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!
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