’ mental health in higher education, Reference Brown 1 with significant numbers of students reporting distress. Reference Neves and Hillman 2 Higher education institutions (HEIs) refer to any tertiary education leading to an academic degree award. 3 In the World Health Organization's international college student survey, a third of first-year students screened positive for at least one common anxiety, mood or substance use disorder as defined by the DSM-IV. Reference Auerbach, Mortier, Bruffaerts, Alonso, Benjet and Cuijpers 4 Correspondingly, British HEIs reported a 94% increase in demand for counselling services from 2012 to 2017. Reference Thorley 5 Despite service demand rising, only 4.9% of students disclosed a mental health condition to their HEI as a disability in the 2019–2020 enrolment, 6 indicating that barriers to student help-seeking still exist. HEIs are seeking effective ways to support students, considering the increased demand and low disclosure rates. Globally, a settings-based, whole-systems approach to improving health has been widely advocated for. Reference Whitelaw, Baxendale, Bryce, MacHardy, Young and Witney 7 – 10 In UK HEIs, this has gained momentum with the ‘University Mental Health Charter’, which outlines how institutions can take a ‘whole-university’ approach to mental health and encourages peer support to be represented in their strategies. Reference Hughes and Spanner 11

Peer support is ‘support provided by and for people with similar conditions, problems or experiences’. Reference Gulliver and Byrom 12 It can be delivered in various ways, including one-to-one mentoring and self-help groups. Reference Solomon 13 Convening people with similar experiences creates a supportive space underpinned by respect, collective responsibility and an agreement on what is helpful. Reference Mead, Hilton and Curtis 14 Two approaches exist: informal and formal. Informal peer support happens naturally within communities when people help others in similar circumstances based on their lived experience. Reference Gulliver and Byrom 12 Without structure, this form of peer support is challenging to evaluate. In contrast, formal peer support brings people with similar experiences together intentionally to share knowledge for mutual benefit, building social connection and reducing loneliness. Reference Solomon 13 , Reference Schubert, Borkman and Powell 15 Formal peer support will be the focus of this review, with the term generally describing higher education students helping each other based on their common lived experience of being a student.

Students find peer support easy to use, and recent research suggests it can increase support service accessibility. Reference Suresh, Karkossa, Richard and Karia 16 Students disclose more to peers than to their HEIs: 75% of students who experienced mental health difficulties reported telling a peer. 17 Since students prefer seeking help from friends more than professional services, Reference Rickwood, Deane, Wilson and Ciarrochi 18 , Reference Ebert, Mortier, Kaehlke, Bruffaerts, Baumeister and Auerbach 19 HEIs want to harness this natural preference through peer support, as recommended in the University Mental Health Charter. Reference Hughes and Spanner 11 A quantitative meta-analysis of 23 peer-run programmes for depression in community health settings found that the interventions produced significant reductions in depressive symptoms, performing as well as professional-led interventions and significantly better than no treatment. Reference Bryan and Arkowitz 20 Although peer support is used by many and seems promising, its effectiveness in higher education settings is unknown. Reference John, Page, Martin and Whittaker 21

There is currently no comprehensive quantitative review of the published and grey literature on peer support interventions evaluated in higher education settings. Peer support in clinical settings is well defined, with competency standards and fidelity assessments providing an emerging standard of practice. Reference Fortuna, Solomon and Rivera 22 In contrast, different forms of peer support exist in HEIs, and guidance is still needed to delineate between models. Reference Monk and Purnell 23 Limited search terms in a previous systematic review, Reference John, Page, Martin and Whittaker 21 which included only three studies, missed relevant research on other forms of peer support. Although studies outline individual benefits for specific types of peer support in higher education settings, Reference Byrom 24 – Reference Bosmans, Young and McLoughlin 27 no current reviews collate all forms of peer support in HEIs that target mental health and well-being in the literature.

Defining a ‘peer’ is also critical to understanding how the kinds of peer support in higher education differ. In broader contexts, definitions of a peer most commonly refer to those who have lived experience with mental health difficulties or have used mental health services in clinical settings. Reference King and Simmons 28 In HEIs, however, other identities, such as ethnicity, sexual orientation or course of study, may provide an additional point of connection. For example, research recommends creating more peer support spaces for Black students. Reference Stoll, Yalipende, Byrom, Hatch and Lempp 29 , Reference Stoll, Yalipende and Haas 30 A synthesis of the definitions of peer support and what it means to be a peer are needed to inform and evaluate current practice, direct future research and clarify the role of peer support in a whole-university approach to student mental health and well-being.

The aim of this review was to screen relevant literature on peer support interventions evaluated in higher education settings worldwide, to identify current practice and assess its effect on measures of student mental health and well-being, by undertaking the following objectives: (a) to synthesise and categorise types of peer support and define peers according to study characteristics; and (b) to evaluate the effectiveness of peer support in higher education for improving student mental health and well-being according to the developed intervention categories.

For the purpose of this review, mental health and well-being are defined according to the University Mental Health Charter. Mental health refers to ‘a full spectrum of experiences ranging from good mental health to mental illness’ and well-being encompasses ‘a wider framework, of which mental health is an integral part, but which also includes physical and social wellbeing’. Reference Hughes and Spanner 11

The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; identifier: CRD42021256552). No amendments were made. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Reference Brennan and Munn 31 , Reference Page, McKenzie, Bossuyt, Boutron, Hoffmann and Mulrow 32 and Synthesis Without Meta-Analysis (SWiM) guidance. Reference Campbell, McKenzie, Sowden, Katikireddi, Brennan and Ellis 33

Eligibility criteria

Studies with a quantitative longitudinal design were included, with and without a control, or comparator. Cross-sectional studies with a control condition were included. Cross-sectional studies lacking a control were excluded. Qualitative-only studies were excluded. Any students (aged ≥18 years) in HEIs were included. Interventions delivering peer support in higher education were included. Interventions that provided a one-off psychoeducation initiative were excluded.

Studies with and without a comparator, or control, were included. Comparator conditions included those not participating in peer support, a waitlist, informal groups, website access only, year group or faculty mentoring. Where a study used a comparator, the population had to be from a similar higher education setting as the primary intervention.

The outcome of this review was a change in the quantitative measure of well-being or mental health for HEI students, such as stress, anxiety, depression, well-being, loneliness and belonging. Studies were excluded if no quantitative measures were reported. Outcomes for anyone other than students receiving the peer support intervention were excluded.

Information sources

In May 2021, a worldwide systematic search of studies written in English was conducted in the databases: Ovid (PsycINFO, Medline, EMBASE), Web of Science (Core Collection) and the Education Resources Information Center (ERIC). The search was limited to the past 30 years in alignment with a previous review that included a study from 1991. Reference Bryan and Arkowitz 20 Grey literature was searched for through OpenGrey 34 and Grey Matters. 35

Search strategy

Search terms were developed in PsycINFO and adapted for other databases. Key words included population terms (e.g. ‘university’ or ‘student’), intervention terms (e.g. ‘peer support’, ‘peer mentoring’ or ‘peer-assisted learning’ or ‘peer to peer’ or ‘peer tutoring’ or ‘peer health education’) and outcome terms (e.g. ‘mental health’ or ‘well-being’). A complete search strategy (see Supplementary Table 1 available at https://doi.org/10.1192/bjo.2023.603 ) was developed with existing systematic reviews with similar keywords, to identify relevant MeSH and free-text terms. Reference John, Page, Martin and Whittaker 21 , Reference Upsher, Nobili, Hughes and Byrom 36 , Reference Lyons, Cooper and Lloyd-Evans 37 Free-text terms identified in relevant studies from a scoping review were also included (e.g. Reference Monk and Purnell 23 – Reference Jacobi 26 ). Grey literature was identified through OpenGrey 34 and Grey Matters, 35 a scoping review and backward citation tracking of included full-text studies. Authors were contacted during the search process via email for clarification or full-text articles.

Selection process

In stage 1, titles and abstracts of papers identified by electronic searches were exported to the Windows desktop version of Clarivate EndNote 20 (London, UK; see https://endnote.com/downloads ) from all databases, to remove duplicates. Reference Hupe 38 The citations were then exported using a Windows browser with the web-based software as a service application, ‘Rayyan-intelligent systematic review’ (Qatar Computing Reseach Institute, Boston, USA; see www.rayyan.ai ), where independent screening by two researchers was conducted. Reference Ouzzani, Hammady, Fedorowicz and Elmagarmid 39 The lead reviewer (J.P.-H.) screened all titles and abstracts, and the second researcher (L.W.) screened 50%. If there was any uncertainty at this stage, papers were included for full-text review. In stage 2, full texts of all papers included in stage 1 were independently screened for inclusion by both researchers (J.P.-H. and L.W.). Any discrepancies were resolved by a third researcher (J.F.).

Data collection process

Data extraction was managed in Windows Microsoft Excel (version 2309) with tables (e.g. study characteristics) and figures (e.g. risk-of-bias data) created. The team developed and approved a data extraction form before being piloted on five studies independently by two researchers (J.P.-H. and L.W.). Data extraction for these studies was compared and refined before applying it to all included studies.

The following data items were extracted upon availability and reported:

(a) Publication characteristics: year of publication, country and HEI of recruitment;

(b) Methodology and study design: longitudinal or cross-sectional with a control;

(c) Population characteristics: sample size, attrition, the mental health status of the population, level of study, students’ year of study, gender, mean age and ethnicity;

(d) Intervention characteristics: type and objective of peer support, number of peer support sessions, duration of intervention, format of delivery and who the peer support is for;

(e) Outcome characteristics/measures: quantitative measures of well-being and/or mental health at pre- and post-intervention for longitudinal studies (with or without a control) or at a particular time point with a control for cross-sectional studies;

(f) Results: mean and standard deviation at baseline and follow-up, P -value and confidence intervals from the intervention group and comparator (where applicable).

Missing data was denoted as ‘not reported’ to indicate its absence for the risk-of-bias assessment.

Study risk-of-bias assessment

The methodological quality of studies included in the review was assessed independently by two reviewers (J.P.-H. and L.W.). A modified American National Institutes of Health (NIH): National Heart, Lung and Blood Institute Health Topics Study Quality Assessment Tool for ‘Before-After (Pre-Post) Studies With No Control Group’ was used. 40 This approach to the risk of bias was chosen as many of the studies lacked a control, and similar reviews demonstrated its utility in higher education settings. Reference Upsher, Nobili, Hughes and Byrom 36

The following outlines the 12 items from the tool used to determine the risk of bias: (item 1) clear study question; (item 2) prespecified eligibility criteria; (item 3) study participants representative; (item 4) all eligible participants enrolled; (item 5) sample size sufficiently large; (item 6) intervention clearly described and delivered consistently; (item 7) outcomes measures prespecified, valid, reliable and assessed consistently across all participants; (item 8) blinding; (item 9) 20% or less attrition in follow-up; (item 10) statistical methods examined changes in outcome measures/statistical tests conducted that provided P -values; (item 11) outcome measures taken multiple times before and after intervention; and (item 12) group level intervention took into account individual-level data to determine effects. 40 For this review, items 8 and 12 were excluded, as they were irrelevant to any of the included studies.

For each study, all items were rated according to the guidance as ‘yes’ (met criteria), ‘no’ (did not satisfy criteria), ‘not reported’, ‘cannot determine’ (unclear from information) or ‘not applicable (not relevant to particular study). 40 Reviewers used these ratings to make a qualitative assessment of overall risk of bias, using the ratings of ‘good’, ‘fair’ or ‘poor’. All risk-of-bias scorings are outlined for study in Supplementary Table 2.

Effect measures

The baseline and post-intervention time points were used only in data extraction to calculate pre (time point 1) and post (time point 2) studies. The mean differences and P -values between pre and post of intervention and control group (when applicable) were calculated with raw data reported in individual longitudinal studies (if available). For cross-sectional studies with a control group, mean differences were calculated between groups at the post-intervention time point (as baseline data was not reported). Outcome data beyond post-intervention were not synthesised. When data was unavailable for calculating mean differences, ‘CD’ (cannot determine) was used.

Standardised mean differences (Cohen's d ) with 95% confidence intervals were calculated when longitudinal studies included a control group. The calculations were made in StataMP version 17 for Windows, 41 with the raw scores of each intervention/control measure, including sample size, mean difference and s.d. For longitudinal studies without a control group, available data such as P -value, Cohen's d and t -values were extracted. The significance of outcomes was also reported, which included the directionality of an improvement or decline.

Synthesis methods

A meta-analysis was not appropriate because of the heterogeneity of study methodologies. The vote counting method outlined in the SWiM reporting guidelines was used. Reference Campbell, McKenzie, Sowden, Katikireddi, Brennan and Ellis 33 Missing data are denoted in the tables. Outcome data were tabulated for each included study and stratified by type of peer support intervention. The most common outcomes assessed in this review were stress, anxiety and depression. In each vote counting synthesis, the following was reported: the number and percentage of studies that affected the most common outcome for each peer support category, the binomial test indicating the probability of the results if the intervention was ineffective (i.e. equal to 0.5) and the 95% confidence intervals for the percentage of effects favouring the intervention. Reference McKenzie and Brennan 42 The binomial test was calculated in StataMP version 17, 41 using the syntax ‘bitesti X Y 0.5’, whereas the 95% confidence intervals were calculated with the syntax ‘cii proportions X Y, level (95)’, where X equates to the number of effects and Y is the number of effects favouring the intervention.

Study selection

As summarised in Fig. 1 , 12 763 records remained after duplicates were removed. A total of 57 papers were included for full-text screening, and a final 28 papers were included.

Fig. 1 Process of identifying eligible studies for inclusion.

Study design characteristics

The study characteristics are outlined in Table 1 alphabetically according to the author, with a reference number used in square brackets for the results section only. The most common study type was the pre–post with a control design. Many studies ( n  = 12) adopted this approach [1, 4, 6–8, 14, 17, 20, 24–26, 28], whereas others ( n  = 7) employed a pre–post without controls design [2–3, 10–12, 15, 27]. Although some studies ( n  = 8) used a randomised controlled trial design [5, 9, 16, 18–19, 21–23], one of these studies [19] only used relevant mental health measures at time point 2, so that this study was analysed as a cross-sectional study with a control design along with one other study [13].

Table 1 Summary of study characteristics in review

Population characteristics

Many studies ( n  = 13) targeted students by year of study, with the majority of studies offering peer support for lower-year students such as ‘first year’ [1, 4, 11–12, 18–19, 22–24] or ‘freshmen and sophomores’ [17]. Students were also recruited by discipline ( n  = 12); ‘nursing/nurse anaesthetists’ [2, 13, 20] and ‘psychology’ [4, 8, 26] courses were the most common. Other population criteria included ‘lived experience of mental health difficulties’ [5, 9], ‘student status’ [22, 28], ‘ethnicity’ [15, 24] and ‘age’ [2, 5, 20, 22]. The complete list is included in Table 1 .

Other population characteristics were also extracted. One study focused on postgraduate students [13]. Others invited both undergraduates and postgraduates students to participate [1, 9]. All other studies were for undergraduate students. The majority of studies reported binary biological sex (male versus female). Of these, five reported the percentage of females in their sample only, leaving the reader to infer that the remaining percentage were males. Of the 22 studies that reported on binary sex in the baseline intervention group, the average proportion was 64.1% females and 35.9% males. Only one study used the term gender instead of sex in reporting; it was still presented in a binary way (44.4% men and 55.6% women [8]. Three studies [3, 13, 15] reported beyond binary sex, with options like ‘other’, ‘non-binary’ or ‘unspecified’ making up an average of 6.9%, along with 59.3% females and 33.8% males. The average mean age across the 20 studies that reported this for the intervention group was 21.6 years of age. Not enough studies reported clearly on gender, sex or mean age in the control group to desegregate this data. Similarly, few studies reported on ethnicity.

Intervention characteristics

Two intervention characteristics were important during this review: how a peer was defined and what type of peer support was investigated. To understand how the studies described a peer, we investigated how students were recruited for peer support (the population) and who facilitated the interventions. The studies referred to these students in various ways, including ‘leaders’, ‘peer supporters’ and ‘peer mentors’. This review uses the term ‘peer facilitators’ to describe any peer leading the intervention. Each study's population and peer facilitator are presented in Table 1 . The shared experiences or identities between the peer facilitators and those accessing peer support helped to define a peer. Peer facilitators were frequently defined by their ‘seniority/year’ ( n  = 13) [1, 4, 6, 11–13, 19–24, 27] or ‘course of study’ ( n  = 11) [2, 6–8, 18–22, 24, 27]. A smaller number of studies recruited peer facilitators by ‘interest’ [3, 23], ‘gender’ [8, 16], ‘age’ [2], ‘lived experience’ of mental health difficulties’ [5, 9] or ‘heritage’ [15, 28]. Five studies created groups where all students participated and supported each other equally for mutual support [9, 14, 17, 25–26]. One study did not specify how they recruited [10]. These experiences and identities further defined being a peer beyond being a student in higher education.

The three categories of peer support created for this review to delineate between types are outlined below. A definition of each type is provided, along with the nomenclature process. The assigned category and each study's terminology (when different) are provided in Table 1 .

Peer-led support group

This peer support gathers groups of students for mutual support. The most used terms of ‘peer-led/peer leader’ groups [5, 8, 14–16, 18, 19, 21] and ‘support groups’ [9, 14, 18–19, 25] or ‘group support’ [3, 16, 22] were both featured in eight studies.

Peer mentoring

Peer mentoring relies on higher-year/more experienced students to support lower-year/less experienced students. Eight studies used the term ‘peer mentoring’ [4, 11–13, 20, 23–24, 28], whereas two others used similar terms such as ‘specialised peer mentoring’ [27] or ‘peer dyad mentoring’ [2]. One study used ‘peer helper’ [7], but this was a one-to-one pairing of a more experienced student with a less experienced student.

Peer learning

This describes peer support that convenes students based on academic objectives. Terms used for this included ‘cooperative learning’ [17], ‘peer-assisted learning’ [1] and ‘peer-led team learning’ [6]. As the terms ‘peer’ and ‘learning’ were used across these studies, this category was named ‘peer learning’.

Most studies were categorised as a peer-led support group ( n  = 14) or peer mentoring ( n  = 11). The least common category of peer support was peer learning ( n  = 3).

The categorisation of these three types of peer support was most challenging with peer mentoring in small groups. Most peer mentoring occurred on a one-to-one basis; however, one study [24] paired mentors with one to three students. The potential small group, mutual nature of this type of peer support made a consideration of it being a peer-led support group necessary. Because the defining factor of this peer support study was that it was for incoming at-risk Latino students, its objective and ultimately self-identification as being a form of peer mentoring decided its final categorisation.

Comparator (control) characteristics

In total, 21 studies used a control group. Comparators in this review varied and included examples such as groups not participating in peer support [1, 6, 7, 13, 17, 20–22, 24, 25–26, 28], a waitlist [5, 8, 16], a group that met informally on occasion [18–19], a separate HEI without peer support [4], students given access to a website only [9], students in a different course or year (without peer support) [14] and faculty mentor pairing [23].

Outcome characteristics

There were 18 outcomes identified. Stress was most commonly measured with the Perceived Stress Scale Reference Cohen, Kessler and Gordon 43 ( n  = 8) [4, 10, 12, 14, 20, 22–24], with other measures being used only once, including the Chipas’ 2011 Survey Reference Chipas and McKenna 44 [13] and the Depression, Anxiety and Stress Scale (DASS-21 Reference Lovibond 45 ) [25]. One study assessed stress by using two measures: the three-item House and Rizzo measure Reference House and Rizzo 46 and Allen's Reference Allen, McManus and Russell 47 two-item measure of mentor-related stress [11].

For anxiety, six measures were used: the State-Trait Anxiety Inventory (STAI) Reference Spielberger 48 ( n  = 4) [1, 2, 6, 8], Generalised Anxiety Disorder-7 scale Reference Spitzer, Kroenke, Williams and Löwe 49 ( n  = 3) [1, 5, 21], Social Anxiety Questionnaire for Adults Reference Caballo, Salazar, Arias, Irurtia, Calderero and Graña 50 ( n  = 1) [6], Liebowitz Social Anxiety Scale Reference Liebowitz, Coryell and Winokur 51 ( n  = 1) [17], DASS-21 Reference Lovibond 45 ( n  = 1) [25] and the Adult Manifest Anxiety Scale – College Version Reference Reynolds, Richmond and Lowe 52 ( n  = 1) [27].

Depression was assessed with the Beck Depression Inventory, Second Edition Reference Beck, Steer and Brown 53 ( n  = 1) [15], Center for Epidemiologic Studies Short Depression Scale 10 Reference Kohout, Berkman, Evans and Cornoni-Huntley 54 ( n  = 1) [5], DASS-21 Reference Lovibond 45 ( n  = 1) [25], ten-item Edinburgh Postnatal Depression Scale Reference Martin and Redshaw 55 ( n  = 1) [24] and Patient Health Questionnaire-9 Reference Adewuya, Ola and Afolabi 56 ( n  = 1) [21].

Three studies measured well-being with the Shortened Warwick–Edinburgh Scale of Wellbeing Reference Stewart-Brown, Tennant, Tennant, Platt, Parkinson and Weich 57 , Reference Tennant, Hiller, Fishwick, Platt, Joseph and Weich 58 ( n  = 1) [3], Positive and Negative Affect Schedule Reference Gençöz 59 , Reference Watson, Clark and Tellegen 60 (PANAS; n  = 1) [7] and Satisfaction with Life Scale Reference Diener 61 , Reference Koker 62 (SWLS; n  = 1) [7].

Loneliness was assessed with only one measure, the revised University of California – Los Angeles Loneliness Scale Reference Russell, Peplau and Cutrona 63 ( n  = 3) [17–19].

Psychological distress was measured with the Clinical Outcomes in Routine Evaluation – Outcome Measure Reference Evans, Connell, Barkham, Margison, McGrath and Mellor-Clark 64 ( n  = 1) [9], Brief Symptom Inventory Reference Derogatis and Melisaratos 65 ( n  = 1) [15] and the 12-item General Health Questionnaire Reference Goldberg and Williams 66 ( n  = 1) [26].

The Index of General Affect from the Index of Wellbeing Scale Reference Campbell, Converse and Rodgers 67 ( n  = 1) [4] and the PANAS Reference Crawford and Henry 68 ( n  = 1) [16] measured negative affect.

These outcomes were measured in one study each: eating disorder pathology, measured with the Eating Disorder Examination Questionnaire Reference Fairburn and Beglin 69 [16]; resilience, measured with the 25-item Resilience Questionnaire Reference Wagnild and Young 70 [21]; quality of life, measured with the Linear Analogue Self-Assessment Reference Flugel Colle, Vincent, Cha, Loehrer, Bauer and Wahner-Roedler 71 [21]; satisfaction with life, measured with the SWLS Reference Pavot and Diener 72 [9]; perceived social support, measured with the Social Provisions Scale Reference Cutrona, Russell, Jones and Perlman 73 [18]; domains of functioning, measured with the Outcomes Questionnaire Reference Lambert, Hansen, Umphress, Lunnen, Okiishi and Burlingame 74 [22]; belonging, measured with a 13-item questionnaire adapted for the study and based on the Institutional Integration Scale Reference French and Oakes 75 [24]; self-efficacy, measured with a 13-item adapted questionnaire Reference Sherer, Maddux, Mercandante, Prentice-Dunn, Jacobs and Rogers 76 , Reference Tipton and Worthington 77 [24]; and self-esteem, measured with Rosenberg's Self-Esteem Scale 78 [4].

One study used multiple measurements for outcomes [28]. It explored psychological adaptation by using a six-item questionnaire similar to the PANAS Reference Koenig-Lewis, Palmer, Dermody and Urbye 79 and a four-item scale gauging life satisfaction. Reference Esses, Burstein, Ravanera, Hallman and Medianu 80 It also measured acculturative stress by using the homesickness and perceived discrimination subscales from the Acculturative Stress Scale for International Students, Reference Sandhu and Asrabadi 81 the language difficulty subscale from the Index of Life Stress Reference Yang and Clum 82 and the Perceived Language Discrimination Scale Reference Wei, Wang and Ku 83 [28].

Quality assessment: risk of bias

The overall risk of bias for each study is outlined in Table 1 . Out of the 28 included studies, five were rated ‘good’ and four were rated ‘good/fair’. In addition, 12 were rated as ‘fair’, one was rated as ‘fair/poor’ and six were rated as ‘poor’.

All studies stated their objective, clarified eligibility criteria, described the representativeness of the population, presented entry criteria, referred to the intervention and defined the well-being or mental health outcome. The quality ratings were thus determined according to sample size, attrition rate, statistical values and multiple time point measurement. Most ( n  = 22) studies were not adequately powered or did not report power analysis [1, 2, 4, 6–15, 17, 20, 22, 23–28]. Many ( n  = 13) had low retention, with loss to follow-up after baseline higher than 20% [3–4, 9, 13, 18–19, 25]. Other studies did not report enough information to determine attrition rates [1, 11, 14, 24, 26–27]. The statistical tests were not reported in five studies [12, 14, 19–20, 24]. Other studies did not report basic statistics such as the number of participants in the intervention/control group at pre- and post- time points, P -values, mean or s.d. at both baseline and follow-up [11–12, 14, 24]. Most studies ( n  = 20) had two time points and did not assess the outcome beyond the pre–post intervention [1, 2, 4, 6, 9–11, 13–15, 17, 19–22, 24–28].

If our synthesis was constrained to studies that were rated as ‘good’ or ‘good/fair’, we would retain studies. Of these, no peer learning would be represented. We only identified three studies of peer learning. All of these studies were rated as ‘fair’ with no power analysis reported and only two time points measured. Constraining the synthesis does not change the proportional representation of peer mentoring and peer-led support group studies.

Individual study results

Every included study is outlined in Table 2 , with the well-being and mental health outcome effect estimates provided where possible. A complete list of the acronyms and definitions of mental health and well-being measures are provided in Supplementary Table 3.

Table 2 Effect estimates for mental health/well-being outcomes per individual study

Note: Information not reported within the table was not reported in the reviewed studies.

SWEMWBS, Shortened Warwick–Edinburgh Scale of Wellbeing; CES-D, Center for Epidemiologic Studies Depression Scale; GAD-7, Generalised Anxiety Disorder; SMD, Standardized Mean Difference; STAI, State-Trait Anxiety Inventory; CORE-OM, CORE Outcome Measure; SWLS, Satisfaction with Life Scale; PSS, Perceived Stress Scale; BDI-II, Beck Depression Inventory; BSI, Brief Symptom Inventory; PANAS, Positive and Negative Affect Schedule; EDE-Q, Eating Disorder Examination Questionnaire; UCLA, University of California – Los Angeles; SPS, Social Provisions Scale; PHQ-9, Primary Health Questionnaire; LASA, Linear Analogue Self-Assessment; RS15, Resilience; OQ-45.2, Outcomes Questionnaire; DASS-21, Depression, Anxiety and Stress Scale; GHQ-12, General Health Questionnaire; EPDS, Edinburgh Postnatal Examination Questionnaire; AMAS-C, Adult Manifest Anxiety Scale – College Version; ASSIS, Acculturative Stress Scale for International Students; SAQ, Social Anxiety Questionnaire for Adult; R-UCLA, Revised University of California – Los Angeles; LSAS, Liebowitz Social Anxiety Scale.

* P  < 0.05.

Results of syntheses

The most frequent outcomes evaluated were stress, anxiety and depression (for peer-led support groups only). Vote counting is reported for these outcomes based on the direction of effect with the binomial probability test and 95% confidence intervals. Effect estimates for less frequently reported outcomes with sufficient data available are reported in Table 2 .

Four studies analysed the effect of the intervention on depression. One study had significant results (25%, 95% CI 0.63–80.59%, P  = 0.625) with a decline in depression symptoms; however, its risk of bias was ‘fair’. The other three studies all found no significant results.

Three studies reported the effect of the intervention on anxiety. One study (33.3%, 95% CI 0.84–90.57%, P  = 1.00) favoured the intervention with reduced anxiety and was rated as ‘good/fair’ in the risk-of-bias assessment. Two studies found no significant results for anxiety.

Three studies analysed stress as an outcome. One study (33.3%, 95% CI 0.84–90.57%, P  = 1.00) had a significant decline in stress, but it was rated as ‘fair’ in the risk-of-bias assessment. One study in this category did not have any significant findings for stress, whereas the other had mixed results, with no significant findings for stress but significant improvements in functioning.

Two peer mentoring studies measured anxiety. One had a significant decrease in anxiety; the other found non-significant results.

Five studies (62.5%, 95% CI 24.49–91.48%, P  = 0.73) found significant results for stress. Of these significant positive results for stress, two of the studies were rated as ‘fair’ following risk-of-bias assessment. The other studies were rated as ‘poor’. Three studies found no significant reduction in stress, but one of these had mixed results, with significant improvements to negative affect.

All three peer learning studies measured anxiety. Although one study had mixed results, the other two reported significant intervention effects (66.67%, 95% CI 9.43–99.16%, P  = 1.00). All three studies were rated as ‘fair’ in their risk-of-bias assessment, with no power analysis reported and only two time points measured.

This review demonstrates a wide variation in interventions and terminology used to describe peer support. Although many use the label to encapsulate all forms of peer support, this does not capture the nuances of different peer support interventions. Previous reviews only using peer support as a search term exhibit this, finding just three studies and missing relevant work. Reference John, Page, Martin and Whittaker 21 We found peer support for student mental health and well-being referred to as everything from cooperative learning to peer-led social support groups. There is little consistency in the terminology. Without a shared vocabulary, it is difficult to understand how different forms of peer support may benefit higher education students. This review identified three main categories of peer support: peer-led support groups, peer mentoring and peer learning. A shared understanding and use of these categorical terms beyond peer support is imperative to future research and dissemination. However, first the definition of a peer needs to be clarified.

Defining a peer

The lack of consistent terminology brings into question how HEIs define a peer. Although peer support is broadly about people supporting each other based on shared experiences, Reference Gulliver and Byrom 12 more is required to define a peer in HEIs. This review defined peer support as higher education students helping each other since all peer facilitators and students accessing peer support had this identity. However, other identities are also being used to define a peer by ‘course’, ‘year/seniority’, ‘heritage’, ‘age’ and ‘lived experience of mental health difficulties’.

Of the studies that defined peers based on their year of study ( n  = 13), ten were for first-year students. Although this may not be surprising for peer mentoring, as it is defined by a higher-year student supporting a lower-year student, this was also seen in peer-led support groups and peer learning. Being described as an ‘acute stressor’, the transition into higher education strains well-being, as students face many changes and can struggle to settle in. Reference Gall, Evans and Bellerose 111 Perhaps this is why so many peer support interventions are focused on first-year students; however, each year in higher education presents new challenges, with stress levels fluctuating throughout a degree. Conley et al Reference Conley, Shapiro, Huguenel and Kirsch 112 found that students in the USA enrolled in a 4-year degree had the poorest psychological functioning across the first two years of study, with improvements seen in the final two years. In England, anxiety triggered by higher education and psychological well-being fluctuated for 3-year degree students; however, depression rates were highest in the final year of study. Reference Bewick, Koutsopoulou, Miles, Slaa and Barkham 113 This finding raises questions about whether students would also benefit from peer support beyond their first year. Of the four papers that offered peer support for higher-year students such as those in their second and third years, Reference Moir, Henning, Hassed, Moyes and Elley 102 , Reference Pinks, Warren-James and Katsikitis 106 third years Reference Short, Kinman and Baker 107 and seniors, Reference Humphrey 95 all were part of the peer-led support group category. None had significant results for improved student mental health and well-being outcomes. Although a need might exist, more research is needed to understand if peer support does improve the mental health and well-being of higher-year students.

Another common way to define a peer was through a course of study. Healthcare studies and psychology were the most frequent courses to offer peer support, with nine of the 12 studies falling within these disciplines. Compared with students from other degrees, studies indicate that medical students have higher rates of mental and emotional difficulties, increased levels of mental distress during training and are less likely to seek help. Reference MacLean, Booza and Balon 114 , Reference Jacob, Li, Martin, Burren, Watson and Kant 115 In one study, however, students from the sciences and arts and humanities had significantly higher mean levels of depression than students from health sciences and social sciences. Reference Ruiz-Hernández, Guillén, Pina and Puente-López 116 A study of nursing students in Spain and Chile found that levels of mental distress reduced over time, indicating that nursing education may be a protective factor against mental health disorders. Reference Reverté-Villarroya, Ortega, Raigal-Aran, Sauras-Colón, Ricomà-Muntané and Ballester-Ferrando 117 Therefore, peer support should be evaluated with students across various courses to understand any differences.

Peer-led support groups

This review defined peer-led support groups as a type of peer support that aims to gather groups of students together for mutual support, which was a unique factor. Mutual support is ‘a process by which persons voluntarily come together to help each other address common problems or shared concerns’. Reference Davidson, Chinman, Kloos, Weingarten, Stayner and Kraemer Tebes 118 Peers form self-help support groups by meeting for mutual assistance. Reference Byrom 24 Although group settings offer mutual support for those attending, the review did not include outcomes for peer facilitators, so the mutuality of these groups warrants further investigation. From descriptions alone, it is hard to discern the extent of mutuality in support provision. Of the four studies that had all students act as facilitators, Reference Humphrey 95 , Reference Kocak 98 , Reference Pinks, Warren-James and Katsikitis 106 , Reference Short, Kinman and Baker 107 all were part of the peer-led support group category except one, which was categorised as peer learning. Reference Kocak 98 One study had facilitators take turns leading, Reference Eren-Sisman, Cigdemoglu and Geban 87 whereas the others had all students trained with no set facilitator for the group sessions so that everyone was expected to participate equally. Reference Pinks, Warren-James and Katsikitis 106 , Reference Short, Kinman and Baker 107

Peer-led support groups had the most mixed findings, so their efficacy remains to be seen. As the most frequently evaluated intervention type, 20 measures were used to explore 14 mental health and well-being outcomes. The various measures might demonstrate indecision on the objective of peer-led support groups. Similarly, the different measures could also be explained by the different delivery methods. Although the ‘group’ aspect of this category was the defining feature, the studies represented a range of interventions, such as a peer-run self-help group, Reference Byrom 24 mutual support group Reference Freeman, Barker and Pistrang 90 and peer-facilitated/-led stress management group/peer education. Reference Fontana, Hyra, Godfrey and Cermak 89 , Reference Frohn, Turecka, Katz and Noehammer 91 The diverse delivery methods may explain the difference in outcome measures assessed and the mixed results of this category. However, many studies lacked detailed descriptions of the interventions. Hence, it is difficult to assess whether they are indeed distinct or if a difference in the nomenclature used to describe interventions explains these results. Based on the heterogenous literature for this peer support, it is impossible to identify when or why some forms improve student mental health. The peer-led support group is therefore a category of peer support that warrants further investigation using shared terminology and clear descriptions of the interventions to understand the factors associated with its efficacy.

In this review, we defined peer mentoring as a type of peer support that relies on higher-year/more experienced students to support lower-year/less experienced students. Mentoring is known broadly as a transfer of knowledge, Reference Parsloe and Wray 119 where a more experienced, usually older, individual guides a mentee with less experience. Reference Budge 120 Depending on the institution, peer mentoring goes by names such as a ‘parent’ programme, ‘buddy’ scheme or ‘family’ programme. No matter the title, peer mentoring programmes operate on the same belief that students who have more experience in higher education can mentor less experienced students.

Peer-led support groups were defined by their group nature; peer mentoring had more heterogeneity in approach. Most peer mentoring happened with mentors supporting mentees on a one-to-one basis, but three of the 11 papers took alternative approaches. These studies paired one mentor with up to three mentees, Reference Phinney, Torres Campos, Padilla Kallemeyn and Kim 105 had a dyad with a group of mentees connecting with one mentor Reference Fullick, Smith-Jentsch, Yarbrough and Scielzo 92 or took a mixed approach with one-to-one meetings and homework assigned to the students receiving support. Reference Eryilmaz 88 All alternative approaches to one-to-one peer mentoring had significant results in the assessed mental health and well-being measures. Overall, the included studies used 17 measures to evaluate ten outcomes. Stress was the predominant outcome, with 62.5% of the studies demonstrating significant, positive results for stress. Therefore, peer mentoring benefits student stress and takes a mostly one-to-one structure; however, other approaches can be helpful. The literature mostly agrees on peer mentoring terminology to describe this type of peer support.

This review defined peer learning as a type of peer support that convenes students based on academic objectives and tends to be situated in departments. Peer-led team learning Reference Eren-Sisman, Cigdemoglu and Geban 87 and cooperative learning Reference Kocak 98 contributed to this category. Cooperative learning creates spaces where students work toward a common purpose and assist each other in learning. Reference Johnson and Johonson 121 , Reference Lee, Ng and Jacobs 122 Peer-led team learning is an experiential learning environment where students build knowledge, talk to each other and develop higher-level reasoning and problem-solving skills by thinking together about the conceptual side of learning. Reference Tien, Roth and Kampmeier 123 – Reference Varma-Nelson, Coppola, Greenbowe, Pienta and Cooper 125 Peer-assisted learning is also part of this category, Reference Bosmans, Young and McLoughlin 27 with Bournemouth University defining it as ‘a scheme that fosters cross-year support between students on the same course’ while encouraging students to learn together and help each other. 126 The approach to learning is socially focused. Reference Hilsdon 127 In this way, peer learning is distinguished from other supportive activities because it is facilitative of student learning; structured and purposeful with training and support; reliant on small groups; open to everyone, non-compulsory and takes place in a safe, more relaxed environment. Reference Ody, Carey, Dunne and Owen 128

Peer learning traditionally focuses on academic objectives. As such, there are few studies assessing the impact of this type of peer support on mental health and well-being. The data captured here, however, suggests that peer-led learning interventions may improve student mental health, with a significant impact on reducing anxiety. Thus, the positionality of peer learning in departments may be an opportunity for HEIs to take a settings-based approach to improve student mental health in the classroom.

Peer support in higher education versus community peer support

Although the promise of peer support in higher education is underpinned by the more established body of research on peer support in community health settings, two issues have been raised through this review. First, the measures being used differ. Two meta-analyses found significant reductions in depressive symptoms for peer support as an intervention in communities, Reference Bryan and Arkowitz 20 , Reference Pfeiffer, Heisler, Piette, Rogers and Valenstein 129 which have been used to justify further exploration of peer support in higher education. Depression was measured as an outcome in only five studies in the higher education context. Of these, one was peer mentoring, which significantly favoured the intervention. The others were peer-led support groups, with only one of the four studies reporting significant benefits to depression. The lack of depression measures makes comparing findings in community settings to HEIs difficult.

Only two peer-led support group studies defined a peer based on their lived experience of mental health difficulties, Reference Conley, Hundert, Charles, Huguenel, Al-khouja and Qin 86 , Reference Freeman, Barker and Pistrang 90 bringing them together with peer facilitators who self-identified as living with a ‘mental illness’ or ‘psychological problem’. This finding contrasts the definitions of a peer used in community mental health settings. The NHS website defines peer support workers as ‘people who have lived experience of mental health challenges themselves’ and who use their experiences to empathise with and support others. This inconsistency in how HEIs classify a peer in contrast to how a peer is defined in community mental health settings in the UK is essential. Because peer support in higher education does not seem to recruit facilitators or students based on lived experience with mental health difficulties, the basic definitions of a peer in a community versus a HEI differ. This disparity in definition and lack of shared outcome measures mean that the comparison between community programmes and peer support in higher education cannot currently be made with the literature.

Limitations of evidence included in the review

No grey literature met the inclusion criteria. A search was undertaken in OpenGrey 34 and Grey Matters, 35 but no results were found. In addition, no relevant grey literature was encountered through cross-referencing the included full-text studies. Although five reports were discovered in a scoping review, all were excluded after screening. They reported on peer support in higher education generally, undertook qualitative evaluation only or did not use a measure of student mental health or well-being that fit the study criteria. Reference Gulliver and Byrom 12 , Reference Stoll, Yalipende and Haas 30 , Reference Andrews, Clark and Davies 130 – Reference Biggers, Yilmaz and Sweat 132 Although grey literature can reduce publication bias and improve the comprehensiveness of a systematic review, Reference Paez 133 more robust reporting in grey literature is needed to meet basic efficacy measures in higher education peer support.

Most included studies lacked a power analysis to assess whether sample sizes were sufficient to detect intervention effects. Of those that reported a power analysis, many had poor retention and/or small sample sizes, which may explain the many non-significant results of this review. Of the 28 included studies, 21 did not report a power analysis. One included study was a primarily qualitative study, where the quantitative element met the inclusion criteria, but the sample size was small ( n  = 2), affecting its quality. Reference Geng, Midford, Buckworth and Kersten 93 Of the seven studies that did report a power analysis, one did not achieve the sample size required. Reference Head 94 Four of these were rated as ‘good’ in the risk-of-bias assessment, but the two others were rated ‘fair’ Reference Kilpela, Blomquist, Verzijl, Wilfred, Beyl and Becker 97 and ‘fair/poor’ Reference Mattanah, Brooks, Brand, Quimby and Ayers 100 because of low retention and poor reporting of outcome measures. A similar review in higher education settings also found many underpowered studies, indicating the need to run interventions to broader cohorts of students across faculties, programmes or similar institutions to improve power. Reference Upsher, Nobili, Hughes and Byrom 36 With only six studies reporting on the funding received, more funding may be required to make adequately powered studies a reality.

Many studies presented incomplete data; for example, unclear sample sizes and missing statistics/ raw data (i.e. means and s.d.). Demographics were also poorly reported, so that it was not possible to disaggregate gender, age or ethnicity for a helpful discussion. Despite many studies missing integral parts, available data were extracted when possible to calculate mean differences, P -values and standardised mean differences for a more consistent synthesis. The reporting in this review may indicate that better guidelines are required. One review of higher education interventions for student mental health and well-being recommended that medical reporting guidelines Reference Groves 134 , Reference Schulz, Altman and Moher 135 are adapted to improve standards. Reference Upsher, Nobili, Hughes and Byrom 36

Outcome measures were too heterogenous for meaningful comparison. Although anxiety and stress were the most common outcomes investigated in the literature, there was little consistency in measures. Although the Perceived Stress Scale was used most to measure stress ( n  = 8) and the STAI was used to measure anxiety ( n  = 4), many other measures were also applied to assess these common outcomes. Some measures, such as the PANAS, were used to measure different outcomes. For example, Eryilmaz Reference Eryilmaz 88 chose to use PANAS and the SWLS to measure subjective well-being, Kilpela et al Reference Kilpela, Blomquist, Verzijl, Wilfred, Beyl and Becker 97 used PANAS to measure negative affect and Thomson and Esses Reference Thomson and Esses 109 used PANAS to measure psychological adaptation. This lack of consistency is an obstacle to comparing and drawing conclusions on effective interventions. A ‘core set’ of well-being measures validated in higher education student populations has been recommended. Reference Dodd, Priestley, Tyrrell, Cygan, Newell and Byrom 136 Similar guidance is needed for stress, anxiety and perhaps depression, as this review's most common outcome measures, to complement existing toolkits. Reference Broglia, Nisbet, Chow, Bone, Simmonds-Buckley and Knowles 137

Limitations of the review process

A meta-analysis was not possible because of the outcome measure heterogeneity, few reported effect sizes (or raw data to calculate them) and limited information on the interventions to compare similar studies. Vote counting is considered a less robust way to synthesise evidence in a systematic review, since no information is given on the magnitude of effects, sample sizes are not considered and combining P -values is a more robust method. Reference Borenstein, Hedges, Higgins, Rothstein, Borenstein, Hedges, Higgins and Rothstein 138 This systematic review is limited by the narrative synthesis taken; however, using SWiM guidelines improved reporting transparency. Reference Campbell, McKenzie, Sowden, Katikireddi, Brennan and Ellis 33 Nonetheless, the synthesis method stipulated by the current evidence available in the field limits the conclusions that can be drawn.

Although the Cochrane tool for assessing risk of bias in randomised trials and other such tools is widely used, Reference Higgins, Thomas, Chandler, Cumpston, Li and Page 139 most do not support multiple study designs. Reference Upsher, Nobili, Hughes and Byrom 36 As this review had seven randomised controlled trials, two cross-sectional with control and 19 pre–post with and without control designs, a different tool was required. A modified NIH ‘Quality Assessment Tool for ‘Before-After (Pre-Post) Studies With No Control Group’ was used for the risk-of-bias assessment. 40 The chosen method was limited in practice because it is designed for studies without a control group, so there were no criteria acknowledging if a study had a control group, which would strengthen its quality. This approach to risk-of-bias assessment was best-suited for the heterogeneity of our included studies; Reference Upsher, Nobili, Hughes and Byrom 36 however, as some studies also had a cross-sectional design with a comparator, the chosen tool was an imperfect option.

In this study's synthesis, the initial baseline and post-intervention measures were included for pre–post intervention outcome measures. The post-intervention measures were synthesised for cross-sectional with a control design. This approach was used because studies included a mix of interim and follow-up measures at varying durations that did not allow for comparison. Although all time points were extracted to see if comparable data was available, only the pre–post measures for longitudinal studies and cross-sectional post-intervention data with control could be used for synthesis. Using the pre–post time points allowed for more comparison and generalisability in the extraction and synthesis process.

Finally, the methodology has an additional limitation. This paper focused on quantitative studies to meet the second of our objectives: to evaluate the effectiveness peer support in higher education. Future work may benefit from reviewing qualitative studies to confirm our categorisation of types of peer support and definitions of peer.

Implications of the results for practice, policy and future research

This systematic review found that peer support in higher education is defined in the literature according to three categories: peer-led support groups, peer mentoring and peer learning. By identifying this nomenclature, HEIs can start using a shared language when evaluating interventions and communicating best practice. It will also improve understanding of the strengths and limitations of peer support in more detail so that areas for further research can be prioritised.

Peer-led support groups come together for mutual support. Exploring the mutuality of peer support for the peer facilitators and those attending was beyond the scope of this review, but should be studied further. In addition, although this form of peer support was the only one to measure depression outcomes multiple times, results were mixed, which may indicate that the category is too broad. Alternatively, as this form of peer support is most comparable to community mental health settings, it may be that the gap in how HEIs and healthcare settings define a peer and measure different outcomes is the barrier to the identification of effective interventions. Further investigation is needed into what specific peer-led support group components improve efficacy.

Peer mentoring is mostly for incoming students to receive support from a higher-year/more experienced student. This type of peer support was the most homogeneous in the terminology used and implementation (one to one). Of the three peer support types, it was also the most promising for improving stress outcomes. Nonetheless, alternative approaches to peer mentoring (e.g. small groups) demonstrated significant results in other measures (e.g. affect and depression), indicating that more research is needed to understand how the structure of peer mentoring affects mental health and well-being outcomes.

Peer learning operates in groups and convenes for academic objectives. Results indicate that significant improvements in anxiety were linked to peer learning. HEIs should consider incorporating relevant measures into existing peer learning programmes so that further investigations of its benefits to mental health and academic outcomes can be made.

In conclusion, despite hopes that peer support in higher education would offer an accessible, setting-based solution to improving student support, the findings of this review are mixed. Of the three types of peer support, two had the most significantly positive results: peer learning reduced anxiety and peer mentoring reduced stress levels. Results for peer-led support groups, however, were varied. Although peer-led support group interventions assessed depression more than any other type of peer support, they did not show a majority of significant results for any of the outcomes measured.

Peer support interventions aimed at improving student mental health and well-being were set up with specific objectives, such as easing the transition into higher education (peer mentoring), meeting academic objectives (peer learning) or enhancing mutual support (peer-led support groups). Furthermore, how a peer was defined in the higher education context varied, which is crucial to understanding the intervention. Students’ years of study and discipline were common features of defining a peer. However, peer-led support groups were the only type that brought together students with lived experiences of mental health difficulties as peers, which is most similar to community mental health settings. This comparability warrants further investigation, as this type of peer support shows promising applications in wider communities.

Various modes of peer support that use specific definitions of a peer are more or less useful for different needs. Although HEIs consider peer support as a potential addition to support services, defining the type of peer support and what a peer is must be considered. Next, researchers and educators need to set standardised mental health and well-being metrics for the various types of peer support, so that more robust studies can be conducted. These findings should be shared widely, using better reporting guidance to elevate best practice. With this, HEIs can start to assess which types of peer support are helpful when and for whom, as part of a whole-university approach to support all students’ mental health and well-being. The definitions of peer support provided in this review, however, are the first steps toward a consistently shared vocabulary to tackle these challenges.

Supplementary material

Supplementary material is available online at https://doi.org/10.1192/bjo.2023.603

The data that support the findings of this study are available from the corresponding author, J.P.-H., upon reasonable request.

J.P.-H. conceptualised the study, wrote, reviewed and edited the manuscript and was responsible for data curation, formal analysis, study investigation and methodology, project administration, resources, validation and visualisation. L.W. contributed to the study methodology and data curation. R.U. supervised the study and reviewed and edited the manuscript. J.F. and N.B. conceptualised and supervised the study, acquired funding and reviewed and edited the manuscript. J.O. conceptualised and supervised the study and reviewed and edited the manuscript.

This work was supported by the UK Research and Innovation Economic and Social Research Council London Interdisciplinary Social Science Doctoral Training Partnership (grant number ES/P000703/1). N.B. was partially supported by a grant from the Economics and Social Research Council: ES/S00324X/1.

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• Volume 10, Issue 1
• Julia Pointon-Haas (a1) , Luqmaan Waqar (a1) , Rebecca Upsher (a1) , Juliet Foster (a1) , Nicola Byrom (a1) and Jennifer Oates (a2)
• DOI: https://doi.org/10.1192/bjo.2023.603

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• Research article
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• Published: 11 November 2020

The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis

• Sarah White 1 ,
• Rhiannon Foster 1 ,
• Jacqueline Marks 1 ,
• Rosaleen Morshead 1 ,
• Lucy Goldsmith 1 ,
• Sally Barlow 2 ,
• Jacqueline Sin 1 &
• Steve Gillard   ORCID: orcid.org/0000-0002-9686-2232 1  

BMC Psychiatry volume  20 , Article number:  534 ( 2020 ) Cite this article

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Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions.

We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data.

Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery.

Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support.

Conclusions

One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support.

Trial registration

Prospero identifier: CRD42015025621 .

Peer Review reports

Mental health and workforce policies in a number of countries advocate the introduction of large numbers of peer workers into mental health services [ 1 , 2 ]. In this context, peer workers are people with personal experience of using mental health services and/ or of mental distress, employed to make use of that experience in providing support to others currently using mental health services. Peer support more generally refers to a mutual exchange of emotional and practical support between people who identify as peers on the basis of shared or similar experiences of mental distress, with the recent origins of organised forms of peer support often ascribed to the mutual aid movement [ 3 , 4 ]. The emergence of trained peer workers, providing peer support to people using mental health services, is a comparatively newer phenomenon, stimulated perhaps in part by assumptions about economic prudence [ 5 ], and in part by suggestions that peer support aids individual recovery [ 6 ]. Peer workers have been employed in a range of roles, providing one-to-one support to individuals using mental health services, as we explore below, supporting and facilitating mutual support groups, or running services provided as an alternative to mainstream provision.

The peer support literature has been reviewed before, with Pitt and colleagues [ 7 ] finding a small reduction in emergency service use where peer workers were compared with other mental health professionals working in similar roles (primarily case management), while Lloyd Evans and team [ 8 ] found a modest positive effect of peer-provided interventions on self-reported recovery and hope. However, both reviews combined studies of individual and group-based peer support – noting substantial heterogeneity in both intervention and trial population – and in both reviews authors cautioned that the majority of trials were of low to moderate quality and that reporting bias in particular might explain these results. More focused reviews have considered peer support for people experiencing depression [ 9 ], and for those experiencing psychosis [ 10 ]. The former considered only group interventions, while the latter combined group, one-to-one and service-level modalities of peer support, and found no evidence of effectiveness of one-to-one peer support. However, a recent, informal review has indicated that a number of new trials of one-to-one peer support in mental health services have been reported [ 11 ], offering a timely opportunity for a systematic review focusing on one-to-one peer support in order to provide an evidence base for the ongoing introduction of peer workers into mental health services internationally.

Exploring heterogeneity of peer support interventions

We note that Pitt and colleagues [ 7 ] identified small differences in effect when considering ‘consumer provider [peer] vs professional staff’ in comparison to ‘consumer provider as an adjunct vs usual care alone’, warranting exploration of this aspect of intervention heterogeneity in the context of one-to-one peer support in this review. Both Pitt [ 7 ] and Lloyd Evans [ 8 ] also note that peer support is often under specified in trial papers, and that it is not always clear how peer support is different from mental health support provided by other types of mental health worker. A wider literature has identified a values-base that specifies how peer support is distinctive from other mental health support, suggesting that peer support is characterised by: a relationship grounded in a sense of connection based on shared experiences [ 12 ]; the use of experiential, rather than formal (taught) knowledge in the peer worker role [ 13 ]; the reciprocal nature of the relationship, with both parties learning from each other in contrast to the uni-directional clinician-patient relationship [ 14 ]. However, it is also noted how the formal, health services environment is not always conducive to the delivery of peer support [ 15 , 16 ].

Studies have identified a number of organisational factors that facilitate the implementation of distinctive peer support into practice, including: a clear, shared understanding of the values informing peer support in the peer worker role [ 17 ]; the importance of dedicated peer support training programmes for peer workers [ 18 ]; the need for support and supervision for peer workers [ 19 ]. Some actors in the peer support community have called for standards in the delivery of peer support in mental health services to ensure that a distinctive, values-based peer support is delivered [ 20 ]. Currently there is a lack of evidence of any association between outcomes and organisational variables supporting the delivery of peer support. There is therefore a case for exploring whether it is possible to operationalise, as a subgroup analysis, the quality of organisational support for one-to-one peer support interventions as an additional approach to exploring the heterogeneity of peer support in mental health services.

This study aims to:

systematically review all the available peer-reviewed evidence for one-to-one peer support interventions for adults using mental health services

evaluate the effects of one-to-one peer support in mental health services on a range of pre-specified outcomes

investigate, using subgroup analyses, how heterogeneity in intervention (i.e. type of peer support, quality of organisational support for peer support) is related to outcome.

This systematic review and meta-analysis adheres to PRISMA guidelines and is funded by the UK National Institute for Health Research as part of larger programme of research investigating peer support in mental health services. The review protocol is registered with the International Prospective Register Of Systematic Reviews, identifier: CRD42015025621.

Definitions

For the purpose of this review we consider one-to-one peer support in mental health services to be support delivered by an individual with personal experiences of using mental health services and/or of mental distress. We refer to the person delivering peer support here as a peer worker , noting that other terms, including peer support worker , peer specialist and consumer employee , have been used elsewhere. Peer workers are employed – whether paid or unpaid – and trained to make use of their experiential knowledge in providing support to someone who shares similar experiences, as part of or alongside the care and treatment they are receiving from mental health services.

Eligibility criteria

Studies were included where peer support was:

provided one-to-one;

intentionally provided by a peer worker;

for adults using mental health services.

Studies were excluded if peer support was:

not the primary means of delivering the intervention;

not one-to-one or intentionally provided by a peer worker;

where mental health was not the primary focus of the intervention.

Other exclusions were applied if the study was not in the English language, non-retrievable, or did not contain empirical data.

Study design

All types of randomised controlled trial (RCT) were included. Other study types were excluded.

Intervention and comparison conditions

We noted above that one-to-one peer support in mental health services has been characterised as either: an adjunctive intervention, delivered by peer workers in addition to care as usual or as an additional component to a treatment or therapy; or as peer workers delivering similar interventions to those delivered by other mental health workers (e.g. where peer workers are employed in a substitute capacity) [ 7 ]. We include both ‘adjunctive’ and ‘substitute’ peer support interventions in this review, and consider all comparator conditions in our primary analysis. Where trials had two or more intervention arms (e.g. with and without peer support) and a control arm, in all cases the comparison chosen was peer support (as intervention condition) and the other enhanced or active condition (as control condition), rather than care as usual or an attention control arm.

As noted above, a variety of outcomes have been assessed in peer support trials. Given that a number of additional trials have emerged since the publication of existing systematic reviews, it is of interest to consider whether the range of outcomes of interest remains broad or has begun to coalesce. We extract data using the set of outcomes explored in the review conducted by Lloyd-Evans and colleagues [ 8 ]. In addition, we consider use of emergency services in order to explore further findings in the Pitt review [ 7 ] and, following other published research into the mechanisms of peer support we include a small number of more socially-focused outcomes that may be impacted by peer support [ 21 ]. The full set of outcomes of interest for this review is as follows:

Hospitalisation

Emergency service use

Overall psychiatric symptoms

Symptoms of psychosis

Depression and anxiety

Quality of Life

Recovery (self-rated)

Empowerment

Satisfaction with services.

Social functioning

Social network support

Working alliance (clinician rated/ patient rated)

Self-stigma

Experienced stigma

Engagement with services

Search methods for identification of studies

The following online bibliographic databases were identified in 2015 based on then existing reviews [ 6 , 7 ] – Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsychINFO and CINAHL Plus – and searched initially from inception until the end of April 2015.

Existing reviews were used to provide a basis for search terms, with authors using their knowledge of the area, including service user researchers JM and RF, to add to search terms. The diagnostic manual DSM 5 [ 22 ] was consulted to provide a systematic structure to ensure mental health terms were inclusive. The search strategy was tested and refined as necessary. All databases were searched using a similar set of terms, strategies and Boolean operators, amended solely for the purposes of the research database management interface and not for content. An example of the search strategy, for MEDLINE, EMBASE and PsychINFO using the OVID interface, is given in Supplementary materials 1 .

Searches were updated on 13 June 2019, with no changes to search terms or search strategy. All papers returned by the search were imported into an Endnote library and any duplicates removed first using the software and then by manual review.

Study selection

Titles and abstracts of all studies returned in the search were independently screened for inclusion in the review by two researchers (two of JM, RF and RM). Disagreements were resolved by discussion using the full text of the paper, with remaining differences resolved by discussion with SG. Reference list and forward citation searching of included studies were used to identify additional papers for inclusion in the review.

Data extraction

Data were extracted for study characteristics from each included study by one of JM, RF or RM using a structured data extraction data sheet (see Table  1 below), with a second researcher (SG) checking for accuracy of extraction for 25% of studies.

For the purposes of exploring heterogeneity of intervention as subgroup analyses in the meta-analysis we also recorded where peer support was provided as an adjunctive intervention and where peer workers were working in a substitute role, as defined above, and in addition rated the quality of organisational support provided for peer support. To do this, studies were independently coded by two members of the team (JM and RM) where they reported any of the following indicators:

Dedicated peer support training;

Clear description of theory, processes or understanding of peer support;

Support structures for peer workers (e.g. supervision).

Discrepancies between researchers were discussed until agreement was reached. Studies were then categorised as having a ‘higher level’ of organisational support for peer support if they fulfilled at least two of the three indicators, or ‘lower level’ if they met one or less indicators.

Extraction of data for meta-analysis

One researcher (RM) extracted data for outcomes onto a bespoke extraction sheet. Data were included if they were assessed using a standardised measure or, in the case of service use data, captured in clinical records. For continuous outcomes, sample sizes, mean and standard deviations by arm were extracted, and for dichotomous outcomes, the number of events and sample size per arm were extracted. All outcome data extraction was checked by statistician SW for accuracy and completeness. If data for a particular outcome were only reported by a single paper that outcome was not included in the meta-analysis. We wrote to authors of included studies for additional information and trial data where it was not included in the published article.

Where outcome data were reported for more than one follow-up point, the longest timepoint was used. Where more than one measure was used to report the same outcome in a study, we included the measure more commonly reported by other studies in the analysis.

Assessment of risk of bias

Each included study was assessed for risk of bias by two researchers (RM, JM), with any differences in assessment resolved by a third researcher (SW), in accordance with Cochrane Collaboration Risk of Bias Tool [ 80 ]:

adequate sequence generation (selection bias)

allocation concealment (selection bias)

blinding of outcome assessment (detection bias)

incomplete outcome data (attrition bias)

selective outcome reporting (reporting bias)

It is important to note that although blinding of participants to allocation is usually assessed, in this particular instance the nature of a peer intervention means that all trial participants are unblinded. As such this particular source of bias is not assessed in this review, in line with existing reviews of peer support.

Statistical analysis

Effect sizes for continuous data were calculated as standardised mean difference (SMD), Hedges’ g, with studies weighted using the inverse variance method [ 81 ]. Risk ratios were calculated for dichotomous outcomes, and studies combined again using the inverse variance method. All pooled effect sizes are reported with 95% confidence intervals calculated using random-effects models. We used intention to treat data in all analyses.

Statistical heterogeneity was assessed through the I 2 statistic which describes the percentage of the variability in effect estimates that is due to heterogeneity rather than chance and the p -value of the χ 2 test (Q) for heterogeneity. A p-value < 0.10 and an I 2  > 50% suggests substantial heterogeneity. Where substantial heterogeneity of effect sizes across trials is observed, subgroup analyses were conducted, comparing studies where:

peer support was provided as an adjunctive intervention, against those studies where peer workers were working in a substitute role;

a higher level of organisational support for peer support were reported, against those studies where a lower level was reported.

Differences between subgroups of studies were tested using the Qint test for heterogeneity, testing if effect sizes differ across subgroups. Review Manager (RevMan 5.2 for Windows) software [ 82 ] was used to conduct the meta-analyses.

A total of 6502 records were identified in the updated search. Of these, 311 studies were potentially eligible and, after further review (as described above) 23 eligible papers were identified, reporting on 19 trials. One trial was reported across four papers [ 23 , 83 , 84 , 85 ] and another trial reported across two papers [ 45 , 86 ]. See Fig.  1 below.

Flowchart of inclusion of studies

Study characteristics

Twelve studies were conducted in the USA [ 23 , 28 , 30 , 31 , 39 , 42 , 44 , 45 , 54 , 63 , 66 , 68 ], three were conducted in the UK [ 35 , 59 , 76 ], one in Canada [ 62 ], one in Australia [ 50 ], one in Germany [ 71 ], and one in Japan [ 74 ]. Eighteen trials were individually randomised and one was a cluster randomised trial [ 54 ]. Six studies described themselves as pilot trials [ 28 , 35 , 45 , 59 , 62 , 68 ], four studies were three-arm trials [ 30 , 31 , 42 , 50 ], and one study used a waitlist control [ 68 ].

Fifteen studies fell into the ‘adjunctive’ peer support group, with eleven of those comparing peer support as an adjunctive intervention to care as usual [ 28 , 31 , 35 , 42 , 45 , 54 , 59 , 66 , 71 , 74 , 76 ]. Two of the eleven [ 31 , 42 ] were three arm trials comparing care as usual, an adjunctive intervention, and the intervention plus an additional peer support component. Another three-arm trial [ 50 ] compared an attention control, intervention, and the intervention plus an additional peer support component. Two papers reported two arm trials of an intervention, with and without adjunctive peer support [ 44 , 63 ], and one study compared the peer support intervention with a waitlist condition (i.e. no-comparator intervention) [ 68 ]. Four studies compared peer workers working in a substitute capacity compared with other mental health workers performing a similar role [ 23 , 30 , 39 , 62 ]. One of these studies was also a three-arm trial [ 30 ], with care as usual as the third arm. Further details about study characteristics can be seen in Table 1 below, with indication given of which comparators were used in the subsequent meta-analysis.

Participants in all studies were adults, although in one study participants were aged 55 or older [ 68 ]. In the majority of studies – twelve – participants were using community mental health services [ 23 , 28 , 30 , 35 , 39 , 44 , 50 , 54 , 62 , 63 , 66 , 76 ]. In three studies participants were recruited as inpatients [ 42 , 45 , 59 ], and in two studies participants were recruited as either inpatients or outpatients [ 71 , 74 ]. In two studies participants were recruited directly from depression clinics [ 31 , 68 ]. Most studies indicated diagnostic inclusion criteria, with seven studies specifying that participants would have diagnoses of either psychotic, or major depressive or mood disorders [ 23 , 30 , 39 , 42 , 45 , 54 , 66 ]. Two studies specified a diagnosis of bipolar disorder [ 44 , 50 ], one of major depressive disorder [ 31 ], one of mild to moderate depression and anxiety [ 68 ], one of either psychotic or personality disorders [ 71 ], and one of dual mental health, and drug or alcohol disorder [ 28 ]. Two studies defined eligibility by duration of mental illness with one specifying at least two years [ 71 ], and the other indicating that mental illness should be persistent [ 62 ]. A number of studies defined the population by service use history. In three studies eligibility criteria were defined by a minimum number of previous, recent psychiatric hospital admissions [ 42 , 45 , 54 ]. One study recruited participants as they approached hospital discharge [ 59 ], one study recruited participants who had been referred to specialist crisis and home treatment teams [ 76 ], and another study recruited participants who were under a court order mandating community mental health treatment [ 63 ].

Sample sizes

Samples sizes in the studies ranged from 21 [ 62 ] to 468 [ 54 ], with a total of 3329 participants in the 19 trials.

Interventions

While descriptions of peer support interventions remains thin in some studies published since the last review [ 8 ], a number of more recent studies do provide detailed descriptions of peer worker roles and what constitutes peer support. Peer workers were reported as delivering a range of different interventions. Five studies reported peer workers working in case management roles [ 23 , 30 , 39 , 42 , 54 ]. Typically, peer workers were expected to fulfil a similar, brokerage-type case management function to other mental health workers, and in addition, to role model their own strengths and experiences of recovery [ 39 ], or to provide social support by arranging social activities [ 42 ]. Three studies reported peer workers working in mentoring or coaching roles [ 44 , 45 , 50 ]. Mentoring and coaching roles varied considerably from offering a very loosely described partnership relationship that aimed to be different to a clinician-patient relationship [ 45 ], to structured online coaching to support participants in producing a detailed, behaviourally-informed recovery plan [ 44 ]. Three studies described peer workers providing support for self-management [ 31 , 62 , 76 ]; for example, in one study peer workers provided one-to-one assistance with rehabilitation goals set by occupational therapists [ 62 ], while in another peer workers supported participants to complete a structured recovery workbook [ 76 ]. Another three studies describing peer workers offering support for recovery [ 59 , 63 , 71 ]. What support for recovery entailed was generally poorly defined, with the exception of Mahlke and colleagues [ 71 ], describing in some detail how peer workers were trained and supported to reflect on and make use of their own experiences as a resource in supporting others with their recovery, but also reported that the intervention was not further manualised, and that peer workers had flexibility in the role, with an emphasis on enhancing the sense of control over their lives that people experienced. Two studies reported peer workers providing support for living independently in the community [ 28 , 66 ]. Peer support in both studies had a strong social focus and in the case of the latter [ 66 ], support was highly individualised and self-directed, involving the peer worker helping the individual to access social support that they identified themselves. Other studies described peer workers providing support for shared decision making in clinical consultations, again with a strong focus on a structured self-management approach [ 74 ], delivering a cognitive behavioural intervention using a structured workbook [ 68 ], and working in a healthcare assistant role [ 35 ].

Most peer support was provided face-to-face but in one study peer support was provided either face to face or by telephone [ 31 ], and in two studies peer support was provided online [ 44 , 50 ]. We note that in three studies peer workers were employed by peer-led organisations or agencies [ 23 , 63 , 66 ]. As noted above, four studies evaluated peer workers as a substitute for other mental health workers working in a similar role, three of those in a case management capacity [ 23 , 30 , 39 ], and in the fourth, providing support for self-management [ 62 ]. In all other studies peer support was adjunctive to care as usual or evaluated as an enhancement to another intervention.

Level of support for peer support interventions

The majority of studies – fourteen and thirteen respectively – described the support and/ or supervision provided to peer workers to deliver the peer support intervention [ 23 , 28 , 35 , 42 , 44 , 45 , 54 , 59 , 62 , 63 , 66 , 68 , 71 , 76 ], and the peer support-specific training provided to peer workers [ 31 , 35 , 39 , 44 , 45 , 54 , 59 , 62 , 63 , 66 , 71 , 76 , 85 ]. In contrast, only five studies explicitly described the theory, processes or understandings of peer support that underpinned the intervention evaluated [ 23 , 28 , 35 , 54 , 71 ].

There was variation in the degree of reporting of support given to peer workers. Reporting of training provided varied from noting that peer workers had received accredited peer specialist training prior to delivering the intervention [ 44 ], to a more detailed description of an extended, structured training program describing module content and mode of delivery [ 71 ]. Description of the support and supervision provided for peer workers also varied, from studies that simply reported that peer workers were provided with support and supervision for the duration of the study [ 59 ], to one which described in some detail the areas covered during weekly, 90 min group supervision sessions for peer workers [ 45 ]. One study said that supervision was provided by a peer support coordinator, with preference being given to employing someone with lived experience of mental illness in that role [ 62 ], while another stated that the director of the consumer case manager team was a consumer [ 23 ]. However no studies clearly stated that supervision for peer workers was provided by someone who was themselves employed to use their personal experiences of mental distress or of having used mental health services in the role. Theory, processes and understanding of peer support also varied in description, with one study [ 71 ] describing a specific peer support change model that underpinned the intervention, while others gave a more general description of the processes that characterise peer support as distinctive from other forms of mental health support [ 35 ].

Three studies did not report any of these organisational support components (dedicated peer support training; underlying theory; support for peer support) [ 30 , 50 , 74 ], and four reported just one component [ 31 , 39 , 42 , 68 ]. In contrast, four studies reported all three components [ 23 , 35 , 54 , 71 ], and eight reported two out of three [ 28 , 44 , 45 , 59 , 62 , 63 , 66 , 76 ].

Studies reported measuring thirteen of the eighteen outcomes of interest, with no studies of one-to-one peer support providing usable data assessing employment, symptoms of psychosis, self-stigma or experienced stigma, or emergency service use. Studies most often measured were hospitalisation [ 23 , 28 , 30 , 35 , 42 , 45 , 59 , 71 , 76 ] and quality of life [ 23 , 28 , 42 , 54 , 59 , 62 , 63 , 66 , 71 ], both measured in nine studies. We note that hospitalisation was variously measured as days in hospital, number of admissions or re-admissions, and community tenure (days spent living in the community, post-intervention, before hospital admission). Overall psychiatric symptoms were measured eight times [ 23 , 42 , 45 , 54 , 63 , 71 , 74 , 76 ], and both of social functioning [ 28 , 31 , 35 , 45 , 50 , 71 , 74 ] and social network support [ 23 , 28 , 35 , 42 , 45 , 63 , 76 ], seven times. Given that many studies used a more general measure of functioning - i.e. the Global Assessment of Function scale [ 29 ] – we subsequently report this outcome as General and Social Functioning. Satisfaction with services [ 31 , 35 , 42 , 45 , 76 ], empowerment [ 50 , 54 , 66 , 71 , 74 ] and working alliance [ 23 , 39 , 66 , 68 , 74 ] were all measured five times. We note that some studies reported both a participant rating of working alliance with staff and a staff rating of working alliance with the participant [ 23 , 74 ], while others only reported a participant rating of staff [ 39 ]. Self-rated recovery was measured in four studies [ 54 , 63 , 66 , 76 ], with wellbeing [ 28 , 42 , 45 ] and engagement with services [ 35 , 39 , 66 ] both measured in three studies. We grouped measures of physical health (e.g. two studies separately reported scores on the physical health subscale of the Lehman Quality of Life Scale) [ 26 ] with a more general measures of wellbeing (Life Skills Profile) [ 36 ], and so we report wellbeing as Physical Health and Wellbeing going forward. Depression and anxiety were also measured in three studies, with only Seeley and colleagues [ 68 ] using a separate measure for each, Proudfoot and colleagues [ 50 ] using a generalised measure for both, and Hunkeler and colleagues [ 31 ] measuring depression only. As a result we retain Depression and Anxiety as a single outcome for the purposes of this review. Finally, hope was measured in two studies [ 44 , 45 ]. Details of the specific tools used to measure these outcomes in each study can be found in Table 1 and are discussed further in the context of the meta-analysis reported below.

Risk of bias

The Risk of Bias ratings are displayed in Fig.  2 . Sequence generation was not sufficiently described in 7 of the 19 trials and was at high risk of bias in one trial. Concealment of the allocation sequence was not sufficiently described in 11 trials, and again at high risk of bias in one trial. Lack of blinding of assessors created a high risk of bias in 3 studies, and in 8 further trials it was unclear if assessors were blind. At the trial level, 3 were at high risk of bias for missing data (i.e. attrition bias) and 6 were unclear. Included studies may have measured but not reported outcomes that are included in this review; 10 with unclear description and 4 with high risk of reporting bias. Seven of the 19 studies [ 44 , 50 , 59 , 63 , 68 , 71 , 76 ] were at low risk of bias on at least three of the five bias categories and not high risk of bias for any category (i.e. might be described as being of low to moderate risk of bias overall), with the majority of those studies having been published since previous reviews. However on balance, overall quality of trials, when compared to previous reviews, remains low to moderate.

Summary of risk of bias of included studies

Quantitative synthesis

Data were available for the meta-analysis from fourteen of the nineteen trials included in the review (sixteen papers), with two or more trials contributing to meta-analyses of nine of our original outcomes. Because of the way data were reported in the studies, we analyse these as eleven outcomes, analysing days in hospital and hospitalised as two discrete outcomes in place of hospitalisation, and separating working alliance into staff-rated and client-rated outcomes. This analysis includes data obtained from one study after contacting study authors [ 74 ]. The number of studies contributing data to each outcome included in the analyses can be seen in Table  2 below. Median length of follow-up was 12 months post randomisation, ranging from 2.5 to 24 months. In the following analyses a positive standardised mean difference (SMD) for the following outcomes - quality of life, social network support, empowerment, recovery, service satisfaction, working alliance (client and staff rated) - indicates the peer support intervention being more effective than the control condition, the opposite being the case for the following; general psychiatric symptoms, depression and anxiety, days in hospital and hospitalised.

Five trials reported the dichotomous outcome of whether hospitalised during follow-up period or not. Follow-up ranged from 3 to 24 months with data on a total of 497 participants. The risk of being hospitalised was reduced by 14% for those receiving peer support (RR = 0.86: 95% CI 0.66, 1.13). Moderate heterogeneity (I 2  = 38%) was found across trials for this outcome. A similar result of a non-significant effect of peer support (SMD = -0.10: 95% CI -0.34, 0.14) and moderate heterogeneity (I 2  = 39%) was found for the days in hospital outcome. The five trials in this meta-analysis had follow-up ranging from 9 to 24 months and a total sample size of 453.

Six trials reported overall psychiatric symptoms with follow-up ranging from 6 to 24 months. Total sample size was 857. There was no evidence of the effect of peer support on symptoms; pooled standardised mean difference was − 0.01 (95% CI -0.21, 0.20). There was a high level of heterogeneity across trials, I 2  = 53%, χ 2 test of heterogeneity. Q = 10.7, p  = 0.057.

Quality of life

A total of 688 participants had quality of life data reported from five trials with follow-up ranging from 12 to 24 months. No effect of peer support was found on quality of life, SMD = 0.08 (95% CI -0.11, 0.26) with moderate heterogeneity across trials, I 2  = 32%.

Three trials reported appropriate recovery data with follow-up ranging from 12 to 18 months and a total sample size of 593. Peer support is shown to have a small but statistically significant benefit on recovery (SMD = 0.22: 95% CI 0.01, 0.42: p  = 0.042) (Fig.  3 ). Only moderate heterogeneity is indicated, I 2  = 38%.

Forest plot for recovery outcome

Four trials with a total sample size of 519 participants and follow-up ranging from 6 to 12 months reported empowerment related outcomes. Empowerment was significantly higher in those receiving peer support, a small effect size, SMD = 0.23 (95% CI 0.04, 0.42: p  = 0.020) (Fig.  4 ). Heterogeneity was low, I 2  = 14%.

Forest plot for empowerment outcome

Satisfaction with services outcome data was available from two trials and a total of 286 participants. Follow-up in the two trials ranged from 12 to 18 months. No effect of peer support was found (SMD = 0.19: 95% CI − 0.05, 0.42) with no heterogeneity, I 2  = 0%.

General and social functioning

Three trials provided data for the general and social functioning outcome on a total sample size of 181. Follow-up in the two trials ranged from 6 to 12 months. No effect of peer support was found (SMD = 0.01: 95% CI -0.32, 0.35) with little heterogeneity, I 2  = 21%.

Four trials reported social network support outcome data with follow-up ranging from 12 to 24 months and a total sample size of 512 participants. While the pooled SMD = 0.09 (95% CI -0.25, 0.42) indicated no effect of peer support on social network support, there is significant heterogeneity across the trials, I 2  = 67%, χ 2 test of heterogeneity. Q = 9.2, p  = 0.027.

Working alliance

Client rated working alliance about staff was reported in three trials and by a total of 213 participants. Follow-up ranged from 6 to 24 months. No heterogeneity was found across trials, I 2  = 0%, but the SMD = 0.24 (95% CI -0,03, 0.51: p  = 0.080) indicates a potentially positive outcome for peer support. The SMD = 0.15 (95% CI -0.18, 0.48) was lower for staff ratings of the working alliance, again with no heterogeneity, I 2  = 0%. This outcome was only rated in 2 trials, a total of 139 participants.

Subgroup analyses

Only two outcomes – overall psychiatric symptoms and social network support – satisfied our condition of sufficient heterogeneity in the data to warrant undertaking subgroups analyses (see Table  3 below). We conducted subgroups analyses of those outcomes as defined earlier: adjunctive peer support interventions compared to those where peer workers were working in a similar or substitute role to other mental health workers; studies reporting a higher level of organisational support for peer support compared to those studies reporting a lower level of organisational support for peer support. These analyses did not explain heterogeneity with respect to overall psychiatric symptoms. A single study [ 42 ], reporting a lower level of organisation support for peer support, found a moderate, significant increase in social network support for people in the peer support arm of the trial (SMD = 0.50: 95% CI 0.14, 0.87), compared to three other studies with a higher level of organisational support for peer support where no significant difference in social network support was found (SMD = -0.04: 95% CI -0.37, 0.28) (Fig.  5 ). It can also be seen in Table 3 that there is evidence that whether peer support is being provided as adjunctive to usual care or as a substitute role impacts the effectiveness of peer support in increasing social network support, Qint = 4.27, p  = 0.039. The effect of peer support is significantly greater when it is delivered as an adjunctive, SMD = 0.23, as opposed to substitute intervention, SMD = -0.30, a difference of 0.53 (Fig.  6 ).

Sub group analysis; social network support by level of organisational support

Subgroup analysis; social network support by type of peer support

Our review has indicated that a number of additional studies of one-to-one peer support have been published in the years following previous systematic reviews, suggesting that it has become viable to consider different modalities of peer support – e.g. group, one-to-one, peer-led services – in separate reviews. Studies remain predominantly conducted in the US, but with a gradual increase in studies being conducted in Europe and beyond. With health systems operating differently in different countries, caution does need to be taken when considering any results in the round.

While this review is focused on one-to-one peer support, we still see the heterogeneity of intervention observed by Pitt [ 7 ] and Lloyd Evans [ 8 ] across modalities of peer support. However it is interesting to note that most studies of peer workers in paraclinical roles, including case-management [ 23 , 30 , 39 , 42 ] and healthcare assistant roles [ 35 ], are now well over 10 years old, as are the majority of studies that compare peer workers to other mental health workers performing a similar role (‘substitute’ peer support) [ 23 , 30 , 39 ]. It is also worth noting that none of those studies of peer workers in paraclinical roles, or of peer workers in substitute roles, contributed data to analyses of those outcomes where a significant positive effect of peer support was found (recovery and empowerment).

Peer support interventions evaluated in more recent studies, in contrast, are almost exclusively evaluating adjunctive peer support, and tend to have either a structured, behavioural focus [ 44 , 62 , 68 , 74 , 76 ], or a more social focus, with peer workers providing a less structured, more peer-led support for recovery [ 45 , 59 , 63 , 66 , 71 ]. We suggest that there is potential, as more trials are published, of conducting focused reviews of specific groups or families of similar one-to-one peer support interventions.

We observe that a wide range of outcomes continue to be used. Of the original list of outcomes considered by Lloyd Evans and colleagues [ 8 ], we found that neither employment nor symptoms of psychosis were measured in the nineteen trials of one-to-one peer support that we reviewed. While Pitt and colleagues [ 7 ] found a small reduction in emergency service use for people receiving peer support we did not include data on emergency service use in our review as we excluded self-reported service use data from our analysis; Pitt and colleagues [ 7 ] themselves had suggested that recall bias and selective reporting of this outcome undermined the reliability of this particular finding.

While measures of general psychiatric symptoms were used in nearly half of all trials, measures of specific symptoms – of depression – were only used in those studies which exclusively recruited from a population diagnosed with depression [ 31 , 50 , 68 ]. Of our additional set of, largely, more socially-focused outcomes, neither internalised nor experienced stigma have been measured to date, although social functioning, social network support and working alliance were all measured in multiple studies, including in older trials [ 23 , 35 ]. If we consider just those outcomes used in multiple studies (outcomes included in our meta-analysis), we see a more focused outcomes-set emerging, balancing clinically-orientated outcomes of general severity of symptoms, functioning and hospitalisation with a set of self-reported, psychosocial outcomes including empowerment, recovery, working alliance and social network support.

As with previous reviews, once data from multiple studies were pooled, we found no difference between peer support and control across the majority of outcomes we considered. This included hope, where Lloyd Evans and colleagues [ 8 ] found a moderate positive impact of peer support, but we note again that their review included peer support provided to groups while we found insufficient studies of one-to-one peer support reporting measurement of hope as an outcome. However, our review does suggest that trial participants offered one-to-one peer support in mental health services experience modest but significant improvement in empowerment and self-reported recovery compared to control group participants, the latter reflecting similar findings by Lloyd Evans and colleagues [ 8 ].

Studies reporting empowerment were for the most part were published since the 2013 [ 7 ] and 2014 [ 8 ] reviews, reflecting the suggestion made by Bellamy and colleagues [ 87 ] that more recent studies indicate that new peer support initiatives might usefully be directed to interventions that, broadly speaking, support individual empowerment. We grouped assessments of empowerment and related constructs together for the purposes of this review, and the studies in the analysis variously used the Patient Activation Measure [ 57 ], the General Self-Efficacy Scale [ 73 ], and the Empowerment Scale [ 67 ]. As a construct, patient activation has a clear focus on the extent to which the individual is able to access the healthcare they need, and is a good fit for interventions that specifically address the way in which the individual engages with their mental health care [ 54 , 74 ]. Self-efficacy taps into the individual’s ability to make use of a wider range of support and care, while the Empowerment Scale has been shown to weight heavily on hope as a factor [ 67 ]. Again, these measures would seem appropriate for interventions focused on supporting recovery [ 63 ] and independence [ 66 ] respectively.

Studies reporting recovery as an outcome again used a range of measures. Salzer and colleagues [ 66 ] use the Recovery Assessment Scale [ 65 ], which measures recovery across five domains of personal confidence, hope, willingness to ask for assistance, goal and success orientation, and coping, and as such would seem particularly attuned to an intervention designed to support independent living. Johnson and colleagues [ 76 ] use the Questionnaire about the Process of Recovery [ 78 ], which comprises an ‘intrapersonal’ subscale that relates to “intrapersonal tasks that an individual is responsible for carrying out and that they complete in order to rebuild their life”, and an ‘interpersonal’ subscale relating to “individuals’ ability to reflect on their value in the external world and on how recovery is facilitated by external processes and interpersonal relationships with others”. Seventeen of the 22 items that comprise the measure load onto the ‘intrapersonal’ subscale, as would seem apposite for the evaluation of a self-management intervention. Chinman and colleagues [ 54 ] use the Mental Health Recovery Measure [ 55 ], measuring recovery in the seven domains of Overcoming Stuckness, Self-Empowerment, Learning and Self-Re-definition, Basic Functioning, Overall Well-Being, New Potentials, and Advocacy/Enrichment. This balance between functioning and wellbeing, and then moving on and realising potential seems well-suited to the case management function of the intervention.

These findings indicate what would seem to be an important relationship between positive impact on outcome, the assessment tool used and the intervention. As such we would suggest that trials exploring these, or indeed other outcomes, in the future should be cognisant of the constructs informing specific assessment tools (e.g. domains, subscales), and ensure that these relate closely to the mechanisms underpinning particular peer worker interventions. We reiterate calls in previous reviews [ 7 ] for a clearer understanding of the mechanisms of peer support, and the theory driven selection of outcomes that relate specifically to what peer workers do.

We note that one further outcome, client-rated working alliance, while not quite significant, demonstrated a similar effect size to the other positive outcomes. In two studies [ 23 , 39 ] participants rated working alliance with peer workers in the intervention arm of the trial, compared to working alliance with mental health professional in the control arm, while in the third study [ 74 ] working alliance with a mental health professional was rated in both arms of the trial, with and without additional peer support. Once data were pooled there was a relatively small sample size for this outcome; more data would produce a more precise estimate of the effect size. This finding suggests that there is merit in exploring working alliance in future studies of one-to-one peer support, especially given other research indicating a potential mechanism for peer support in bridging and enabling connection between service users and mental health professionals [ 21 ].

We note that while both measures of hospitalisation analysed were in a positive direction (i.e. a reduction in days in hospital and risk of hospitalisation), neither were significant. The lack of positive association between the offer of peer support and reduction in psychiatric symptoms also suggests that, while studies are using a balance of clinical and more psycho-socially focused outcomes, one-to-one peer support in mental health services is unlikely to impact on clinical outcomes.

There was significant heterogeneity of data for two outcomes (overall psychiatric symptoms and social network support). While our subgroup analyses did not explain heterogeneity with respect to overall psychiatric symptoms, analyses did offer insight into the relationship between peer support and social network support. Finding that a single study [ 42 ], reporting a lower level of organisation support for peer support, indicated a moderate, significant increase in social contacts, while studies reporting a higher level of support for peer support did not, appears counter-intuitive. Looking closely, authors note that the increase in positive outcome was accounted for by additional contacts with peer workers and professional staff, rather than any increase in contacts with family or friends [ 42 ].

Furthermore, peer support that was provided in addition to care as usual was significantly more likely to increase social network support than peer support provided by peer workers employed in a substitute role. At the least, these findings suggest that it is worth considering measuring social network support in future studies, while giving consideration to how the peer support intervention might be functioning to increase social contacts. In addition, we would suggest that we have demonstrated that our approach to operationalising an analysis of organisational support for peer support is feasible and might be pursued in future reviews, subject to the availability of suitable data. Continued improvement in reporting peer support interventions might usefully include good description of the organisational support provided for peer workers [ 88 ].

While cost was not one of our outcomes of interest we note that claims have been made about the potential contribution to reducing the cost of mental healthcare that peer support might make [ 5 ]. Only one of the nineteen trials included in our review considered cost, but was not sufficiently powered to draw any conclusions [ 59 ]. As such, analysis of the cost-effectiveness of one-to-one peer support in mental health services is largely absent from the evidence base to date.

Limitations

Overall quality of trials, when compared to previous reviews, remains low to moderate, although we note that, in our set of trials of one-to-one peer support, more recent trials appear less likely to have serious risk of bias and more likely to have low risk of bias on a majority of assessments, and so we tentatively suggest that the quality of studies is improving. Reporting bias, due to incomplete reporting of outcomes data, remains an issue and, as such, this downgrading of the quality of the overall evidence base does limit the strength of findings of this review. We note that for our two main positive outcomes, self-reported recovery and empowerment, all but one of the studies that reported measuring these outcomes included usable data in trial papers. However completeness of reporting of outcomes is essential to inform good quality evidence with respect to peer support in mental health services going forward.

In focusing on one-to-one peer support we have produced a more focused review than previous studies. However we acknowledge that studies remain heterogenous, especially with respect to clinical population (for example, only one study [ 71 ] specified chronicity of diagnosis). In addition, we note the range of terms used to describe peer support roles and acknowledge that our search might not have been wholly inclusive. Like all reviews, the validity of our study is defined by the strategy we describe above.

One-to-one peer support in adult mental health services has a modest, positive effect on empowerment and self-reported recovery, and might potentially also impact on measures of working alliance between service users and mental health workers, and social network support. It seems unlikely that one-to-one peer support has a positive impact on clinical outcomes such as symptoms or hospitalisation, given data available for this review, suggesting that the benefits of peer support are largely psychosocial, operating at both individual (interpersonal) and relational (intrapersonal) levels. The quality of reporting, both of trial methods and design of peer support interventions, has improved somewhat but needs to continue to do so - especially with respect to complete reporting of outcome measurements - in order to maximise the usefulness of the evidence base for service providers and policymakers. Future trials should also consider appropriate assessment of cost-effectiveness of peer support in mental health services.

While some older trials of one-to-one peer support evaluated peer workers working in paraclinical roles, and/ or in substitute roles, newer studies focus on peer workers providing adjunctive interventions; either structured, behavioural interventions, or more socially focused, self-directed, flexible support for recovery. This review suggests that future trials of one-to-one peer support in mental health services should focus on peer workers providing interventions that are additional to usual care; outcomes for peer support are no better than control where peer workers are compared to other mental health workers doing similar work, and might be worse for outcomes such as social network support, possibly because such roles do not enable peer workers to enact a more distinctive way of working.

We suggest that studies should carefully consider the specific mechanisms of action of peer support, with trials designed so that choice of assessment tools (the constructs that are measured) reflect the specific function of the peer support intervention and the distinctive way in which peers work compared to other mental health workers. If and where peer support is having a beneficial effect, there will be a greater likelihood of observing this in a more carefully designed trial. Furthermore, as the evidence base for peer support grows it would be methodologically desirable to conduct more focused reviews of groups of similar interventions (rather than continuing to review a heterogenous group of interventions as a whole). Finally, this review demonstrated the potential to explore heterogeneity in peer support, in relation to outcome, in terms of the quality of organisational support provided to peer workers.

It is of interest to compare our findings with the concurrent review of group peer support conducted by Lyons and colleagues. We similarly identified that heterogeneity of intervention remains a feature of the evidence base while noting that a small number of types or functions of peer support are emerging (with a number of trials of peer-supported self-management identified by both reviews). Both reviews are also indicative of a modest, positive effect of peer support on self-reported recovery and an absence of effect, in the evidence to date, on clinical outcomes. Again, both reviews indicate that reporting bias – incomplete reporting of outcomes – continues to undermine the quality of the evidence base as whole.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Confidence Interval

Diagnostic and Statistical Manual

Standard Mean Difference

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White, S., Foster, R., Marks, J. et al. The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis. BMC Psychiatry 20 , 534 (2020). https://doi.org/10.1186/s12888-020-02923-3

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Analyzing the role of family support, coping strategies and social support in improving the mental health of students: Evidence from post COVID-19

Chunying yang.

1 School of Special Education, Zhengzhou Normal University, Zhengzhou, Henan, China

2 Faculty of Education, Henan University, Kaifeng, Henan, China

3 Department of Educational Psychology and Counselling, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia

Qinglei Wang

4 Faculty of Sports and Exercise Science, University of Malaya, Kuala Lumpur, Malaysia

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The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

The COVID-19 pandemic and the multifaceted response strategies to curb its spread both have devastating effects on mental and emotional health. Social distancing, and self-isolation have impacted the lives of students. These impacts need to be identified, studied, and handled to ensure the well-being of the individuals, particularly the students.

This study aims to analyze the role of coping strategies, family support, and social support in improving the mental health of the students by collecting evidence from post COVID-19.

Data was collected from deaf students studying in Chinese universities of Henan Province, China. A survey questionnaire was designed to collect data from 210 students. Descriptive statistics were calculated using SPSS 21 while hypothesis testing was carried out using Mplus 7.

The results demonstrated that family support was strongly positively linked to mental health and predicted coping strategies. The direct relationship analysis showed that coping strategy strongly predicted mental health. Furthermore, coping strategies significantly mediated the relationship between family support and mental health. Additionally, the results highlighted that PSS significantly moderated the path of family support and coping strategies only.

Family support and coping strategies positively predicted mental health, whereas, family support was also found to be positively associated with coping strategies. Coping strategies mediated the positive association between family support and mental health. However, perceived family and other support only moderated the relationship between family support and coping strategies.

1. Introduction

Mental health has become a topic of increased concern in recent years in COVID-19. Numerous studies have provided evidence suggesting heightened levels of psychological distress in this community compared to the general population. This psychological strain of COVID-19 among teenagers has brought severe and long-lasting consequences of mental health, which lead to poor physical health outcomes, such as the rise of cardiovascular disorders, and poor mental health (MH) outcomes. Teenagers struggle more than adults do with the mental burden of this influence since they lack the adult’s coping mechanisms and physiological development ( Rawat and Sehrawat, 2021 ). Teenagers who already have MH problems face even more MH issues during times of crisis ( Gavin et al., 2020 ).

The Director General of the World Health Organization, on the recommendation of the Emergency Committee, declared the novel Corona virus also known as COVID-19 a Public Health Emergency of International Concern, and the virus has had devastating effects on the economy, education, and society ( Priya et al., 2021 ). From the very beginning of the outbreak, health officials devised a multifaceted response strategy to stop the spread of COVID-19. A key component of the plan was self-isolation or home quarantine. Social isolation is one of the steps the governments have taken to curb the virus’s spread. Social isolation can have an impact on MH, escalating signs of stress, anxiety, and depression ( Robb et al., 2020 ). In recent years, colleges and universities have seen an increase in the number of students experiencing psychological distress. The underlying cause might be the inexperience of college students, who frequently struggle to cope with stress, particularly when faced with academic, interpersonal, and career-related problems. Numerous studies have indicated that students from both eastern and western China have displayed symptoms of depression in the wake of COVID-19 ( Chen et al., 2021 ; Zhang et al., 2021 ; Zhao et al., 2021 ). Numerous studies continue to place a strong emphasis on the MH of college students, particularly when it comes to identifying the underlying causes of psychopathological symptoms. Studies have also looked at how students’ transition to university is impacted by academic stress. These research found that undergraduate students were already more stressed, anxious, and depressed than the overall population ( Guo et al., 2021 ). The already poor prospects for these students’ MH were further aggravated by the stress and worry associated with COVID-19.

These factors are connected to distinct socially isolating situations, such as classroom distractions, the use of particular teaching techniques that are socially isolating, and the overwhelming uncertainty that resulted from precautionary measures to stop or slow the spread of the virus have also added to the severity of the situation. The general public along with particular circumstances that may be having various effects as a result of the actions performed during this time, amplifying its magnitude, has been studied in various studies undertaken in the pandemic context ( Covan, 2020 ; Scharmer et al., 2020 ; Bakioğlu et al., 2021 ; Wu et al., 2021 ). The majority of studies conducted with undergrads during the disease outbreak have concentrated on MH; understanding of knowledge and traits associated with the pandemic; and how educational strategies were crafted to cope with the challenge ( Gavin et al., 2020 ; Liang et al., 2020 ; Pfefferbaum and North, 2020 ; Budimir et al., 2021 ; Saltzman et al., 2021 ). Other research has noted the rise in stress, sadness, and anxiety symptoms as well as the coping mechanisms of undergrads ( Kobbin et al., 2020 ). Undergraduate students may experience new or increased stress due to the COVID-19 pandemic, which can be upsetting and result in a variety of MH issues.

The general lack of clarity surrounding the pandemic, the abrupt switch to and participation in online classes, and COVID-19’s effects on the lives of students were frequent causes of heightened stress and worry ( Rodríguez-Hidalgo et al., 2020 ). According to a study, the COVID-19 outbreak puts students at a greater risk of acquiring depression and suicidality ( Sinyor et al., 2021 ). After university campuses closed, students continued to perceive their academic future as having relatively dim prospects. The situation was rendered even more precarious for students by social isolation and a lack of sufficient and efficient MH support. Due to these variables, young people who are attending college are now even more at risk of developing MH problems ( Li X. et al., 2021 ).

Social support is defined as the provision of practical assistance by members of extended family, friends, and coworkers ( Bjørlykhaug et al., 2021 ). Likewise, it is defined as “support made available to an individual through social relationships to other people, groups, and the greater community” ( Heaney and Israel, 2008 ). There are multiple ways to measure social support, however, one of the most commonly used indexes of social support has been perceived social support (PSS). It is not only easy to measure the PSS but the accuracy aspect is also of utmost importance as it depicts a relatively precise state of MH. Numerous studies have shown how PSS improves MH in stressful circumstances ( Wang and Eccles, 2012 ). Signs of deteriorating MH have been observed in people who receive less or no social support when they are stressed and depressed ( Li F. et al., 2021 ). PSS also has an impact on the course of depression and is crucial to recovery from affective disorders. Coping is the term for people’s ways of thinking and acting to deal with the internal and external pressures of stressful situations ( Kobbin et al., 2020 ).

Studies have demonstrated how various groups adopt coping mechanisms, a central idea in psychology research, with particular attention to the issue at hand ( Budimir et al., 2021 ). People with a high intolerance for uncertainty were more likely to perceive the pandemic as dangerous and to employ coping techniques that centered on emotions during prior epidemic occurrences, such as the H1N1 pandemic in 2009. This was revealed by research on stress management in epidemic events ( Vogel et al., 2022 ). Research with university students during the SARS pandemic in 2003 highlights the importance of coping as a defense mechanism against the damaging effects of stressors on overall perceived health ( Blume et al., 2021 ). Additionally, research revealed that in response to stressors connected to SARS, people used less active coping strategies (focused on problems) and more avoidable coping mechanisms (focused on emotions; Bai et al., 2004 ). Adaptive strategies in the wake of the pandemic can be explored, particularly with regard to the educational setting, such as the substitution of distant activities for on-site activities. A key factor influencing depression symptomatology is social support. Numerous studies have demonstrated that people who are depressed experience considerable, persistent psychosocial challenges.

Particularly, lower levels of social support are linked to higher levels of depression symptoms ( Wang and Eccles, 2012 ). The standard of emotional support offered by others is referred to as PSS. Additionally, studies reveal that levels of PSS are strongly linked to metrics of lowered stress and mental distress along with enhanced well-being ( Wang et al., 2018 ). However, the majority of studies on adolescents’ social support focus on their families, and very few studies look at their peers’ social support ( Oktavia et al., 2019 ). Our study takes into account how family, friends, and significant others are seen in terms of social support. According to a study of the literature and research, social support (particularly as perceived by adolescents) has been examined both separately as a psychological and social risk factor for depression and in conjunction with other factors to moderate the relationship between life events and depression, or as a moderator variable, as it is in this study. One of them is the buffering model, which holds that support shields people from the potentially harmful consequences of stressful situations ( MulejBratec et al., 2020 ). This study sought to ascertain whether there is a connection between students’ coping mechanisms during social withdrawal brought on by the pandemic and MH based on the gap in current knowledge. The research also looked at how family support (FS) and PSS (PSS) are associated with the mental health (MH) of the students. Furthermore, it investigates the mediating role of coping strategies and moderating role of PSS. It is anticipated that the findings of this inquiry will advance understanding in these areas.

Even though there have been numerous studies in the field of MH, however, the literature gap regarding the roles and relationships of coping strategies and PSS, as well as their mediating and moderating behaviors still exists. The goal of this research is to create a framework for concurrently examining the roles and interactions of the variables. The following research questions are the focus of the study.

How does FS influence the MH of the students after COVID-19? How FS is associated with coping strategy? How do coping strategies influence the MH of students post-COVID-19? What role is played by coping strategies between FS and MH? How does PSS from friends and others affect the relationship between FS and MH? How does PSS from friends affect the relationship between FS and coping strategy?

After an extensive review of available relevant literature, it was found that studies have been done to investigate coping strategies and MH related but no study has been done until now to know the answers to these research questions using a single framework. Thus, from the available literature, the current study firstly assumes FS positively influences MH and is positively associated with a coping strategy. The study further assumes that coping strategy positively influences MH and it positively mediates the relationship between FS and MH. It is also hypothesized in the current study that PSS from friends and others positively moderates the relationship between FS and MH and PSS from friends and others positively moderates the relationship between FS and coping strategy.

The following are the potential contributions of the study: Firstly, in accordance with the stress-health theory, the study offers a thorough and systematic analysis of the ideas of coping mechanisms, FS, and MH. Secondly, the study makes a contribution through its creative and distinctive approach, which suggests and examines the connections between PSS and coping mechanisms. Thirdly, the research adds to the integrated analytical framework that examines the connection between familial support, coping mechanisms, and MH by incorporating PSS from friends and other people. The theoretical perspective is explicated in an original form by the study’s framework. Additionally, the work has both applied as well as theoretical implications. Following is a summary of the remaining section of the current study: The overview of the literature was offered in Section 2 of this research study. In Section 3, actual techniques and analyses have been presented. The statistical analysis and empirical findings were reported in the following section. The debate, findings, and theoretical and practical ramifications have all been condensed at the end.

2. Literature review and hypotheses development

2.1. theoretical support and background.

According to the conservation of resource theory, stressful situations could lead to difficulties with a person’s physical or MH ( Mao et al., 2021 ). The COVID-19 pandemic’s primary characteristics as a novel infectious illness are that it is extremely contagious and dangerous, developing quickly, and has no effective medications for either prevention or therapy. Students’ MH during the pandemic outbreak was impacted by a number of stressful pandemic-related factors, such as personal daily routine disruptions and individual physical health under threat from the COVID-19 sickness.

Mental illness is a result of social exclusion and ongoing worry about contagion. The COVID-19 situation has had significant negative effects on people’s health ( Pfefferbaum and North, 2020 ). However, researchers are concentrating more on how this quickly developing worldwide catastrophe may affect the MH of the aging population. The psychological impact of COVID-19 on teenage MH has gotten very little consideration ( Rawat and Sehrawat, 2021 ). The psychological strain of COVID-19 among teenagers should be a prominent aspect in the COVID-19 study due to the severe and long-lasting consequences of MH, which lead to poor physical health outcomes, such as the rise of cardiovascular disorders, and poor MH outcomes. Teenagers struggle more than adults do with the mental burden of this influence since they lack the adult’s coping mechanisms and physiological development ( Rawat and Sehrawat, 2021 ). Teenagers who already have MH problems face even more MH issues during times of crisis ( Gavin et al., 2020 ).

2.2. Relationship between coping strategy, family support and mental health

The effects of COVID-19 on family well-being include a quarantine that restricts movement, financial difficulty, decreased income, a lack of job, obesity, and worsening non-communicable diseases. Nature and range of risks that have emerged after COVID-19 have expanded and increased. The risks involve physical as well as psychological aspects such as the risk of hospitalization or even losing one’s life, failing to access food, vulnerability related to family, and psychological health problems. Furthermore, the chances of maltreatment of children also increased in the wake of social isolation ( Rapoport et al., 2021 ). A survey revealed increased instances of child treatment during school breaks, summer, and amid natural disasters ( Rapoport et al., 2021 ). The only seemingly beneficial aspect of COVID-19 might be the benefit of having more family time that one could spend as the restrictions on the movement either slowed down or stopped the mobility of people confining them to their residences.

Additionally, family interactions have also been severely affected by COVID-19( Pan, 2020 ). In difficult times like COVID-19, a family’s ability to manage difficulties and deal with risks, stress, and crises is referred to as family support. The capacity to not only survive but also recover from the negative impact of any troublesome situation can be referred to as FS. Some key factors in developing this capacity of FS are adaptation, acceptance, and management in the wake of untoward incidents ( Shin et al., 2021 ). Parents are essential in building the family’s resilience during a widespread public health crisis. Children’s and teenagers’ resilience is influenced by parents’ resilience, including how well they look after their extended family members while still being able to take care of themselves.

Children can adapt well to the epidemic if their parents do so in a positive way. It’s critical to have parental assistance available to lessen the effects of COVID-19. Support from family members during the epidemic may lessen concerns about depression and anxiety ( Yang et al., 2020 ). According to studies, a large number of people experience tension and worry while there are extended lockdowns because of the pandemic ( Budimir et al., 2021 ). The level of concern in people regarding contracting COVID-19 themselves is lower than this apprehension for their family members ( Gavin et al., 2020 ). In addition, elderly people tend to experience less anxiousness.

Anxiety lessens with an increase in age. Core reasons lie in the fact that coping mechanisms become more and more effective with an advance in age, moreover, better financial stability also plays its part ( Drentea, 2000 ). Adjustment, social integration, greater communication, and proper financial management are significant FS factors. Maintaining family resilience requires flexibility, which is the ability to pay attention to changing circumstances and adjust one’s approach to meet those demands.

Due to school closures caused by the COVID-19 pandemic, students now take their classes online. Physical activity, travel, and other logistical stresses may be lessened as a result of home learning. On the other hand, stress can also result from home education. Some students may find home learning to be very difficult owing to scholastic issues, limited internet connection, and insufficient resources ( Soetisna et al., 2021 ). During the pandemic, families might lack the tools and information necessary to manage at-home education. In addition, parents struggle to raise their children while juggling domestic chores, working remotely in the wake of economic insecurity, and fear of loss of work. Parents struggle to achieve a work-life balance and contend with several shifting circumstances while engaging in physical distance, which increases stress ( Dinh, 2020 ).

Families experience distress when schools are closed. To boost children’s and parents’ readiness to accept homeschooling during the epidemic and ensure that kids get good grades, families have to be better educated on how to assist one another. Households with special needs children have to cope with additional stress during a pandemic. Children with special needs spend all of their time living with family members as a result of the closure of the school. Children have little time for social activities outside of their homes during the pandemic. The need for an easy environment at home becomes even more important and pertinent particularly for the family which has special needs child. In order to create a setting that fosters family resilience, parents must learn to control their stress and obtain social support. The pandemic has drastically changed the family routines that affect both physical as well as MH of family members ( Ameis et al., 2020 ). The family can deal with the pandemic together, though, by creating routines and engaging in activities that involve all members, such as scheduling mealtimes together, participating in household chores together, fostering effective communication, engaging in thrilling activities, getting regular physical workouts, being vigilant regarding cleanliness, and developing good sleep habits, which is crucial, particularly in the wake of COVID-19.

These habits may enhance the family’s capacity to care for each other and provide better support to one another. Families are better able to help one another when there are protective factors (which foster the capacity for adaptation or recovery in times of crisis) and recovery variables (which assist in development growth; Semenov and Zelazo, 2019 ). These factors may make the family more competent to deal with the crisis and struggle as a unit. The main factors in FS are a wholesome amalgamation of useful and healthy family activities that help a family create and maintain a strong trust-based bond enabling all family members to sustain during adverse circumstances ( Semenov and Zelazo, 2019 ). From all the above research findings about FS, MH, and coping strategy it is assumed that FS has a positive relationship with coping strategy and MH.

H1 : Family support is to positively influence the mental health. H2 : Family support is positively associated with coping strategy.

How people handle stress has a significant psychological impact on how stressful life events like COVID-19 affect people’s MH. The broad definition of coping is the mental and behavioral strategies people use to control their stress ( Obbarius et al., 2021 ). When faced with challenging circumstances, like the pandemic, it is typical to use coping mechanisms or behaviors that encourage adjustments and solutions to the problems being faced. People employ a variety of coping mechanisms to deal with difficult situations or times ( Budimir et al., 2021 ). The two types of coping models, according to Folkman and Lazarus, are the problem-and emotion-focused models ( Obbarius et al., 2021 ). When faced with a stressful scenario, both coping mechanisms are employed, however, their efficacy varies. Self-distraction, stress management, exclusion, medication, moral support usage, keeping informed, and behavioral adjustments are just a few of the many coping mechanisms that have been proven extremely effective. However, the question of whether one strategy is better than another is hotly contested. More successful than other methods for reducing the effects of stress and promoting MH can be those that include addressing and resolving stresses ( Nshimyiryo et al., 2021 ).

Avoidant tactics may be effective in lowering short-term stress, but they are typically viewed as damaging in the long run since they do not directly address the stressor, exposing people to high levels of stress over extended periods. A person’s stress response may have an impact on their health over time. It is therefore likely that coping with COVID-19-related trauma inappropriately may lead to MH issues in the future. To improve family wellbeing, it’s critical to establish a regular appreciation practice. To foster a sense of community, loyalty, harmony, and happiness among family members, it is critical that the members maintain open lines of interaction and find enjoyable activities to do regularly.

Additionally, when parents or other family members ask for assistance, forming positive reinforcement with them is crucial. Examples of these people include siblings, acquaintances, extended families, and colleagues. Technology use for support networks and interaction amid social isolation is crucial ( SayinKasar and Karaman, 2021 ). Utilizing technological tools to avail social support helps keep friends and family connected and supportive of one another through a trying time. Resilience during the pandemic is positively impacted by supportive families, good parenting, and effective coping mechanisms. During a severe disruption scenario like a pandemic, family activities are crucial for greater well-being ( Petersen et al., 2021 ). The above-mentioned facts from the available literature help us devise our hypotheses 3 and 4 as coping strategy influences MH positively and mediates the relationship between FS and MH.

H3 : Coping strategy is to positively influence the mental health. H4 : Coping strategy to mediate the relationship between family support and mental health.

2.3. Social support and mental health

Social support is defined as “support made available to an individual through social relationships to other people, groups, and the greater community” ( Heaney and Israel, 2008 ). There are multiple ways to measure social support, however, one of the most commonly used indexes of social support has been PSS. It is not only easy to measure the PSS but the accuracy aspect is also of utmost importance as it depicts a relatively precise state of MH. Numerous studies have shown how PSS improves MH in stressful circumstances ( Wang and Eccles, 2012 ).

Though PSS and received social support are entirely distinctive from each other, however, it is generally believed that the relationship between these otherwise distinct supports should be high, particularly in scenarios when the demanded support is equivalent to the provided support ( FasihiHarandi et al., 2017 ). Similar to this, other authors contend that the recollection of helpful behaviors displayed can be used to gauge perceived support ( Özmete and Pak, 2020 ). We believe that social support received by an individual during the COVID-19 pandemic equals the required social support by an individual, therefore, we measured that the received social support reflected the level of PSS. However, social support and social support resources may not be mistaken as similar but they should be understood as distinct.

According to a study one’s subjective perceptions of the availability of social support from other users on social networks are represented by perceived support ( Noret et al., 2020 ). According to various studies, perceived support quality is more closely correlated with MH than real personal network structure ( Kandeğer et al., 2021 ). Numerous factors have an impact on people’s MH. Previous research has established that the availability of social support along with effective coping strategies helps maintain good MH ( FasihiHarandi et al., 2017 ). A correlation between social support provided by the family and stress symptoms related to post-trauma was found. However, no such correlations were found when social support was provided by the friends. In a different study, peer social support was found to be more effective at preventing psychological distress than social support provided by family members ( Özmete and Pak, 2020 ).

Recently, there has been a rise in interest in new approaches such as latent profile analysis (LPA) for studying the many types of networks of social support ( Mai et al., 2021 ). Furthermore, some scholars utilized cluster analysis to analyze typologies of the social network, however, these analyses are based on different notions. More significantly, the studies that have already been published showed that various support profiles would have varying relationships with outcomes related to MH ( Wang et al., 2018 ). In particular, one study used LPA and discovered that four different profiles of social support have different correlations to elder migrants’ well-being ( Burholt et al., 2018 ).

According to one study, older persons who participated in the social support profile that was locally integrated had a lower risk of dementia than those who participated in the social support profile that was family-dependent ( Yang et al., 2020 ). Researchers discovered different patterns of relations between different profiles of social support and outcomes of MH. The susceptibility of the youth was found to be higher vis-à-vis pessimism and stress irrespective of sources of social support. Social support particularly from family and friends plays a significantly important role in managing MH menaces such as anxiety and depression. LPA directly estimates the membership probability from the model, making it more plausible to examine the outcomes of individual clustering than the conventional method of clustering. LPA being a person-centric strategy helps specifically in identifying different subgroups of people who have similar social support behaviors ( Mai et al., 2021 ). A regression mixed model can be constructed using the LPA model and additional outcome variables to confirm the association between profiles and results. In order to investigate the profiles of sources of social support and the association between these profiles and MH in this study, we did an LPA and used the regression mixture model (BCH technique).

According to research, social support serves as a buffer against depression or the unfavorable consequences of stress ( Wilson et al., 2020 ). It also serves as a buffer between stressful life events and depression. Keeping in view the above facts from the literature the current study assumes that PSS from friends and others positively moderates the relationship between FS and MH it is also hypothesized that PSS from friends and others positively moderates the relationship between FS and coping strategy.

H5 : Perceived social support from friends and others is to positively moderate the relationship of family support and mental health. H6 : Perceived social support from friends and others is to positively moderate the relationship of family support and coping strategy.

Research framework

3. Methodology

3.1. sample and data collection procedures.

The prospective respondents were the students studying in various universities of China. We selected the Henan province of China for this purpose and 10 large universities of the province were the main target. Because of Covid, it was expected that most of the students stayed at their homes and with their families faced some short of mental disorders. Therefore, to collect data about the study variables, we used a validated survey questionnaire which was circulated to the selected universities’ help desks/information desks for anonymous self-rated responses. As the data collection was related to highly sensitive and personal matters, i.e., MH, family/friends support and coping strategies, and because the population was unknown, we opted for a combination of snow ball and purposive sampling technique (non-probability sampling). In addition to this, for identifying the target respondents, we also sought help from the staff of student affairs.

We targeted 350 deaf students from the concerned universities as the exact no. of students in the target universities remained unknown and not confirmed by the concerned authorities. We therefore, followed the guidelines of various scholars; for example, recommended that “each item should be represented using 5 samples,” who suggested that “sample of 300 will be considered as good,” proposed that “the size of the sample should be 20 times greater than the expected factors” (if factor analysis is to be conducted) and for conducting SEM, N  = 100–150 is acceptable ( Anderson and Gerbing, 1988 ). Keeping in view the recommendations from these researchers and an average response rate (if any) we determined a sample size of 350 out of which 260 questionnaires were filled and 210 turned out to be valid (response rate 60%). These questionnaires were used for further analysis.

3.2. Measurement

All the scales used in this study were adapted from previous researches and were already validated by the scholars. Family support was adapted and its sample item was “I get the emotional help and support I need from my family.” The scales of coping strategies and were adapted from Hamby, and its sample item was “When dealing with a problem, I try to see the positive side of the situation.” The questions of perceived support from friends were adapted, and its sample item was “I can count on my friends when things go wrong.” Likewise the scale items of other’s support were adapted the study of, and its sample item was “There is a special person in my life who cares about my feelings.” Moreover, the measurement questions of MH and its three dimensions, i.e., cognitive, emotional, psychology were adapted and its sample item was “I’ve been feeling optimistic about the future.” All the items were measured at 7 Point Likert scale.

3.3. Analysis strategy

To analyze the data, SPSS 21 was used for calculating basic and descriptive statistics while Mplus 7 was applied for hypothesis testing. But prior to moving toward hypothesis testing, we have examined the measurement model in order to ensure the reliability and validity of the constructs, the details of which are discussed in the next section.

4.1. Assessment of measurement model

First of all, researchers analyzed the measurement model keeping in view the requirements of “convergent validity and discriminant validity,” while structural model was assessed in the next step ( Anderson and Gerbing, 1988 ). This research applied Mplus 7, a frontline software which has the potential to handle both normal and non-normal data ( Van Der Linden et al., 2017 ). Mplus 7 output provides the following model fit indices, i.e., “Chi-square,” “root mean square error of approximation (RMSEA),” “comparative fit index (CFI),” “Tucker Lewis index (TLI)” and “standardized root mean square residual (SRMR)” which were used to determine the model fitness. Accordingly, the criterion for model fit indices given by Hu and Bentler (2009) in Table 1 and it can be observed that all the values are lesser than the threshold levels.

Model fitness.

χ 2 , Chi square value, df, Degree of freedom.

According to Hair (2009) , convergent validity is assessed taking into account the standardized loadings of all the items of the construct/scale. It is important for the scale items to have STDYX >0.5, which is this case. Moreover, the research instrument had 34 items in total and the standardize loadings of all the items ranged from 0.694 to 0.894, which signals the existence of convergent validity (see Figure 1 ). Additionally, to ensure the internal consistency, convergent validity of the scale, we calculated CR and AVE of the constructs. As the study conducted confirmatory factor analysis, that’s why it was important to compute to these values. However, according to the criteria, for a construct to have internal consistency, it is recommended that the values of CR to remain at least 0.7 or greater, while the values of AVE should at least pass the minimum threshold level of 0.5 ( Fornell and Larcker, 1981 ). The results in Table 2 confirmed that the scale met the criteria of internal consistency.

Confirmatory factor analysis.

Factor loadings, composite reliability and convergent validity.

N  = 210, AVE, average variance extracted; π, standardized loadings; FS, Family support; COGCOP, cognitive coping; DIVCOP, diversion coping; MHC, cognitive aspect of mental health; MHE, emotional aspects of mental health; MHP, psychological aspects of mental health; PSF, perceived social support from friends; PSO, perceived social support from others. The bold values indicate the results for corresponding statistics for the whole variable.

4.2. Determining correlation and discriminant validity

In order to determine whether the scale has discriminant validity or not, comparing the squared root of the AVE with the correlation coefficient was essential ( Fornell and Larcker, 1981 ). For this purpose, diagonal bolded values were compared with the off-diagonal values in Table 3 . It can be observed that the diagonal values remained greater than the correlation coefficients, which depicted a strong evidence of validity.

Correlation and discriminant validity.

All values are significant ** p  < 0.05; FS, Family support; COP, Coping strategies; MH, Mental Health; PSS, Perceived social support from others and friends.

In addition to this, we calculated variance inflation factor to test the existence of multicollinearity. The analysis of the multicollinearity showed that the VIF values were <3 which confirmed the model did not have the issue of multicollinearity.

4.3. Measuring descriptive statistics

The variability of the data was assessed by analyzing the mean values and standard deviation from the mean. The analysis presented in Table 4 revealed the MEAN values of the variables and their standard deviation.

Mean and standard deviation.

Std., standard deviation of the construct; FS, family support; COP, coping strategies.

The mean scores of the variables ranged from 5.01 of FS to 6.38 of PSS whereas the standard deviation ranged from 0.587 of COP to 1.023 of FS. The values of standard deviation remained well within prescribed range and the data was found to be good to enough to be handled using Mplus ( Van Der Linden et al., 2017 ). To compliment this, we also calculated Skewness/Kurtosis to make assessment about the normality of the data. It was found that the values of both the statistical measures were well within acceptable range. Table 4 placed above provides variable specific details about normality and data variability.

4.4. Test of spurious correlation/(CMV)

As the researcher collected survey data at a single point of time and from the same students who suffered some sort of MH issues during COVID-19, therefore, it was important to make sure that the correlation between the said variables was not spurious. For this purpose, Harman’s single-factor was applied to assess the values of CMV. As shown in the Table 5 , the single factor explained 33.269% of variance, which was far below the standard limit of 49%. If the result demonstrate that less than half (50%) of the variance is explained by the factor, then it is believed that CMB is not a cause of concern.

Common method variance analysis.

4.5. Hypothesis testing

The Following section presents the results of direct association, indirect association and the role of the moderator, respectively.

Table 6 contains information about the hypotheses of direct relationship. As pointed out by Henseler et al. (2009) , the standardized coefficients are the same as the regression coefficients, that’s why, the decision about the hypothesis were made based upon the standardized coefficients and their significance (value of ps) provided in Mplus 7 output. The results demonstrated that FS was strongly positively linked to MH with β  = 0.236 and was significant at 0.00. Therefore, H1 was supported (see Figure 2 ). Likewise, H2 examined the relationship between FS and coping strategies. The results exposed that FS positively predicted coping strategies with β  = 0.520 and p -value 0.00. Hence H2 was also found to be supported (see Figure 3 ). Finally, for direct relationship, the link between coping strategy and MH was also determined. The researcher found out that “coping strategy” strongly predicted MH with β  = 0.534 and p -value 0.000. Therefore, H3 was supported as per the prediction of the researcher (see Figure 4 ).

Hypothesis testing for direct relationship.

Direct relationship between FS and MH.

Direct relationship between FS and coping strategy.

Direct relationship between coping strategy and MH.

Results in Table 7 were about H4 which was related to the mediation analysis. As per the requirement, mediation analysis was performed to confirm whether the intervening/mediating variable (MV) enhanced the impact of IV to the DV ( Hair, 2011 ). The researcher opted for, “bootstrapping procedures” to test the significance of the mediation path ( Preacher and Hayes, 2004 ; Preacher et al., 2010 ). The analysis revealed that specific indirect effect was significant at 0.05. The STDYX of SIE (specific indirect effect) was β  = 0.301 and ( p  = 0.00) with a 95% CI [0.154–0.148]. Because the upper CI and lower CI values did not include zero, therefore, it was confirmed that “coping strategies” positively and significantly mediated the relationship of “family support” and “MH.” Thus H4 was supported (see Figure 5 ).

Hypothesis testing for mediation.

All values are significant ** p  < 0.05. SIE, specific indirect effect; Stdyx, standardized beta coefficient; CI, confidence interval; COP, coping strategies; MH, mental health; PSS, perceived social support from others and friends.

Mediation of coping strategy between FS and MH.

Fore investigating the moderating role of PSS, the study first examined its role on the relationship of FS and MH. Therefore, in order to proceed with the analysis, researcher applied “Xwith” technique for creating the interaction term between concerned IV-MV ( Van Der Linden et al., 2017 ) and for assessing the effect of interaction term (see Figures 6 , ​ ,7). 7 ). These results exposed that H5 was not supported as the Table 8 indicated that the interaction effect of PSSXFS (moderating variable * IV) was β  = 0.147 ( p  = 0.228) with a 95% CI [−0.054 to 349].

Theoretical model for mediation of coping strategy between FS and MH.

Interaction plott showing the moderating effect of PSS on FS—MH relationship.

Hypothesis testing for moderation analysis.

FS, family support; COP, coping strategies; MH, mental health; PSS, perceived social support from others and friends; Stdyx, standardized beta coefficient; CI, confidence Interval.

In Hypotheses 6, it was predicted that PSS will positively moderate the relationship of FS and COP. The results in Table 8 indicated that the direct effect of FS on COP was β  = 0.263 ( p  = 0.00) and its 95% CI [0.135–0.391], the direct effect of moderating variable PSS on COP was β  = 0.695 ( p  = 0.00) with 95% CI [0.536–0.855] and the interaction effect of FSXPSS (moderating variable * IV) was β  = 0.357 (0.002) with a 95% CI [0.171–0.544] (see Figure 8 ). Additionally, Simp-Slope analysis revealed that this moderation effect was greater when the values of PSS were higher and positive, whereas, the effect was lower and positive when the values of PSS were lower. These values implied that H6 was supported (see Figure 9 ).

Moderating effect of PSS on FS—COP relationship.

Interaction platt showing the moderating effect of PSS on FS—COP relationship.

5. Discussion

Around the world, 10%–20% of teenagers experience MH issues. The vulnerability of teenagers during the COVID-19 epidemic is likely to have an impact on this figure. Poor MH leads to negative outcomes such as suicidal tendencies, behavioral issues, and emotional abnormalities, therefore, the need for research in this regard to eliminate or lessen the impact of poor MH is paramount. As the MH of young people has already been in tattered shape globally, COVID-19 has made the case even more precarious. The need to conduct quality research to combat MH issues in the wake of a pandemic of COVID-19’s size has increased manifolds. Keeping in view these facts, we identified our research topic, research questions and including coping strategies and their relationships with post COVID-19 MH of the students.

The current article discussed the literature on family and PSS and MH of the individuals after COVID-19 pandemic keeping in view the stress-health theory. The literature review gave us an insight into the research that has already studied coping strategies for MH. The studies have shown that the pandemic and the factors related to it like quarantine, social distancing, and travel restrictions have been proven stressful for the students and other communities. The stress and anxiety produced by the situations like school closures, unemployment, insufficient health facilities, and uncertainties related to study, work, and personal life have negatively affected the MH and physical well-being of the people ( Pfefferbaum and North, 2020 ). Keeping in view the importance of coping strategies after the pandemic we selected a framework that could serve the literature both theoretically and practically.

Previous studies on coping strategies and PSS have not studied their roles as mediators and moderators in a single framework. The current study fills this literature gap and first of all, it assumed that FS is positively associated with MH. The data analysis showed that FS is significant and strongly positively linked to MH with β  = 0.236, thus supporting the H1 (see Figure 2 ). Likewise, H2 examined the relationship between FS and coping strategies. The results revealed significant values for both of these variables thus H2 has been accepted as well (see Figure 3 ). Finally, for a direct relationship, the link between coping strategy and MH was determined. The researcher found out that coping strategy strongly predicted MH by showing significant values, the prediction of the researcher was supported by the results of the analysis, and H3 was accepted (see Figure 4 ). The mediation analysis was done to check the acceptance or rejection of H4. It has been explained in the results section earlier that mediation analysis was performed to confirm whether the intervening/mediating variable (MV) enhanced the impact of IV to the DV. The analysis was done by using “bootstrapping procedures” which showed that the upper CI and lower CI values do not include zero, therefore, it is confirmed that “coping strategies” positively and significantly mediated the relationship of “FS” and “MH.” The results supported the acceptance of the H4 (see Figure 5 ). The analysis to investigate H5 was carried out further, and the moderating role of PSS “Xwith” technique was used. The results obtained from the analysis have shown that H5 was not accepted, the analytical values for H5 have been explained in the results section. One of the plausible reasons for this insignificant moderation effect could be the either lesser social support received by the students in the times COVID-19 from friends and others. Secondly, due to social restrictions, no one from the social circle of the students would have been willing to extend their support for their friends who faced MH issue. Thirdly, students struggled with MH placed more value on FS and remained open to it instead of relying on the support of friends and others. Similarly, the results in Table 7 showed the values for the direct effect of FS on COP and the values for the direct effect of moderating variable PSS on COP (H6). Additionally, Simp-Slope analysis was carried out to reveal the moderation effect of PSS, the results of which indicate that H6 was accepted (see Figure 9 ).

Our research findings show that the hypotheses H1, H2, H3, H4, and H6 were accepted which means that FS positively influences MH and is positively associated with coping strategy. Then the findings show that coping strategy positively influences MH and it mediates the relationship between FS and MH. Further, our finding has shown that PSS positively moderates the relationship of FS and coping strategy which is consistent with the research findings which revealed that PSS mitigates the negative effects of stress and fosters psychological ( Huang and Zhang, 2021 ). However, our findings do not accept that PSS positively moderate the relationship of FS and MH.

6. Conclusion

The COVID-19 pandemic and the multifaceted response strategies to curb its spread both have devastating effects on mental and emotional health. Social distancing, and self-isolation have impacted the lives of students. These impacts need to be identified, studied, and handled to ensure the well-being of the individuals, particularly the students. Therefore, current study aimed to analyze the role of coping strategies, family support, and social support in improving the MH of the students by collecting evidence from post COVID-19. Data was collected from the students studying in Chinese universities. A survey questionnaire was designed to collect data form 210 students. Descriptive statistics were calculated using SPSS 21 while hypothesis testing was carried out using Mplus 7. The results highlighted that the coping strategy a person uses to deal with challenging or complicated unfavorable situations is crucial since it will have an impact on their psychosocial outcomes, especially their MH. Positive and negative coping are opposites of one another. People who used mostly constructive coping mechanisms had less emotional disturbance than those who used destructive coping mechanisms ( Budimir et al., 2021 ). Additionally, the study highlighted the significant role of family members and how they can support the fight against mental disorders. Results have also exposed the fact that students not only need FS but also the support from friends and others in order to develop effective coping strategies to deal with the MH issues stress caused by various factors. Therefore, in the future, we propose to investigate the rationale for expanding the model of cognitive vulnerability by including PSS. Resulting in fresh questions about the potential and necessity of moving forward not only toward an integrated model but also etiological models as well as novel opportunities for research and practical applications.

7. Implications

Our research has significant ramifications for medical practice, research institutions, and health policy. Academic institutions should first become more aware of any additional needs and any MH issues that their students may have. Future studies should involve participants from other nations and ethnic groups because COVID-19 control strategies and the scope of outbreaks varied among nations. The coping techniques we incorporated in the survey were chosen in a way that students might find interesting to engage with, but the list was not comprehensive, and well-liked techniques may not always be the best ways to guard against negative effects on MH. A wider range of coping mechanisms should be the subject of more research to determine their effectiveness. In conclusion, the effects of COVID-19 on students’ MH have been underappreciated. We enjoin teachers, higher education institutions, and specialists in MH to give their pupils the proper support during the pandemic.

Giving students instruction to help them develop self-efficacy and providing them with useful skills to cope with challenges may assist them in better managing the heightened stress that entails COVID-19. As it has been noticed that strong and effective coping strategies were highly useful in helping students manage their stress. The role of MH practitioners needs to be recognized by the administrators so that they can help those students that require MH assistance. Students’ ability to cope with stress and build social support may help them avoid the negative effects of the corona virus epidemic on their mental and psychological health. As a result, by implementing theory-tested interventions or programs, families, friends, and educators should promote psychological resilience and strengthen positive coping mechanisms among students. These interventions could be offered in creative methods, such as webinars, online seminars, and on-demand movies, due to limits like social isolation and lockdown measures.

Students’ endurance and confidence are improved through inter professional, debriefing programs and online cognitive behavioral therapy ( Schmutz, 2022 ). Additionally, enhancing social support may provide people a feeling of greater mental stability, lowering their worries and anxieties and allowing them to operate normally during the epidemic. Students’ morale will rise and their MH will be maintained if they are encouraged to openly discuss their experiences and difficulties in their education following COVID-19.

Data availability statement

Ethics statement.

The studies involving human participants were reviewed and approved by, the Department of Educational Psychology and Counselling, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia. The patients/participants provided their written informed consent to participate in this study.

Author contributions

CY and HG worked on conceptualization. NW and QW worked on data collection. YL and EW worked on writing the draft. The authors read and agreed to the submitted version of the manuscript.

This study was funded by Research on the Construction of the Training System for Outstanding Special Teachers in the New Era-The key project of Teacher Education Curriculum Reform of the Education Department of Henan Province in 2019 (no. 2019-JSJYZD-058).

Conflict of interest

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

Publisher’s note

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

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• Copy URL https://www.pbs.org/newshour/politics/house-will-go-to-court-for-biden-audio-after-dojs-refusal-to-prosecute-says-speaker-johnson

House will go to court for Biden audio after DOJ’s refusal to prosecute, says Speaker Johnson

WASHINGTON (AP) — Speaker Mike Johnson said Friday that the House will go to court to enforce the subpoena against Attorney General Merrick Garland for access to President Joe Biden’s special counsel audio interview, hours after the Justice Department refused to prosecute Republicans’ contempt of Congress charge.

READ MORE: Garland won’t be prosecuted for contempt over refusal to provide Biden audio, DOJ says

“It is sadly predictable that the Biden Administration’s Justice Department will not prosecute Garland for defying congressional subpoenas even though the department aggressively prosecuted Steve Bannon and Peter Navarro for the same thing,” Johnson said in a statement. “This is yet another example of the two-tiered system of justice brought to us by the Biden Administration.”

In a letter to Johnson earlier Friday, a Justice Department official cited the agency’s “longstanding position and uniform practice” to not prosecute officials who don’t comply with subpoenas because of a president’s claim of executive privilege.

The Democratic president last month asserted executive privilege to block the release of the audio, which the White House says Republicans want only for political purposes. Republicans moved forward with the contempt effort anyway, voting Wednesday to punish Garland for refusing to provide the recording.

Assistant Attorney General Carlos Felipe Uriarte noted that the Justice Department under presidents of both political parties has declined to prosecute in similar circumstances when there has been a claim of executive privilege.

Accordingly, the department “will not bring the congressional contempt citation before a grand jury or take any other action to prosecute the Attorney General,” Uriarte said in the letter to Johnson. The letter did not specify who in the Justice Department made the decision.

Republicans were incensed when special counsel Robert Hur declined to prosecute Biden over his handling of classified documents and quickly opened an investigation. GOP lawmakers — led by Reps. Jim Jordan and James Comer — sent a subpoena for audio of Hur’s interviews with Biden, but the Justice Department only turned over some of the records, leaving out audio of the interview with the president.

Republicans have accused the White House of suppressing the tape because they say the president is afraid to have voters hear it during an election year. A spokesperson for Jordan criticized the Justice Department’s move Friday, saying, “The rule of law for thee, but not for me.”

A transcript of the Hur interview showed Biden struggling to recall some dates and occasionally confusing some details — something longtime aides say he’s done for years in both public and private — but otherwise showing deep recall in other areas. Biden and his aides are particularly sensitive to questions about his age. At 81, he’s the oldest-ever president, and he is currently seeking another four-year term.

The attorney general has said the Justice Department has gone to extraordinary lengths to provide information to the lawmakers about Hur’s investigation. However, Garland has said releasing the audio could jeopardize future sensitive investigations because witnesses might be less likely to cooperate if they know their interviews might become public.

In a letter last month detailing Biden’s decision to assert executive privilege , White House counsel Ed Siskel accused Republicans of seeking the recordings so they can “chop them up” and distort them to attack the president. Executive privilege gives presidents the right to keep information from the courts, Congress and the public to protect the confidentiality of decision-making, though it can be challenged in court.

The Justice Department noted that it also declined to prosecute Attorney General Bill Barr, who was held in contempt in 2019. The Democratically controlled House voted to issue a referral against Barr after he refused to turn over documents related to a special counsel investigation into former President Donald Trump.

The Justice Department similarly declined to prosecute former Trump White House chief of staff Mark Meadows after he was held in contempt of Congress for ceasing to cooperate with the Jan. 6 Committee investigating the attack on the U.S. Capitol. Years before that, then-Attorney General Eric Holder was held in contempt related to the gun-running operation known as Operation Fast and Furious. The Justice Department also took no action against Holder.

Two former Trump White House officials, Peter Navarro and Steve Bannon, were prosecuted for contempt of Congress for defying subpoenas from the Jan. 6 committee. They were both found guilty at trial and sentenced to four months in prison. Navarro has been behind bars since March, and Bannon has been ordered to report to prison by July 1.

The special counsel in Biden’s case, Hur, spent a year investigating the president’s improper retention of classified documents, from his time as a senator and as vice president. Hur said he found insufficient evidence to successfully prosecute a case in court.

Hur cited limitations with Biden’s memory and the president’s cooperation with investigators that “could convince some jurors that he made an innocent mistake.” Hur’s report also described the president as “someone for whom jurors will want to identify reasonable doubt.”

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Journal of Materials Chemistry A

Review of carbon-support-free platinum and non-platinum catalysts for polymer electrolyte fuel cells: will they feature in future vehicles.

Polymer electrolyte fuel cells have attracted considerable attention as possible replacements for internal combustion engines (ICEs) in light duty vehicles for journeys typically over 300 miles as well for as medium/heavy duty vehicles. In these vehicle types, carbon black is currently used as the support for platinum (Pt)-based catalysts at the cathode and anode. Carbon black is protected from corrosion during startup/shutdown and unwanted fuel (H2) starvation by controlling the potential of both electrodes using high-cost system-level measures. Carbon-support-free Pt-based cathode catalysts, which are durable at the high potentials experienced during startup/shutdown due to the reverse current decay mechanism, have therefore been studied extensively over the last two decades. Anodes with impeded oxygen reduction reaction (ORR) activity have also been developed over the last decade to suppress cathode degradation, as the high potential at the cathode is caused by the reduction of contaminated O2 molecules at the anode. During H2 starvation, the potential of the anode exceeds that of the cathode, which reverses the cell voltage. Theoretical studies have predicted that binary and nonbinary stoichiometric oxides should be stable under these cathode and anode conditions. This paper focuses on non-carbon supports beyond the typical oxides. Both conductivity and surface area are crucial in decreasing Pt loading to the platinum group metal (PGM) level used in exhaust gas catalytic converters in conventional gasoline-fueled ICE-powered vehicles. As the conductivity of powders/particles is a particular focus of this article, reports on suboxides and nitrides with metallic characters are covered. Some Pt/non-carbon catalysts exhibit higher ORR activity and durability against startup/shutdown at the cathodes, as well as higher durability against cell reversal at the anodes, compared with conventional carbon-supported Pt or platinum–cobalt (PtCo) catalysts under specific conditions such as high Pt loading or low relative humidity. The origin of these beneficial properties is reviewed. In contrast to these positive results, negative reports of non-carbon supports at the anode and cathode are also highlighted, and the advantages and disadvantages of using non-carbon supports are discussed. Recent improvements in carbon-support-free, non-PGM cathode materials with the use of conductive TiN and associated challenges are also reviewed.

• This article is part of the themed collections: Journal of Materials Chemistry A HOT Papers and Journal of Materials Chemistry A Recent Review Articles

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Filmmaker Wins New Shot at Seeing Student Loan Fraud Suit Papers

By Daniel Seiden

A documentary filmmaker will have another chance to gain access to papers filed under seal in a False Claims Act suit against Nelnet Inc., Brazos Higher Education Service Corp., and other student-loan companies that settled for $58 million.

The US Court of Appeals for the Fourth Circuit on Tuesday reversed a lower court ruling denying filmmaker Michael Camoin’s motion to unseal those documents, which were filed by whistleblower Jon Oberg when he moved for summary judgment in his 2007 case alleging US Department of Education fraud.

The lower court erred in holding that Camoin lacked a right of access to ...

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