Introductions

Today's topic: Introductions

 

Your introduction is the first impression you make on your readers, and as the saying goes, "you never get a second chance to make a first impression."  Unfortunately, many writers neglect to give the introduction the careful attention it deserves.  The result can be a reader who trudges reluctantly into the body of the paper, disinterested in or confused about the author's message--or worse, a reader who decides not to read the paper at all.

 

An introduction has two jobs.  It should engage the reader's attention and interest, and it should clearly and specifically preview the content of the paper.

 

#1.  Engage the reader's interest:

 

You can accomplish this in a number of different ways.  How you choose to do so will depend on the type of paper you're writing--its purpose and audience--and what your paper is about.  You may remember from your undergraduate English 101 class that the instructor sometimes encouraged you to open with an anecdote or an appeal to the reader's emotions.  This is okay for certain types of papers--personal narratives, for example, or persuasive essays on controversial topics.  In scientific writing, however, it's best to stay away from those techniques. 

 

In scientific writing, you can engage your readers' attention by convincing them of the importance and relevance of your topic--essentially, by showing them why they should care.  If you are writing about diabetes, you can provide statistics about how widespread the disease is, how many Americans it affects, its consequences and complications, how many people die from it each year, and how much money it costs the healthcare system.  You might show how much more prevalent the disease has become in recent years. 

 

Let's look at an example.  This is an excerpt from the introduction to a paper titled “Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure” by Hammash, Lennie, Seongkum, Chung, Lee, & Moser, 2012. 

 

        The purpose of this study was to assess the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a measure of depressive symptoms in patients with heart failure (HF). HF affects more than 5.7 million Americans.¹ About 14% to 63% of patients with HF have depressive symptoms.^2-4

             Depression in patients with HF is associated with poor functional status, poor adherence to medication and exercise, poor perceived control, increased morbidity and mortality, and increased readmission rates. ^5-15 Therefore, identifying depressive symptoms in patients with HF is important to improve patients’ physical and mental well-being. However, depressive symptoms commonly go undiagnosed and untreated.^16-19 Several factors may contribute to under-treatment, but a major issue is lack of clinician familiarity and comfort with assessing depression.²⁰ The potential overlap of depressive symptoms and symptoms of HF or associated co-morbidities also creates a challenge for clinicians in the diagnosis of depressive symptoms in patients with HF.^21,22

The Beck Depression Inventory-II (BDI-II) is a valid, self-report measure of depressive symptoms; however, it is relatively long and complex. It consists of 21 items with up to six response options for each. On average, it takes about five minutes to complete. The BDI-II also has a pre-administration fee, which makes it expensive to use in the primary care settings. Thus, non-psychiatric health care providers need a brief instrument to diagnose depressive symptoms, particularly in the population of patients with HF.

Notice how the authors immediately establish the prevalence of heart failure, and how many heart failure patients suffer from depression.  Not only that, but they also describe some serious consequences of depression in this population--poor functional status, increased morbidity and mortality, etc.  This establishes the importance of the problem.  They go on to point out a further problem; despite the importance of identifying and treating depression in heart failure patients, depressive symptoms often go unnoticed and unmanaged.  They explain that the current gold standard measurement tool for depressive symptoms (the Beck Depression Inventory) is long, complicated, and expensive to use in the primary care setting.  They assert, then, that providers need a better, easier tool for diagnosing depressive symptoms in patients with heart failure.

The authors have done a beautiful job of concisely explaining the problem at hand, and convincing us of its importance.  Each piece builds on the pieces before in a smooth, logical flow of ideas.  In a moment I'll show you how they go on to describe their paper's purpose...

 

#2.  Clearly and specifically preview the paper's content:

 

Think of an introduction as a road map for your paper.  A reader should be able to read your introduction and know precisely, specifically, what your paper will be about. An important part of this equation is the inclusion of a clear and complete purpose statement.  You may have also heard this referred to as a thesis statement or statement of specific aims.  Whatever you call it, it's a crucial part of your paper's introduction (and contrary to the name, a purpose statement does not have to fit into a single sentence--they are often several sentences long).

 

One common problem with purpose statements is that they are too vague.  For example:

 

The purpose of this paper is to explore the effects of instant messaging on youth literacy.

 

Why isn't this a strong purpose statement?  Because it's too general.  It doesn't express a point of view, or provide any details about what aspects of the topic the paper will cover.  Does the author think that instant messaging is having positive effects on youth literacy?  If so, what are those positive effects?  Does he think instant messaging is having negative effects on youth literacy?  What negative effects? 

 

I could imagine a dozen different papers on the topic of instant messaging and youth literacy.  From reading the sentence above, I can't tell much about what the author's paper will be about.  So let's look at another version of this same sentence:

...Instant messaging seems to be a beneficial force in the development of youth literacy because it promotes regular contact with language, the use of a written medium for communication, and the development of an alternative form of literacy.*

 *From a sample student essay by David Craig, in The St. Martin's Handbook, 6th ed., by Andrea Lunsford.

 

This is a much stronger purpose statement.  It tells us the author's point of view--that instant messaging has positive effects on the development of youth literacy.  It also previews the three main reasons why the author believes this is true.  I assume the rest of the essay will follow the road map set out in this purpose statement, and that the author will fully develop each of those three arguments in order to convince us of his overall point.

 

Let's get back to the Hammash, et al. introduction we looked at in the previous section.  Note how these authors preview the content of their paper.  I'll reproduce the entire introduction here, so that you can see it in one piece. I will highlight what I view as the purpose statement in blue.

        The purpose of this study was to assess the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a measure of depressive symptoms in patients with heart failure (HF). HF affects more than 5.7 million Americans.¹ About 14% to 63% of patients with HF have depressive symptoms.^2-4

             Depression in patients with HF is associated with poor functional status, poor adherence to medication and exercise, poor perceived control, increased morbidity and mortality, and increased readmission rates. ^5-15 Therefore, identifying depressive symptoms in patients with HF is important to improve patients’ physical and mental well-being. However, depressive symptoms commonly go undiagnosed and untreated.^16-19 Several factors may contribute to under-treatment, but a major issue is lack of clinician familiarity and comfort with assessing depression.²⁰ The potential overlap of depressive symptoms and symptoms of HF or associated co-morbidities also creates a challenge for clinicians in the diagnosis of depressive symptoms in patients with HF.^21,22

The Beck Depression Inventory-II (BDI-II) is a valid, self-report measure of depressive symptoms; however, it is relatively long and complex. It consists of 21 items with up to six response options for each. On average, it takes about five minutes to complete. The BDI-II also has a pre-administration fee, which makes it expensive to use in the primary care settings. Thus, non-psychiatric health care providers need a brief instrument to diagnose depressive symptoms, particularly in the population of patients with HF.

            The PHQ-9 is a simple instrument derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) version to help clinicians easily screen for depression disorder in primary care settings.²³ It is a self-report questionnaire based on the nine diagnostic criteria for major depressive disorder in the Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV).²⁴ The PHQ-9 has evidence of reliability and validity in a variety of populations, mainly in primary care and general hospital settings as well as in general population;^{23, 25-32} however, it has not been validated in patients with HF.  The purpose of this study was to assess the reliability and validity of the PHQ-9 as a measure of depressive symptoms in patients with HF. The specific aims were to: 1.) assess the internal consistency, reliability, and homogeneity of the PHQ-9; 2.) evaluate the concurrent validity of the PHQ-9 using the BDI-II as the gold standard; and 3.) evaluate the construct validity of the PHQ-9 by testing the following hypotheses:

•       Hypothesis 1: The PHQ-9 will have acceptable sensitivity and specificity using the BDI-II as the criterion for comparison.

•       Hypothesis 2: Patients with higher levels of perceived control will have lower PHQ-9 scores

 

In the next paragraph (beginning "The PHQ-9..."), the authors get into the specific details of their paper.  Having convinced us in the first half of their introduction that depression in heart failure patients is a serious problem, and that it is going underdiagnosed and undertreated, AND that the current gold standard tool is inadequate, they now proceed to describe the tool they believe will work better, the PHQ-9.  They briefly describe the PHQ-9, and explain that it has delivered good results in the hospital, general population, and primary care settings. However, they tell us, it has not been validated in heart failure patients.  This leads us to the central purpose of the paper, which is a report of a research study which aimed to assess the PHQ-9's usefulness as a measure of depressive symptoms in heart failure patients.  The authors go on to list the specific aims of their study, and the hypotheses they sought to test. 

 

You may notice that the first sentence of this introduction might be viewed as a purpose statement.  I would argue that this introduction actually has two purpose statements--the first sentence of the introduction, which briefly tells us the general purpose of the paper, and a much more detailed one (highlighted in blue) at the end of the introduction.  Not all writers include a general purpose statement at the beginning, but I think in this case it was a good approach. 

 

 

So that's it.  An introduction should engage our interest by establishing the topic and convincing us of its importance and relevance, and provide us with a clear and specific road map of the paper's content and purpose.  Remember how important a first impression is, and spend some extra time and effort on your next introduction.  Also, pay attention to the introductions of the articles you read for class.  Reading well-written introductions will help you train yourself to write them.

 

I hope you've found this week's post helpful.  Happy scribbling!

Advice to Start the Semester

Today's topic: Advice to start off the semester

This week's writing tip was inspired by one of the new students in our program, who wrote to me asking what general advice I would give to someone new to graduate school.  However, my advice applies not only to new students, but to all students.  Hopefully these suggestions will help you manage your writing more effectively.

1. Ask questions. 

Many students are reluctant to ask questions of their instructors.  Sometimes it's because of shyness.  Sometimes it's because they don't want to "bother" the instructor.  Sometimes it's because they haven't taken the time to read through their syllabus, rubric, or assignment prompt carefully enough to formulate any questions.  By the time they realize they're not clear on what is expected of them, it might be too late to ask substantive questions.

It is crucial to make sure that you fully understand what is expected of you in class.  If you don't fully understand a writing assignment, or something on a grading rubric or syllabus, ask for clarification.  If the answer you get doesn't fully clarify the situation, then keep on asking questions until you are 100% clear on what you're supposed to do.  Remember, if your instructor doesn't know you're confused, s/he can't help you.  Most instructors have had the frustrating experience of having to give a student a low grade on a paper because s/he just didn't understand the assignment.  When this happens, nine times out of ten the student never asked a single question about the paper before turning it in.

The same goes when you're working with me on a paper or presentation.  If I give you a comment or suggestion that you don't fully understand, make sure to ask me to explain more thoroughly.  That way, we can both be confident that we're communicating clearly.

And remember: Questions aren't bothersome.  They are a crucial part of the learning process, and you're here to learn.  We are here to help you do that.

2. Read your assignment prompts, rubrics, and syllabi carefully.  Turn your assignment prompts into checklists.

Let me give you an example to illustrate why it's so important to read assignment prompts carefully.  Many instructors write assignment prompts in paragraph form.  Most writing assignments will ask for a number of different things--some description or definition, some explanation, some analysis or interpretation, etc.  Often, we ask students to analyze by using the word "Why?"  That one word can ask you to delve more deeply into a topic.  But it's a three-letter word, and can be easily missed in a block of text.  If you miss that "Why?" you might end up leaving that important analysis out of your paper, which could have serious repercussions for your grade.

I can tell you that one of the main problems I see in student writing is a failure to fulfill each of the requirements of the assignment.  Students frequently, FREQUENTLY miss something--often, it's something crucial. 

So.  Read course materials carefully.  Ideally, read assignment prompts aloud.  Reading aloud forces you to slow down, so you will be less likely to miss something.  Also, it's a good idea to turn assignment prompts into checklists.  If your prompt is written as a paragraph, copy and paste it into a new document and put each requirement on a separate line.  Once you've written a first draft of your paper, you can use your checklist to make sure you haven't missed anything. 

3. Seek out help when you need it.

Again, we (the faculty) are here to help you learn.  Don't flounder around alone.  If you need help, ask for it.  If the help you need is in writing or presentation prep, send me an email; that's what I'm here for. 

And please, if you need help, don't put it off.  I've lost count of the number of times I've heard a student say, "I WISH I'd come to see you earlier in the program!"  Often, a student puts off coming to see me until late in the game.  I can still help them then, but students who go this route often wish they'd asked for my help sooner.  Learn from their experience.

4. Read your writing out loud.

As I mentioned earlier, reading aloud forces you to slow down.  This alone makes you far more likely to catch mistakes--both big mistakes, like problems with sentence structure or organization, and small mistakes like typos.  Also, oddly enough, research shows that when we read silently we don't read every word on the page.  We skim our eyes over the text and pick up the meaning, but we don't "hear" how the sentences sound.  This means that we can easily miss confusing or awkward sentence structure in our own writing.  Reading aloud solves this problem.

There is a wealth of evidence in the field of composition and rhetoric (a.k.a. writing) that supports how helpful this technique is for writers.  You don't have to read your paper aloud every time, but you should do an oral read-through at least a couple of times before you turn in your final draft.

5. Use the resources available to you. 

For my part, this includes the "Writing Resources" website on Blackboard, my "Writing Tips" blog and "Writing Tip of the Week" emails, and the occasional brown-bag workshops I offer, not to mention my one-on-one consultation services. 

We also offer you many other terrific resources.  Beverly Hilton, the Medical Center Library's liason to the College of Nursing, is one example.  Beverly is a wonderful resource for any questions you may have about conducting a literature search, using the library websites or databases, etc.  Robert Shapiro, the Medical Center Library's resident EndNote guru, is another wonderful resource.  Robert is always happy to answer questions about the EndNote software, and he teaches classes in EndNote throughout the year. 

In addition to that, your advisor and professors are all wonderful sources of information and inspiration.  These are just a few examples of the many resources available to you here.

I could go on for another four pages, but I promised myself I'd stick to the top five.  I hope you found this week's post helpful.  As always, happy scribbling!