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15 Best Websites to Download Research Papers for Free

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Is your thirst for knowledge limited by expensive subscriptions? Explore the best websites to download research papers for free and expand your academic reach.

Today, navigating through the academic terrain often feels like being stuck in an intellectual desert, parched for knowledge.

With paywalls acting like impenetrable fortresses, accessing scholarly articles becomes a herculean task. However, a beacon of hope exists in the form of free-access platforms, quenching our thirst for intellectual wisdom. Let’s set sail on this scholarly journey.

Table of Contents

Do you recall the Z Library, a once-prominent source of free academic resources? While its seizure by the FBI was a stark reminder of copyright considerations, it also marked a transformative phase in the digital academic landscape. 

Today’s champions of academia aren’t just about offering free access, they uphold ethics and copyright respectability. Let’s delve into these repositories that are reshaping the academia world. You can download free research papers from any of the following websites.

Best Websites to Download Research Papers

#1. sci-hub – best for accessing paywalled academic papers.

• Unlocks millions of academic articles
• Known as the ‘Robin Hood’ of research
• Free and easy to use

Sci-Hub is the defiant maverick of the academic sphere. Often termed the “Pirate Bay of Science,” it presents an unconventional solution to the paywall barrier, freely providing access to a vast range of scholarly literature.

What are the benefits of Sci-Hub?

• Unlimited Access: Unlocks paywalled research papers
• Extensive Database: Hosts a wide variety of academic disciplines
• User-friendly: Features a simple interface and easy navigation

Despite its contentious standing, Sci-Hub offers an invaluable service to knowledge-seekers. While navigating the tightrope between access and legality, it represents a game-changing force in the world of academic research.

Source: https://www.sci-hub.se

#2. Library Genesis (Libgen) – Best for a Wide Range of Books and Articles

• Houses a comprehensive collection of books and articles
• Allows downloading in various formats
• Free and efficient

If the pursuit of knowledge was a grand voyage, Library Genesis, or Libgen, would undoubtedly be your trusty compass and map. Like the vast sea brimming with hidden treasures, Libgen is an expansive library with riches ranging from academic papers to rare textbooks, and even popular fiction. 

It’s not just a repository, but a vibrant confluence of multiple disciplines and interests, catering to the unique intellectual appetite of each knowledge seeker.

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What are the benefits of Libgen?

• Multidisciplinary: Holds resources for a vast array of subjects
• Diverse Content: Offers not just articles but also books, textbooks, and fiction
• Format Freedom: Allows content download in various formats

Libgen, with its remarkable expanse and variety, is the academic equivalent of a treasure trove. It’s a one-stop destination for researchers and readers, making it an invaluable ally in the quest for knowledge.

Source: https://libgen.is

#3. Unpaywall – Best for Legal Open Access Versions of Scholarly Articles

• Provides legal access to millions of academic articles
• Fast and user-friendly
• Free and ethically sound

Unpaywall is the stately knight of the academic world. Upholding the banner of ethics, it gallantly charges through the battlefield of paywalls, breaking barriers and making scholarly literature accessible.

Unpaywall doesn’t just give you a key; it gives you a legal, ethically sound key to the treasure chest of academic wisdom. This website is not merely a tool; it’s a testament to the idea that knowledge should be accessible to all, without compromising on legality and respect for authorship.

What are the benefits of Unpaywall?

• Legal Access: Enables legitimate access to research papers
• Wide Reach: Features an extensive, continuously updated database
• Cost-free: All services are available without any charges

For those who believe in the harmony of free access and ethical consideration, Unpaywall is a guiding star. It reflects an ideal blend of accessibility, legality, and respect for intellectual property .

Source: https://unpaywall.org

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#4. Directory of Open Access Journals (DOAJ) – Best for Peer-Reviewed Open Access Journals

• Repository of high-quality, open-access, peer-reviewed journals
• Covers all subjects and many languages
• Free to use

DOAJ is one of the most popular open access repositories that offers peer-reviewed, open-access journals across numerous subjects and languages. More than just a tool, DOAJ symbolizes the collaborative ethos of academia, fostering a global exchange of knowledge with no entry ticket.

What are the benefits of DOAJ?

• High Quality: Ensures all listed journals are peer-reviewed for quality assurance
• Wide Range: Features journals covering numerous subjects and languages
• Free Access: No cost attached to access these resources

The DOAJ, in its essence, manifests the democratic spirit of academic research. It’s an indispensable platform for researchers seeking high-quality, peer-reviewed, open-access resources across a wide range of subjects.

Source: https://doaj.org

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#5. Open Access Button – Best for Free Versions of Paywalled Articles

• Finds legal free versions of paywalled articles
• Fast, simple, and reliable
• Free and respects copyright laws

Just like the rush of adrenaline you feel when you find a forgotten $20 bill in your old jeans, Open Access Button brings the same excitement to the academic sphere. 

It is your trusty detective, sniffing out legal, freely accessible versions of those pesky paywalled articles. More than just a tool, it represents an ethical, innovative solution to the widespread issue of paywall barricades in academic research.

What are the benefits of Open Access Button?

• Legal & Free Access: Hunts for legal, open versions of paywalled research papers
• User-friendly: Easy to use with swift results
• Ethical: Respects and upholds copyright laws

Open Access Button serves as the ethical bridge between knowledge seekers and the scholarly content they need. Its commitment to providing free, legal access upholds the values of respect and fairness in academia.

Source: https://openaccessbutton.org

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#6. Science Open – Best for a Wide Variety of Open Access Scientific Research

• Features over 60 million articles
• Facilitates academic networking and discussion
• Free and comprehensive

Consider Science Open as a bustling town square in the city of scientific knowledge, where scholars from all walks of life gather, discuss, and dissect over 60 million articles. 

It’s not just like the best university libraries, it’s a collaborative arena for scientists, researchers, and curious minds alike. By fostering open discussions and peer reviews, it not only disseminates information but also nourishes a robust, global scientific community.

What are the benefits of Science Open?

• Vast Library: Provides access to over 60 million research items
• Collaborative Platform: Encourages networking, discussion, and public peer review
• Comprehensive: Covers a wide array of scientific disciplines

Science Open is more than a tool; it’s a community fostering open scientific discourse. Its vast resources and collaborative platform make it a vital player in modern scientific research.

Source: https://www.scienceopen.com

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#7. CORE – Best for Open Access Content Across Disciplines

• Harvests research papers from repositories worldwide
• Features millions of open access articles

CORE is like a skilled artisan, meticulously crafting a vast tapestry of open-access content across various disciplines. By aggregating data from repositories worldwide, it weaves together a rich, comprehensive picture of global research. 

This tool doesn’t merely provide access; it delivers an integrated research experience that pushes the frontiers of academia and knowledge exploration.

What are the benefits of CORE?

• Wide Coverage: Harvests data from global repositories, providing extensive coverage
• Open Access: Features millions of open access research papers
• User-friendly: Simple, efficient interface for seamless navigation

With its unparalleled aggregation and comprehensive access, CORE embodies the grand orchestra of global research. It stands as an essential tool in the modern researcher’s toolkit.

Source: https://core.ac.uk

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#8. ERIC – Best for Education Research

• Specialized in education research literature
• Offers a wide range of resources, including articles, reports, and studies
• Free and tailored for educators and researchers

Like an esteemed professor, ERIC curates and presents a wealth of scholarly resources for educators, policymakers, and researchers. It serves as a guiding light, illuminating the path to evidence-based practices and enriching the field of education.

What are the benefits of ERIC?

• Focus on Education: Offers a specialized collection of education research literature
• Comprehensive Resources: Includes articles, reports, studies, and more
• Tailored for Educators: Provides valuable insights and tools specifically for educators and researchers

ERIC stands as a pillar in the realm of education research, equipping educators with the knowledge and evidence they need to drive innovation and improve educational practices.

Source: https://eric.ed.gov

#9. PaperPanda – Best for Free Access to Research Papers

• Provides free access to research papers across multiple disciplines
• Offers convenient search and download options
• Free and user-friendly

PaperPanda is always there to assist you in your quest for knowledge. With its vast collection of research papers spanning various disciplines, PaperPanda ensures that you have the resources you need right at your fingertips. 

It’s like having a personal research assistant, guiding you through the maze of scholarly literature.

What are the benefits of PaperPanda?

• Wide Range of Disciplines: Offers research papers across multiple fields of study
• Easy Search and Download: Provides convenient search and download options
• User-Friendly Interface: Makes the research process smooth and accessible

PaperPanda, with its user-friendly approach and expansive collection, simplifies the journey of accessing research papers. It empowers researchers and knowledge enthusiasts by putting a world of information within reach.

Source: https://paperpanda.app

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#10. Citationsy Archives – Best for Research Papers from Numerous Fields

• Curates a vast collection of research papers
• Offers easy-to-use citation and bibliography management tools

As you navigate through the vast corridors of this digital library, you’ll discover a wealth of academic resources from diverse fields. 

Citationsy Archives provides access to valuable research papers. It also equips you with powerful citation and bibliography management tools, ensuring that your scholarly journey remains organized and efficient.

What are the benefits of Citationsy?

• Extensive Collection: Curates a wide variety of research papers from numerous fields
• Citation Management: Offers user-friendly tools for organizing citations and creating bibliographies
• Comprehensive Support: Helps researchers streamline their academic workflow

Citationsy Archives serves as a haven for researchers seeking a comprehensive collection of research papers. Its integrated citation and bibliography management tools make it an indispensable companion in the scholarly pursuit.

Source: https://citationsy.com

#11. OA.mg – Best for Direct Download Links to Open Access Papers

• Provides direct download links to open access papers
• Offers a straightforward, no-frills interface

OA.mg presents a no-nonsense approach to providing direct download links to scholarly articles, ensuring that you have immediate access to the knowledge you seek. With its simplicity and efficiency, OA.mg streamlines the process of finding and accessing open access papers.

What are the benefits of OA.mg?

• Direct Download Links: Offers quick access to open access papers without unnecessary hurdles
• Simplicity: Features a straightforward interface for effortless navigation
• Efficient Access: Saves time by bypassing intermediary steps in accessing research papers

OA.mg stands as a reliable conduit between knowledge seekers and open access papers. Its focus on direct download links enhances the efficiency of accessing scholarly resources.

Source: https://oa.mg

#12. Social Science Research Network (SSRN) – Best for Social Sciences and Humanities Research

• Specializes in social sciences and humanities research
• Hosts a vast collection of scholarly papers, working papers, and preprints
• Free and tailored for researchers in these fields

This digital haven caters to the intellectual curiosity of scholars in these fields, providing access to a wealth of scholarly papers, working papers, and preprints.

SSRN fosters collaboration and knowledge-sharing, creating a vibrant community at the forefront of social sciences and humanities research.

What are the benefits of SSRN?

• Specialized Content: Focuses on social sciences and humanities research
• Diverse Collection: Offers scholarly papers, working papers, and preprints
• Research Community: Facilitates collaboration and knowledge-sharing among researchers

SSRN serves as an invaluable resource for researchers in the social sciences and humanities, fostering a community that drives innovation and advancements in these fields.

Source: https://www.ssrn.com

#13. Project Gutenberg – Best for Free Access to eBooks

• Houses a vast collection of free eBooks
• Covers a wide range of subjects and genres
• Free and easily accessible

Project Gutenberg is a paradise for book lovers and knowledge enthusiasts. This impressive collection of free eBooks spans various subjects and genres, from classic literature to scientific works. 

Project Gutenberg opens the doors to a world of literary exploration, providing access to timeless wisdom and captivating stories that shape our intellectual landscape.

What are the benefits of Project Gutenberg?

• Extensive eBook Collection: Offers a vast selection of free eBooks
• Diverse Subjects and Genres: Covers a wide range of topics and literary genres
• Free and Accessible: Provides easy access to literary works without any cost

Project Gutenberg serves as a testament to the power of literature and the accessibility of knowledge. It enables readers worldwide to embark on intellectual journeys through its extensive collection of free eBooks.

Source: https://www.gutenberg.org

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#14. PLOS (Public Library of Science) – Best for Open Access to Scientific and Medical Research

• Publishes open access scientific and medical research
• Features high-quality, peer-reviewed articles
• Free and promotes global scientific collaboration

As a leading publisher of open access research, PLOS fosters the dissemination of cutting-edge scientific discoveries to a global audience. 

With a commitment to quality and peer-reviewed excellence, PLOS supports the collaborative spirit of scientific advancement, empowering researchers and scientists to share their findings freely.

What are the benefits of PLOS?

• Open Access Publications: Provides free access to high-quality scientific and medical research
• Peer-Reviewed Excellence: Ensures rigorous peer review for published articles
• Global Scientific Collaboration: Facilitates knowledge sharing and collaboration among researchers worldwide

PLOS stands at the forefront of the open access movement, promoting the free flow of scientific and medical knowledge. It represents the spirit of collaboration and transparency, empowering researchers to push the boundaries of human understanding.

Source: https://plos.org

#15. arXiv.org – Best for Preprints in Science, Mathematics, and Computer Science

• Specializes in hosting preprints in science, mathematics, and computer science
• Provides early access to cutting-edge research
• Free and fosters collaboration among researchers

arXiv.org is the epicenter of preprints in science, mathematics, and computer science. This virtual haven serves as an incubator for innovative ideas, granting researchers early access to the latest findings and nurturing collaboration within these rapidly evolving disciplines.

What are the benefits of arXiv?

• Cutting-Edge Research: Provides access to preprints, allowing early exploration of groundbreaking ideas
• Interdisciplinary Reach: Spans science, mathematics, and computer science, fostering cross-disciplinary collaboration
• Global Knowledge Exchange: Encourages the sharing of research findings and facilitates collaboration among researchers worldwide

arXiv.org stands as a catalyst for scientific progress, offering a glimpse into the future of research. By providing early access to preprints, it fuels innovation, collaboration, and the acceleration of knowledge in science, mathematics, and computer science.

Source: https://arxiv.org

In a world where knowledge is king, accessing a research paper shouldn’t feel like an impossible task. Thanks to these free and innovative websites, we can escape the barriers of paywalls and dive into a vast ocean of intellectual wealth. 

From the rebellious spirit of Sci-Hub to the collaborative nature of PLOS, these digital champions are reshaping the academic landscape.

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14 Websites to Download Research Paper for Free – 2024

Download Research Paper for Free

Table of contents

2. z-library, 3. library genesis, 4. unpaywall, 5. gettheresearch.org, 6. directory of open access journals (doaj), 7. researcher, 8. science open, 10. internet archive scholar, 11. citationsy archives, 13. dimensions, 14. paperpanda – download research papers for free.

Collecting and reading relevant research articles to one’s research areas is important for PhD scholars. However, for any research scholar, downloading a research paper is one of the most difficult tasks. You must pay for access to high-quality research materials or subscribe to the journal or publication. In this article, ilovephd lists the top 14 websites to download free research papers, journals, books, datasets, patents, and conference proceedings downloads.

Download Research Paper for Free – 2024

14 best free websites to download research papers are listed below:

Sci-Hub is a website link with over 64.5 million academic papers and articles available for direct download. It bypasses publisher paywalls by allowing access through educational institution proxies.  To download papers Sci-Hub  stores papers in its repository, this storage is called Library Genesis (LibGen) or library genesis proxy 2024.

Visit: Working Sci-Hub Proxy Links – 2024

Z-Library is a clone of Library Genesis, a shadow library project that allows users to share scholarly journal articles, academic texts, and general-interest books via file sharing (some of which are pirated). The majority of its books come from Library Genesis, however, some are posted directly to the site by individuals.

Individuals can also donate to the website’s repository to make literature more widely available. Z-library claims to have more than  10,139,382 Books  and  84,837,646 Articles  articles as of April 25, 2024.

It promises to be “the world’s largest e-book library” as well as “the world’s largest scientific papers repository,” according to the project’s page for academic publications (at booksc.org). Z-library also describes itself as a donation-based non-profit organization.

Visit: Z-Library – You can Download 70,000,000+ scientific articles for free

The Library Genesis aggregator is a community aiming at collecting and cataloging item descriptions for the most part of scientific, scientific, and technical directions, as well as file metadata. In addition to the descriptions, the aggregator contains only links to third-party resources hosted by users. All information posted on the website is collected from publicly available public Internet resources and is intended solely for informational purposes.

Visit: libgen.li

Unpaywall harvests Open Access content from over 50,000 publishers and repositories, and makes it easy to find, track, and use. It is integrated into thousands of library systems, search platforms, and other information products worldwide. In fact, if you’re involved in scholarly communication, there’s a good chance you’ve already used Unpaywall data.

Unpaywall is run by OurResearch, a nonprofit dedicated to making scholarships more accessible to everyone. Open is our passion. So it’s only natural our source code is open, too.

Visit: unpaywall.org

GetTheResearch.org is an  Artificial Intelligence(AI)  powered search engine for search and understand  scientific articles  for researchers and scientists. It was developed as a part of the  Unpaywall  project. Unpaywall is a database of 23,329,737 free scholarly Open Access(OA) articles from over 50,000 publishers and repositories, and make it easy to find, track, and use.

Visit: Find and Understand 25 Million Peer-Reviewed Research Papers for Free

DOAJ (Directory of Open Access Journals) was launched in 2003 with 300 open-access journals. Today, this independent index contains almost 17 500 peer-reviewed, open-access journals covering all areas of science, technology, medicine, social sciences, arts, and humanities. Open-access journals from all countries and in all languages are accepted for indexing.

DOAJ is financially supported by many libraries, publishers, and other like-minded organizations. Supporting DOAJ demonstrates a firm commitment to open access and the infrastructure that supports it.

Visit: doaj.org

The researcher is a free journal-finding mobile application that helps you to read new journal papers every day that are relevant to your research. It is the most popular mobile application used by more than 3 million scientists and researchers to keep themselves updated with the latest academic literature.

Visit: 10 Best Apps for Graduate Students 

ScienceOpen  is a discovery platform with interactive features for scholars to enhance their research in the open, make an impact, and receive credit for it. It provides context-building services for publishers, to bring researchers closer to the content than ever before. These advanced search and discovery functions, combined with post-publication peer review, recommendation, social sharing, and collection-building features make  ScienceOpen  the only research platform you’ll ever need.

Visit: scienceopen.com

OA.mg is a search engine for academic papers. Whether you are looking for a specific paper, or for research from a field, or all of an author’s works – OA.mg is the place to find it.

Visit: oa.mg

Internet Archive Scholar (IAS) is a full-text search index that includes over 25 million research articles and other scholarly documents preserved in the Internet Archive. The collection spans from digitized copies of eighteenth-century journals through the latest Open Access conference proceedings and pre-prints crawled from the World Wide Web.

Visit: Sci hub Alternative – Internet Archive Scholar

Citationsy was founded in 2017 after the reference manager Cenk was using at the time, RefMe, was shut down. It was immediately obvious that the reason people loved RefMe — a clean interface, speed, no ads, simplicity of use — did not apply to CiteThisForMe. It turned out to be easier than anticipated to get a rough prototype up.

Visit: citationsy.com

CORE is the world’s largest aggregator of open-access research papers from repositories and journals. It is a not-for-profit service dedicated to the open-access mission. We serve the global network of repositories and journals by increasing the discoverability and reuse of open-access content.

It provides solutions for content management, discovery, and scalable machine access to research. Our services support a wide range of stakeholders, specifically researchers, the general public, academic institutions, developers, funders, and companies from a diverse range of sectors including but not limited to innovators, AI technology companies, digital library solutions, and pharma.

Visit: core.ac.uk

Dimensions cover millions of research publications connected by more than 1.6 billion citations, supporting grants, datasets, clinical trials, patents, and policy documents.

Dimensions is the most comprehensive research grants database that links grants to millions of resulting publications, clinical trials, and patents. It

provides up-to-the-minute online attention data via Altmetric, showing you how often publications and clinical trials are discussed around the world. 226m Altmetric mentions with 17m links to publications.

Dimensions include datasets from repositories such as Figshare, Dryad, Zenodo, Pangaea, and many more. It hosts millions of patents with links to other citing patents as well as to publications and supporting grants.

Visit: dimensions.ai

PaperPanda is a Chrome extension that uses some clever logic and the Panda’s detective skills to find you the research paper PDFs you need. Essentially, when you activate PaperPanda it finds the DOI of the paper from the current page, and then goes and searches for it. It starts by querying various Open Access repositories like OpenAccessButton, OaDoi, SemanticScholar, Core, ArXiV, and the Internet Archive. You can also set your university library’s domain in the settings (this feature is in the works and coming soon). PaperPanda will then automatically search for the paper through your library. You can also set a different custom domain in the settings.

Visit: PaperPanda

I hope, this article will help you to know some of the best websites to download research papers and journals for free.

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UGC-CARE List of Journals – Arts and Humanities – 2024

Choosing a phd supervisor 9 key factors to consider, 10 ideas to get 10x more google scholar citations.

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Sci-Hub is the most controversial project in today science. The goal of Sci-Hub is to provide free and unrestricted access to all scientific knowledge ever published in journal or book form.

Today the circulation of knowledge in science is restricted by high prices. Many students and researchers cannot afford academic journals and books that are locked behind paywalls. Sci-Hub emerged in 2011 to tackle this problem. Since then, the website has revolutionized the way science is being done.

Sci-Hub is helping millions of students and researchers, medical professionals, journalists and curious people in all countries to unlock access to knowledge. The mission of Sci-Hub is to fight every obstacle that prevents open access to knowledge: be it legal, technical or otherwise.

To get more information visit the about Sci-Hub section.

Thank you for joining Sci-Hub mailing list!

Get Scholarly Articles for Free

Harvard Library has paid for your access to hundreds of websites — from the New York Review of Books to the Oxford English Dictionary to the journal Nature: Chemical Biology . You just need to connect via HarvardKey.

The library offers many tools to quickly check if you have free online access. Each tool has features that you may find helpful at different times. Most people mix and match for different purposes. Find the one that's right for you.

Google Scholar

Get access directly from Google Scholar results.

• Adds the "Try Harvard Library" link to your Google Scholar results
• Selects the best access point for you

Browser Extensions

Adding a browser extension is a way to get articles Harvard Library pays for - no matter what website you're using.

Lean Library

Install the Lean Library plugin to automate access.

• Checks every website that you visit and reloads via Harvard Key automatically
• Notifies you if an ebook or online article is available via Harvard
• No action required: Lean Library is always working in the background
• May sign you out of personally subscribed accounts

Check Harvard Library Bookmarklet

Get one-click access with the Check Harvard Library Bookmark.

• Works on most browsers, including on your phone
• Reloads the page you're on via Harvard Key
• You're in control: use the bookmark when you want to check for access

Check Harvard Library Bookmark

Stay current with your favorite academic journals, preview the table of contents, and never miss a new article. Harvard Library offers free accounts.

Library Access via VPN

Harvard vpn.

Don't want to keep logging in using HarvardKey? Searching for articles while abroad? You can get the same access as a campus computer by installing and configuring a Harvard VPN.

• Generally removes the need to log in to Harvard Key
• Some sites won't recognize VPN, some sites only work on VPN
• Can be helpful for access outside of the United States

Instructions on how to install the VPN client (via HUIT)

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Looking for another type of access or free articles? Find answers to commonly asked questions and ask your own. Library staff members are also available via chat during posted hours.

Best Websites To Download Research Papers For Free: Beyond Sci-Hub

Navigating the vast ocean of academic research can be daunting, especially when you’re on a quest for specific research papers without the constraints of paywalls. Fortunately, the digital age has ushered in an era of accessible knowledge, with various platforms offering free downloads of scholarly articles.

In this article, we explore some of the best websites that provide researchers, students, and academicians with free access to a plethora of research papers across diverse fields, ensuring that knowledge remains within everyone’s reach.

Best Websites To Download Research Papers For Free

Google scholar.

As a researcher, you might find Google Scholar to be a repository brimming with academic papers covering a broad span of domains like social sciences, computer science, and humanity, including:

• Journal articles
• Conference papers, and

Unlike other websites to download research papers, Google Scholar provides free access to a vast collection of scholarly literature, making it one of the best websites to download research.

Not every article is available in full PDF format directly; however, Google Scholar often links to other open access resources like DOAJ (Directory of Open Access Journals) and open-access repositories where you can directly download papers.

For instance, if you’re searching for a specific 2023 research paper in mathematics, you can use Google Scholar to locate the paper and check if it’s available for free download either on the platform itself or through links to various open access sources.

In many cases, Google Scholar integrates with tools like Unpaywall and Open Access Button, which are browser extensions that help you find free versions of paywalled articles.

These extensions often redirect you to open-access content, including those on platforms like Sci-Hub and Library Genesis, although it’s crucial to be aware of the legal and ethical implications of using such services.

ResearchGate

ResearchGate is a unique platform that blends social networking with academic research, making it an essential tool for researchers and scientists across various disciplines.

Here, you have access to a digital library of millions of research papers, spanning fields from computer science to social sciences and beyond.

When you’re on ResearchGate, downloading a research paper is relatively straightforward, especially if it’s open access. Many researchers upload the full PDF of their work, providing free access to their peer-reviewed articles.

If the research paper you’re interested in isn’t available for direct download, ResearchGate offers a unique feature: you can request a copy directly from the author.

This approach not only gets you the paper but also potentially opens a line of communication with leading experts in your field.

It’s important to note that ResearchGate isn’t just a repository; it’s a platform for discovery and connection. You can:

• Follow specific researchers
• Join discussions, and
• Receive notifications about new research in your domain.

While it doesn’t have the controversial direct download links like Sci-Hub or Library Genesis, ResearchGate offers a more ethical and legal route to accessing academic papers. 

ScienceOpen

ScienceOpen is a comprehensive repository that hosts a multitude of open-access research articles across various fields, from the social sciences to computer science. 

The process of downloading a research paper on ScienceOpen is remarkably straightforward. Since it’s an open-access platform, most of the papers are available to download as PDFs without any cost.

This means you can access high-quality, peer-reviewed academic research without encountering paywalls that are often a barrier in many other scientific platforms.

For instance, if you’re delving into the latest 2023 scientific papers in mathematics, ScienceOpen can be your go-to source. You can easily search for research papers using:

• Browsing through various open access journals featured on the site.

The direct download feature simplifies access to these papers, making it convenient for you to obtain the research you need.

Directory of Open Access Journals (DOAJ)

The Directory of Open Access Journals (DOAJ) is a digital library is an extensive repository of open-access, peer-reviewed journals, covering a wide array of subjects from humanities to nuclear science.

When you’re navigating DOAJ, you’ll discover that it’s not just a platform to download research papers; it’s a gateway to a world of academic research.

Each journal article listed is freely accessible, meaning you can download these scholarly articles without any cost or subscription.

The process is simple: search for research papers using specific keywords, subjects, or even DOAJ’s advanced search functionality that includes filters like:

• Language, or
• The year of publication.

For example, if you’re delving into the latest developments in scientific research in 2023, DOAJ allows you to refine your search to the most recent publications.

Once you find a relevant research paper, you can easily access the full text in PDF format through a direct download link. This is particularly useful for accessing high-quality, open-access research papers that are not always readily available on other platforms like Sci-Hub or Library Genesis.

PubMed hosts millions of research articles, primarily in the fields of medicine and life sciences, but also encompassing a broad range of scientific research.

When you’re on PubMed, you can search for research papers using:

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While PubMed lists both open-access and subscription-based journal articles, it offers a unique feature for accessing papers for free.

If you’re looking for a particular research paper, say in the domain of computer science or social sciences from 2023, you can directly access its abstract on PubMed. For open access articles, a free full-text link is often available, allowing you to download the research paper in PDF format.

PubMed integrates with tools like Unpaywall and the Open Access Button. These browser extensions help you find open-access versions of the articles you’re interested in, bypassing the paywalls that often restrict access to scholarly literature.

While PubMed itself doesn’t provide direct download links for all articles, its connection with these tools and various open access repositories ensures that you, as a researcher, have greater access to scientific papers.

Sci-Hub (with Caution)

Sci-Hub, often dubbed the ‘Pirate Bay of Science,’ has been a game-changer in the scientific community since its inception by Alexandra Elbakyan in 2011.

It operates as a controversial, yet widely used platform providing free access to millions of research papers and academic articles that are typically locked behind paywalls.

As a researcher, you might find Sci-Hub an intriguing, albeit contentious, tool for accessing scholarly literature.

When you’re looking to download a research paper from Sci-Hub, the process is relatively straightforward. Say you need a journal article on computer science or a groundbreaking study in social sciences from 2023; you just need to have the DOI (Digital Object Identifier) of the paper.

By entering this DOI into Sci-Hub’s search bar, the website bypasses publisher paywalls, offering you direct download links to PDF versions of the articles.

It’s crucial to note that while Sci-Hub provides access to a vast repository of scientific research, its legality is under constant scrutiny. The platform operates via various proxy links and has been the subject of numerous legal battles with publishers and academic institutions.

Nevertheless, Sci-Hub remains a popular go-to for researchers and scientists globally, especially those without access to university libraries or digital archives.

While it opens doors to a wealth of knowledge, users should be aware of the ethical and legal implications of using such a service in their respective countries.

Wrapping Up: You Can Get Free Academic Papers 

The digital landscape offers a wealth of resources for accessing academic research without financial barriers. The platforms we share here provide an invaluable service to the scholarly community, democratising access to knowledge and fostering intellectual growth.

Whether you’re a seasoned researcher or a curious student, these websites bridge the gap between you and the vast world of academic literature, ensuring that the pursuit of knowledge remains an inclusive and equitable journey for all. Remember to consider the legal and ethical aspects when using these resources.

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Open access in scientific publishing represents a transformative approach that breaks down traditional barriers to knowledge dissemination. It is a movement dedicated to making scientific research freely available to all, fostering a more inclusive and collaborative scientific community. At its core, open access allows for the unrestricted sharing of research findings, enabling scientists, academicians, and the general public to access and utilize scientific papers without the constraints of subscription fees or licensing restrictions. This paradigm shift in scholarly communication is driven by the belief that knowledge, particularly that which is publicly funded, should be a communal resource, accessible to everyone for the greater good of society.

In the realm of scientific research, open access has numerous advantages. It accelerates the pace of discovery by allowing researchers to build upon existing work without delay, facilitating interdisciplinary collaboration and cross-pollination of ideas across various fields. This is particularly crucial in addressing global challenges, where rapid and unencumbered access to research can lead to faster solutions. Furthermore, open access democratizes knowledge by making it available to researchers in developing countries who may not have the resources for expensive journal subscriptions, thereby narrowing the research gap between high and low-income countries.

The open access model also aligns with the digital age's ethos of openness and transparency. It enables a more efficient validation and critique process, as a larger audience can scrutinize and contribute to the research. This can lead to higher quality and more reliable scientific work. Moreover, it provides an equal platform for emerging researchers and institutions to share their findings, ensuring that the visibility and impact of research are not confined to those within well-funded, prestigious entities.

However, the transition to open access is not without challenges. The sustainability of publishing models, quality assurance, and equitable distribution of costs are ongoing concerns. Despite these hurdles, the open access movement is gaining momentum, driven by the global scientific community's commitment to an open, accessible, and collaborative future in research. As we move forward, open access stands as a beacon of progress, symbolizing a world where knowledge is a shared and freely accessible asset, driving innovation and societal advancement.

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JSTOR hosts a growing curated collection of more than 50,000 open research reports from 187 think tanks and research institutes from around the world. These publications are freely accessible to everyone on JSTOR and discoverable as their own content type alongside journals, books, and primary sources. We update research reports on our platform each month as they become available through contributing institutes.

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Research reports provide current analysis on many of today’s most discussed and debated issues from a diversity of ideological and international perspectives representing 40 countries and 29 languages. A sample of topics would include: climate change, border security, fake news, cybersecurity, electric vehicles, artificial intelligence, energy policy, gender issues, terrorism, remote learning, recent trends in business and economics, and various public health issues, including COVID-19.

Although the briefs, papers, and reports published by these institutes are not peer-reviewed, they are written by policy experts and members of the academic community who are fellows in residence. This is content that impacts policy, both foreign and domestic. It is also increasingly used by faculty in their classrooms for its currency, breadth, and accessibility.

JSTOR’s research reports cover seven Areas of Focus: Business & Economics, Critical Race & Ethnic Studies, Education, Gender & Sexuality, Public Health, Security Studies, and Sustainability.

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Input from faculty and librarians revealed that although research reports were for the most part freely available outside of JSTOR, they were hard to find and not easily discoverable alongside relevant material. It was also difficult for students to differentiate between the most credible research reports and a growing corpus of questionable sources on the Web.

JSTOR has attempted to redress these issues by centralizing a curated collection of think tank research reports on a single platform, making this content freely available to all JSTOR users, and enhancing its discoverability through comprehensive searching and the application of rich metadata.

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Many students and researchers need to find a paper for their research, to complete the review of an article, or while writing their thesis. Many papers can be found through your university library, but for those that you may not have access to through your institution, we take a look at the three largest open access sites, as well as sci hub and Library Genesis .

Unpaywall Unpaywall is a website built by Impactstory, a nonprofit working to make science more open and reusable online. They are supported by grants from the National Science Foundation and the Alfred P. Sloan Foundation. What they do is gather all the articles they can from all the open-access repositories on the internet. These are papers that have been provided by the authors or publishers for free, and thus Unpaywall is completely legal. They say they have about 50-85% of all scientific articles available in their archive. Works with Chrome or Firefox.

PaperPanda PaperPanda is a free browser extension for Chrome that gives you one-click access to papers and journal articles. When you find a paper on the publisher’s site, just click the PaperPanda icon and the panda goes and finds the PDF for you.

Open Access Button The Open Access Button  does something very similar to Unpaywall, with some major differences. They search thousands of public repositories, and if the article is not in any of them they send a request to the author to make the paper publicly available with them. The more people try to find an article through them, the more requests an author gets. You can search for articles/papers directly from their page, or download their browser extension.

Library Genesis Library Genesis is a database of over 5 million (yes, million) free papers, articles, entire journals, and non-fiction books. They also have comics, fiction books, and books in many non-english languages. They are also known as LibGen or Genesis Library. Many of the papers on Library Genesis are the same as sci hub, but what sets them apart is that Library Genesis has books as well.

OAmg OAmg lets you search for journal articles and papers, download them, and of course cite them in your Citationsy projects. After entering a query it searches through all published papers in the world and shows you the matches. You can then click a result to see more details and read a summary. It will also let you download the paper through a couple different, completely legal open access services. www.oa.mg

Sci-Hub (link updated August 2022) Finally, there’s Sci Hub . Science-Hub works in a completely different way than the other two: researchers, students, and other academics donate their institutional login to Schi-Hub, and when you search for a paper they download it through that account. After the articles has been downloaded they store a copy of it on their own servers. You can basically download 99% of all scientific articles and papers on SciHub. Just enter the DOI to download the papers you need for free from scihub. Shihub was launched by the researcher Alexandra Elbakyan in 2011 with the goal of providing free access to research to everyone, not only those who have the money to pay for journals. Many in the scientific community praise hub-sci / sciencehub for furthering the knowledge of humankind and helping academics from all over the world. shi hub has been sued many times by publishers like Elsevier but it is still accessible, for example by using a sci hub proxy.

You can find links to Sci-Hub on Wikipedia ( https://en.wikipedia.org/wiki/Sci-Hub ) or WikiData ( https://www.wikidata.org/wiki/Q21980377#P856 ).

Referencing and Writing Advice Unlocking Knowledge Getting the green light when using plagiarism detection software doesn’t mean you haven’t plagiarised.

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The mechanism of water oxidation using transition metal-based heterogeneous electrocatalysts.

* Corresponding authors

a Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi’an 710119, P. R. China E-mail: [email protected] , [email protected] , [email protected]

The water oxidation reaction, a crucial process for solar energy conversion, has garnered significant research attention. Achieving efficient energy conversion requires the development of cost-effective and durable water oxidation catalysts. To design effective catalysts, it is essential to have a fundamental understanding of the reaction mechanisms. This review presents a comprehensive overview of recent advancements in the understanding of the mechanisms of water oxidation using transition metal-based heterogeneous electrocatalysts, including Mn, Fe, Co, Ni, and Cu-based catalysts. It highlights the catalytic mechanisms of different transition metals and emphasizes the importance of monitoring of key intermediates to explore the reaction pathway. In addition, advanced techniques for physical characterization of water oxidation intermediates are also introduced, for the purpose of providing information for establishing reliable methodologies in water oxidation research. The study of transition metal-based water oxidation electrocatalysts is instrumental in providing novel insights into understanding both natural and artificial energy conversion processes.

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S. Yang, X. Liu, S. Li, W. Yuan, L. Yang, T. Wang, H. Zheng, R. Cao and W. Zhang, Chem. Soc. Rev. , 2024, Advance Article , DOI: 10.1039/D3CS01031G

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This paper is in the following e-collection/theme issue:

Published on 24.4.2024 in Vol 26 (2024)

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

Authors of this article:

• Helen J Gooch, BSc   ; 
• Kathryn A Jarvis, PhD   ; 
• Rachel C Stockley, PhD  

Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom

Corresponding Author:

Helen J Gooch, BSc

Stroke Research Team

School of Nursing and Midwifery

University of Central Lancashire

BB247 Brook Building

Victoria Street

Preston, PR1 2HE

United Kingdom

Phone: 44 1772894956

Email: [email protected]

Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions.

Objective: This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT.

Methods: Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1).

Results: From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality.

Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation.

Introduction

Digital health technologies (DHTs) comprise apps, programs, or software used in the health and social care systems [ 1 ]. They are considered to have almost unlimited potential to transform health care interventions and delivery and empower people to take a greater role in their own care and well-being [ 2 , 3 ].

Stroke is one of the leading causes of acquired disability worldwide, with around 12 million people experiencing a stroke each year [ 4 ]. Rehabilitation is a complex, multifaceted process [ 5 ] that facilitates those with health conditions and disabilities to participate in and gain independence in meaningful life roles [ 6 ]. It is considered an essential aspect of health care provision following a stroke [ 7 ] as a means to address poststroke impairments, which can involve motor, sensory, and cognitive functions. Changes in the ability to move due to impairment of both movement and sensory function are commonly experienced by people following a stroke [ 8 ] and are addressed by physical rehabilitation comprising regular, intensive practice and repetition of movements and tasks [ 9 , 10 ]. Conventional physical rehabilitation often struggles to deliver the intensity required to optimize recovery [ 11 ], and over recent years, there has been significant interest in the use of DHTs, such as virtual reality (VR), telerehabilitation, robotics, and activity monitors [ 12 - 16 ], to enhance and increase the intensity of rehabilitation. DHTs can provide a whole intervention or be used as a component of a wider intervention; the term DHT-based intervention has been used within this review to refer to both situations.

For many people who survive a stroke, rehabilitation requires individuals to engage in regular and frequent rehabilitative activities to achieve improvements in function and realize their optimal recovery. This necessitates adjustments to an individual’s behavior [ 17 ] over a sustained period of time. Changing behavior is a complex process and is underpinned by a variety of different theories, models, and frameworks [ 18 ], such as social cognitive theory [ 19 ] or the behavior change wheel framework [ 20 ]. Individual activities within a complex intervention that are designed to change behavior can be separated into replicable active components widely referred to as behavior change techniques (BCTs) [ 21 ]. Historically, labels applied to BCTs have lacked consensus, resulting in uncertainty and difficulty in comparing interventions. This has been addressed in the behavior change technique taxonomy version 1 (BCTTv1) [ 22 ], a classification system of 93 distinct BCTs clustered into 16 groups, which is a well-recognized tool to provide consistency with BCT reporting in interventions. DHTs provide an emerging opportunity to support the behavior change required within physical stroke rehabilitation interventions through facilitators that are embedded within the technology itself that aim to form, alter, or reinforce behaviors [ 23 ]. Understanding of this area is limited, with most literature exploring the use of DHTs to support behavior change focused on specific health-related behaviors such as physical activity or healthy eating [ 24 ] rather than as a core component of a type of rehabilitation intervention. Motivation is acknowledged to play an integral role in behavior change [ 25 ], and it is often assumed that DHTs provide motivation to engage with rehabilitation [ 26 ]. However, for this assumption to be realized, the DHTs must be able to support and deliver interventions that facilitate the vital changes in behavior needed to promote prolonged and sustained engagement in stroke rehabilitative activities. Imperative to this is understanding the theories, models, and frameworks that underpin interventions and the BCTs (active components) within the interventions [ 27 - 29 ]. The theories, models, and frameworks alongside the BCTs will be referred to hereinafter as approaches. Within the context of DHT-based physical stroke rehabilitation interventions, approaches to behavior change warrant further investigation.

Aim and Objectives

This scoping review aimed to identify if and how behavior change approaches are incorporated within DHT-based physical stroke rehabilitation interventions. Specifically, it sought to:

• Establish if behavior change theories, models, and frameworks, or BCTs, are described when reporting on DHT-based interventions that have been developed or evaluated for use in poststroke physical rehabilitation.
• Identify if behavior change theories, models, or frameworks underpin the interventions and which of these are being used.
• Identify if the BCTTv1 is being used to report BCTs within interventions.
• Determine which BCTs (based on the BCTTv1) can be identified within the interventions.
• Explore whether the type of technology influences the techniques used to change behaviors.

Review Methodology

A scoping review was completed and reported following established guidelines [ 30 , 31 ] and the Preferred Reporting of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR; Multimedia Appendix 1 ) [ 32 ]. The protocol was registered with the Open Science Framework [ 33 ].

Eligibility Criteria

Any published sources that reported a completed primary research study in which a behavior change approach could be identified within a DHT-based physical stroke rehabilitation intervention were included ( Multimedia Appendix 2 ). Physical rehabilitation comprised interventions that addressed an impairment, or sequela of impairment, of sensory function and pain, neuromusculoskeletal and movement-related functions, or voice and speech, as defined by the International Classification of Functioning, Disability, and Health [ 34 ]. Completed primary research included all types of studies, both quantitative and qualitative, and no minimum sample size or intervention length was set. The BCTTv1 [ 22 ] was used to support the identification of BCTs within the interventions.

Information Sources and Search Strategy

A systematic database search was conducted in Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL Register of Controlled Trials, and AMED on March 21, 2023. The search was completed in collaboration with an information specialist who provided support with the development of the free text and thesaurus search terms, created the final search, adjusted the searches for the different databases, and ran the search. It consisted of 4 distinct search streams: behavior change, DHT, physical rehabilitation, and stroke, which were then combined ( Multimedia Appendix 3 ). Searches were restricted to the English language (due to review resources) and by date to search from 2001; the date restriction acknowledges the main time period of DHT growth [ 35 ], captures sources reported in systematic reviews of DHTs in stroke rehabilitation [ 12 - 16 ], and is reflected in other scoping literature exploring DHTs [ 24 ]. Additional sources were identified by hand searching, including scrutiny of the included source reference lists.

Selection of Sources of Evidence

The titles and abstracts of deduplicated sources from database searches and hand searches were independently screened by 2 reviewers, 1 of whom had completed the BCTTv1 web-based training package [ 36 ] to inform decisions made around the use of BCTs. Any conflicts were discussed, and if a consensus was not reached, the source was included for full-text screening. Attempts were made to locate a completed study publication from eligible conference abstracts, protocols, and trial registry entries. Full-text sources were screened independently by 2 reviewers, and disagreements were resolved by a third reviewer. Reasons for full-text exclusion were recorded. EndNote X9 software (Clarivate) and the Rayyan web tool software (Qatar Computing Research Institute) [ 37 ] were used to facilitate the source selection process.

Data Charting Process

A review-specific data charting tool was developed and initially piloted using 3 sources by 3 reviewers, and then further developed iteratively throughout the process [ 30 ]. Data charting was completed collectively by 2 reviewers. When several sources referred to a single study, these sources were grouped together for data charting, and if a source identified additional sources for further detail of the intervention (eg, a protocol or supplementary material), then this information was also used to support data charting.

The data charting tool was developed with reference to the Template for Intervention Description and Replication (TIDieR) checklist [ 27 ] and with a focus on the DHT-based intervention and behavior change approaches ( Multimedia Appendix 4 [ 14 , 38 - 40 ]). In the absence of a recognized predefined taxonomy for DHTs, the DHTs used in the sources were charted iteratively by the type of technology [ 41 ] from the information provided about the intervention. Over time, DHT categories emerged and were defined ( Multimedia Appendix 4 ). Discrete BCTs were identified from the intervention detail provided using the BCTTv1 [ 22 ] ( Multimedia Appendix 5 [ 42 ]). A pragmatic decision was made that the single reviewer who had completed the BCTTv1 web-based training package [ 36 ] would code the interventions to the BCTTv1. Any areas of uncertainty were discussed in detail among the review team.

Synthesis of Results

In accordance with the aims of a scoping review, formal assessments of methodological quality were not completed [ 30 , 31 ]. Findings were synthesized using descriptive statistics facilitated by SPSS Statistics 28.0.0.0 (IBM Corp) and Microsoft Excel (version 2208; Microsoft Corporation) and presented in text, table, and chart formats. The characteristics of the included sources, specifically participant numbers, age, and time since stroke, and intervention details, were summarized to provide contextual information for the review. Time since stroke was based on a published timeline framework [ 43 ], which describes the following phases: acute (1-7 days), early subacute (7 days to 3 months), late subacute (3-6 months), and chronic (greater than 6 months).

The behavior change theories, models, or frameworks underpinning the DHT-based interventions and sources where interventions had already been coded to the BCTTv1 were summarized. The use of individual BCTs, as coded by reviewers from intervention descriptions, was briefly summarized; however, the main focus of the BCT synthesis was completed by grouping the BCTs into the 16 BCTTv1 clusters, in order to provide an overview of their use across the sources and allow comparison with other reviews [ 44 , 45 ]. A cluster was only identified once per source, irrespective of the number of individual BCTs within that cluster. Relationships between BCTTv1 clusters and between DHT type and BCTTv1 clusters were descriptively explored. A relationship map was used to visually represent the strength of the connections between the BCTTv1 clusters, with a thicker line indicating that variables were more frequently reported together. No inferential statistical analysis was used.

From a total of 1973 sources screened, 357 full-text sources were assessed for eligibility, then after grouping sources that referred to a single study, 103 (5%) distinct sources were included in the review [ 46 - 148 ] ( Figure 1 ). Of the 245 sources excluded at full-text screening, 165 (67%) were excluded due to a lack of a behavior change approach.

Characteristics of Sources of Evidence

All sources of evidence were studies and will be referred to as such hereinafter. The number of studies in this field has rapidly increased over time ( Figure 2 ), from a single study in 2004 to 8 in 2022, with a peak of 15 in 2021. The majority (86/103, 83%) [ 47 - 51 , 53 - 56 , 58 , 59 , 61 , 63 - 68 , 71 - 86 , 89 - 95 , 97 - 105 , 107 , 109 , 111 , 112 , 114 , 115 , 117 - 126 , 128 - 136 , 138 - 148 ] were published in the past 10 years. Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , 71 , 79 , 81 - 84 , 89 , 111 , 113 - 125 , 132 , 136 , 140 , 143 , 146 , 147 ], with the remainder in Asia (16/103, 16%) [ 50 , 59 , 61 , 91 , 94 , 95 , 98 , 100 , 102 - 104 , 107 , 135 , 139 , 144 , 148 ], Australasia (9/103, 9%) [ 75 , 96 , 105 , 106 , 112 , 130 , 131 , 133 , 134 ], Africa (1/103, 1%) [ 90 ], and a single multicontinental study (1/103, 1%) [ 73 ]. Almost half (45/103, 44%) the studies are reported as feasibility or pilot studies [ 49 , 56 , 58 , 64 , 66 , 68 , 69 , 72 - 74 , 76 , 77 , 79 , 82 - 84 , 89 , 90 , 92 , 93 , 95 , 97 , 100 - 104 , 106 , 108 , 114 , 116 , 117 , 119 , 122 , 124 - 126 , 131 , 134 , 136 , 138 , 139 , 141 , 143 , 147 ]. Other study designs included randomized controlled trials (20/103, 19%) [ 50 , 51 , 60 , 61 , 65 , 75 , 80 , 85 , 86 , 91 , 107 , 109 , 112 , 128 - 130 , 137 , 144 , 146 , 148 ], single session investigations (19/103, 18%) [ 47 , 52 , 57 , 59 , 71 , 78 , 87 , 88 , 98 , 110 , 115 , 118 , 120 , 123 , 127 , 132 , 133 , 135 , 142 ], nonrandomized experimental designs (13/103, 13%) [ 53 - 55 , 62 , 63 , 67 , 81 , 94 , 96 , 99 , 105 , 113 , 145 ], case studies (4/103, 4%) [ 46 , 48 , 70 , 140 ], and realist evaluations (2/103, 2%) [ 111 , 121 ].

Participants

There were a total of 2825 participants in the 103 included studies. Studies tended to be small, with a median of 16 participants and a range of 1-188. Only half (55/103, 53%) the studies [ 46 - 48 , 50 , 56 , 57 , 59 , 61 , 64 , 67 , 69 - 72 , 78 , 79 , 82 , 87 , 88 , 92 , 93 , 95 - 99 , 101 , 102 , 105 , 106 , 108 , 111 - 121 , 123 - 127 , 134 , 138 - 140 , 142 , 143 , 145 , 147 ] reported the minimum and maximum age of participants, which ranged from 17 to 99 years. Over three-quarters (83/103, 81%; 2508 participants) of studies reported the time since the onset of stroke. Of these 83 studies, 1 (1%; 48 participants) study [ 91 ] was conducted in the acute phase, 14 (17%; 504 participants) studies [ 60 , 61 , 68 , 74 , 79 , 92 , 100 , 102 , 109 , 114 , 133 , 144 , 146 , 148 ] were conducted in the early subacute phase, 11 (13%; 316 participants) studies [ 59 , 65 , 66 , 72 , 75 , 76 , 81 , 104 , 107 , 121 , 134 ] were conducted in the late subacute phase, and 57 (69%; 1640 participants) studies [ 46 , 48 , 49 , 51 , 53 , 54 , 57 , 63 , 64 , 67 , 69 , 70 , 73 , 78 , 80 , 82 , 84 , 85 , 88 , 89 , 93 - 99 , 101 , 103 , 105 , 106 , 108 , 111 - 113 , 117 - 120 , 122 - 125 , 127 - 131 , 136 - 142 , 145 , 147 ] were conducted in the chronic phase [ 43 ].

Study Intervention

An overview of study intervention characteristics is provided ( Table 1 ). Interventions were focused on upper limb rehabilitation in almost two-thirds (65/103, 63%) of the studies [ 46 - 49 , 51 , 54 - 59 , 62 - 65 , 68 , 71 , 72 , 74 , 75 , 77 - 81 , 85 - 88 , 92 , 95 , 96 , 99 , 101 - 103 , 105 - 108 , 110 , 112 , 113 , 116 - 118 , 121 , 123 - 125 , 127 , 128 , 132 , 133 , 135 - 137 , 139 - 142 , 144 - 147 ]. Nearly all interventions (96/103, 93%) [ 46 - 80 , 84 - 94 , 96 - 117 , 119 - 121 , 124 - 148 ] were delivered to individual participants, with over half (62/103, 60%) [ 46 - 50 , 53 - 58 , 60 , 61 , 64 - 70 , 72 , 74 - 77 , 79 , 80 , 82 - 86 , 89 , 90 , 93 , 94 , 96 , 97 , 99 , 101 , 105 , 111 , 112 , 116 , 117 , 119 - 122 , 126 , 129 - 131 , 134 , 136 , 138 , 139 , 141 , 143 - 145 , 147 ] delivered fully or partly in the participant’s homes. Two-thirds (70/103, 68%) of studies [ 46 - 50 , 52 - 54 , 57 , 60 , 62 , 63 , 65 - 74 , 76 - 84 , 86 - 93 , 98 , 100 , 102 , 104 , 108 , 109 , 112 - 115 , 117 , 118 , 120 , 122 - 125 , 129 - 131 , 135 - 138 , 140 - 142 , 144 - 146 , 148 ] included partial or full supervision of the intervention, with this predominately being provided face-to-face (48/70, 69%) [ 46 , 47 , 52 , 57 , 60 , 62 , 63 , 67 , 68 , 71 , 73 , 78 , 81 - 84 , 86 - 89 , 91 , 92 , 98 , 100 , 102 , 104 , 108 , 109 , 112 - 115 , 117 , 118 , 120 , 122 - 125 , 135 - 137 , 140 , 142 , 144 - 146 , 148 ]. Interventions lasted between a single session and 26 weeks.

Of the 103 studies, over half (n=57, 55%) of the studies [ 46 , 47 , 51 - 54 , 57 , 61 , 63 , 67 , 68 , 70 , 71 , 73 , 75 - 78 , 81 , 84 - 86 , 88 - 91 , 93 , 95 , 96 , 98 , 100 , 102 - 104 , 106 , 109 , 112 , 114 , 115 , 123 - 126 , 129 , 130 , 132 , 133 , 135 - 138 , 140 , 143 - 147 ] included 1 type of DHT, 30 (29%) studies [ 48 , 49 , 55 , 56 , 58 - 60 , 62 , 64 , 69 , 83 , 92 , 94 , 97 , 99 , 101 , 105 , 107 , 108 , 110 , 111 , 113 , 116 , 118 , 121 , 122 , 127 , 128 , 139 , 142 ] included 2 types, and 16 (16%) studies [ 50 , 65 , 66 , 72 , 74 , 79 , 80 , 82 , 87 , 117 , 119 , 120 , 131 , 134 , 141 , 148 ] included 3 types. VR was the most frequently used DHT (58/103, 56%) [ 46 - 49 , 51 - 53 , 57 , 59 , 62 , 63 , 65 , 66 , 69 , 71 , 72 , 74 , 77 , 78 , 80 , 81 , 84 - 89 , 92 , 95 , 96 , 98 , 102 - 104 , 106 , 112 , 113 , 115 , 117 - 120 , 123 - 128 , 132 , 135 - 137 , 140 , 142 , 143 , 146 - 148 ] followed by apps (31/103, 30%) [ 50 , 55 , 56 , 58 , 61 , 64 - 66 , 72 , 74 , 75 , 79 , 82 , 83 , 94 , 97 , 99 , 101 , 105 , 108 , 111 , 114 , 116 , 119 - 122 , 131 , 134 , 139 , 141 ]. Further information on intervention characteristics with detail on associated citations is available ( Multimedia Appendix 6 [ 46 - 148 ]).

a F2F: face-to-face.

b DHT: digital health technology.

c VR: virtual reality.

Behavior Change Theories, Models, and Frameworks

Most studies (93/103, 90%) [ 46 - 49 , 51 - 62 , 64 - 73 , 75 - 89 , 91 - 93 , 96 - 106 , 108 - 115 , 117 - 137 , 139 , 140 , 142 - 148 ] endeavored to link the intervention to behavior change; however, in the majority of these studies (75/93, 81%) [ 46 , 51 - 56 , 58 - 62 , 64 - 69 , 71 - 73 , 75 , 77 - 89 , 91 - 93 , 96 , 97 , 99 - 101 , 103 - 106 , 108 , 110 , 112 , 114 , 115 , 117 - 120 , 123 , 124 , 127 , 128 , 131 - 137 , 139 , 140 , 142 - 144 , 146 - 148 ], this explanation was centered on the reporting of the techniques perceived to change behaviors without direct reference to use of the BCTTv1 or on the reporting of a component of the intervention or the whole of the intervention as motivating. These explanations lack detail on how or why this influences behavior change. Examples of this included “the app also provided performance feedback, allowing the user to compare their current performance against their score from the previous session” (Bhattacharjya et al [ 56 ]) and “games motivate patients to engage in enjoyable play behavior” (Cramer et al [ 66 ]). A limited number of studies (18/103, 17%) [ 47 - 49 , 57 , 70 , 76 , 98 , 102 , 109 , 111 , 113 , 121 , 122 , 125 , 126 , 129 , 130 , 145 ] articulated 1 or more theories, models, or frameworks of behavior change. While it is acknowledged that the BCTTv1 is a taxonomy framework rather than a theoretical framework, for the purpose of this review, it has been included as a framework for behavior change. A total of 13 different theories, models, or frameworks were identified within these 18 studies, with social cognitive theory being the most frequently reported (6/18, 33%) [ 76 , 109 , 111 , 121 , 129 , 130 ], followed by the behavior change technique taxonomy (4/18, 22%) [ 48 , 49 , 122 , 129 ], game design theory (3/18, 17%) [ 47 , 57 , 125 ], operant conditioning (3/18, 17%) [ 47 , 98 , 121 ], and self-determination theory (3/18, 17%) [ 48 , 49 , 126 ]. Further information on behavior change theories, models, and frameworks, with details on associated citations, is available ( Multimedia Appendix 7 [ 47 - 49 , 57 , 70 , 76 , 98 , 102 , 109 , 111 , 113 , 121 , 122 , 125 , 126 , 129 , 130 , 145 ]).

Behavior Change Techniques

Despite 4 studies acknowledging the BCTTv1, explicit BCTTv1 codes were only reported in 2 studies (2/103, 2%) [ 48 , 122 ]. However, a third study (1/103, 1%) mapped the techniques used to change behavior directly to the transtheoretical model [ 145 ]. There was a median of 3 (range 1-14) individual BCTs coded per study, with a total of 383 BCTs across the 103 studies. The most frequently identified individual BCTs were feedback on behavior and nonspecific reward ( Multimedia Appendix 8 ).

There was also a median of 3 (range 1-8) BCTTv1 clusters per study, with a total of 288 clusters coded across the 103 studies. The most frequently used of the 16 possible clusters were feedback and monitoring (88/103, 85%) [ 46 - 60 , 62 - 69 , 71 - 74 , 76 , 78 - 80 , 82 - 92 , 94 - 106 , 108 - 113 , 116 , 117 , 119 - 129 , 134 - 146 , 148 ], reward and threat (56/103, 54%) [ 46 - 49 , 51 - 53 , 55 - 57 , 62 , 65 , 69 , 71 , 72 , 74 , 77 , 80 , 81 , 85 , 86 , 88 , 89 , 91 , 92 , 95 , 96 , 98 , 102 , 103 , 106 - 108 , 112 , 113 , 115 , 117 - 119 , 121 - 125 , 128 , 132 , 134 - 137 , 140 , 142 , 143 , 146 - 148 ], goals and planning (33/103, 32%) [ 49 , 58 , 60 , 65 - 68 , 70 , 72 , 74 , 76 , 79 , 80 , 82 , 83 , 90 , 91 , 93 , 94 , 97 , 100 , 109 , 111 , 112 , 121 , 122 , 126 , 129 , 130 , 134 , 138 , 141 , 145 ], and shaping knowledge (33/103, 32%) [ 46 , 48 , 50 , 53 - 56 , 58 , 60 , 61 , 64 - 72 , 74 , 75 , 86 , 94 , 97 , 101 - 103 , 108 , 111 , 113 , 114 , 120 , 129 - 131 , 139 - 141 ]. Other BCTTv1 clusters used were social support (24/103, 23%) [ 48 , 49 , 58 , 60 , 64 , 67 , 70 , 72 , 73 , 79 , 80 , 82 , 84 , 90 , 93 , 101 , 108 , 117 , 119 , 129 - 131 , 134 , 141 ], comparison of behavior (23/103, 22%) [ 46 , 50 , 53 , 54 , 60 , 61 , 64 - 66 , 74 , 75 , 81 , 86 , 101 , 104 , 111 , 114 , 118 , 122 , 123 , 125 , 131 , 139 ], associations (16/103, 15%) [ 58 , 60 , 65 , 66 , 68 , 75 , 80 , 83 , 87 , 90 , 110 , 120 , 131 , 133 , 139 , 144 ], repetition and substitution (6/103, 6%) [ 60 , 82 , 109 , 122 , 129 , 130 ], scheduled consequences (3/103, 3%) [ 47 , 80 , 88 ], natural consequences (2/103, 2%) [ 129 , 138 ], comparison of outcomes (2/103, 2%) [ 47 , 133 ], antecedents (1/103, 1%) [ 60 ], and self-belief (1/103, 1%) [ 70 ]. The clusters of regulation, identity, and covert learning were not identified. Within the context of the review, it was noted that the reward and threat cluster only included reward-based BCTs. A tabulated summary and graphical representation of the BCTTv1 clusters is available ( Multimedia Appendix 9 [ 46 - 148 ]).

The exploration of clusters that were reported together in an intervention ( Figure 3 ) identified the strongest relationship between the clusters of feedback and monitoring and reward and threat. Clear links were also identified between feedback and monitoring and 4 other clusters: goals and planning, shaping knowledge, social support, and comparison of behavior, and between the shaping knowledge and comparison of behavior clusters.

Behavior Change Techniques and Digital Health Technology

The feedback and monitoring cluster was reported most frequently for all types of DHT ( Figure 4 ), with the greatest proportion of this cluster in robotics (11/25, 44%) [ 59 , 62 , 87 , 92 , 110 , 113 , 117 , 127 , 128 , 142 , 148 ], VR (52/148, 35%) [ 46 - 49 , 51 - 53 , 57 , 59 , 62 , 63 , 65 , 66 , 69 , 71 , 72 , 74 , 78 , 80 , 84 - 89 , 92 , 95 , 96 , 98 , 102 - 104 , 106 , 112 , 113 , 117 , 119 , 120 , 123 - 135 - 137 , 140 , 142 , 143 , 146 , 148 ], and sensors (17/48, 35%) [ 50 , 55 , 56 , 87 , 94 , 99 , 101 , 105 , 108 , 110 , 111 , 116 , 119 - 121 , 134 , 141 ]. Robotics and VR also often used the reward and threat cluster (9/25, 36% [ 62 , 92 , 107 , 113 , 117 , 118 , 128 , 142 , 148 ] and 48/148, 32% [ 46 - 49 , 51 - 53 , 57 , 62 , 65 , 69 , 71 , 72 , 74 , 77 , 80 , 81 , 85 , 86 , 88 , 89 , 92 , 95 , 96 , 98 , 102 , 103 , 106 , 112 , 113 , 115 , 117 - 119 , 123 - 125 , 128 , 132 , 135 - 137 , 140 , 142 , 143 , 146 - 148 ], respectively), while the goals and planning cluster was a dominant second cluster in activity monitors (13/53, 25%) [ 67 , 68 , 76 , 79 , 80 , 82 , 91 , 100 , 109 , 122 , 129 , 138 , 145 ].

Summary of Evidence

This scoping review provides a comprehensive overview of approaches used to support changes in behavior in DHT-based physical stroke rehabilitation interventions. Research in this field is in its infancy, with the predominance of studies in this review being described as pilot or feasibility studies with limited participants.

Despite using comprehensive behavior change search terms, only a limited number (103/1973, 6%) of screened sources were included. Over two-thirds of full-text sources were excluded as they did not describe or refer to any behavior change theories, models, or frameworks or BCTs, suggesting that in general, explicit behavior change approaches are not reported as being integral to DHT-based physical stroke rehabilitation.

Only 18 (17%) of the 103 included studies articulated a theory, model, or framework to underpin the intervention, which aimed to change behavior, despite widely published recommendations about the importance of overt use of theory when developing, evaluating, and reporting interventions [ 27 , 29 ], including those related to behavior change [ 28 ]. The proportion of studies articulating a behavior change theory, model, or framework in this work is significantly lower than review findings in non-rehabilitation DHT-based interventions that have sought to influence specific behaviors such as physical activity or weight control [ 24 , 44 ]. These reviews have identified up to two-thirds of sources reporting a theory, model, or framework. However, our findings mirror the relative absence of behavior change theories, models, and frameworks in rehabilitation interventions more generally, irrespective of whether they use digital technology [ 149 ] or not [ 45 ], and it is widely recognized that the complex nature of rehabilitation often results in the essential characteristics of interventions being poorly defined [ 150 ]. Consistent with our findings in these other reviews, a variety of theories, models, and frameworks were found to underpin interventions, with social cognitive theory being the most frequently reported [ 24 , 44 , 45 , 149 ]. The explicit description of BCTs using the BCTTv1 within DHT-based physical stroke rehabilitation interventions is also poorly reported (2%), despite a significant proportion of the sources being dated after the publication of the BCTTv1 in 2013 [ 22 ]. This lack of acknowledgment of behavior change approaches impedes the accumulation of knowledge within this field.

It is important that both the underpinning theory and BCTs are reported so the mechanisms by which the BCTs elicit change can be better understood [ 21 ]. The general assumption that the motivational and captivating aspects of DHTs will promote prolonged and repeated engagement with rehabilitative activities, in particular in those DHTs that incorporate game design [ 151 ], risks suboptimal outcomes for patients and wasted investment of time and money if the mechanisms by which the DHT elicits change are not considered.

When exploring which BCT clusters featured within the reviewed DHT-based interventions, the findings relating to the commonly used clusters of feedback and monitoring, goals and planning, and shaping knowledge are consistent with findings from DHT-based interventions to change a specific behavior [ 44 ] and non-DHT–based rehabilitation [ 45 ]. However, a novel finding in our review was the frequent identification of the reward and threat cluster, although it was noted that all techniques related to reward and none to threat. A large number of studies in this review used VR technology, which frequently incorporates gamified tasks or gameplay. Reward is an integral part of game design theory alongside feedback [ 152 ], and so it is perhaps unsurprising that the feedback and monitoring, and reward and threat clusters dominated and an association between these 2 clusters was seen.

Limitations

Rehabilitation is a process that comprises multiple behaviors and so exploring approaches to change behavior within this context was complicated. There were challenges in searching and screening sources for inclusion as few studies explicitly reported approaches to change behavior, and there is a similarity in the vocabulary used within behavior change and other theoretical approaches (eg, “feedback,” which is used within motor learning). Similarly, only a very small proportion of studies explicitly reported BCTs within interventions. The lack of clear reporting of behavior change introduces the risk that sources may be omitted during both the searching and screening process highlighting the difficulty of comprehensively reviewing this field of work. An inclusive approach to screening reduced the risk of erroneously excluding sources, but it is perhaps inevitable that the sources included reflect those studies that have reported a behavior change approach rather than all studies that have used one.

This lack of clear BCT reporting also posed challenges for intervention coding. The use of the BCTTv1 aimed to ensure the review used a generalizable nomenclature to describe BCTs, and the 1 reviewer who had completed BCTTv1 training coded all the interventions. It is acknowledged that decisions made in the application of the BCTTv1 within the context of the review will have introduced some subjectivity in intervention coding, which will ultimately influence the review findings. Although the coding process could have been made more robust by having a second reviewer trained in the BCTTv1 also code the interventions, regular and extensive discussions between all members of the review team took place with the aim of ensuring consistency with the coding process. Clear documentation as to how the BCTTv1 was used within this review ( Multimedia Appendix 5 ) supports transparency as to the decisions made and the reproducibility of the review.

The absence of a recognized predefined taxonomy for DHTs posed a challenge when categorizing the DHT interventions, acknowledging that the distinction between the categories used to present the results is open to interpretation. A description of how the reviewers interpreted these categories is provided ( Multimedia Appendix 4 ).

Implications for Research

Future studies aimed at developing and evaluating DHT-based rehabilitation interventions, including those relating to physical stroke rehabilitation, need to ensure there is explicit recognition and reporting of the specific approaches used to change behavior, articulating both the theory on which the intervention is based and how the intervention plans to deliver the change in behavior using universally recognized terminology. This should be reported as part of a program theory and potential mechanisms of action, which are key parts of developing and evaluating complex interventions [ 29 ]. This detailed reporting would further support an understanding of how changes in behavior could be best enabled by DHT-based rehabilitation interventions and how this contributes to changes in patient outcomes. It would also enable further evaluation of the optimal behavioral components of interventions, enabling patients to use and clinicians to deliver the most effective DHT-based rehabilitative interventions. More generally, as the use of DHTs expands, there is an urgent need for some form of taxonomy to categorize and clearly define the different types of DHTs to facilitate consistent reporting, replication, and comparison of DHT-based interventions.

This novel and original review is the first to explore if and how approaches to change behavior are incorporated within DHT-based physical stroke rehabilitation. It demonstrates that a minority of studies report using approaches to change behavior within this context, despite these changes in behavior being vital to meet the demands of rehabilitative activities. Those who do report behavior change often lack the underpinning detail as to how the DHT-based intervention will facilitate these changes. In order for DHT-based interventions to realize their potential within rehabilitation and their impact on patient outcomes, approaches to change behavior must be embedded in the intervention and appropriately reported.

Acknowledgments

The authors would like to thank Catherine Harris (Information Specialist, University of Central Lancashire) for her assistance in developing the search strategy and running the searches, and Rebekah Murray (Undergraduate Research Intern, University of Central Lancashire) for her support with aspects of the screening and data charting process.

This work was funded by a UK Research and Innovation Future Leaders Fellowship (grant MR/T022434/1).

Data Availability

All data supporting this study are openly available from the University of Central Lancashire repository [ 153 ].

Authors' Contributions

RCS conceived the review focus and oversaw the work. HJG developed the review design and search strategy. HJG, KAJ, and RCS completed the screening of the identified sources. HJG and KAJ piloted the data charting tool. HJG completed the data charting, data analysis, and the initial manuscript draft. KAJ and RCS reviewed and made substantial contributions to the manuscript. All authors approved the final manuscript.

Conflicts of Interest

None declared.

Preferred Reporting of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist.

Inclusion and exclusion criteria.

Full search strategy as used in Medline.

Data charting tool.

Review-specific behavior change technique taxonomy coding decisions.

Intervention characteristics (with associated references).

Behavior change theories, models, and frameworks reported (with associated references).

Individual behavior change techniques coded.

Behavior change technique taxonomy clusters identified (with associated references).

• Evidence standards framework for digital health technologies. National Institute of Clinical Excellence (NICE). 2018. URL: https://tinyurl.com/mpmrwrwx [accessed 2022-01-25]
• Castle-Clark S. The NHS at 70: What will new technology mean for the NHS and its patients? Kings Fund. 2018. URL: https://tinyurl.com/44k9fmat [accessed 2024-04-05]
• Topel E. The Topol review: preparing the healthcare workforce to deliver the digital future. Health Education England, NHS. 2019. URL: https://topol.hee.nhs.uk/ [accessed 2022-01-19]
• GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil. 2020;34(5):571-583. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Rehabilitation. World Health Organisation. 2023. URL: https://www.who.int/news-room/fact-sheets/detail/rehabilitation [accessed 2023-05-04]
• Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurol Res Pract. 2020;2:17. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32(6):1279-1284. [ FREE Full text ] [ CrossRef ] [ Medline ]
• National clinical guideline for stroke for the United Kingdom and Ireland. Intercollegiate Stroke Working Party. 2023. URL: https://tinyurl.com/yxy6b9tp [accessed 2023-05-02]
• Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? a systematic review and meta-analysis. PLoS One. 2014;9(2):e87987. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lang CE, Macdonald JR, Reisman DS, Boyd L, Kimberley TJ, Schindler-Ivens SM, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009;90(10):1692-1698. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017;11(11):CD008349. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020;1(1):CD010255. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lynch EA, Jones TM, Simpson DB, Fini NA, Kuys SS, Borschmann K, et al. Activity monitors for increasing physical activity in adult stroke survivors. Cochrane Database Syst Rev. 2018;7(7):CD012543. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2018;9(9):CD006876. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2020;10(10):CD006185. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jones F, Riazi A. Self-efficacy and self-management after stroke: a systematic review. Disabil Rehabil. 2011;33(10):797-810. [ CrossRef ] [ Medline ]
• Behaviour change: general approaches. National Institute of Clinical Excellence. UK. National Institute of Clinical Excellence (NICE); 2007. URL: https://tinyurl.com/yfthycch [accessed 2024-04-05]
• Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ. Prentice-Hall; 1986.
• Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M, Kelly MP, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53(8):693-707. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81-95. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Oinas-Kukkonen H. A foundation for the study of behavior change support systems. Pers Ubiquit Comput. 2012;17(6):1223-1235. [ CrossRef ]
• Taj F, Klein MCA, van Halteren A. Digital health behavior change technology: bibliometric and scoping review of two decades of research. JMIR Mhealth Uhealth. 2019;7(12):e13311. [ FREE Full text ] [ CrossRef ] [ Medline ]
• West R, Michie S. A Guide to Development and Evaluation of Digital Behaviour Change Interventions in Healthcare. London. Silverback Publishing; 2016.
• Lewis GN, Rosie JA. Virtual reality games for movement rehabilitation in neurological conditions: how do we meet the needs and expectations of the users? Disabil Rehabil. 2012;34(22):1880-1886. [ CrossRef ] [ Medline ]
• Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Michie S, Prestwich A. Are interventions theory-based? development of a theory coding scheme. Health Psychol. 2010;29(1):1-8. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-146. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Peters MDJ, Godfrey CM, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide, Australia. JBI; 2020. [ CrossRef ]
• Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Gooch H, Stockley R, Jarvis K. Behaviour change approaches within digital health technology-based interventions in physical rehabilitation following stroke: a scoping review protocol Version 2 081122. OSF Registries. 2022. URL: https://osf.io/yjn5g [accessed 2022-11-15]
• ICF checklist. World Health Organisation. 2003. URL: https://tinyurl.com/5fz6krew [accessed 2022-01-19]
• Hillyer M. How has technology changed—and changed us—in the past 20 years? World Economic Forum. 2020. URL: https://tinyurl.com/5n74wsym [accessed 2023-10-18]
• Online training. BCT Taxonomy v1. 2022. URL: http://www.bct-taxonomy.com/ [accessed 2022-03-08]
• Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wadley M, Bradbury M, Stockley R. Virtual reality. The Chartered Society of Physiotherapy. URL: https://www.csp.org.uk/professional-clinical/digital-physiotherapy/virtual-reality [accessed 2024-03-29]
• Cambridge dictionary. Cambridge University Press and Assessment. URL: https://tinyurl.com/2f2mx6kz [accessed 2024-03-29]
• Weber LM, Stein J. The use of robots in stroke rehabilitation: A narrative review. NeuroRehabilitation. 2018;43(1):99-110. [ CrossRef ] [ Medline ]
• English C, Ceravolo MG, Dorsch S, Drummond A, Gandhi DB, Green JH, et al. Telehealth for rehabilitation and recovery after stroke: state of the evidence and future directions. Int J Stroke. 2022;17(5):487-493. [ CrossRef ] [ Medline ]
• Taub E, Crago JE, Burgio LD, Groomes TE, Cook EW, DeLuca SC, et al. An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. J Exp Anal Behav. 1994;61(2):281-293. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12(5):444-450. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Asbjørnsen RA, Smedsrød ML, Solberg Nes L, Wentzel J, Varsi C, Hjelmesæth J, et al. Persuasive system design principles and behavior change techniques to stimulate motivation and adherence in electronic health interventions to support weight loss maintenance: scoping review. J Med Internet Res. 2019;21(6):e14265. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bayly J, Wakefield D, Hepgul N, Wilcock A, Higginson IJ, Maddocks M. Changing health behaviour with rehabilitation in thoracic cancer: a systematic review and synthesis. Psychooncology. 2018;27(7):1675-1694. [ CrossRef ] [ Medline ]
• Alankus G, Proffitt R, Kelleher C, Engsberg J. Stroke therapy through motion-based games: a case study. ACM Trans Access Comput. 2011;4(1):1-35. [ CrossRef ]
• Alankus G, Kelleher C. Reducing compensatory motions in motion-based video games for stroke rehabilitation. Hum Comput Interact. 2015;30(3-4):232-262. [ CrossRef ]
• Allegue DR, Kairy D, Higgins J, Archambault PS, Michaud F, Miller W, et al. A personalized home-based rehabilitation program using exergames combined with a telerehabilitation app in a chronic stroke survivor: mixed methods case study. JMIR Serious Games. 2021;9(3):e26153. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Allegue DR, Higgins J, Sweet SN, Archambault PS, Michaud F, Miller W, et al. Rehabilitation of upper extremity by telerehabilitation combined with exergames in survivors of chronic stroke: preliminary findings from a feasibility clinical trial. JMIR Rehabil Assist Technol. 2022;9(2):e33745. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Asano M, Tai BC, Yeo FY, Yen SC, Tay A, Ng YS, et al. Home-based tele-rehabilitation presents comparable positive impact on self-reported functional outcomes as usual care: the Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) randomised controlled trial. J Telemed Telecare. 2021;27(4):231-238. [ CrossRef ] [ Medline ]
• Ballester BR, Maier M, Mozo RMSS, Castañeda V, Duff A, Verschure PFMJ. Counteracting learned non-use in chronic stroke patients with reinforcement-induced movement therapy. J Neuroeng Rehabil. 2016;13(1):74. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bardack A, Bhandari P, Doggett J, Epstein M, Gagliolo N, Graff S, et al. EMG biofeedback videogame system for the gait rehabilitation of hemiparetic individuals. Digital Repository at the University of Maryland. 2010. URL: https://drum.lib.umd.edu/bitstream/handle/1903/10082/CHIP.pdf?sequence=1&isAllowed=y [accessed 2023-02-27]
• Bellomo RG, Paolucci T, Saggino A, Pezzi L, Bramanti A, Cimino V, et al. The WeReha Project for an innovative home-based exercise training in chronic stroke patients: a clinical study. J Cent Nerv Syst Dis. 2020;12:1179573520979866. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Benvenuti F, Stuart M, Cappena V, Gabella S, Corsi S, Taviani A, et al. Community-based exercise for upper limb paresis: a controlled trial with telerehabilitation. Neurorehabil Neural Repair. 2014;28(7):611-620. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bhattacharjya S, Stafford MC, Cavuoto LA, Yang Z, Song C, Subryan H, et al. Harnessing smartphone technology and three dimensional printing to create a mobile rehabilitation system, mRehab: assessment of usability and consistency in measurement. J Neuroeng Rehabil. 2019;16(1):127. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bhattacharjya S, Cavuoto LA, Reilly B, Xu W, Subryan H, Langan J. Usability, usefulness, and acceptance of a novel, portable rehabilitation system (mRehab) using smartphone and 3D printing technology: mixed methods study. JMIR Hum Factors. 2021;8(1):e21312. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Burke JW, McNeill MDJ, Charles DK, Morrow PJ, Crosbie JH, McDonough SM. Optimising engagement for stroke rehabilitation using serious games. Vis Comput. 2009;25(12):1085-1099. [ CrossRef ]
• Burridge JH, Lee ACW, Turk R, Stokes M, Whitall J, Vaidyanathan R, et al. Telehealth, wearable sensors, and the internet: will they improve stroke outcomes through increased intensity of therapy, motivation, and adherence to rehabilitation programs? J Neurol Phys Ther. 2017;41(Suppl 3):S32-S38. [ CrossRef ] [ Medline ]
• Cai S, Wei X, Su E, Wu W, Zheng H, Xie L. Online compensation detecting for real-time reduction of compensatory motions during reaching: a pilot study with stroke survivors. J Neuroeng Rehabil. 2020;17(1):58. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chumbler NR, Quigley P, Li X, Morey M, Rose D, Sanford J, et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke. 2012;43(8):2168-2174. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chung BPH, Chiang WKH, Lau H, Lau TFO, Lai CWK, Sit CSY, et al. Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: a single-blind randomized controlled trial. Hong Kong Physiother J. 2020;40(1):63-73. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Colombo R, Pisano F, Mazzone A, Delconte C, Micera S, Carrozza MC, et al. Design strategies to improve patient motivation during robot-aided rehabilitation. J Neuroeng Rehabil. 2007;4:3. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Colomer C, Llorens R, Noé E, Alcañiz M. Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil. 2016;13(1):45. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Conroy SS, Harcum S, Keldsen L, Bever CT. Novel use of existing technology: a preliminary study of patient portal use for telerehabilitation. J Telemed Telecare. 2022;28(5):380-388. [ CrossRef ] [ Medline ]
• Cramer SC, Dodakian L, Le V, See J, Augsburger R, McKenzie A, et al. Efficacy of home-based telerehabilitation vs in-clinic therapy for adults after stroke: a randomized clinical trial. JAMA Neurol. 2019;76(9):1079-1087. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, et al. A feasibility study of expanded home-based telerehabilitation after stroke. Front Neurol. 2020;11:611453. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Danks KA, Roos MA, McCoy D, Reisman DS. A step activity monitoring program improves real world walking activity post stroke. Disabil Rehabil. 2014;36(26):2233-2236. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Da-Silva RH, Moore SA, Rodgers H, Shaw L, Sutcliffe L, van Wijck F, et al. Wristband accelerometers to motivate arm exercises after Stroke (WAVES): a pilot randomized controlled trial. Clin Rehabil. 2019;33(8):1391-1403. [ CrossRef ] [ Medline ]
• Deng H, Durfee WK, Nuckley DJ, Rheude BS, Severson AE, Skluzacek KM, et al. Complex versus simple ankle movement training in stroke using telerehabilitation: a randomized controlled trial. Phys Ther. 2012;92(2):197-209. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Deutsch JE, Maidan I, Dickstein R. Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke. Phys Ther. 2012;92(8):1065-1077. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Dias P, Silva R, Amorim P, Lains J, Roque E, Pereira ISF, et al. Using virtual reality to increase motivation in poststroke rehabilitation. IEEE Comput Graph Appl. 2019;39(1):64-70. [ CrossRef ] [ Medline ]
• Dodakian L, McKenzie AL, Le V, See J, Pearson-Fuhrhop K, Quinlan EB, et al. A home-based telerehabilitation program for patients with stroke. Neurorehabil Neural Repair. 2017;31(10-11):923-933. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Dorsch AK, Thomas S, Xu X, Kaiser W, Dobkin BH, SIRRACT investigators. SIRRACT: an international randomized clinical trial of activity feedback during inpatient stroke rehabilitation enabled by wireless sensing. Neurorehabil Neural Repair. 2015;29(5):407-415. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Edwards D, Kumar S, Brinkman L, Ferreira IC, Esquenazi A, Nguyen T, et al. Telerehabilitation initiated early in post-stroke recovery: a feasibility study. Neurorehabil Neural Repair. 2023;37(2-3):131-141. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Emmerson KB, Harding KE, Taylor NF. Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial. Clin Rehabil. 2017;31(8):1068-1077. [ CrossRef ] [ Medline ]
• Ezeugwu VE, Manns PJ. The feasibility and longitudinal effects of a home-based sedentary behavior change intervention after stroke. Arch Phys Med Rehabil. 2018;99(12):2540-2547. [ CrossRef ] [ Medline ]
• Fluet GG, Qiu Q, Patel J, Cronce A, Merians AS, Adamovich SV. Autonomous use of the home virtual rehabilitation system: a feasibility and pilot study. Games Health J. 2019;8(6):432-438. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Foreman MH, Engsberg JR. A virtual reality tool for measuring and shaping trunk compensation for persons with stroke: design and initial feasibility testing. J Rehabil Assist Technol Eng. 2019;6:2055668318823673. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fusari G, Gibbs E, Hoskin L, Lawrence-Jones A, Dickens D, Crespo RF, et al. What is the feasibility and patient acceptability of a digital system for arm and hand rehabilitation after stroke? a mixed-methods, single-arm feasibility study of the 'OnTrack' intervention for hospital and home use. BMJ Open. 2022;12(9):e062042. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Gauthier LV, Nichols-Larsen DS, Uswatte G, Strahl N, Simeo M, Proffitt R, et al. Video game rehabilitation for outpatient stroke (VIGoROUS): a multi-site randomized controlled trial of in-home, self-managed, upper-extremity therapy. EClinicalMedicine. 2022;43:101239. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Goršič M, Cikajlo I, Goljar N, Novak D. A multisession evaluation of an adaptive competitive arm rehabilitation game. J Neuroeng Rehabil. 2017;14(1):128. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Grau-Pellicer M, Lalanza JF, Jovell-Fernández E, Capdevila L. Impact of mHealth technology on adherence to healthy PA after stroke: a randomized study. Top Stroke Rehabil. 2020;27(5):354-368. [ CrossRef ] [ Medline ]
• Guidetti S, Gustavsson M, Tham K, Andersson M, Fors U, Ytterberg C. F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology—a feasibility study. BMC Neurol. 2020;20(1):387. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Held JP, Ferrer B, Mainetti R, Steblin A, Hertler B, Moreno-Conde A, et al. Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system. Eur J Phys Rehabil Med. 2018;54(4):545-553. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. Virtual reality-based rehabilitation as a feasible and engaging tool for the management of chronic poststroke upper-extremity function recovery: randomized controlled trial. JMIR Serious Games. 2022;10(3):e37506. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hung NT, Paul V, Prakash P, Kovach T, Tacy G, Tomic G, et al. Wearable myoelectric interface enables high-dose, home-based training in severely impaired chronic stroke survivors. Ann Clin Transl Neurol. 2021;8(9):1895-1905. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Johnson MJ, Shakya Y, Strachota E, Ahamed SI. Low-cost monitoring of patients during unsupervised robot/computer assisted motivating stroke rehabilitation. Biomed Tech (Berl). 2011;56(1):5-9. [ CrossRef ] [ Medline ]
• Johnson MJ, Van der Loos HFM, Burgar CG, Shor P, Leifer LJ. Experimental results using force-feedback cueing in robot-assisted stroke therapy. IEEE Trans Neural Syst Rehabil Eng. 2005;13(3):335-348. [ CrossRef ] [ Medline ]
• Jonsdottir J, Baglio F, Gindri P, Isernia S, Castiglioni C, Gramigna C, et al. Virtual reality for motor and cognitive rehabilitation from clinic to home: a pilot feasibility and efficacy study for persons with chronic stroke. Front Neurol. 2021;12:601131. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kamwesiga JT, Eriksson GM, Tham K, Fors U, Ndiwalana A, von Koch L, et al. A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce, after stroke in Uganda. Global Health. 2018;14(1):82. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kanai M, Izawa KP, Kobayashi M, Onishi A, Kubo H, Nozoe M, et al. Effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke: a randomized controlled trial. Clin Rehabil. 2018;32(8):1047-1056. [ CrossRef ] [ Medline ]
• Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot Enhanced Stroke Therapy Optimizes Rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil. 2021;18(1):10. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kessler D, Anderson ND, Dawson DR. Occupational performance coaching for stroke survivors delivered via telerehabilitation using a single-case experimental design. Br J Occup Ther. 2021;84(8):488-496. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kim DY, Kwon H, Nam KW, Lee Y, Kwon HM, Chung YS. Remote management of poststroke patients with a smartphone-based management system integrated in clinical care: prospective, nonrandomized, interventional study. J Med Internet Res. 2020;22(2):e15377. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kim J, Lee M, Kim Y, Eun SD, Yoon B. Feasibility of an individually tailored virtual reality program for improving upper motor functions and activities of daily living in chronic stroke survivors: a case series. Eur J Integr Med. 2016;8(5):731-737. [ CrossRef ]
• King M, Hijmans JM, Sampson M, Satherley J, Hale L. Home-based stroke rehabilitation using computer gaming. N Z J Physiother. 2012;40(3):128-134. [ FREE Full text ]
• Kringle EA, Setiawan IMA, Golias K, Parmanto B, Skidmore ER. Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology. Disabil Rehabil Assist Technol. 2020;15(8):908-916. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kumar D, Sinha N, Dutta A, Lahiri U. Virtual reality-based balance training system augmented with operant conditioning paradigm. Biomed Eng Online. 2019;18(1):90. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Langan J, Bhattacharjya S, Subryan H, Xu W, Chen B, Li Z, et al. In-home rehabilitation using a smartphone app coupled with 3D printed functional objects: single-subject design study. JMIR Mhealth Uhealth. 2020;8(7):e19582. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lawrie S, Dong Y, Steins D, Xia Z, Esser P, Sun S, et al. Evaluation of a smartwatch-based intervention providing feedback of daily activity within a research-naive stroke ward: a pilot randomised controlled trial. Pilot Feasibility Stud. 2018;4:157. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lawson S, Tang Z, Feng J. Supporting stroke motor recovery through a mobile application: a pilot study. Am J Occup Ther. 2017;71(3):7103350010p1-7103350010p5. [ CrossRef ] [ Medline ]
• Lee M, Pyun SB, Chung J, Kim J, Eun SD, Yoon BC. A further step to develop patient-friendly implementation strategies for virtual reality-based rehabilitation in patients with acute stroke. Phys Ther. 2016;96(10):1554-1564. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lee M, Son J, Kim J, Pyun SB, Eun SD, Yoon BC. Comparison of individualized virtual reality- and group-based rehabilitation in older adults with chronic stroke in community settings: a pilot randomized controlled trial. Eur J Integr Med. 2016;8(5):738-746. [ CrossRef ]
• Lee MM, Shin DC, Song CH. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study. J Phys Ther Sci. 2016;28(7):2019-2024. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Levy T, Crotty M, Laver K, Lannin N, Killington M. Does the addition of concurrent visual feedback increase adherence to a home exercise program in people with stroke: a single-case series? BMC Res Notes. 2020;13(1):361. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lewis GN, Woods C, Rosie JA, McPherson KM. Virtual reality games for rehabilitation of people with stroke: perspectives from the users. Disabil Rehabil Assist Technol. 2011;6(5):453-463. [ CrossRef ] [ Medline ]
• Li X, Wang L, Miao S, Yue Z, Tang Z, Su L, et al. Sensorimotor rhythm-brain computer interface with audio-cue, motor observation and multisensory feedback for upper-limb stroke rehabilitation: a controlled study. Front Neurosci. 2022;16:808830. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lum PS, Taub E, Schwandt D, Postman M, Hardin P, Uswatte G. Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. J Rehabil Res Dev. 2004;41(3A):249-258. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mansfield A, Wong JS, Bryce J, Brunton K, Inness EL, Knorr S, et al. Use of accelerometer-based feedback of walking activity for appraising progress with walking-related goals in inpatient stroke rehabilitation: a randomized controlled trial. Neurorehabil Neural Repair. 2015;29(9):847-857. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Matarić MJ, Eriksson J, Feil-Seifer DJ, Winstein CJ. Socially assistive robotics for post-stroke rehabilitation. J Neuroeng Rehabil. 2007;4:5. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mawson S, Nasr N, Parker J, Davies R, Zheng H, Mountain G. A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation. JMIR Rehabil Assist Technol. 2016;3(1):e1. [ FREE Full text ] [ CrossRef ] [ Medline ]
• McNulty PA, Thompson-Butel AG, Faux SG, Lin G, Katrak PH, Harris LR, et al. The efficacy of Wii-based Movement Therapy for upper limb rehabilitation in the chronic poststroke period: a randomized controlled trial. Int J Stroke. 2015;10(8):1253-1260. [ CrossRef ] [ Medline ]
• Mihelj M, Novak D, Milavec M, Ziherl J, Olenšek A, Munih M. Virtual rehabilitation environment using principles of intrinsic motivation and game design. Presence: Teleop Virt Environ. 2012;21(1):1-15. [ CrossRef ]
• Mitchell C, Bowen A, Tyson S, Conroy P. A feasibility randomized controlled trial of ReaDySpeech for people with dysarthria after stroke. Clin Rehabil. 2018;32(8):1037-1046. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Moan ME, Vonstad EK, Su X, Vereijken B, Solbjør M, Skjæret-Maroni N. Experiences of stroke survivors and clinicians with a fully immersive virtual reality treadmill exergame for stroke rehabilitation: a qualitative pilot study. Front Aging Neurosci. 2021;13:735251. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mountain G, Wilson S, Eccleston C, Mawson S, Hammerton J, Ware T, et al. Developing and testing a telerehabilitation system for people following stroke: issues of usability. J Eng Des. 2010;21(2-3):223-236. [ CrossRef ]
• Nijenhuis SM, Prange GB, Amirabdollahian F, Sale P, Infarinato F, Nasr N, et al. Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke. J Neuroeng Rehabil. 2015;12:89. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Novak D, Nagle A, Keller U, Riener R. Increasing motivation in robot-aided arm rehabilitation with competitive and cooperative gameplay. J Neuroeng Rehabil. 2014;11:64. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, et al. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: a mixed methods study. BMC Health Serv Res. 2020;20(1):562. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Olafsdottir SA, Jonsdottir H, Magnusson C, Caltenco H, Kytö M, Maye L, et al. Developing ActivABLES for community-dwelling stroke survivors using the Medical Research Council framework for complex interventions. BMC Health Serv Res. 2020;20(1):463. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Parker J, Mawson S, Mountain G, Nasr N, Zheng H. Stroke patients' utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation. BMC Med Inform Decis Mak. 2014;14:46. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Paul L, Wyke S, Brewster S, Sattar N, Gill JMR, Alexander G, et al. Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study. Top Stroke Rehabil. 2016;23(3):170-177. [ CrossRef ] [ Medline ]
• Pereira F, Badia SBI, Jorge C, Cameirão MS. The use of game modes to promote engagement and social involvement in multi-user serious games: a within-person randomized trial with stroke survivors. J Neuroeng Rehabil. 2021;18(1):62. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Perez-Marcos D, Chevalley O, Schmidlin T, Garipelli G, Serino A, Vuadens P, et al. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. J Neuroeng Rehabil. 2017;14(1):119. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Popović MD, Kostić MD, Rodić SZ, Konstantinović LM. Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation. Biomed Res Int. 2014;2014:520374. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Proffitt R, Lange B. Feasibility of a customized, in-home, game-based stroke exercise program using the Microsoft Kinect® sensor. Int J Telerehabil. 2015;7(2):23-34. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Rosati G, Oscari F, Reinkensmeyer DJ, Secoli R, Avanzini F, Spagnol S, et al. Improving robotics for neurorehabilitation: enhancing engagement, performance, and learning with auditory feedback. IEEE Int Conf Rehabil Robot. 2011;2011:5975373. [ CrossRef ] [ Medline ]
• Rowe JB, Chan V, Ingemanson ML, Cramer SC, Wolbrecht ET, Reinkensmeyer DJ. Robotic assistance for training finger movement using a Hebbian model: a randomized controlled trial. Neurorehabil Neural Repair. 2017;31(8):769-780. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sakakibara BM, Lear SA, Barr SI, Goldsmith CH, Schneeberg A, Silverberg ND, et al. Telehealth coaching to improve self-management for secondary prevention after stroke: a randomized controlled trial of Stroke Coach. Int J Stroke. 2022;17(4):455-464. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Saywell NL, Vandal AC, Mudge S, Hale L, Brown P, Feigin V, et al. Telerehabilitation after stroke using readily available technology: a randomized controlled trial. Neurorehabil Neural Repair. 2021;35(1):88-97. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Scrivener K, Sewastenko J, Bouvier-Farrell A, MacDonald K, Van Rijn T, Tezak J, et al. Feasibility of a self-managed, video-guided exercise program for community-dwelling people with stroke. Stroke Res Treat. 2021;2021:5598100. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Shah N, Amirabdollahian F, Basteris A. Designing motivational games for stroke rehabilitation. New Jersey. IEEE; 2014. Presented at: 7th International Conference on Human System Interactions (HSI); June 16-18, 2014;166-171; Costa da Caparica, Portugal. [ CrossRef ]
• Signal NEJ, McLaren R, Rashid U, Vandal A, King M, Almesfer F, et al. Haptic nudges increase affected upper limb movement during inpatient stroke rehabilitation: multiple-period randomized crossover study. JMIR Mhealth Uhealth. 2020;8(7):e17036. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Simpson DB, Bird ML, English C, Gall SL, Breslin M, Smith S, et al. "Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke". Top Stroke Rehabil. 2020;27(2):93-102. [ CrossRef ] [ Medline ]
• Song X, van de Ven SS, Chen S, Kang P, Gao Q, Jia J, et al. Proposal of a wearable multimodal sensing-based serious games approach for hand movement training after stroke. Front Physiol. 2022;13:811950. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Standen PJ, Threapleton K, Richardson A, Connell L, Brown DJ, Battersby S, et al. A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial. Clin Rehabil. 2017;31(3):340-350. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Subramanian SK, Lourenço CB, Chilingaryan G, Sveistrup H, Levin MF. Arm motor recovery using a virtual reality intervention in chronic stroke: randomized control trial. Neurorehabil Neural Repair. 2013;27(1):13-23. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sullivan JE, Espe LE, Kelly AM, Veilbig LE, Kwasny MJ. Feasibility and outcomes of a community-based, pedometer-monitored walking program in chronic stroke: a pilot study. Top Stroke Rehabil. 2014;21(2):101-110. [ CrossRef ] [ Medline ]
• Toh SFM, Gonzalez PC, Fong KNK. Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: a mixed-methods study. Digit Health. 2023;9:20552076231153737. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Tsekleves E, Paraskevopoulos IT, Warland A, Kilbride C. Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology. Disabil Rehabil Assist Technol. 2016;11(5):413-422. [ CrossRef ] [ Medline ]
• Uswatte G, Taub E, Lum P, Brennan D, Barman J, Bowman MH, et al. Tele-rehabilitation of upper-extremity hemiparesis after stroke: proof-of-concept randomized controlled trial of in-home Constraint-Induced Movement therapy. Restor Neurol Neurosci. 2021;39(4):303-318. [ CrossRef ] [ Medline ]
• Valdés BA, Van der Loos HFM. Biofeedback vs. game scores for reducing trunk compensation after stroke: a randomized crossover trial. Top Stroke Rehabil. 2018;25(2):96-113. [ CrossRef ] [ Medline ]
• Wairagkar M, McCrindle R, Robson H, Meteyard L, Sperrin M, Smith A, et al. MaLT—combined motor and language therapy tool for brain injury patients using kinect. Methods Inf Med. 2017;56(2):127-137. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wei WXJ, Fong KNK, Chung RCK, Cheung HKY, Chow ESL. "Remind-to-Move" for promoting upper extremity recovery using wearable devices in subacute stroke: a multi-center randomized controlled study. IEEE Trans Neural Syst Rehabil Eng. 2019;27(1):51-59. [ CrossRef ] [ Medline ]
• Whitford M, Schearer E, Rowlett M. Effects of in home high dose accelerometer-based feedback on perceived and actual use in participants chronic post-stroke. Physiother Theory Pract. 2020;36(7):799-809. [ CrossRef ] [ Medline ]
• Widmer M, Held JPO, Wittmann F, Valladares B, Lambercy O, Sturzenegger C, et al. Reward during arm training improves impairment and activity after stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2022;36(2):140-150. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wittmann F, Held JP, Lambercy O, Starkey ML, Curt A, Höver R, et al. Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system. J Neuroeng Rehabil. 2016;13(1):75. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Yuan Z, Peng Y, Wang L, Song S, Chen S, Yang L, et al. Effect of BCI-controlled pedaling training system with multiple modalities of feedback on motor and cognitive function rehabilitation of early subacute stroke patients. IEEE Trans Neural Syst Rehabil Eng. 2021;29:2569-2577. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chong MS, Sit JWH, Karthikesu K, Chair SY. Effectiveness of technology-assisted cardiac rehabilitation: a systematic review and meta-analysis. Int J Nurs Stud. 2021;124:104087. [ CrossRef ] [ Medline ]
• Hart T, Dijkers MP, Whyte J, Turkstra LS, Zanca JM, Packel A, et al. A theory-driven system for the specification of rehabilitation treatments. Arch Phys Med Rehabil. 2019;100(1):172-180. [ CrossRef ] [ Medline ]
• Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: defining "gamification". New York, NY, US. Association for Computing Machinery; 2011. Presented at: Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments; September 28-30, 2011;9-15; Tampere, Finland. [ CrossRef ]
• Barrett N, Swain I, Gatzidis C, Mecheraoui C. The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation. J Rehabil Assist Technol Eng. 2016;3:2055668316643644. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Welcome to UCLanData. University of Central Lancashire. URL: https://uclandata.uclan.ac.uk/383/ [accessed 2024-03-29]

Abbreviations

Edited by A Mavragani; submitted 15.05.23; peer-reviewed by M Broderick, G Sweeney, E Crayton, D Pogrebnoy; comments to author 11.10.23; revised version received 14.11.23; accepted 26.12.23; published 24.04.24.

©Helen J Gooch, Kathryn A Jarvis, Rachel C Stockley. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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• 15 April 2024
• Correction 22 April 2024

Revealed: the ten research papers that policy documents cite most

• Dalmeet Singh Chawla 0

Dalmeet Singh Chawla is a freelance science journalist based in London.

You can also search for this author in PubMed   Google Scholar

Policymakers often work behind closed doors — but the documents they produce offer clues about the research that influences them. Credit: Stefan Rousseau/Getty

When David Autor co-wrote a paper on how computerization affects job skill demands more than 20 years ago, a journal took 18 months to consider it — only to reject it after review. He went on to submit it to The Quarterly Journal of Economics , which eventually published the work 1 in November 2003.

Autor’s paper is now the third most cited in policy documents worldwide, according to an analysis of data provided exclusively to Nature . It has accumulated around 1,100 citations in policy documents, show figures from the London-based firm Overton (see ‘The most-cited papers in policy’), which maintains a database of more than 12 million policy documents, think-tank papers, white papers and guidelines.

“I thought it was destined to be quite an obscure paper,” recalls Autor, a public-policy scholar and economist at the Massachusetts Institute of Technology in Cambridge. “I’m excited that a lot of people are citing it.”

The most-cited papers in policy

Economics papers dominate the top ten papers that policy documents reference most.

Data from Overton as of 15 April 2024

The top ten most cited papers in policy documents are dominated by economics research; the number one most referenced study has around 1,300 citations. When economics studies are excluded, a 1997 Nature paper 2 about Earth’s ecosystem services and natural capital is second on the list, with more than 900 policy citations. The paper has also garnered more than 32,000 references from other studies, according to Google Scholar. Other highly cited non-economics studies include works on planetary boundaries, sustainable foods and the future of employment (see ‘Most-cited papers — excluding economics research’).

These lists provide insight into the types of research that politicians pay attention to, but policy citations don’t necessarily imply impact or influence, and Overton’s database has a bias towards documents published in English.

Interdisciplinary impact

Overton usually charges a licence fee to access its citation data. But last year, the firm worked with the publisher Sage to release a free web-based tool , based in Thousand Oaks, California, that allows any researcher to find out how many times policy documents have cited their papers or mention their names. Overton and Sage said they created the tool, called Sage Policy Profiles, to help researchers to demonstrate the impact or influence their work might be having on policy. This can be useful for researchers during promotion or tenure interviews and in grant applications.

Autor thinks his study stands out because his paper was different from what other economists were writing at the time. It suggested that ‘middle-skill’ work, typically done in offices or factories by people who haven’t attended university, was going to be largely automated, leaving workers with either highly skilled jobs or manual work. “It has stood the test of time,” he says, “and it got people to focus on what I think is the right problem.” That topic is just as relevant today, Autor says, especially with the rise of artificial intelligence.

Most-cited papers — excluding economics research

When economics studies are excluded, the research papers that policy documents most commonly reference cover topics including climate change and nutrition.

Walter Willett, an epidemiologist and food scientist at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, thinks that interdisciplinary teams are most likely to gain a lot of policy citations. He co-authored a paper on the list of most cited non-economics studies: a 2019 work 3 that was part of a Lancet commission to investigate how to feed the global population a healthy and environmentally sustainable diet by 2050 and has accumulated more than 600 policy citations.

“I think it had an impact because it was clearly a multidisciplinary effort,” says Willett. The work was co-authored by 37 scientists from 17 countries. The team included researchers from disciplines including food science, health metrics, climate change, ecology and evolution and bioethics. “None of us could have done this on our own. It really did require working with people outside our fields.”

Sverker Sörlin, an environmental historian at the KTH Royal Institute of Technology in Stockholm, agrees that papers with a diverse set of authors often attract more policy citations. “It’s the combined effect that is often the key to getting more influence,” he says.

Has your research influenced policy? Use this free tool to check

Sörlin co-authored two papers in the list of top ten non-economics papers. One of those is a 2015 Science paper 4 on planetary boundaries — a concept defining the environmental limits in which humanity can develop and thrive — which has attracted more than 750 policy citations. Sörlin thinks one reason it has been popular is that it’s a sequel to a 2009 Nature paper 5 he co-authored on the same topic, which has been cited by policy documents 575 times.

Although policy citations don’t necessarily imply influence, Willett has seen evidence that his paper is prompting changes in policy. He points to Denmark as an example, noting that the nation is reformatting its dietary guidelines in line with the study’s recommendations. “I certainly can’t say that this document is the only thing that’s changing their guidelines,” he says. But “this gave it the support and credibility that allowed them to go forward”.

Broad brush

Peter Gluckman, who was the chief science adviser to the prime minister of New Zealand between 2009 and 2018, is not surprised by the lists. He expects policymakers to refer to broad-brush papers rather than those reporting on incremental advances in a field.

Gluckman, a paediatrician and biomedical scientist at the University of Auckland in New Zealand, notes that it’s important to consider the context in which papers are being cited, because studies reporting controversial findings sometimes attract many citations. He also warns that the list is probably not comprehensive: many policy papers are not easily accessible to tools such as Overton, which uses text mining to compile data, and so will not be included in the database.

The top 100 papers

“The thing that worries me most is the age of the papers that are involved,” Gluckman says. “Does that tell us something about just the way the analysis is done or that relatively few papers get heavily used in policymaking?”

Gluckman says it’s strange that some recent work on climate change, food security, social cohesion and similar areas hasn’t made it to the non-economics list. “Maybe it’s just because they’re not being referred to,” he says, or perhaps that work is cited, in turn, in the broad-scope papers that are most heavily referenced in policy documents.

As for Sage Policy Profiles, Gluckman says it’s always useful to get an idea of which studies are attracting attention from policymakers, but he notes that studies often take years to influence policy. “Yet the average academic is trying to make a claim here and now that their current work is having an impact,” he adds. “So there’s a disconnect there.”

Willett thinks policy citations are probably more important than scholarly citations in other papers. “In the end, we don’t want this to just sit on an academic shelf.”

doi: https://doi.org/10.1038/d41586-024-00660-1

Updates & Corrections

Correction 22 April 2024 : The original version of this story credited Sage, rather than Overton, as the source of the policy papers’ citation data. Sage’s location has also been updated.

Autor, D. H., Levy, F. & Murnane, R. J. Q. J. Econ. 118 , 1279–1333 (2003).

Article   Google Scholar  

Costanza, R. et al. Nature 387 , 253–260 (1997).

Willett, W. et al. Lancet 393 , 447–492 (2019).

Article   PubMed   Google Scholar  

Steffen, W. et al. Science 347 , 1259855 (2015).

Rockström, J. et al. Nature 461 , 472–475 (2009).

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Many Americans find value in getting news on social media, but concerns about inaccuracy have risen

Social media plays a crucial role in Americans’ news consumption . Half of all U.S. adults say they at least sometimes get news there, according to a 2023 Pew Research Center survey .

Those who get news on social media name a variety of things that they like about it, including convenience, speed and the element of social interaction. But some social media news consumers also express concerns about news there being inaccurate, low quality and politically biased. The share who say inaccuracy is the aspect they dislike most has increased from 31% to 40% in the past five years.

These findings come from a broader Center survey of U.S. adults’ news habits . The survey asked Americans who get news on social media to describe – in their own words – the things they like and dislike most about getting news there. Their responses were then sorted into categories.

Pew Research Center asked two open-ended questions about what people like and dislike most about getting news on social media as part of a survey on U.S. adults’ news habits. The survey of 8,842 U.S. adults was conducted from Sept. 25 to Oct. 1, 2023.

Everyone who completed the survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the  ATP’s methodology .

We asked all respondents who say they get news on social media to answer the open-ended questions. Responses were manually coded into categories. In total, we coded 4,507 open-end responses on what respondents like the most and 4,453 responses on what respondents dislike the most.

Here are the  questions used for the fall 2023 survey , along with responses, and its  methodology .

We asked whether Americans prefer social media or news outlets for various types of information on a separate ATP survey conducted March 20-26, 2023, among 3,576 U.S. adults. Here are the questions used for the spring 2023 survey , along with responses, and its  methodology .

Pew Research Center is a subsidiary of The Pew Charitable Trusts, its primary funder. This is the latest report in Pew Research Center’s ongoing investigation of the state of news, information and journalism in the digital age, a research program funded by The Pew Charitable Trusts, with generous support from the John S. and James L. Knight Foundation.

What Americans like about getting news on social media

The aspects of getting news on social media that Americans value have not changed much since 2018 , the last time we asked these questions. Convenience remains the top thing people like most about getting news on social media. One-in-five social media news consumers say this, with responses such as “It’s at my fingertips,” “I can easily get it” and “It’s available all the time and anywhere.”

Another 9% say they like the speed with which they can get news there, describing news on social media as “fast and to the point” and “quick and easy to digest.”

Smaller shares say they like interaction with others , the up-to-date nature of the news, the content or format , and the variety of sources and stories .

Meanwhile, 7% of Americans who get news on social media say they don’t like anything about the experience, and an additional 32% did not offer a response.

What Americans dislike about getting news on social media

Many social media news consumers also see downsides to getting news this way. Four-in-ten Americans who get news from social media say inaccuracy is the thing they dislike most about it – an increase of 9 percentage points since 2018. This category of responses includes concerns about unverified facts, misinformation, “fake news” and unreliable sources.

A much smaller share of social media news consumers (8%) say they dislike the low quality of news there, with some giving clickbait or a lack of in-depth coverage as examples. Others say the news on social media is too biased or political (6%) or they don’t like the way people behave there (5%).

Another 1% of social media news consumers say censorship is what they dislike most. This category – which we used for the first time in the 2023 survey – includes responses such as “Too much censorship by the sites” and “I really dislike when some of my view points are removed.” There are no significant differences in the shares of Democratic and Republican social media news consumers who say they’re concerned about news censorship on social media. In fact, there are no partisan differences within any of these complaint categories.

Just 4% of respondents say they don’t dislike anything about getting news on social media. Another 31% did not answer the question.

Social media posts versus news outlets: Which do Americans prefer for certain types of information?

The perceived downsides of getting news on social media may help explain why many Americans prefer to go directly to news outlets instead. In a separate Center survey, U.S. adults who say they at least sometimes get news on social media were asked whether they prefer reading social media posts or going directly to news outlets for five different types of information. Those types of information include the basic facts about an issue or event as well as in-depth information and opinions on it.

Americans prefer to get four of the five types of information from news outlets over social media. However, a substantial share say they like getting each type of information from news outlets and social media about the same.

For example, 45% of respondents say they prefer news outlets for getting the most in-depth information about an issue or event, while only 11% prefer social media posts for this. An additional 34% say they value both sources equally, while 8% say they prefer neither option.

Social media news consumers also tend to prefer news outlets over social media to get:

• The basic facts about an issue or event (39% vs. 14%)
• Up-to-date information about an event as it is happening (34% vs. 21%)
• Information about how an issue or event impacts them (31% vs. 15%)

In each of these cases, roughly four-in-ten or more say they like social media and news outlets about the same.

In contrast, equal shares of Americans prefer news outlets and social media when it comes to opinions on an issue (22% each).

Previous Center research has shown that younger Americans are more likely than older Americans to prefer getting news from social media , and that pattern also appears in the findings of this survey. Adults under 30 express a clear preference for using social media over news outlets to get opinions on an issue (36% vs. 13%) and up-to-date information as an event is happening (35% vs. 21%). Americans ages 65 and older are much more likely to prefer news outlets over social media for every type of information we asked about. 

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• Media Industry
• News Habits & Media
• Social Media & the News

Luxuan Wang is a research associate at Pew Research Center

Naomi Forman-Katz is a research analyst focusing on news and information research at Pew Research Center

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