We surveyed and interviewed COVID-19 vaccine trial participants in Oxford, UK, on their views about taking part in a vaccine trial and the role of animals in trials. We found that trial participants mirrored assumptions about legitimate reasons for animal testing embedded in regulation and provided insight into (i) the nuances of public opinion on animal research; (ii) the co-production of human and animal experimental subjects; (iii) how vaccine and medicine testing, and the motivations and demographics of clinical trial participants, change in an outbreak; and (iv) what public involvement can offer to science.Preclinical  testing and human testing of drugs and vaccines are rarely considered by social scientists side by side. Where this is done, it is typically for theoretically exploring the ethics of the two situations to compare relative treatment. In contrast, we empirically explore how human clinical trial participants understand the role of animal test subjects in vaccine development. Furthermore, social science research has only concentrated on broad public opinion and the views of patients about animal research, whereas we explore the views of a public group particularly implicated in pharmaceutical development:  New pharmaceutical products, including vaccines, are first tested in nonhuman animals  for safety. Because animal and human biology are not identical, medicines must then be tested on humans before regulatory approval. A large amount has been written about the social and ethical dimensions of both elements of animal and human testing, including the motivations and experiences of healthy clinical trial participants in non-outbreak scenarios  and how Rarely, however, are these human and nonhuman elements of testing considered side by side. Where this is done, it typically involves examining clinical trial participants’ use of “guinea pig” and “lab rat” metaphors  or theor“Co-production” is an idiom first described by experimental subjects: humans and animals whose bodies are sites for testing, but who may not directly benefit from the product being tested. Through exploring COVID-19 vaccine clinical trial participants’ views on animal testing, we explore how their identities as test subjects are produced in relation to research animals. In short, we unpack how human and animal experimental identities are co-produced. We propose that doing so can inform understanding of the ethics and practices of experimentation and provide insight into interspecies subjectivities and identities through a reflection on humans’ perceptions of their animal counterparts.Thus, co-production of health and care has been examined in relation to research animals and patient groups. However, to our knowledge, social scientists have not explored the co-production of human and animal Our analysis also contributes to the important conversations about the role of public groups in steering the direction of animal research. Animal testing has long been a subject of public interest. In the UK, debate has been ongoing since at least the nineteenth century, though the nature of discussions has changed over time . Public In light of these concerns, various efforts are made to bring public groups, such as patients, on board. Regulation is one such approach, with the UK’s Animals (Scientific Procedures) Act of 1986 drafted with the aim of reaching a compromise between the interests and concerns of scientists, vets and other animal welfare advocates, and the public . In receClinicalTrials.gov identifier: NCT04324606), commonly known as the Oxford or AstraZeneca vaccine, was tested on animals and humans; and how animal testing was presented to volunteers and public groups. We then explore human volunteers’ perspectives on whether animal testing is necessary, before examining how the trial participants spoke about their own roles as experimental subjects in relation to animals. We conclude by reflecting on what these findings tell us about public opinion on animal research, the co-production of human and animal experimental subjects, how vaccine and medicine testing change in an outbreak, and what public involvement can offer to science.We begin by describing how the ChAdOx1 nCoV-19 vaccine  laboratories as well as in pigs via collaboration with researchers at the Pirbright Institute . FurtherAnimal testing featured in the participant information sheet (PIS) for the study (see Online Supplement) and corresponding video. The PIS stated, “Until now, this vaccine has only been tested on laboratory mice and other animal species and this is the first time that the vaccine will be given to humans” . The PISThe first clinical trial in humans of ChAdOx nCoV-19 started in April 2020 as a single-blinded, randomized phase I/II trial COV001; . The triSurvey respondents were quite evenly split by gender , and 45 to 55 years was the largest age-group . Most respondents reported their nationality as British, , 8 percent (28 of 349) reported being European, and 2 percent (8 of 349) American. Other nationalities included New Zealand, Mexican, Filipino, Canadian, and Japanese. Most respondents identified as white British , with only 6 percent (21 of 349) describing their ethnicity as Black, Asian, and Minority Ethnic (BAME). More than half of respondents  were educated to postgraduate level and 56 percent (197 of 349) were employed full time, with education, law, and government services the most commonly reported occupational groups. About 40 percent (138 of 349) were living with a partner, 50 percent (173 of 349) were single, and 62 percent (216 of 349) were without children (see Online Supplement for further demographic information).Interviews took place via Microsoft Teams and were recorded and transcribed verbatim. Interviews typically took between forty-five minutes to one and half hours and were conducted by eleven members of the study team. We believe that the survey response was high because this appeared to be a group highly motivated to be involved in research, with a view that the trial (and associated research) was of high importance. The pandemic meant that many were working from home or furloughed, which offered some flexibility in being able to take part in interviews conducted remotely .We conducted a thematic and discourse analysis of the interview transcripts using NVivo version 12, in order to identify key themes and patterns occurring in discussions, as well as connections between subtopics to link types of conversation clusters together. A codebook was developed iteratively by the team, and regular meetings were used to check for coding consistency. We also conducted an inter-coder reliability test that demonstrated good-to-excellent reliability. Such an approach draws on This paper draws predominantly on our analysis of interview material where animal testing is discussed. We also selectively use the survey data on demographics as well as two relevant questions about the motivation to take part in the trial and the risk posed by the quick turnaround from animal to human testing. We do not use the interview and survey data in full because they incorporated a wide range of topics, including opinions about the general risk and safety of the trial, media representation, experience of taking part in the trial during the pandemic, and attitudes to vaccines. This information is not relevant to the research questions of the current paper and were therefore not included. The full survey questionnaire and interview guide are contained in the Online Supplement.It’s a bit like blood or organ donation: potential huge gain to someone else for little or no cost to myself, so there’s not really any reason not to. In normal times this wouldn’t apply, since it would have had a bigger impact on everyday life. (CQS-65490989)Others also referred to the uniqueness of the COVID-19 outbreak and lockdown as important for encouraging their involvement, with one respondent (CQS-65481676) explaining, “It was something fun to do—we were in lockdown and there was very little else!”The demographic profile could help explain why financial compensation was cited as an important motivator by only 4 percent (13 of 349) of survey respondents. More commonly, people spoke of being motivated by a desire to “help” or being personally affected by COVID-19. One participant (CQS-65481067), for example, explained, “I lost a family member to COVID shortly before my vaccination and would not wish the experience of losing someone during this pandemic on anyone.” Respondents also referred to other altruistic actions like blood donation in explaining why they participated. As one put it:Participants for phase I clinical trials of the ChAdOx nCoV-19 vaccine were typically employed professionals educated to degree level. This stands in contrast with phase I clinical trials in the US, which often attract economically disadvantaged, ethnic minority men , and in Is animal testing necessary to develop vaccines and treatments? We examine people’s answers in relation to their views on (i) justifications for animal testing and (ii) the relationships between human and animal experimental subjects.Some participants raised the subject of animal testing during interviews spontaneously. Where this didn’t happen, we asked them: I don’t think it’s right, but I think it is necessary. … Yes, I do firmly believe that life is very important no matter what you are. Whether you are a chicken or you are a person, but I feel for the sake of mankind, it’s necessary to test on animals first, yes. (CQI-0337)In other words, participants generally supported the use of animals in testing for vaccines and medicines, reasoning that animal lives are worth compromising or sacrificing for the sake of saving humans. This reasoning closely aligns with the ethics adopted in the UK’s Animals (Scientific Procedures) Act (A(SP)A). Embedded in A(SP)A is an ethic of utilitarianism, exemplified most clearly by the obligation of Home Office inspectors tasked with approving research, and local Animal Welfare and Ethical Review Bodies . For example, one participant reflected that “for vaccines and medical trials where it’s potentially for the use of something that’s going to cure or help humans, I think sometimes animal testing is unavoidable” (CQI-0477). The same participant argued, speaking specifically about vaccines, “we have to be sure that they’re not going to kill people.” Another proposed that humans and animals have equal moral worth, meaning that animal testing can be simultaneously wrong and necessary: AWERBs; , to weig AWERBs; . Thus, r AWERBs; .Reduce the number of animals used, Refine methods so as to minimize harm, and Replace animal research with alternatives whenever possible Opinion polls typically show that a substantial minority (38 percent in 2018) believe that testing cosmetics on animals is permitted in the UK Interestingly, a similar point was made by a participant (CQI-0306) who referred to their identity as a meat-eater: “I don’t really feel like I can comment on animal testing if I eat meat.” Thus, even though one participant was vegetarian and the other a meat-eater, both argued that their choices in the domain of food consumption mean that they cannot reasonably object to animal testing.Two participants spoke of cosmetic testing alongside references to vegetarianism and veganism. As another area in which companies  directly appeal to consumers via narratives of ethical or responsible consumption, dietary ethics served as another touchpoint for participants seeking to articulate their views about the ethics of animal testing. This offers an interesting parallel with the “ethical boundary-work”  undertaken by scientists who conduct animal research. Scientists in this context complain of being unfairly singled out by animal advocates, on the grounds that their work is more humane, and better regulated and justified, compared with other domains of animal use such as farming . In a seIn sum, participants’ perspectives on the justifications for animal testing suggest broad alignment with the principles embedded in UK animal research regulation and with the views often expressed by researchers and laboratory workers . This diI don’t know enough about the science. … People are trying to reduce animal experiments to the minimum, so I assume the fact that they still do it means it’s necessary. (CQI-0341)I’m not an expert. I don’t know.…I can’t give an easy yes or no answer, because I don’t think I know enough. But again, I have to trust that there are people that know and that they’re doing it in the best way that they can, I guess. (CQI-0472)Conversely, one participant attributed their certainty that animal testing is necessary to their role as a health-care professional: “I’m from healthcare, I know that you need to test on animals first, so that actually reassured me more than anything, that they had done that” (CQI-0436). Both self-identified experts and nonexperts therefore saw the scientific merit of research as relevant for assessing ethics. This idea is also embedded in the UK’s animal research regulations, with A(SP)A license applications requiring thorough justification of the scientific merits of the proposed research and where possible evidence of peer review .Despite their nuanced perspectives on the ethics of animal testing, participants often caveated their statements by noting that they are not experts, again echoing the findings of a recent poll in which 38 percent of those surveyed felt “not very well informed” and a further 26 percent “not at all informed” about animal research . Six notDespite acknowledging the relevance of science for making ethical judgments, and their own lack of scientific expertise, participants also expressed trust that someone more qualified has already determined that animal testing is necessary as captured by use of phrases like “I assume.” This trust in authority may, however, be more widespread among these clinical trial participants than the broader public. According to the 2011 Census, 43 percent of Oxford’s population was qualified to degree level or above, compared with the England average of 27 percent. Clinical participants followed this trend. Recent surveys demonstrate the heightened trust in science that comes with education, particularly in science subjects .the reason it seems to me that we have to have vaccinations is because viruses can now, and other diseases, can spread so easily through a heavily urbanized, globally connected population … So, it’s because of the world we’ve made that vaccines become necessary. … I think vaccines in that respect are a sort of emergency measure to cure the symptoms of a society that hasn’t evolved and hasn’t developed in an ecologically grounded way. So, in that respect I’m against vaccines. But I mean, I realize the necessity of them, but I wish we would, if they’re that important for human beings to have a vaccine, we should trial them on ourselves and not on animals first. (CQI-0493)In short, this participant expressed distrust in modern society and institutions , yet this distrust also motivated their involvement in the clinical trial.This general sense of trust was captured in responses to survey questions about the vaccine’s risks and likelihood of success: while over a third  thought that new vaccines are riskier than established ones, half  thought that the vaccine would work. Indeed, clinical trial participants almost by definition would not include vaccine critics given their willingness to facilitate vaccine production and thus may be more broadly trusting of scientists than the average Briton. However, one interviewee presented a slightly different perspective, arguing that vaccines have only become necessary due to modern (and undesirable) living conditions. They connected this view to their opposition to animal testing:We now explore how participants talked about their own role as experimental subjects in relation to those of animals, particularly with respect to safety, care, differences between human and animal bodies, and consent.For some participants, the role of animal testing in vaccine development was not something they had given much thought, despite this being covered in the consent process: “I don’t know. I hadn’t really thought about it” (CQI-0347). Others, however, expressed a desire for more information  or indicated that they had given considerable thought to animal testing. For these participants, animal testing served as a source of both concern and reassurance. In terms of concerns, six interviewees spoke about the potential increased risk of severe disease following vaccination, highlighted in animal trials against SARS, which presented risks that they needed to come to terms with. One interviewee explained that they “read the information sheet quite carefully,” and the information about the SARS animal trials “was slightly concerning, but not a massive concern. I thought okay, that’s an element there and you have to accept that” (CQI-0479).I don’t think anyone would actually be willing to do human trials if there was no evidence to back up that you would be safe from it. I think most people would prefer it to be tested on an animal before. (CQI-0408)Two participants, in articulating this idea, specifically referred to primate testing, with one stating that “no safety data at all from primates or other animal studies would be high risk, I would say” (CQI-0355). The second participant, who identified as a scientist and used the laboratory-specific term “NHP” (nonhuman primate), concluded, “I was pleased that it’d gone into NHPs and that had been assessed” (CQI-0346).For other participants, the knowledge that the vaccine had been tested on animals, and the results from animal testing, reduced concern, since “knowing that it’s been tested on animals as well is reassuring” (CQI-0363). As another participant put it:Thus, animal testing was perceived as a tool of public reassurance, enabling the first human test subjects to participate with some degree of confidence, because (as one put it) “it’s not just you that is just being tested” (CQI-0363). Animal testing was therefore perceived as playing an important role in allowing clinical trial participants to take risks in a responsible way . This reassurance is derived simultaneously from the scientists , and from the animals’ bodies, which are trusted (particularly those of fellow primates) to act as reasonable proxies for our own.On the other hand, the use of primates specifically was a cause for concern for two participants, one being the participant who argued that modern society produces pandemics. For the other, the use of a highly intelligent animal was a source of discomfort, though they also did not see an alternative. The understanding that the vaccine had been tested on primates was a particular source of reassurance and concern, which came across in how frequently chimpanzees, monkeys, and primates were mentioned (forty-seven times by twenty-seven participants), despite chimpanzees not being used in any animal studies during the development of the Oxford vaccine. Indeed, chimpanzees cannot legally be used in medical testing in the UK and EU. The specific monkey species used in preclinical studies (rhesus macaques) was not referred to by any of our respondents, nor were the other species used (pigs and ferrets). The only exception to this was a reference to mice when a participant mentioned their knowledge of preclinical animal trials.A subject of particular public concern on COVID-19 vaccines was the speed at which human testing progressed. Questions on whether sufficient animal testing had been conducted circulated readily, despite indications from government regulators in various countries early in the pandemic that they would still require animal testing. Given the attention paid to this subject, we asked survey respondents whether they thought the trial was riskier because testing had progressed to human participants quickly after animal testing. Answers to this question displayed in  had had it before I did. And that’s not the best review in the world, but hey ho. But no. Yes, I wasn’t too worried. (CQI-0443)I did get a little scared once I experienced the side-effects after having the initial vaccine because I was part of phase one, so once again, only six chimpanzeesFor other participants, concerns about the fast pace of animal trials were mitigated by trust in the scientists: “my guess is that nothing that was important was missed” (CQI-0438), “the most important factor is the strong belief in the experts that it’s safe” (CQI-0432), and “they wouldn’t have asked for people to volunteer to have it if they hadn’t done preliminary checks” (CQI-0481).Respondents indicated awareness that the animal trial may have been quicker or less extensive than usual: “the animal studies were probably shortened slightly” (CQI-0481); “maybe [typically] they would do more extensive animal testing than they did” (CQI-0438); “It has been animal tested, but has been rushed through basically” (CQI-0375). One participant mentioned that this fast pace became a minor concern once they personally experienced side-effects:I found it amazing how quick everything had been put into place and how well they’d done it, lining up all the approvals processes so that we were screened before they’d even finished the animal studies, and that was a remarkable thing. (CQI-0455)Another participant who has worked on clinical trials as a scientist felt assured that speed and safety had been properly balanced: “this is as fast as we could go, safely” (CQI-0452). Others also cited the idea that in an outbreak scenario, speed is desirable. As one put it, “if we are trying to speed things up and move it forward, in a race almost against the virus that’s out there, you have to do that [move quickly] at some stage” (CQI-0481). Another even suggested that this ought to become a model for vaccine development in future outbreaks: “I think it should be done for a lot more vaccines, to especially help pandemics or epidemics” (CQI-0452).Speed was also at times portrayed in a positive light, for example, demonstrating good organization:I personally would not have done it [participated in the clinical trial] if there hadn’t been animal trials. Because like I say, there are people who rely on me to do certain things for the continuation of their life. And the same thing if you had kids, you wouldn’t do it. (CQI-0334)For this participant, animal testing is not merely a form of reassurance for the public in general, but specifically in the context of their own life. Human and animal test subjects are here envisioned as connected via a chain of care, in which animals care for human clinical trial participants by reducing their risk, enabling them to in turn provide care for others. There is a personalization of harm–benefit analysis in how to balance benefits to society against the risk of harm to individuals and therefore dependents. These reflections demonstrate how harm–benefit analysis cuts across scales and relations.Participants often spoke of their willingness to be involved in the trial in connection with their daily lives and responsibilities. Their willingness to be exposed to the risks of a vaccine trial for the wider social good was balanced against other kinds of personal commitments and obligations:my thought was somebody has to step up at the initial stage and test it. If it’s been tested in a laboratory, say, on mice and monkeys or other primates and that, there has to come a time when you have to trial it in human beings because that’s where it’s going to end up. (CQI-0481)At the same time, people sometimes spoke about their own suitability as test subjects, citing confidence in their own robust immune systems as a reason for participating. People therefore spoke not only of the suitability of animals as the first experimental subjects but also about their own bodies as appropriate test sites prior to public distribution of the vaccine. In a sense, they saw animal test subjects as reducing the risk for them and their fellow clinical trial participants, and their own bodies as in turn protecting other humans with less robust immune systems. This idea was reinforced by some participants’ references to knowing people who had died of COVID-19, and their desire to prevent this from happening to others. In this vein, one participant described their role as one important step in the process of testing, which moves from mice, to monkeys, to humans:Seven interviewees spoke about themselves, and others, as being ideal test subjects through comparisons with guinea pigs. Guinea pigs feature as a common metaphor among clinical trial participants given their associations with experimentation . Using tYet the guinea pig reference was also used to indicate risk, with one participant explaining that given vaccines are untested “there’s still a risk involved because you’re asking people to essentially be guinea pigs” (CQI-0363). Another noted that their family “thought it was very brave to be a guinea pig in the trial, which I hadn’t really thought was the case” (CQI-0385). One participant alternatively referred to themselves as being a “lab rat”: when asked about receiving information from the trial team the participant noted they would like to have “inside information” but understood “I’m strictly a lab rat for this” (CQI-0440). This usage hints at a slight differentiation between guinea pigs being used for experimentation and lab rats to produce data.The use of animal metaphors, and view of humans as a (later) link in the chain of care that begins with research animals, indicates a willingness to view animals as the most suitable initial test subjects. However, one participant stood out in detailing a slightly different perspective on the appropriateness of certain bodies for use in experiments. Noting that they would prefer to live in a world where “there would be computer modelling and then human trials” rather than animal testing and that the primate testing “kind of bothered me,” they explained that a central reason for participating in the trial was to “put my money where my mouth was:” “if I want to live in a world where there’s no animal testing then I have to be prepared to put myself forward” (CQI-0479). For them, participating was acknowledging a solidarity with animals and also contributing to the possible end of animal trials in future. Their own body and those of fellow humans were therefore viewed as more ethical test sites than animal bodies. Yet they expressed a degree of hesitancy in committing to whether they would have participated had no animal testing been conducted – “I think would have still done it, hopefully” – suggesting that while they may disapprove of animal testing, they nonetheless do gain some reassurance from it. For them, animal bodies may not be ethically appropriate test sites, but they perhaps do still provide valuable information.It’s just difficult because we as humans can consent to being on a trial. Animals don’t have the same rights. I can’t see what the alternative would be. (CQI-0363)In contrast, the second participant referred to their own willingness to participate, signaling that human testing is different because “humans can make the free will decision to do it” . Enabling human choice to participate, in this participant’s eyes, requires ignoring animals’ choices. However, animal testing also arguably provides more information for humans to make informed choices.A final connection made between animal and human test subjects related to agency and consent. Two participants noted the lack of choice that research animals have in whether to act as test subjects. Yet both still argued for the necessity of animal testing, despite its somewhat coercive nature:There was a report in…. It was either the BBC or the Guardian that used the word guinea pigs, which obviously is very common. …[I]t’s not a fair way of describing participants because informed consent is such a massive deal, and we go to such huge lengths to make sure that participants are well informed and understand their rights to withdraw, and all that sort of thing. (CQI-0347).In this view, animal and human test subjects are quite distinct from one another, making comparisons via metaphors inappropriate.This emphasis on informed choice was echoed by another participant, who objected to the common guinea pig metaphor on the grounds that they (presumably unlike the guinea pig) consented fully to their involvement in research:To conclude, we reflect on what asking clinical trial participants about their fellow nonhuman experimental subjects can tell us about: (i) public opinion on animal research; (ii) the co-production of human and animal experimental subjects; (iii) how vaccine and medicine testing does, or should, change in an outbreak; and (iv) what public involvement can offer to science.Too often, discussions about animal research are highly polarized, with both “sides” of the debate seeking to characterize “the public” as agreeing with them . Yet, ouDespite its illegality in the EU and UK, cosmetic testing continues to loom large in the public imaginary, suggesting that even in this well-educated, pro-science public, substantial misconceptions about animal research persist. The frequent references to testing on chimpanzees  echo this idea. Yet, whether these lingering misconceptions present any substantial problem for science is debatable, since they did not prevent people from volunteering as trial participants. Instead, these misconceptions tended to arise in contexts where participants articulated their nuanced positions about the circumstances under which animal testing is justified, and the troubling yet reassuring use of highly intelligent, human-like model organisms. Misinformation was, therefore, in this context not necessarily an impediment to trust or involvement in science .One key point around co-production was participants’ view of animals  as the most suitable initial test subjects. The commonly held view that animal testing is reassuring, providing confidence in the safety of the vaccine, suggests a certain degree of faith in the model organism concept whereby animals are assumed to be reasonable proxies for humans, despite the known shortcomings of this assumption .Participants also expressed an overwhelmingly positive view of their own roles as test subjects, using guinea pig and lab rat metaphors (which carried slightly different connotations) to express their sense of contributing to society and protecting the vulnerable during a health crisis. Comparing oneself to an animal was in this context not intended to convey dehumanization  but rathWe might expect that animals used in vaccine testing would be similarly viewed as model citizens who use their bodies to protect vulnerable humans. However, participants saw an important difference between themselves and research animals as being animals’ lack of choice. This is not to say that participants believed animals cannot choose, but simply that they viewed animals as coerced in the research laboratory. Recent STS scholarship has highlighted how animals in the laboratory can still exert agency and shape the direction and results of research . Yet theParticipants did, however, view themselves as having freely chosen to participate in the vaccine trial and hence as fundamentally different to research animals. This view stands in contrast to the view commonly expressed by healthy phase I clinical trial participants in the UK in nonoutbreak contexts that they have “no choice” but to enroll , 73. OneThus, in an outbreak where the general public is affected by an illness and responses to it, there is a resulting change to the motivations and demographics of phase I clinical trial participants. There is also a change to perceptions of the requirements for preclinical animal research, with many participants viewing the shortened time frame of testing as understandable and even desirable. This view echoes discussions around what, if anything, can be learned from the rapid development of COVID-19 vaccines for other diseases, including the possibility that the experience could “prompt a regulatory rethink” around testing . For exaBecause trust in vaccines is ordinarily secured in part through large-scale testing over extended periods, relaxing efficacy requirements would require greater reliance on trust in scientists and scientific processes. As our data suggest, even in this case where animal testing was completed but the time frame was condensed, trust in science was important for participants’ willingness to be involved. Many pointed out that they are not themselves experts and had therefore placed their trust in the researchers. Participants’ frequent reminders that they are not experts suggests that they did not feel empowered to contribute technical knowledge in this context and that having experts guide them was important. This point resonates with a critique of “mode 2” science: that publics may prefer that experts take on leadership roles, and are frustrated by the “withholding [of] expertise” , 802.What our study participants did think they could contribute was not only their bodies as suitable test sites but also their perspectives on when, and why, animal testing is justified. Their reflections demonstrate how they might contribute to steering the direction and ethics of animal research through their personal beliefs and experiences, as a supplement to the more broad-brush picture presented by opinion polls  or policClick here for additional data file.Supplemental Material, sj-docx-1-sth-10.1177_01622439211057084 for Co-producing Human and Animal Experimental Subjects: Exploring the Views of UK COVID-19 Vaccine Trial Participants on Animal Testing by Samantha Vanderslott, Alexandra Palmer, Tonia Thomas, Beth Greenhough, Arabella Stuart, John A. Henry, Marcus English, Rebecca de Water Naude, Maia Patrick-Smith, Naomi Douglas, Maria Moore, Susanne H. Hodgson, Katherine R. W. Emary and Andrew J. Pollard in Science, Technology, & Human ValuesClick here for additional data file.Supplemental Material, sj-docx-2-sth-10.1177_01622439211057084 for Co-producing Human and Animal Experimental Subjects: Exploring the Views of UK COVID-19 Vaccine Trial Participants on Animal Testing by Samantha Vanderslott, Alexandra Palmer, Tonia Thomas, Beth Greenhough, Arabella Stuart, John A. Henry, Marcus English, Rebecca de Water Naude, Maia Patrick-Smith, Naomi Douglas, Maria Moore, Susanne H. Hodgson, Katherine R. W. Emary and Andrew J. Pollard in Science, Technology, & Human ValuesClick here for additional data file.Supplemental Material, sj-docx-3-sth-10.1177_01622439211057084 for Co-producing Human and Animal Experimental Subjects: Exploring the Views of UK COVID-19 Vaccine Trial Participants on Animal Testing by Samantha Vanderslott, Alexandra Palmer, Tonia Thomas, Beth Greenhough, Arabella Stuart, John A. Henry, Marcus English, Rebecca de Water Naude, Maia Patrick-Smith, Naomi Douglas, Maria Moore, Susanne H. Hodgson, Katherine R. W. Emary and Andrew J. Pollard in Science, Technology, & Human Values


The use of technologies that provide objective, digital data to clinicians, carers, and service users to improve care and outcomes comes under the unifying term Digital Health. This field, which includes the use of high-tech health devices, telemedicine and health analytics has, in recent years, seen significant growth in the United Kingdom and worldwide. It is clearly acknowledged by multiple stakeholders that digital health innovations are necessary for the future of improved and more economic healthcare service delivery. Here we consider digital health-related research and applications by using an informatics tool to objectively survey the field. We have used a quantitative text-mining technique, applied to published works in the field of digital health, to capture and analyse key approaches taken and the diseases areas where these have been applied. Key areas of research and application are shown to be cardiovascular, stroke, and hypertension; although the range seen is wide. We consider advances in digital health and telemedicine in light of the COVID-19 pandemic. The realisation that digital solutions can deliver support and real impact for healthcare, patient management and outcomes, as well as medical research has been a driver for new adoption of technologies —capturing a timespan of just over a decade. These dates were chosen to highlight current and developing trends. Resulting publications were restricted to those with at least one United Kingdom (or UK) affiliation, as well as having an available abstract. While the approach does not guarantee that a UK organisation/institution has led the research captured within the publication, it captures all those publications that are at least aligned to the UK. The exact search used can be found in 3.2.Network analysis was carried out using the Cytoscape software . Cytosca4.4.1.n = 119, n = 100), asthma (n = 98), hypertension (n = 92), diabetes (n = 69), dementia (n = 51), myocardial infarctions (n = 50), coronary artery disease (n = 33), epilepsy syndrome (n = 30), and schizophrenia (n = 30). Reports on digital health research and applications related to cerebrovascular disease peaked in 2020, with a reduction in the number of publications in the following year ; these terms were divided into two groups for presentation purposes .n = 466), “Smartphone” (n = 444), “Mobile applications” (n = 429) and “Software” (n = 341). The least common associations were with the terms “Digital divide” (n = 8) and “Telerehabilitation” (n = 13).The term “Telemedicine” was found most frequently in the analysed publications , followed by “Internet”  to include video-consultations, text message reminders to take medicine or exercise; and other mobile applications and methods for people to access their health information. Empowering telemedicine (remote diagnosis and/or patient treatment), and the availability of molecular phenotyping such as whole-genome sequencing, are driving forces that can augment healthcare. Furthermore, artificial intelligence (AI) approaches, applied to single- or multi-dimensional healthcare data, can enable new approaches in diagnosis, decision support, and treatment.In this work, we examined the growth and possible links of interest between diseases, age groups, and digital health approaches, methods and applications. By mining textual information captured within biomedical publications associated with at least one UK-based author, in the form of MeSH descriptors, and their co-occurrences, we identified patterns and associations that elucidate the scope of the current landscape of UK-aligned digital health research. Co-authorship across country borders on some submissions to learned journals may occasionally indicate a lower involvement of UK researchers. In general however, rules and guidelines for authorship mean that awareness and commitment to the research is clear for all authors.5.1.via telemedicine . Anticipatory care (with community services), personalised care, cardiovascular disease case-finding, and, tackling inequalities, start soon. The use of telemedicine in meeting some of these requirements is to be seen as an advantage. Negative impact on the doctor–patient relationship, the quality of the physical examination, and the quality of care have all been highlighted as issues in telemedicine as well as the need for appropriate infrastructure and investment to work effectively  and over 40% of those aged 75 + do not use the internet  compared to a private sector investment of about £250 million. A 2015 report commissioned by the Office of Life Sciences on digital health in the UK has identified the UK as an early adopter of several areas in the digital health market, such as telecare and primary care electronic health record systems . In partnovation  has descnovation .In other words, the activation energy required for changing behaviours with respect to apps has likely been modulated by the pandemic. This then enables further initiatives on digital health to potentially proceed more rapidly. This does not however, diminish the legal, ethical, safety, access and privacy issues that need to be addressed post COVID-19, neatly summarised by Budd et al. . Other evia Cochrane reviews. This is because peer reviewed publications remain a form of currency in acceptance of changes in healthcare practice. Abernethy et al. .Understanding the rate of pace of change in the size and the shape of the digital health economy, and progress in further adoption can be, in part, achieved by measuring research outputs and y et al.  have def5.6.It should be noted that some of the trends observed by this study, especially in association with digital health technologies, could be, at least in part, a reflection of the evolution of the language researchers use to describe technology or advances in the technology itself. For example, a switch from using the terms “cell-phone” or “mobile-phone”, to “smartphone”. This in turn could skew some of the conclusions drawn. Further, UK activity was determined by inclusion of at least one UK-based author, even in cases where research may have been led in other countries. There is the caveat that some articles considered are inclusive of international collaboration and globalisation phenomena which may slightly alter data interpretation. In future work we will assess specific areas identified as very active in the UK and consider how healthcare can be ameliorated by improved education and research within the dynamic growth buds of Digital Health in the UK.One shortcoming is that industry do not necessarily publish their tools or findings to protect intellectual property. Nonetheless our aim has been fulfilled with the analysis of works published in learned journals.6.Through the mining of associations in published works, we have gained an understanding of the progressive development of- and trends in digital health using quantitative measures on peer reviewed publications. Importantly, the method includes an analysis of NHS activity which is fundamentally important in the UK to adoption and usage of new technologies at scale. This methodology has thrown up key points as described in the discussion. The data here and produced elsewhere, using this methodology, allow critical analysis of a field of research. Thus our tool can be used iteratively to monitor trends in the field. Furthermore, as neologisms are an aspect of this field, they can easily be included in the searches to maintain an up-to-date analysis of trends for patients, practitioners, and industry.


The divorce rate in China is rising yearly, and the concept of marriage is changing, triggering many social topics related to single parents. Among them, gender-awareness education for children in single-parent families is particularly worthy of attention, as there has been insufficient exploration of how parents transfer their gender role concepts to their children. This study conducted in-depth interviews with 58 single parents and children from 29 families in Suzhou and constructed the mechanism for intergenerational transmission of gender roles in single-parent families based on grounded theory. It found that single parents' gender stereotypes, the starting point of the intergenerational transmission mechanism, have been diluted. It affords them a more enlightened attitude towards child-rearing style, and they expect more equality in the gender role of their offspring. However, in some parents' actual parenting process, when the children's sexualization behaviours exceed their acceptance range, they will communicate with children in an authoritative and didactic way to “correct” the children's behaviour. In addition to direct verbal instruction, parents' expectations of their children's gender roles will be implicitly conveyed through various parent-child interactions in daily life to affect the formation of their children's gender roles. In the intergenerational transmission of gender roles, external people  have horizontal socialisation effects on children to modify or strengthen the results of gender education from their parents. Under the comprehensive influence of the above factors, the children's gender roles are finally determined. These studies expand previous theories and studies and have significant theoretical and practical implications. China is a developing country, and the concept of marriage among Chinese families is also changing. In 2020, there will be 4.3 million couples divorcing in China, and the divorce rate will reach 3.1 ‰. The rising divorce rate has brought about many global social problems. For example, the economic and social resources of single-parent families may be relatively insufficient , unemploThe gender role is one of the important contents of individual socialisation, which is the gender and personality characteristics formed through a long process in a specific culture . It refeThe family microsystem has the most direct, initial, and powerful influences on cultivating children's gender roles . In raisMost studies have found that single parenthood negatively impacts children's gender roles. The children may have difficulty acquiring opportunities to learn the behaviour corresponding to their physiological sex if the single parents have a different physiological sex than their children. This discourages their formation of androgyny and affects their identification with a certain gender role . Some reHowever, it has been argued that the gender roles of parents and children may be more flexible in single-parent families . ResearcIn conclusion, the family structure changes due to parental divorce, and the intergenerational transmission of gender roles may also be affected positively or negatively. It is worth further exploring how the gender role constructed by parents transfers to children in single-parent families in a single-parent family system.22.1Suzhou, Jiangsu Province, which is characterized by “rapid economic development”, “significant divorce rate” and “rapid integration of migrant population”, occupies an important position in China's economic and social development. In 2022, the Gross Economic Product (GEP) of Suzhou is $33.381 billion, ranked as sixth in China . Suzhou 2.2This study adopted an intensity sampling strategy based on theoretical sampling principles to select typical cases with high information intensity. The only criterion for sample selection was whether it could provide new insights to build or deepen the theory . We did The researchers, with the help of Suzhou's local government, contacted 13 middle schools; data saturation was reached after in-depth interviews with 58 people from 29 single-parent families (offspring and their single parents). A single-parent family refers to a family in which only one parent lives with the child due to widowhood, divorce, separation, or being unmarried . In orde2.3At the beginning of the study, the researchers contacted 13 high schools with the help of the local Suzhou Education Bureau and obtained consent from the school authorities. Informed consent was obtained from all 29 guardians and their children for this study. Approval was also obtained from the ethics committee of Soochow University. The researchers explained the purpose and procedures of the interviews and that participation was completely voluntary and could be terminated at any time. The interviews were carried out over a span of 40 days, commencing in mid-November 2020 and concluding at the end of early January 2021. All participating parents were divorced and had been raising their children alone for a stable period. Researchers assigned each participant a number to ensure anonymity. The number is made up of four parts: (1) the first letter of the parent's name, (2) the first letter of the child's name, (3) a number indicating the order in which the interview was conducted, and (4) a lowercase letter indicating the specific member of the family structure. Thus, FS1 (f) represents the father in father-son family number 1 and MD2 (d) represents the daughter in mother-daughter family number 2.This study used semi-structured interviews. The researchers conducted pre-interviews with families around us before the in-depth interviews. The focus was on the issue of “gender role education in single-parent families” to provide a basis for the formal interview outline. All interviews were conducted on campus to ensure that the children were familiar and comfortable with the environment. And all were conducted in Chinese to avoid language ambiguity or barriers. The interviewers were psychology researchers trained in communicating with interviewees to ensure their ability to complete the interviews. The participants' demographic information was surveyed and recorded during the formal interviews. Questions related to single parents’ gender roles were emphasised, such as “What kind of personality do you think you have? What kind of career do you want your child to pursue in the future? What factors do you consider when taking care of your children in your daily life?“. There was no time limit for the interviews; it ended when the information reached saturation and the interviewees had nothing more to add. All interviews lasted between 40 and 80 min and were recorded throughout. The researchers converted all recordings into verbatim transcripts for subsequent analysis within 24 h of the interviews, yielding over 500,000 transcribed words.This study adopted a qualitative research strategy guided by Glaser and Strauss's Grounded Theory . Its' go33.1Parents’ gender role concepts mainly include recognising their gender role characteristics and having views on the different gender concepts in social culture.I used to think I could only be someone who did simple work, who couldn't do anything. But when I got divorced, I felt I could do anything and didn't need to prove it to anyone’. In addition, children in single-parent families had distinct feelings about their parents' gender behaviours that differed from their physiological sex and believed their parents played a more complex role in the family. As FD8(d) said, ‘My dad ties my hair every morning … and I think, well, he's just like a dad and a mom at the same time’. Such interactions may influence children's perceptions of their gender roles. As FD8(d) mentioned in the follow-up interview, ‘I am considered a tomboy all through the school; that's just who I am’.This study found that single parents' self-awareness was consistent with their physiological sex for most of their gender role characteristics. However, they also often had androgynous gender role traits. Single parents have to take on the responsibilities of both gender roles at work and in life, which may magnify their heterosexuality. Single parents who split up have to assume both gender roles at work and in life, which may amplify their androgynous gender role traits. This trait was evident in single mothers; as MS1(m) stated, ‘the man dominates the outside, and the woman dominates the inside’, perhaps because they often need to work outside the home and take care of the family. They believed the distinction between duties outside and inside the home should not just be based on physiological sex, but on ‘whoever has the time to do it’ (MS2(m)), or ‘Whoever has the ability to earn money. It is not necessary to divide who is the main worker’ (MS1(m)). They also believed that the differences between men and women were mainly physiologic , so they held more open views on those occupations with obvious gender labels. For example, MS2 (m) said, ‘I think it's great’ that men choose to be kindergarten teachers or nurses as a career. These perceptions of single parents implicitly influenced their offspring's perceptions of gender roles and the division of labour in the family. For example, the daughter in the FD4 family, whose father was responsible for household chores, disagreed with the traditional division of labour between males and females, saying, ‘I grew up in an environment where it was unnecessary for men outside and women inside, like my father can do (housework) and he does it when he has time, so I think men should do housework too’. However, this study also found that a few parents still had traditional gender stereotyping. For example, a minority of the single parents interviewed believed that women were more attentive than men and, therefore, better suited to domestic work; men, on the other hand, were better suited for heavy labour or mechanical jobs. Overall, only a small number of respondents held this view. The single parents interviewed were more inclined to hold gender equality views.Single parents were less likely to agree with division of labour and gender differences, such as ‘3.2Parents’ gender-role parenting of their offspring can be divided into two aspects: parent-led gender-role expectations for their offspring and child-led gender-role-free development.You can't depend on anyone because this society is very realistic, and if you depend on others, you will be eliminated by society’. Single mothers have similar parenting attitudes towards their daughters. For example, MD1's (m) requirement was that her daughter be ‘an independent person who can help others and also have a sense of responsibility’ and MS1(m) emphasised ‘educating him to be a man with responsibility and commitment’ when dealing with her son. Single fathers' requests to their sons were more direct. FS2 (f), for example, told his son, ‘You have to be responsible’, while FS3 (f) emphasised the importance of strength, telling his son he ‘must be strong because you are a boy’.Some interviewed parents believed that their own families could not provide a strong guarantee for their children after a divorce. Therefore, single parents emphasised their offspring's “independence”, “strength”, and “responsibility” when it came to gender role expectations. For example, FD7 (f) mentioned the requirements for her daughter, ‘stability of occupation’ regarding what they wanted their sons or daughters to do in the future. MS9 (m) expected her son to have ‘a stable job with a good skill’, MS6(m) hoped her son would work as an ‘office clerk’, and FD1(f) hoped that he could help her daughter ‘find a stable job’, showing that single parents did not show gender-specific expectations regarding their children's careers.Single parents emphasised the ‘Because I have more time, I also cooperate with her. For example, we wear a Chinese costume , and go for a walk on Pingjiang Road . I feel quite good’. Parents also expressed respect for their children's future job aspirations; for example. MS5(m) said, ‘Since he chose this, like a male kindergarten teacher or a gynecologist, right? I'm sure I'll support him’.Most parents believed they gave their offspring freedom during their gender role development, respecting their independent choices. This was mainly reflected in parents giving their adolescent children some right to decide their affairs. For example, most parents allowed their children to choose clothes and interest classes independently and participate in some outside-the-home activities. Some parents, such as MD2(m), even participated in those activities with their children: ‘I'll give you a chance today; I won't say anything to you, do you know how to do it? Throw it in the trash’. After that, he stopped giving his daughter pocket money and repeatedly said, ‘I'm very angry, where did you get the money, how can you buy lipstick, how old are you still’.However, further research showed that although single parents allowed their offspring to develop their cognition freely, it was still difficult for them to implement their behaviours fully. The parents praised their offspring and reinforced behaviours that conformed to their expectations, but criticized behaviours they saw as unacceptable. For example, FD8(f) believed his daughter should not use lipstick in junior high school, so when she unintentionally took out her lipstick, he said angrily, ‘3.3The parents transmitted their gender role concepts and awareness to their offspring through explicit (direct praise or criticism) and implicit (various other forms of parent-child interaction) means. There were also gender differences in the proactivity of single parents’ parent-child interactions.wash the dishes after dinner (FS2(s))’. In addition, tutoring was a special and very common form of parent-child interaction. The entrance exam is one of the most important educational events in a Chinese family; as such, Chinese parents attach great importance to their offspring's academic performance, and the children's test scores generally inspire praise or criticism. Different gender role characteristics were reflected in the tutoring process, impacting the children's gender role development. For example, MD8(d) mentioned that her parents had different tutoring styles: ‘Dad was there to teach me, and then I still didn't know how to do it, so he hit me, it made me cry. Then my mom scolded him, and then my mom taught me. The good kind of guidance is a very gentle kind of teaching me, and I did not cry, just listen to her guidance’. However, in single-parent families, the offspring relied on the sole parent's teaching and had to “correct” their own “mistakes”. As MS9(s) mentioned, ‘when there are most arguments about tutoring, it's always my mom who is right and good, and I always wrong’.Single parents directly informed the children through verbal instruction and indirectly conveyed their expectations through diverse parent-child interactions. For example, in most single-parent families, children were required to share the household chores to compensate for the absence of one parent. In particular, the children in the “Father-Son” families were often required to do housework such as ‘I work late and come back after she has gone to bed, and then I leave very early in the morning. Basically, there is little opportunity for communication’. FD6(d) said, when asked about her father's companionship, ‘he is at work and has no time for me’. The parents were aware of this problem but did not have good ways to deal with it. For example, MS9 (m) mentioned, ‘Now I do not have much time to take care of him or to tutor him, which may cause him not develop some good habit’.Several parents also said they had little opportunity for parent-child interaction because they were busy with work. FD5 (f) had little time to communicate with his daughter because of his early morning and late evening work: ‘talk like friends’ with their children. MD2(m) said, ‘I know she loves me too, but I want her to express something. Be able to express it, meaning not just let me feel it, let me hear or see it, express it directly’. Such expressions were less common among single fathers, who were usually more restrained in dealing with their children and showed passivity in parent-child communication. For instance, when FD6(f) mentioned parent-child communication, he emphasised, ‘I am sometimes embarrassed to say it, it is my mother who talks to her’. FD5(f) also showed passive characteristics in parent-child communication; when communicating with his daughter, he usually ‘just made a quick comment’, adding that ‘it's up to her to listen or not’. The offspring's willingness to communicate with their parents will be weakened if the single father is passive, retreats in parent-child communications, and is unwilling to accept their gender role teaching. As FD3(d) mentioned in the interview, ‘Usually when he says these things like how girls should be, I just change the subject or shut up immediately’.Single mothers showed a more positive and proactive willingness to communicate with their children than single fathers. Most single mothers in the interview were more inclined to express their love to children directly, saying that they were willing and able to ‘3.4There are many special parenting challenges in single-parent families; divorce can lead directly to personality changes in both parents and children, and gender role transmission is more difficult when the child's physiological sex differs from their single parent's. Single parents must consider how to communicate with their offspring about divorce.After the divorce, I think I can do everything’ (MS1(m)). However, some single mothers expressed their helplessness and feelings about the absence of men in the family. MD9(m), for example, mentioned that ‘Women, without men, definitely can't do anything. Have no motivation to do anything’. In addition, single parents' androgynous characteristics were amplified after divorce; for example, MS9(m) mentioned that her personality became more masculine after divorce; ‘So I feel like I've become a bit of masculinity and have to be strong myself’. The offspring's gender role characteristics also changed in some respects; MS4(m) emphasised that her son became ‘grumpy’ and ‘irritable’ and believed ‘the changes in the family that may have led to these negative changes. Before it was quite good’.Parental divorce is an important experience for whole-family life. The interviews revealed that single parents' views on the division of labour and their perceptions of their gender role characteristics changed after their divorce as they had to bear a burden once shared by two people. Some parents thought themselves fully capable of coping alone: ‘I talk to his mother about the children's education, and what I don't understand about … I communicate with her occasionally about education issue’. Accordingly, FS1 (s) had a more positive perception of female gender roles. Similarly, FD3 (f) had a negative evaluation of his ex-spouse, and his daughter (FD3 (d)) voiced disapproval of traditional female gender roles: ‘Why must all girls be a great lady?’The offspring's perceptions of a particular gender were also influenced by the single parent's post-divorce comments about their ex-spouse. When their comments were positive, their offspring were more likely to have a positive perception of the ex-spouse's gender; when they were negative, so were the offspring's perceptions. For instance, FS1(f) had a generally positive perception of his ex-spouse and they communicated about their child's education: ‘I might kind of like to look for his dad in him’ (MS7 (m)). However, most offspring did not share this projection, which may be generalised as disapproval of certain gender roles. As FD3 (d) directly stated in the interview, ‘My dad keeps saying how you're exactly like your mom … I wish dad wouldn't keep associating me with my mom like this way.’ In contrast, such projections by single parents were not found when their offspring and ex-spouse's physiological sex differed.In addition, this study found that when the child had the same physiological sex as the ex-spouse, some parents confessed to projecting their perceptions of the ex-spouse onto their offspring, ‘Since our divorce, he misses his mother's love’. FS3(f) also mentioned that his son missed his ex-wife after the divorce: ‘he is separated from his mother and wants his mother very much. He misses his mother very much’. They found it difficult to make up for this sense of loss and could do little more than ask their children to ‘be strong’ and ‘not to cry’. FS3(f) would say to her son, ‘Be strong and don't cry out. Don't cry. But it is normal to cry, and I want to teach him that this is the way to be strong as a boy’. All these interactions were integrated into their children's gender role development.In the study, most single parents felt guilty about the effect of their divorce on their offspring. FS1(f) said in the interview, ‘power’ as fathers when teaching their sons. She was concerned that her son ‘might be girlish if he keeps living with me’. On the other hand, single parents felt ‘some things are not easy to talk about’ (FD6(f)) when dealing with children of the opposite physiological sex, such as fathers dealing with daughters' menstruation. Single fathers clearly felt the parenting difficulties caused by the absence of one gender role from the family; FD5(f) kept saying: ‘If only her mother were around, she could tell her about menstrual problems’.One of the main reasons single parents face difficulties in their gender parenting is that the dislocation of one parent's role results in the absence of a major role model from the child's gender role development process. Although the single parents thought there was no obvious difference between their and their ex-spouses’ work and life abilities , they still faced insurmountable difficulties in their gender role parenting. On the one hand, parents believed there was a lack of direct role models in their offspring's gender role development. For example, MS5(m) felt it difficult for single mothers to have the same ‘It's just that I spent less time with my children. Well, that I was probably too busy. I probably just, um, didn't have a good balance. I don't have a good balance, and I actually regret it a little bit now in terms of the children, but I had to survive first, right?’ Children's gender role development was also somewhat affected. FD8(d) mentioned that she had to learn many things on her own because her single father had to work to secure the family's income; ‘My father is the only one in our family who works and makes money, it was that time  when I couldn't even tie my own hair’.Single parents also had to spend more time working outside the home because the absence of one parent reduced the family's workforce, so they faced greater financial pressure. Thus, the single-parent children in the study often lacked their parents' companionship. The single parents felt helpless about this; as MS9(m) said, ‘3.5The external influences of others on children's gender role development in single-parent families came from two main sources: teachers and peer groups in the school, and the ex-spouse and family members other than the single parent.My father said I should be strong, and many teachers said the same thing’. In addition, the children compared their behaviour with traditional social and cultural conceptions of gender roles, using their peers' behaviours as a reference object. For example, FD4(d) mentioned, ‘I think the girls in our class are quite happy and lively, but I don't think they are like traditional girls. I can't find any more traditional girls in our class'.The single parents interviewed indicated that their children spend more time in school than with them, suggesting teachers and peers could significantly influence their gender role development. Teachers' important influence in this research was shown mainly in their ability to reinforce or modify single-parent children's gender role upbringing. For example, FD7(d) stated, ‘I used to tell my grandmother when I was upset, and she would always listen to me (FD5(d))’.Single parents repeatedly mentioned grandparents' involvement in parenting, suggesting family members played a crucial role in children's gender role development, particularly when the single parent and child were of different physiological sexes. For example, in “Father and Daughter” families, grandmothers often had the responsibility of teaching granddaughters about biology and listening to their worries ; ‘my mother once said that girls already physiologically vulnerable, so you should be better in your career’. The single parents were well aware of this influence. FD1(f), for example, believed his daughter's character was deeply influenced by his ex-wife: ‘Her personality is the same as her mother's, which means that she has been quite sensible since she was a child’.In addition, the ex-spouse's influence over their offspring did not disappear after the divorce. The single parent's ex-spouse could give the children additional perspectives on gender roles, complement the single parent's gender-role parenting, and serve as a role model in the children's gender role development process. For instance, FD4(d) mentioned that ‘4This study used qualitative research methodology to construct a mechanistic route for intergenerational gender role transmission in single-parent families . It foun4.1Based on the interview data, this study identified single parents' gender role perceptions as the origin of the intergenerational gender role transmission mechanism in single-parent families, informing their gender parenting attitudes and behaviours and thereby influencing their children's gender role formation through both explicit and implicit transmission paths. The effects of changes in family structure were reflected in several aspects of the intergenerational transmission mechanism.Single parents were more open to characteristics once thought gender specific; for example, being “considerate” was often considered a female characteristic. This result was consistent with previous studies ,54. TheyAn individual's values can significantly predict their corresponding attitudes, influencing their decisions and behaviour . ParentsSingle parents with more egalitarian gender attitudes' expectations of their offspring's gender roles are less influenced by traditional gender stereotypes; their children's gender role formation is affected by more open gender parenting attitudes and behaviours and daily parent-child interactions. During this process, other people, including grandparents, teachers, and peers, have a horizontal socialising influence on the children, modifying or reinforcing the single parents' gender parenting. The children's gender roles were ultimately determined under the combined influence of these multiple factors.4.2In accordance with previous findings, our results further conformed that there is the discrepancy between the attitude and behaviour of single parents' gender role education . Most siThis inconsistency between cognition and behaviour could be because single parents' attitudes toward gender equality are not strong enough. There is still a traditional gendered division of labour in social life; for example, nursing, domestic work, kindergarten teaching, and similar occupations are dominated by women, while men inevitably dominate engineering, machinery, manual labour, and similar professions. This gendered workplace impacts and limits single parents' concepts of gender equality, preventing them from being applied across the board. Studies have shown that while parents do not perceive gender differences in their parenting, the amount of time they spend with their children varies according to their children's physiological sex .Previous studies have found that single parents' poor education efforts may be due to their lack of effective methods  and diffThis suggests that the government and relevant departments should effectively help single-parent families increase their social resources and provide effective support policies to meet parents' and children's special needs. In addition, the single parents in this study tried to uphold gender equality and respect their children's free development in terms of cognition, but it was difficult to achieve unity in their cognition and behaviour. Therefore, single parents should strengthen their more equal gender concepts, continue to learn scientific and advanced gender parenting methods, and implement open parenting in their behaviour rather than just staying at the cognitive level.4.3The intergenerational transmission of gender roles has two major pathways: explicit and implicit. This finding was consistent with previous studies ,69. The The implicit path refers to single parents imperceptibly transmitting their gender role concepts through daily parent-child interactions, such as parent-child activities, housework, and tutoring. Parents' gender behaviour in daily life was more likely to be the object of imitation than their direct gender parenting. Some studies have found that parents' gender behaviour is a better predictor of offspring's gender role attitudes than their gender beliefs . TherefoStudies have confirmed the correlation between offspring's perceived parenting style and gender identity . Single Interventions targeting single parents should prioritize resources and support to improve their parenting skills and promote positive parent-child interactions. For example, workshops, counseling services, and support groups specifically for single parents could provide guidance for effective communication strategies, conflict resolution and promotion of gender equity in family dynamics. In addition, providing community resources such as child care services, educational programs, and mentoring opportunities could alleviate some of the single parents' life challenges and allow them to devote quality time to nurturing their children's development. In summary, interventions for single parents should emphasize effective parent-child communication, promote gender equity in daily life, and recognize the importance of positive and harmonious relationships in promoting the healthy development of children's gender roles.4.4In line with previous works, our results also found that other family members (such as grandparents) in the home environment also influence children's gender roles. Teachers can reinforce or modify single-parent children's gender parenting, and peers are an important reference for children's gender role development ,78. ThisThe Chinese family model is characterized as “inhabited by small colonies” and strongly emphasised the value of the extended family. Due to China's economic and social development, parents must devote more time and energy to working, and “intergenerational education” has become an important supplementary form of parent-child education . As suchlisten to their teachers’, which gives teachers an important role in children's gender role development. Some children mentioned that their teachers ‘say the same thing’ as their parents do in their gender parenting. Teachers' education can complement and modify parents' gender parenting through verbal and non-verbal interactions. This finding was consistent with previous study [all the students in our class are also … ’ Campus peer groups have the effect of “abandoning the bad and promoting the good” in adolescents' personality development, supporting each other academically and emotionally and taunting children who play games that do not correspond to their physiological sex; children will intentionally adjust their behaviour to conform to gender role norms to be appreciated by their peers. Thus, school is an important personality socialisation site and plays an important role in guiding children's gender role development.In addition, China has emphasised respect for teachers since ancient times, and parents in modern compulsory education often emphasize that children should ‘us study : teacherVertical and horizontal socialisation mechanisms play interdependent roles in gender role formation . Therefo5This study used semi-structured interviews to collect saturated data from 29 single-parent families  on a household basis. It further constructed the mechanism of intergenerational transmission of gender roles in single-parent families through the qualitative research strategy of grounded theory. The mechanism presented four conclusions. Firstly, as the starting point of the intergenerational transmission of gender roles, the parents' gender role cognition influences their gender parenting attitudes and behaviours, which in turn influences the formation of the children's gender roles. Secondly, there is a discrepancy between the attitude and behaviour of single parents' gender role education. Although most parents in the interviews agreed that gender roles should be equalised in parenting attitudes, they were still prone to be constrained by traditional gender concepts in their behaviours, and took coercive measures to adjust their children's behaviours that were beyond their acceptance. Furthermore, the intergenerational transmission of gender roles consists of explicit and implicit pathways. The explicit pathway encompasses parents' direct verbal instructions to their children, while the implicit pathway involves single parents shaping their children's gender roles through various daily parent-child interactions, such as outdoor activities, household chores, and academic tutoring. Finally, the mechanism points out that grandparental education and horizontal socialisation are important complementary forms. The results of the study enriched the theoretical results of the intergenerational transmission of gender roles in single-parent families, and also had a guiding role in constructing the children's gender roles in practice.6There are several limitations to the current study that should be acknowledged. First, it used a cross-sectional design with a family-based qualitative research approach to explore the mechanisms of intergenerational transmission of gender roles in single-parent families. Grounded theory requires in-depth interviews with respondents to uncover as much underlying information as possible . To ensuSecond, the sample of this study was limited to the Chinese single-parent families, therefore the data may not be replicable to other cultural backgrounds. Some family background characteristics were not included in the sampling structure, such as the time since the divorce, whether the ex-spouse and offspring were in contact, and whether the children lived with their grandparents after the divorce. Future research could be refined in these areas to explore the effects of different variables on the intergenerational transmission of gender roles in single-parent families.Third, this study focused on how gender role perceptions were transmitted from single parents to their offspring. Although perceptions and attitudes were mainly transmitted from parents to children, the possibility that children may reciprocally influence their parents cannot be completely ruled out. Thus, the possible interaction between parental and offspring gender roles deserves attention in future studies.Data will be made available on request.All procedures performed in research involving human participants conform to the ethical standards of the Institutional Research Council and conform to the 1964 Helsinki Declaration and subsequent amendments. The study was approved by the Institutional Review Board (or Ethics Committee) of Soochow University (protocol code KY20220564B).National Social Science Foundation of China (grant numbers 18BRK039). In addition, we sincerely thank the teachers who supported and assisted the project research and the participants who participated in the project.The work was supported by the I-Jun Chen: Writing - review & editing, Writing - original draft, Funding acquisition, Formal analysis, Data curation, Conceptualization. Zisong Chen: Writing - original draft, Resources, Project administration.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.