American Indians (AI) face significant disparities in HIV/STI morbidity and mortality, and historical, structural, interpersonal, and individual level barriers stymie prevention efforts. The objective of this paper is to examine barriers to HIV/STI prevention among reservation-based AI. We conducted face-to-face qualitative interviews with 17 reservation-based AI community leaders and community members in Southern California on HIV/STI knowledge and attitudes and barriers to prevention. The disruption of traditional coping mechanisms and healing processes were compromised by historical trauma, and this allowed stigmas to exist where they did not exist before. This impacted access to healthcare services and trust in medicine, and is linked to individuals adopting negative coping behaviors that confer risk for HIV/STI transmission . Most of the participants reported that HIV/STIs were not discussed in their reservation-based communities, and many participants had a misperception of transmission risk. Stigma was also linked to a lack of knowledge and awareness of HIV/STI’s. Limited available services, remoteness of communities, perceived lack of privacy, and low cultural competency among providers further hindered the access and use of HIV/STI prevention services. These findings highlight the need to address the historical, structural, and interpersonal factors impacting individual-level behaviors that can increase HIV/STI transmission among reservation-based AIs. Prevention work should build on community strengths to increase HIV/STI knowledge, reduce stigma, and increase access to preventative care while using culturally grounded methodologies. At the end of 2018, approximately 1.2 million people were living with HIV in the United States . DespiteHIV/STI disparities among AI/AN cannot be explained fully by differential involvement in behaviors, such as substance use and risky sexual practices, which increase disease transmission risk . Access Communities that are affected by, or at risk for HIV, must be actively involved in prevention efforts to ensure the buy-in and cultural appropriateness of prevention efforts. Community engagement is particularly important in AI/AN communities. Although previous work has identified factors that are related to HIV prevention among AI/AN communities ,14,15,16We conducted a cross-sectional qualitative study using a semi-structured interview guide to capture in-depth information on the barriers and facilitators to HIV/STI prevention among reservation-based AI. The study population involved a multi-tribe consortium served by a Southern California Tribal Health Clinic (SCTHC). This work was conducted in a region that has been ranked as being in the top 10 of all U.S. counties with the highest rates of chlamydia and gonorrhea in 2018 . It is aA total of 17 interviews were conducted with community leaders and community members, at which point saturation of themes was achieved. The participants were 18 years or older who either worked in the community or were a community member. To protect participant and community confidentiality, participant sex and age were not collected in order to limit the amount of identifying information on record. This decision was made in consultation with the tribal IRB and tribal members.Recruitment was conducted using purposive sampling and targeted outreach methods to recruit diverse perspectives from community members, community stakeholders, tribal leaders, and service providers. The goal was to capture a diversity of HIV/STI attitudes and perceptions across the consortium reservation region. We worked closely with community leaders to ensure that we were obtaining diverse perspectives on HIV/STI in the community from participants who have experience/knowledge of the local health concerns within the community. Qualitative interviews were conducted to obtain information on HIV/STI knowledge and attitudes and barriers to HIV/STI prevention. The semi-structured interview guide was developed in collaboration with community members and leaders, and with feedback from the tribal Institutional Review Board (IRB) to ensure that it was appropriate for use in the local context. The guide included questions, such as: (1) What are the top health concerns in your community? (2) How big of an issue is HIV/AIDS in your community? (3) Where do members of your community find information about HIV and STI? Interviews were conducted in a private setting at the health clinic and local community venues. The interviews lasted up to one hour in length, with an average interview length of 41 min. Participants were compensated $20 for their time. Interviews were audio recorded and transcribed by a HIPAA-compliant independent transcription service. Research staff verified the transcription accuracy and removed all personal and community identifying information. All of the participants provided written informed consent prior to the start of the interview. The study protocol was approved by the Institutional Review Boards (IRB) at the University of California San Diego  and the SCTHC that represents the multi-tribe consortium (Approved: 14 March 2019). This manuscript was also reviewed and approved by the IRB at the SCTHC (Approved: 26 January 2021).MAXQDA 10  was used to manage qualitative data, coding, and analysis. Two team members conducted a thematic analysis independently and a codebook was developed during the reviewing process of the transcripts. Codes were deductively developed from the topics in the interview guide and inductively developed from additional topics discussed during the interviews ,18,19. CFour overarching themes emerged from the data: (1) Historical/Intergenerational Trauma, (2) HIV/STI Related Stigma, (3) Misperception of Risk, and (4) Privacy/Mistrust in Medicine. The four overarching themes highlighted the historical, structural, interpersonal, and individual level factors impacting HIV/STI prevention with the multi-tribe consortium. Within and between each of the four themes, the identified barriers operated on different social-ecological levels and were largely interrelated, reflecting the complex interplay between historical, structural, interpersonal, and individual factors. For example, many of the barriers stemmed from infrastructure problems that limited knowledge about HIV/STIs, increased stigma, decreased availability of testing and prevention services, and led to a general lack of trust in medical institutions that provide care. Community members highlighted the impact of historical and intergenerational trauma on both access to, and engagement in, care and prevention. Many community members discussed the impact of colonization on behaviors and health outcomes. That comes from a lot of the historical trauma, which they don’t understand—right?—and the intergenerational trauma. Um, and our older family members, um—they’ve just been exhibiting—they’ve just been doing it [dealing with historical trauma] for so long it’s—it’s normalized.The legacy of historical trauma was described as coping behaviors that are passed down from generation to generation through behavior modeling. Younger community members learn to enact coping behaviors that are modeled by previous generations. Without the stable presence of adults  modeling healthy coping behaviors, many AI/AN youths are vulnerable to adopting negative coping behaviors. And it just—uh, families, you know, um, teaching their kids what’s right and wrong from wrong. A lot of families—lot of family members grow up, no dad, no mom, so you can kinda tell someone’s—where they’re gonna end up in 10 years, you know. But, uh, it’s—a lot of the tragic stuff does happen to ‘em, so they do go and they get curious, and they go into that, you know, whether it’s be drugs or even sexual activity.Participants also discussed community members not wanting to deal with historical/intergenerational trauma, including mental health problems which result from this trauma. For example, AI/AN community members may use maladaptive coping behaviors, such as avoidance , in reaction to trauma that they or their communities have experienced. But we know when people are not feeling good about themselves or they’re depressed or they’re suicidal or somethin’ like that, you know, they’re—they’re—they’re gonna start making risky behaviors or decisions, and, you know, that, uh, often re—often leads to risky sexual, uh, decisions, so I think that plays a huge role.In addition to impacting the behaviors of community members, historical/intergenerational trauma was also discussed as causing a disconnect from cultural values and introducing stigma in their communities. Participants discussed how the colonization of tribal communities introduced the concept of shame, which negatively impacted the culture of AI/AN communities.And, you know, uh, the—the—the boarding schools did a really good job at, you know, bringing on the rest of the shame that we didn’t have, and we didn’t even have a word for shame in our language, you know, prior. So I think that’s a—the—a huge role in where we’re at here, 300 years later, you know.During discussion of shame as a construct introduced during colonization, AI/AN participants described ways in which the experience of shame led to cultural changes. For example, shame impacted one’s experience and reactions to puberty and the sharing of knowledge regarding sexual practicesYeah. So like in the traditional culture, uh, you know, when, uh—let’s say for—for a little girl, for instance, when—you know, today when they have their period it’s kinda like a thing—a thing of shame, and—and they often hide it, and they don’t tell their parents, and—and—but in the old culture, you know, they were revered. They were celebrated, and they were taught, you know, um, how to care for themselves, and—and I know they were even taught, you know, uh, by other women, adult women, you know, how to be a good lover, and how to have sex correctly, and—and—and, uh, you know, it wasn’t—it wasn’t a taboo issue.The participants discussed how various forms of historical trauma  resulted in significant changes in their communities, including the loss of cultural practices and the introduction of shame. Shame, in turn, led to individuals adopting negative coping behaviors that confer risk for HIV/STI acquisition and prevent the use of HIV/STI prevention services.Not only does stigma stymie conversations about HIV/STIs, among other topics, it also impacts community members’ willingness to engage in prevention services, testing, and care. I think there’s, like, a maybe a stigma with HIV. A lot of people know about it, but they’re not really too familiar about it, or if they have it, you won’t really know, or you’ll hear someone—hey, they might have that, and so, uh, a lot of hearsay. You know, small community, word gets around…Community members fear both the loss of their anonymity when visiting the tribal clinics and the potential for becoming the focus of hearsay within the community. Some of the participants stated, if a patient is seen receiving services or treatment by someone they know, community members might spread this information. Uh, gossip talk like that. Um, uh, STIs, I mean, obviously it happens. You know, I mean, uh, j-just awareness, I think, is the biggest thing, a big thing for that, um, yeah.The hindering effect that stigma has on testing for HIV/STI and seeking services for other stigmatized conditions also leads to a lack of awareness about disease status and prevention methods. This may increase the potential for increased rates of HIV/STIs in the community. The silence from disease stigma facilitates progression to more severe disease within the community, as both the prevention and treatment of disease are under-utilized services. I don’t think anybody ever feels comfortable because that’s an admission of something that you might have done. Or—or reckless behavior. HIV was often discussed as a problem of the past and not a current concern among community members. Most of the participants said that they never knew or heard of someone being infected with HIV, and they perceived that rates of STIs were low in the community. For example, one participant reported being unaware of anyone being infected with HIV or STIs in the community. I don’t think they’re really aware of the, I mean, I’m sure they are aware of ‘em, but they don’t, I think most people don’t think that they exist here in our communities. Um, it’s not, um, that common to have somebody in the community that’s infected with anything like that, um, as far as like AIDS or HIV. Um, as for the other smaller like, you know, like chlamydia and gonorrhea and stuff like that, you do hear about that every now and then. Perceptions of low prevalence and risk of HIV/STI appeared to be a factor contributing to the absence of discussion about HIV in the community and the lack of community awareness about HIV/STI prevention services.Yeah. I think for the community, it’s not on their minds because they don’t hear it, they don’t see it, they haven’t heard HIV/AIDS since the 90s… So, um, some people might be under the impression that it’s been cured. The participants also stated that community members will not engage in conversations about HIV/STI unless a community member in their social circle becomes infected. Participants do not believe that the community members, especially tribal elders, are comfortable engaging in more in-depth HIV/STI-related discussions due to the stigma and taboo nature that is associated with these topics.Man, I think that starts in the home. I think, uh—I think the adults are gonna have to be educated better, and—and—and then, you know, carry that on in the home. As that—you know, the-the—those—those kinds of topics, you know, where, uh—where—became taboo through, you know, forced religion and—and stuff like that, and so, you know, the—our older generation, they—they didn’t have the knowledge because it wasn’t somethin’ that was taught to them in boarding school—.Participants attributed stigma and the lack of educational resources on HIV/STIs as drivers of the silence around HIV risk behaviors, including sexual behaviors and substance use. The participants reported that most people in need of HIV/STI testing and/or treatment would be afraid of going to local clinics due to stigma and fear of questioning from their provider or others at the clinic. This fear is further exacerbated by the rural nature of the consortium communities that are geographically isolated from neighboring communities and have limited access to transportation. The distance and access to transportation creates a barrier for those who need to seek HIV/STI services at local clinics, which can be up to a 45-min. drive for community members. Further, if community members want to attend a clinic outside the community—either because services are not available at the local clinics or because they want to avoid seeing someone they know—the drive is even farther. There’s a transportation problem, so anything outside of the [local] clinic, because of our population—a lot of it is very rural. There’s not always—there’s—there’s almost no public transportation in those places, and so to get access to those services is—is almost—i- it’s basically impossible.When people are able to access services, a willingness to engage in care and be tested for HIV/STIs is further hindered by mistrust in medical systems. Medical mistrust has stemmed from historical problems that involve these institutions, particularly problems with the historical mistreatment of AI/AN by medical systems, as well as issues related to privacy. A lack of perceived privacy when seeking services was a prominent barrier to seeking and receiving treatment reported by participants. Participants reported the small community population and interwoven familial relationships make it impossible to maintain anonymity when seeking medical services. The participants reported that they would not seek services or disclose medical information to their provider if their friends or family work at the clinic and/or have access to their medical records. The fear of lack of privacy becomes elevated for those seeking services, especially if the services pertain to stigmatizing issues, including sexual health, substance abuse, or mental health. don’t trust it, um…and I do see that a lot in the community, um, but they have no other resources to go to, so they have to go to the [local] clinic.Given that local clinics are often staffed by community members, people are afraid of their information getting out. But, um, I think they’re reluctant to come in if they know that they’re gonna see somebody they know. So sometimes it’s because of our own—our own families may not get the services that they normally would, because I might be checking you in the front desk. Um, that might be a barrier. Or to get my HIV medication from a cousin who works in the pharmacy.There were multiple perspectives about privacy and trust from participants.No, not so much. They don’t trust—trust clinics so much. They—’cause, like, the [local] clinic, you know, everybody knows people, you know? You know? And everybody talks out here. And everybody knows somebody and yeah. So people—people like ch- tend to, like, go away—go out of here somewhere else, you know, to get—for—for services like that.The participants also emphasized the need for cultural competence  from providers, which was discussed as a barrier to establishing a trusting patient–provider relationship and helping community members to seek care and prevention for HIV/STIs. The participants also discussed the lack of comprehensive care, such that medical professionals may not ask questions related to STI/HIV risk and prevention. A barrier to establishing quality care by tribal service providers stems from the lack of experience and knowledge regarding sensitive or stigmatized health issues in the community. This creates an additional challenge for community members, as they must seek knowledge from multiple sources regarding their health issues.And—and—and it’s hard to find a lot of Indian people, you know, or, um, minority people that—to—to—to have that education and have that—that—that strength so that you can relate, you know, to—to—to somebody? You know?These issues are further exacerbated by community members not feeling comfortable talking to clinicians about their health issues due to the perception of high staff turnover and that services are not consistent throughout their visits.Yeah. Um, there’s like a lot of like people that I know that have, um, struggles with going to the clinic and talking to someone. Um, I’m even one of ‘em that I stopped going…because every time I would go, it was like s—they were s—phasing ‘em out or—you know...This qualitative study that involved interviews with AI/AN community members and leaders in Southern California provided rich contextual information on barriers to HIV/STI prevention. Historical/intergenerational trauma was described as having broad impacts on the community, including the health of community members. AI reservations are often tight-knight communities given their remoteness and rurality. We found privacy concerns and the ability to maintain confidentially around one’s sexual health to be barriers in accessing prevention services in this setting. The participants also indicated stigma hindered discussion surrounding HIV/STI-related topics in the multi-tribe consortium. Most of the participants reported having never heard about anyone in the community having ever being infected with HIV and, therefore, assuming risk of HIV/STI infection was low. However, national surveillance data show that the region where the reservations are located have some one of the highest rates of chlamydia and gonorrhea in the U.S. . DevelopLimited access to private or public transportation was identified by the participants as a barrier to accessing health services, including HIV/STI prevention. A lack of transportation to distant health care facilities has been previously identified as a prominent barrier to accessing healthcare in other AI/AN communities ,21. In sParticipants discussed multiple types of stigma and shame. HIV/STI related stigma in healthcare settings was discussed as being a barrier to seeking care and engaging in prevention services. Further, stigma from community members and family was described as preventing people from discussing HIV/STIs. The multiple and co-occurring forms of stigma and shame that are described by study participants are situated within a framework where historical traumas  provide the context for understanding contemporary stressors  and the impact that these stressors have on AI health  ,29,30. TA lack of knowledge and misperception of personal risk were also identified as barriers to HIV/STI prevention efforts, suggesting a need for culturally tailored HIV/STI education along the life span. Most of the prevention efforts have been directed toward AI/AN adolescents, since they are vulnerable to risky sexual and substance use behavior during their sexual development ,32,33,34Moreover, although our study suggests a need for increased HIV/STI education, other studies have found that increased HIV knowledge among AI/AN does not necessarily lead to decreased HIV risk behaviors ,36. RathHIV/STI prevention efforts may be potentially more impactful and sustainable if they capitalized on the strengths and existing resources of AI/AN communities. Involving tribal communities through ongoing community-based participatory research (CBPR) is one approach to identifying barriers to HIV/STI-related services. CBPR involves the community at all stages of the research process in a collective and reflective process to ensure that community perspectives and knowledge help guide the objective, design, and conduct of the research. CBPR has been shown to be critical in building a sustainable research infrastructure and for implementing strategies to improve health outcomes in AI/AN communities, including efforts to address HIV . The actThis study had a few limitations that should be taken into account when interpreting the results. First, while the saturation of themes was concluded by our team, it is possible we did not capture all perspectives about barriers and facilitators to HIV/STI prevention given the stigma surrounding HIV/STIs that may have inhibited the sharing of information by participants. Given this, our results may not generalize to all rural and semi-rural AI. However, these findings are useful for understanding major barriers to HIV/STI prevention that can be further explored in future studies. Second, we were unable to record participants’ sex, age, or tribal affiliation/location in order to limit the identifiable information and protect participant identity in accordance with tribal IRB. While this information could add additional context to some of our findings, we worked closely with community members and community leaders to recruit a diverse group and capture a variety of perspectives. Future qualitative and quantitative studies with a larger sample size should also collect additional contextual information to confirm and expand on these results as we work to create a community drive prevention program for AI.As found in this study, barriers to HIV/STI prevention among AI were rooted in historical and intergenerational trauma that led to increased stigma and shame. The adoption of negative coping behaviors to deal with historical/intergenerational trauma further hindered HIV/STI prevention efforts. Limited services and transportation, remoteness of the communities, privacy concerns, and the lack of HIV/STI knowledge also contributed to reduced engagement in HIV/STI prevention and care. Based on our findings, it is important that culturally grounded HIV/STI prevention programs are developed and delivered by providers who are knowledgeable about the unique challenges that AI may face when seeking HIV/STI care.


In the spring of 2020, schools and universities around the world were closed because of the COVID-19 pandemic. The relative lockdown affected more than 1.5 billion learners as teachers and students sheltered at home for several weeks. As schooling moved online, teachers were forced to change how they taught. In the research presented here, we focus on university mathematics professors, and we analyze how their practice, knowledge, and beliefs intertwine and change under these circumstances. More specifically, the context of the pandemic and the relative lockdown provides us with the experimental basis to argue that the new practice affected both knowledge and beliefs of mathematics teachers and that practice, knowledge, and beliefs form a system. Being part of a system, the reactions to change in practice can be of two types, namely, the system as a whole tries to resist change, or the system as a whole changes — and it changes significantly. The research presented here proposes a model for describing and analyzing what we called a teaching system and examines three cases that help to better depict the systemic nature of teaching. During the pandemic spread at the beginning of 2020, almost all schools and universities were closed, and teachers had to rapidly re-organize their practice to provide online learning environments for their students .Parallel to teacher knowledge, a central role for beliefs emerges: that is, not only what a teacher knows, but also what a teacher believes, impacts what and how they teach Ball, . Green  investigBy nature, beliefs are also “hidden” , usually immersed in a constructivist environment Ball, . This meWe propose to model this reciprocal influence as a connection between practice (labeled as “P”) and the belief system (labeled as “B”). Furthermore, we consider P and B as nodes in a graph, and we draw an undirected edge  between them to represent their connection and reciprocal influence see Fig. .Fig. 1TAnother method for producing changes in belief structures has emerged from the work of Rolka et al. , in whicFinally, there is a connection between practice and knowledge, as recalled in the previous paragraphs Hurrell, , 1987. Tteaching system  a need to rapidly, with little to no preparation, transition instruction online; (2) execute the transition online and subsequent online instruction under traumatic conditions of a pandemic; and (3) pursue extended online teaching with little to no information regarding if this transition to online teaching will be temporary or more permanent. We assert that these three factors constitute crisis online course transitioning and teaching as opposed to conventional online course transitioning and teaching (p.3)The peculiarity of the COVID-19 pandemic is that teacher practice has been forced to change: teachers had to adjust their teaching in order to provide digital (in place of in-classroom) teaching to their students. In Cutri et al.’s  words:DuFor us, this represents an opportunity to explore how a forced change in practice has an effect (or not) on beliefs and knowledge and for exploring the P–B–K system as a whole.If our conjecture on the systemic nature of teaching holds true, then, when a change in one of its three elements occurs, either the system as a whole tries to resist the change and to repair the damage, maintaining its status as it was before the perturbation , or the system as a whole changes, and perturbation propagates through the other elements . Specifically, we investigate if a change in practice can direct us to consider teaching as having a systemic nature and, thus, if we can observe either scenario mentioned above.The COVID-19 lockdown affected up to 1.5 billion learners spread over 194 countries see Fig. . To imprforce majeure as opposed to a political initiative. Thirdly, there was an absence of the rigid prescriptions about what or how to teach that normally accompany teaching revisions . Why?Q2: What are the difficulties/potentialities that you faced (during the first week)? Which ones did you expect?Q3: Did you change anything with respect to the first week of lessons? If so, what influenced your choice?Participants in this study were contacted via email and invited to fill in an online questionnairen = 13) were teaching in classes with less than 100 students at the time of the global lockdown.In all, 48 university professors from 13 different countries volunteered to answer the online questionnaire about how their teaching had changed during the COVID-19 lockdown. Of these, 18 participants provided detailed answers to all questions, and, as such, they represent the sample of this study. Of these 18 participants, 13 came from Europe, 4 from the Americas, and 1 from Israel. The majority (14 of 18) were teaching a mathematics course, 2 were teaching a physics course, and 2 were teaching a mathematics education course. In this study, we consider only mathematics professors, the majority of whom . BI can be connected to either old (P) or new practice (PI) and to either old or new knowledge. It depends on how the teachers described and lived the change in P, B, or K. In Cindy’s case, it connects to PI  directly caused the perturbation that led to a change in beliefs (BI). Eventually, a (new) stable teaching system will form. For example, if Cindy does not like to share power with students, the (old) stable teaching system will be reached, but if she abandons her old belief (B), a (new) teaching system will be established, and the emerged belief becomes hard to change as it connects with practice and knowledge that strengthen the new system composed by PI–BI–K. In Cutri et al.’s  one in which the teaching system tries to resist change and repair itself (Alejandro and Giovanni) and (ii) one in which the system initiates a change and becomes dynamic (Carlo). These scenarios are not meant as generally exhaustive representations of all possible ways that mathematics professors experienced the lockdown, but they represent different ways a change in practice has produced a move (or not) for the entire teaching system.The first case we analyze is that of Alejandro, a mathematics educator who was teaching Calculus I to a medium-sized class (50–100 students) of first year university students in Santiago, Chile. On March 16, 2020, the whole city of Santiago was put under mandatory quarantine due to an increase in cases , Alejandro answered that, when he was forced to teach online, he prepared the first lesson doing some technical tests, sharing information with colleagues and searching for new tools . Instead of being problem-based and interactive, Alejandro’s first lesson was transmissive and based on slides. This represented a big shift in Alejandro’s practice (PI): (i) communication from teacher to students is important ; and (ii) group work online is troublesome. These beliefs were induced by the forced change in practice (PI). We represent BI and PI as connected to each other in Fig. After the first week, Alejandro answered that he was not satisfied with how it went because he did “not know if students were following the explanation.” As a result, he wrote in response to Q2, “[…] group work has not worked very well in online classes.” From these claims, we can infer that two beliefs emerged . Alejandro’ knowledge did not change even if prompted by the former belief (B) on the importance of students’ participation and problem solving, which was pushed aside by his limited technological knowledge. This forced his practice towards a new static scenario  and had 2 years of experience as a lecturer in Italy. Italy was one of the most affected countries in the pandemic during the spring of 2020 and went through a long national quarantine that lasted more than 60 days in some areas  was formed by these guidelines. Moreover, Giovanni’s answers in section S1 informed us that his practice (P) was featured by traditional transmissive lessons from the front of the room. In section S1, he also claimed that “for teaching is crucial to prepare good notes and the talk.” From this, we infer that he had an explicit belief (B) about the relevance of the material and the importance of the teacher’s lecture. P–B–K in Fig. I .After the first week of online classes, Giovanni was satisfied because he did not have technical difficulties and “students were active and participated during the lecture.” However, he reported in Q2 that “interaction with students is less than during in-person classes, but they might use the chat to provide me with some feedback. Maybe they would ask more questions than usual.” Giovanni mentioned the chat and students’ participation, which we label BI Fig. , but we I); a belief about the importance of interaction with students emerged (BI) but did not connect to PI because Giovanni was satisfied with his lessons and the belief (B) about the importance and quality of his lecture seemed more relevant for him. We conjecture that BI was also ignored because of Giovanni’s lack of  knowledge. Thus, only practice (PI) changed, and the system with PI–B–K stabilized as it appears in Fig. Giovanni migrated his practice online (PI). We, thus, represent Carlo’s initial configuration in Fig. Like Giovanni, Carlo worked in Milan and conducted research in STEM topics . He was an associate professor who had been teaching numerical analysis and calculus for the past 15 years. Unlike Giovanni, however, Carlo was interested in pedagogical aspects. Prior to the COVID-19 lockdown, Carlo taught transmissively using the blackboard and rarely used slides (P). During the pandemic, he had to teach his course entirely online, with a large class of about 200 students he had never met in person. Carlo received guidelines from his institution describing how to conduct lectures: he was told to use a video conference system (such as MS Teams) as a tool to broadcast his lectures. These guidelines formed his initial knowledge (K) in his teaching system. Once Carlo received the guidelines, his main concerns were about the technical difficulties with the use of the videoconference system and about the students’ feedback. Indeed, Carlo was not confident at all with respect to the idea of online teaching, because he liked to have face-to-face interaction with his students and he did “not feel familiar with technological instruments for online live teaching.” From Carlo’s answers, we can infer that he held an explicit belief (B) that it is important to be familiar with technological tools to teach online. As with everyone, COVID-19 brought a change in practice . We notice that, unlike Giovanni, Carlo planned to actively use the chat as part of the lesson and prompted the students to use it. This allowed Carlo to change his practice even more, since he also planned “for the following weeks to be more flexible with [his] schedule and to prepare some small exercises students can do in real-time to be even more active during class” (PII). The new change in practice led another belief (BII) to develop, namely. the importance of collaboration.During the first week, he discovered that he “could use the chat [embedded in the online environment] to ask yes/no questions.” After the first week, Carlo searched for a way to interact with his students: “I am resorting to the chat for collecting students’ feedback to the exercises during the lesson, moreover I would also like to discuss orally with students.” Carlo became familiar with the use of the chat, thus improving both his technological and his pedagogical knowledge (KI for Carlo occasioned a belief (BI) to emerge. In order to address it, Carlo acquired new knowledge (KI); this allowed him to change his practice (PII) that led belief BII to emerge. There was a dynamic situation in which Carlo’s beliefs, practice, and knowledge were changing and influencing each other, as shown in Fig. To sum up, at the beginning of the semester, the shift from P to PI). This shift presented an opportunity for researchers to observe change initiated by a shift in practice that was neither negotiable nor politically motivated. This is relatively rare in comparison to changes in practice prompted by a change in beliefs or knowledge occasioned by, for example, professional development  overpowered the belief about the value of problem-solving and discussion (B). This, coupled with his relative lack of technological knowledge, had the consequence that Alejandro’s online teaching (PI) was very different from his in-person teaching (P): the active participation of students was replaced by transmissive lessons. True, we can question how a professor who had little or no experience with online teaching can learn to manage online group discussion with 50–100 students within a week. However, what is relevant, in our view, is that Alejandro’s way of dealing with the transition to online teaching emphasized the concern on the mathematical content rather than on the way mathematical concepts are shared and used by learners. Cutri et al.  was not carried forward, because limited pedagogical knowledge did not prompt Giovanni to design lessons that promote the use of the chat by students. We can also say that Giovanni adhered to a transmissive view of mathematics teaching. These two scenarios highlight that (lack of) knowledge may hinder change in teachers’ practice  no connection with her traditional ones or because a new belief emerges but it is discarded by the system. Other kinds of staticity can emerge. For instance, there might be a change in knowledge but without a change in both practice and belief, because the beliefs towards students do not change as reported in Andrà et al.  provoked the emergence of beliefs (BI) about the importance of student-to-teacher communication and the acquisition of technological knowledge (KI). We described such dynamics as an evolution from PI to BI and then to KI. Carlo’s emerging belief (BI), coupled with acquisition of technological knowledge (KI), drove further change in practice (PII). This, in turn, prompted the belief (BII), as a dynamical teaching system begins to evolve. Remarkably, Carlo’s appreciation for transmissive teaching was challenged by the emergence of the importance of students’ voices, and, as a result, mathematics teaching became more participative in Carlo’s lessons. And students’ ideas turned out to count more than he believed at the beginning of the online semester. Carlo is a case of teacher change, and change is related to practice, beliefs, and knowledge because teaching has been shown to have a systemic nature. True, in this study, we focused only on P, B, and K as constitutive elements of a teaching system. However, Akkerman et al. In Carlo’s scenario, we observe that the shift in practice . For those who preferred the windmill, the emergence of new (implicit) beliefs resulted in a continuous evolution of the system. For those who built walls, change in beliefs was not accompanied by change in knowledge, and the COVID-19 lockdown–induced practice became static, apart from the actual migration from in-person to online teaching. We would like to add that there is no judgment on our side on either choice. These teachers represent three ways of living with change, with pros and cons in every case.The COVID-19 pandemic created a problematique, our data provided evidence that teaching can be thought of as having a systemic nature, and, in line with many previous research findings, the main components of a teaching system are practice, beliefs, and knowledge. Moreover, the P–B–K model has the potential for research to capture many relevant aspects of teaching, such as the importance of teacher’s knowledge in connection to practice and beliefs, as well as to determine whether there are conditions for teacher change or not. By not limiting itself to observation of classroom practices, or to beliefs, or to (lack of) knowledge, the P–B–K model considers teaching as a system made of distinct but intertwined elements, wherein a change in one element comprises a change in the others. As a consequence, we can argue that the model provides insight on how a teacher’s teaching system evolves. On one hand, the teaching system may stabilize due to lack of knowledge and/or resistance of the belief system; on the other hand, the teaching system may spin until a new, different teaching system stabilizes.Back to the research


Crucial to the success of the COVID-19 vaccination campaign is the rate of people who adhere to it. This study aimed to investigate the reasons underlying people’s willingness to get vaccinated in a sample of Italian adults, considering the effects of different individual characteristics and psychological variables upon positive vs. negative/hesitant vaccination intentions, as well as subjects’ self-reported motivations for such intentions. An anonymous cross-sectional survey was distributed online in February 2021. The results showed that trust in science, number of vaccinations received in 2019, and belief that COVID-19 is more severe than the common flu, were associated with positive vaccination intentions. “Chance externality” health locus of control showed both direct and indirect effects upon positive vaccination intentions. Anxiety symptoms and participants’ perceived psychological status also showed indirect positive effects. Subjects’ self-reported motivations varied interestingly across positive vs. negative/hesitant intentions. Implications of these findings for identifying effective pro-vaccination messages are discussed in the final section of the paper. During the last year, scientific laboratories worldwide have worked on an unprecedented timeline  to creatTo date, the potential acceptance rates of a generic COVID-19 vaccine as well as the factors influencing acceptance have been investigated in 33 different countries, revealing self-reported acceptance rates that range from almost 90% in China to less than 55% in the Middle East, Russia, Africa, and several European countries ,7,8,9,10Studies investigating COVID-19 vaccine hesitancy so far have focused primarily on the relationship between sociodemographic factors and cultural and personal beliefs, on the one hand, and the willingness to get vaccinated, on the other. In particular, positive intentions with respect to the COVID-19 vaccination have been shown to be associated with factors such as being male, married, an older adult, having a higher education, being a healthcare professional, having been vaccinated against influenza in the previous season, as well as perceiving a high risk of COVID-19 infection, trusting information from institutional sources, and believing in vaccinations’ efficacy and medical advice more generally ,9,12,13.We argue that, in addition to these factors, other variables more closely related to individual psychological characteristics should be taken into account when dealing with vaccine hesitancy, as has been suggested by Rieger  and MurpBuilding on this, the purpose of the present study was to investigate the effects of different individual characteristics , and different psychological variables  on COVID-19 vaccine acceptance or hesitancy/resistance in a sample of adults in Italy. Moreover, self-reported reasons motivating positive or hesitant/negative vaccination intentions were investigated with the aim of providing insights for public health authorities about what types of incentives or messages are likely to be most effective to increase vaccines community uptake.From 6 January to 28 February 2021, an anonymous cross-sectional survey was developed and distributed online across Italy using the Qualtrics software . The sampling procedure employed was the so-called “Exponential Non-Discriminative Snowball Sampling” . ParticiA total of 1256 surveys were collected. Of these, 1074 (85.5%) were deemed suitable for the analyses. Of the 182 (14.5%) remaining ones, 166 (91.2%) were excluded because participants completed less than 90% of the survey, and 16 (8.8%) because they did not give their consent to participate see .The study was approved by the ethical committee of the University of Milan and all respondents included in the analysis signed an online informed consent form before completing the survey.The survey collected multiple variables through ad hoc questions similar to those used in other studies ,8,9,13. Perceived physical and psychological statuses were evaluated on a five-point Likert scale (from 1 = “Poor” to 5 = “Excellent”). Subjective probability of contracting COVID-19 was evaluated through a visual analogue scale ranging from 0  to 10 . Participants’ fear of contracting COVID-19; their trust in government, health institutions, and science; as well as their opinions about COVID-19’s dangerousness were all evaluated through a five-point Likert scale (from 1 = “Strongly disagree” to 5 = “Strongly agree”). Willingness to get the COVID-19 vaccination was assessed through the following question: “As soon as a COVID-19 vaccine becomes available to you, do you intend to get vaccinated?”. Respondents could answer “Yes”, “No”, or “I do not know” and were then asked to explain their responses (open question). Differently from previous studies that asked subjects to explain their answers only in the case of “No” or “I don’t know” responses , the present study evaluated subjects’ explanations also in the case of “Yes” responses, since the authors were interested in investigating the extent to which the kinds of explanations provided varied across the three different answers. See the Finally, the present study investigated subjects’ opinions about whether there are any “culprits” to blame for the pandemic. This was done through the following question: “Do you think there is anyone who can be held responsible for the pandemic?”. Subjects who answered “Yes” were then asked to indicate who they did hold responsible. The aim of this question was to identify conspiracist beliefs about the  origins of the virus. All participants were screened for symptoms of anxiety using the GAD-7 . It is aHealth locus of control refers to the belief that health is in one’s control  or is not in one’s control . Among adults, external locus of control is associated with negative health outcomes, whereas internal locus of control is associated with favorable outcomes . The MHLSubjects’ self-reported motivations for their willingness/unwillingness to get the COVID-19 vaccination passed through a three-step categorization process. In the first step, independent categorizations were made by three different experimenters. In the second step, the three sets of categories that thereby emerged were compared, and only those categories that had been identified by at least two experimenters were kept. In the third step, those categories went through the external revision of a fourth experimenter. The categories that resulted from this three-step procedure, together with their frequencies and percentages, are listed in Answers containing more than one explanation were sorted into multiple categories  because I want to protect myself and the community I live in” was sorted both in the “Self-protection” and in the “Moral/social duty” categories).Motivations provided for the willingness/unwillingness to get vaccinated against COVID-19 are reported in Negative or hesitant answers, on the other hand, were motivated by five main sorts of reasons, appealing, respectively, to: (1) concerns about the vaccine’s safety ; (2) concerns about the vaccine’s efficacy ; (3) skepticism about the vaccine’s necessity in relation to the subject’s condition ; (4) personal health issues that make the vaccine specifically contraindicated for the subject ; (5) the existence of effective vaccine alternatives . In the case of “I don’t know” responses, a further kind of reason provided was: (6) insufficient and confusing information available on the vaccine’s costs and benefits (23 responses). Finally, three respondents reporting a negative intention toward the vaccine explained it by expressing general no-vax attitudes.Frequencies, percentages and representative examples of the responses belonging to each category are reported in Continuous variables are presented as mean ± standard deviation, and they were compared using a t test for independent samples. Variables not normally distributed are presented as median and interquartile range and were compared with the Wilcoxon rank sum test. Categorical data are reported as frequency and percentage and were compared using an χ2 test or Fisher exact test, as appropriate.Willingness to get a COVID-19 vaccination was defined as 0  and 1 . Independent predictors of willingness to get a COVID-19 vaccination were identified via multiple logistic regression analysis with stepwise selection of the variables. The consistency and reliability of the identified subset of predictors were tested by a cross-validation iteration procedure. At each step the dataset was randomly split into two halves. The independent predictors were selected in the first half (training set) and the resulting model was tested for significance in the second half (testing set). The procedure was repeated 200 times with different random splits. The predictor was considered as reliable if it was selected and confirmed at least 75% of the time.The assessment of direct and indirect effects of psychological variables upon the willingness to get the COVID-19 vaccination was made using path analysis. Health locus of control, anxiety symptoms, and perceived psychological status were used as predictors, and those variables that had been resulting significantly from the cross-validation iteration procedure were used as mediators. The path analysis was performed by using the SAS Proc CALIS procedure  based on structural equation modelling. The strength of direct and indirect relationships between variables was quantified by standardized β coefficients.p-values below 0.05 were considered as significant and all tests were two-sided. All analyses were performed using SAS statistical package V. 9.13 .All the variables considered in the study are showed in The mean ages of both groups (respondents who intended to get vaccinated against COVID-19 as well as those who did not or were in doubt) were close to middle age—with a range that varied from 18 to 88 years old. Male prevalence was significantly higher among those who intended to get vaccinated. Marital status did not differ between the two groups. Almost all participants were Italian  and most of them were located in Northern Italy. The majority of participants were employed, and the number of healthcare professionals was significantly higher among those who were willing to get vaccinated. Those who intended to receive the COVID-19 vaccine reported a better physical and psychological state compared to the others. Interestingly, those who reported negative or hesitant vaccination intentions had a higher chance externality health locus of control compared to the others. Respondents who intended to receive the COVID-19 vaccine estimated to have a greater chance of contracting the disease and reported greater fear for themselves, their families, and their friends in relation to that possibility. Furthermore, they also reported a higher trust in government, medical institutions, and science.Forty-seven percent of subjects expressing negative/hesitant vaccination intentions said that there is someone responsible for the pandemic, whilst only 27.3% of those with positive vaccination intentions did so. In response to the follow-up open question about who can be held responsible, two main categories of “culprits” were indicated: (1) culprits responsible for the origin of the virus , and culprits responsible for the spread of the virus .Among respondents with negative/hesitant vaccination intentions, 73.7% identified the “culprits” as those responsible for the virus origins, while the remaining 26.3% identified the “culprits” as subjects responsible for the virus spread. Among respondents with positive vaccination intentions, 49.5% identified the “culprits” as subjects responsible for the virus origins, and 50.5% as those responsible for the virus spread.Results of the cross-validation analysis are reported in As shown in As reported in Moreover, we observed an indirect effect of GAD-7 on the willingness to be vaccinated (Panel B). Interestingly, this relationship passed through the number of vaccinations received in 2019 for 50% and significant others’ willingness to be vaccinated for the remaining 50%.As reported in There was an indirect effect of perceived psychological status on subjects’ willingness to be vaccinated (Panel B). This effect passed through significant others’ willingness to be vaccinated for 57% and the number of vaccinations performed in 2019 for the remaining 43%.The main aim of the present study was to investigate which variables may influence the decision to get vaccinated against COVID-19. Results of the cross-validation process showed that the number of vaccinations received in 2019 was the strongest predictor associated with positive COVID-19 vaccination intentions. This result is in line with previous studies showing that a positive intention toward receiving the COVID-19 vaccination is strongly associated with a general tendency to get vaccinated ,9,13. WiInterestingly, significant others’ willingness to get COVID-19 vaccination is associated with subjects’ unwillingness to be vaccinated. This finding is quite complex to be explained, but it could be perhaps justified by the fact that the percentage of people who do not intend to get the COVID-19 vaccination is lower than the one of those who want to.Differently from what was observed in previous studies, which found that older, male, married, and employed subjects with a high income were more favorable toward getting a COVID-19 vaccination ,7,10,13,The reasons that subjects provided to explain their negative vaccination intentions (“no” responses) turned out to be by and large overlapping with those given to explain hesitant intentions (“I don’t know” responses)—thereby suggesting that, in most cases, the hesitation does not amount to a neutral stance but is closer to a negative one. Both in the case of negative and hesitant vaccination intentions, the most commonly cited reason was a concern about the safety of the vaccine  followed by reasons mentioning concerns about the vaccine efficacy (“it is still possible to contract COVID-19 after being vaccinated”) and about the vaccine necessity (“I don’t need the vaccine since I’m not at risk of getting the virus”). In the case of hesitant intentions, another commonly cited reason was the lack of sufficient and clear information on the vaccine’s costs and benefits.In cases of positive vaccination intentions, on the other hand, the most commonly cited reason was a social/ethical duty to protect one’s community, followed by reasons referring to a desire for self-protection, a belief in the efficacy of the vaccine, a desire to “have one’s life back”, and a general attitude of trust in science.Importantly, many of these self-reported reasons for positive vs. negative/hesitant vaccination intentions can be seen as the opposite sides of the same coin. Concerns about the vaccine’s safety are clearly the flipside of a desire for self-protection; and skepticism about the vaccine’s efficacy is the flipside of the belief that the vaccine is effective. More generally, the majority of the reasons provided to explain negative and hesitant vaccination intentions presuppose a mistrust in the information from scientific/medical sources, which is the flipside of the trust in science cited by subjects who reported positive vaccination intentions.This suggests that at least some of the basic desires and needs that are at the root of positive and negative/hesitant vaccination intentions are the same, although subjects have radically different perceptions and beliefs about the world and notably about how such desires and needs can be satisfied .That said, there were also some distinctive reasons that were cited to explain only the positive vaccination intentions and not the negative/hesitant ones . Most notably, the social/ethical considerations that were the most commonly cited reason with which subjects explained their positive intentions to get vaccinated were never mentioned to explain negative/hesitant intentions. This suggests that subjects with positive vaccination intentions perceive themselves as “ethical”—and their own actions as driven by “pro-social” attitudes—much more than subjects with negative/hesitant vaccination intentions do.Though it is important to note that what is at stake here are indeed self-perceptions: considering that what was collected were self-reported reasons—which might well be influenced by post hoc confabulation ad desirability bias. The findings do not in themselves prove that subjects with positive vaccination intentions are actually driven by ethical and pro-social motivations more than hesitant/no-vaxxers are . Indeed, Rieger (2020) found that when altruistic motivations are triggered in vaccination hesitant/resistant subjects, such motivations do have the potential to influence subjects’ decision-making, eventually leading many of them to shift toward more positive vaccination intentions.Although few participants explicitly mentioned belief in conspiracy theories among the reasons for their negative/hesitant vaccination intentions, previous studies suggest that such beliefs are often associated with (if not directly responsible for) the said intentions. Hornsey et al. found a general connection between conspiratorial thinking and anti-vaccination attitudes , and SalIn line with these results, the present study found that positive answers to the question whether there is anyone who can be held responsible for the pandemic were significantly more common among subjects with negative/hesitant vaccination intentions (47%), than among those with positive vaccination intentions (27%). Moreover, even when subjects with positive vaccination intentions said that they thought there were those responsible for the pandemic, often they did not refer to people responsible for the original creation of the virus in a lab, but rather to people responsible for the virus spread (due to failures to adopt adequate preventive behaviors)—which is a rather reasonable view that arguably does not involve any conspiracist claim.Overall, then, the present study solidly replicates previous findings according to which conspiracist attitudes  are associated with negative or hesitant vaccination intentions. This suggests that effective information campaigns about the nonhuman origins of the Sars-CoV-2 virus might have positive effects on overcoming vaccine hesitancy.The current pandemic is having a significant impact on public mental health. Numerous studies in the last year have pointed out the deleterious effects of the pandemic and the consequent containment measures   upon pubQuite surprisingly, neither perceived psychological status nor self-reported anxiety had a direct effect on the willingness to be vaccinated. Nevertheless, respondents who reported more anxiety symptoms (in the previous two weeks) and who did not receive any vaccination in 2019 were less willing to receive the COVID-19 vaccine. On the other hand, subjects who reported a generally better psychological status and got a vaccine in 2019 showed more positive intentions to be vaccinated. It might well be that anxiety amplifies doubts and fears about the COVID-19 vaccine, especially in those people who are not that used to getting vaccinations in general, although further studies are needed to test this hypothesis.Particularly interesting are the results concerning health locus of control. In line with Olagoke et al. , higher The negative association between chance externality locus of control and the belief that COVID-19 can be more severe than the common flu, on the other hand, may be related to a poor health literacy, as suggested by a previous study .Finally, the fact that negative/hesitant vaccination intentions were associated both with conspiracist beliefs about the human origin of the pandemic and with a higher “chance externality” health locus of control is in line with many previous studies that highlighted a close connection between conspiratorial thinking and high external locus of control in general ,32.This study had the following main limitations. First, despite the attempt to collect data from an Italian geographically distributed sample, the majority of the respondents ended up being from the North of Italy (and in particular from the Lombardy region), so the study sample is not really representative of the entire country and may be biased by the sampling method . Second, most of the respondents turned out to be young and well-educated adults, so the results must be interpreted with caution. Third, the use of a cross-sectional study design makes it hard to establish causality and requires a careful interpretation of results. Fourth, data were collected at the very beginning of the vaccination campaign, so only vaccination intentions and not the actual vaccination uptake could be tested. Moreover, only one vaccine was available at that time, and data about potential lethal side effects related to the COVID-19 vaccine were much more limited than they are now. Fifth, the present study investigated subjects’ self-reported reasons to get vaccinated, which might not (fully) match with the actual reasons that motivated subjects’ responses . Finally, the motivations to get COVID-19 vaccination categorization process did not employ automated sentiment analysis software, and future studies should implement this qualitative type of analysis.To date, evidence about psychological factors and personal motivations implicated in the willingness or unwillingness to get the COVID-19 vaccination is limited. The present study started filling this gap based on a sample of Italian respondents, paying close attention to psychological variables—including anxiety symptoms, perceived psychological status, and health locus of control—as well as personal motivations underlying vaccination intentions.Moreover, the data collected lay the basis for important suggestions about which interventions might prove helpful to increase vaccination acceptance rates. For one thing, the finding concerning the relation between high “chance externality” health locus of control and negative/hesitant vaccination intentions suggests that interventions aimed at boosting people’s sense of control and feelings of empowerment might be effective. Of course, implementing such interventions is not easy. As noted by Van Prooijen , the most promising strategy to boost empowerment is arguably education, the effects of which can only be appreciated in the long-term. But other shorter-term strategies to boost empowerment and perceived control are also possible—such as improving transparency in public decision-making, providing detailed information about the decisions that are enforced upon citizens, as well as giving citizens themselves the opportunity to “voice” their opinions about such decisions, thereby increasing their sense of control about them ,34.The findings concerning subjects’ self-reported reasons for their vaccination intentions, on the other hand, provide insights about the sorts of messages that might positively influence such intentions. The fact that concerns about the vaccine’s safety, efficacy, and necessity (together with a lack of sufficient information about the vaccine itself) were the most commonly cited reasons for negative/hesitant vaccination intentions suggests that pro-vaccination messages should seek to address those three sorts of concerns at length, providing extensive and accessible information about each of them. The idea that messages of that sort might positively influence vaccination intentions gets preliminary support from the study by Rieger , which found that a message highlighting that COVID might be dangerous also for young and healthy people, hence that the vaccination might be necessary also for them if they want to avoid health troubles, led a significant amount of hesitant and resistant subjects to change their mind, expressing more favorable vaccination intentions.In fact, it is worth noting that Rieger’s study showed that even more effective in influencing hesitant and resistant subjects were messages highlighting altruistic reasons in favor of the vaccine—i.e., the sort of “ethical/social” reasons that in the present study were mentioned by respondents with positive vaccination intentions. The fact that those very reasons proved effective to influence also hesitant and resistant subjects makes sense in the light of the present study observation that all subjects, irrespectively of their vaccination intentions, seem to be moved by the same basic desires and needs—whilst they differ in the ways in which they believe those needs can be satisfied. So, perceiving oneself as ethical and altruistic is arguably desirable for everyone, but the point is that some subjects do not see the vaccine as a means to behave altruistically. If it were possible to persuade them that it actually is such a means, this might well make them willing to get vaccinated.


The study argues that while the existing research on buzzwords mainly involves the functional and pragmatic analysis of their individual specimen, such as “engagement”, “synergy” or “development”, an alternative approach can be implemented to look into the nature and immediate implications behind the term in question. The suggested approach involves investigating the occurrences of the term proper as opposed to analysing individual buzzwords. The authors hypothise and demonstrate that linguistic context of the term “buzzword”, i.e. the peculiarities of its occurrence alongside different language units and patterns, may provide credible inferences concerning the key properties attached to the term and afford some illuminating perspective on the prevailing attitudes towards it. The study uses titles of research and newspaper articles retrieved from Google Scholar as material for the research due to better representation of the term in titles as opposed to full texts, as well as titles' higher informativity and better descriptive saturation. Apart from the prevailing focus on the immediate linguistic context surrounding the term, the inferences made in this study also stem from the frequency data showing how often a certain feature of buzzwords is being mentioned in the titles. The study showed that while the greatest emphasis is being placed on the field of use and temporal lifecycle of buzzwords, the attitudes towards them can be best of all described by examining the place of the term in oppositions. As illustrated in the paper, these oppositions reflect the idea of the term's inferior status by opposing it to more favourable concepts. Buzzword, Vogue word, Google Scholar, Co-occurrence, Title. Only a little digging will be enough to unearth a long roster of fashionable catchwords with elusive meaning that have emerged within a certain institutional discourse, such as trade, agriculture, information technology, artificial intelligence, education, advertising, etc. Anyone with a minimum level of exposure to the outside world would recognise the intriguing items such as As literature review below will show, meticulous examination of individual vogue words is something that has been done extensively and from a variety of perspectives, which has contributed immensely to the research on buzzwords. This includes identifying their functions, tracing their etymology, specifying their meaning, coming up with a precise definition for the fashionable word in question, and even measuring people's ability to predict whether a certain word is going to create a buzz eventually. This line of research with the focus on individual vogue words found in various institutional narratives is covered amply in scientific literature and has provided grounds for specifying the key characteristics of buzzwords: they are chiefly coined within a certain  community, they gain wide acceptance by being used a lot, they become fashionable as they grow popular, and their semantics is ambiguous for various reasons. Thus, a typical definition found in academic literature and dictionaries will read as follows:“A buzzword is a word or expression that has become fashionable in a particular field and is being used a lot by the media while having little or imprecise meaning but sounding impressive to outsiders”  that might be helpful in at least clarifying the meaning behind the term as well as the firmly established attitudes towards it.2The dominant property of a buzzword, and the one stressed most persistently in the literature, is easily deduced from its self-explanatory “buzz” component with expressions like “get a buzz out of something”, or “create a buzz”, or “what's the buzz” coming to mind in association with something exciting or intriguing. In the long run, creating intrigue and drawing attention actually came to serve as the central functions attributed to buzzwords often referred to as “fashion words” : 58.This concept of an attractive “shell” designed to intrigue and grab the attention of the people is widely criticised by scholars. The tendency to “package common-sense ideas under seductive new names” : 34, priThus surfaces the controversy surrounding buzzwords that represent abstract notions agreed upon within a linguo-cultural community even though their practical meaning remains a subject of debate, something bottom line, globalise, incentivise, proactive, robust, synergy and value-added, and encourage using the buzzword if it is “lively and capable of injecting some spunk into a dull sentence”  is not so much an individual trademark, but rather a commitment to identify oneself as part of a community. This aspect of buzzwords prompted scholars to describe them as elements of a shared language , exclusimanagement by objective, synergy and vertical integration were topping the business charts in the 1970s, 1980s and 1990s, respectively.The importance attached to trendiness and the time-sensitive nature of buzzwords brings to the forefront the temporal aspect of the issue, for “different words buzz at different times and in different contexts” : 37, aftiterate, which used to mean “a design process where various elements would progress through sequential steps, to hone in on the optimal solution; and now it means nothing beyond merely describing a stage in a process” the search for material was conducted through search queries implemented in two stages to incorporate two main morphological forms of the word in question, i.e. the singular “buzzword” and the plural “buzzwords” in order to ensure better coverage;2)no filters in the advance search mode, such as specific time period or relevance, were applied for the same reason;3)the search was conducted in incognito mode to ensure that no previous searches influenced the ultimate results.Since this paper intends to analyse the occurrences of the term “buzzword” in research and newspaper titles, the material for the study had to be collected via an existing database for written research and journalistic content, such as Google Scholar, which was ultimately resorted to as one of the most representative web search engines indexing the full text and metadata of scholarly literature across an array of publishing formats and disciplines. The following principles were adhered to in using this search tool:Continuous sampling of material retrieved a total of 719 titles. The sample was further grouped per different functional and pragmatic markers, derived and labelled by us, whereby the final volume of the processed occurrences eventually expended as many of the titles incorporated more than one marker of interest. Since the study is not concerned with the content of research presented in the sample and only intends to look into the immediate language units accompanying the term in question within the titles, the sampling method did not support any kind of differentiation content-wise and incorporated titles of newspapers and research articles concerned with various areas of scholarly interest, including internet technology, biology, medicine, politics, language, economics, management, business, education, etc. Apart from the prevailing focus on the immediate linguistic context surrounding the term, the inferences made in this study also stem from the frequency data showing how often a certain feature of buzzwords is being mentioned in the titles.4The search for the occurrences of the term “buzzword” throughout the sample of 719 examples allowed us to differentiate between 11 categories of marked occurrences labelled as follows: intended purpose (4); positiveness (17); coined term (19); taking action or call to action (29); change in perception, implementation or connotation (50); need for clarification, explanation or definition (54); downgrading and critique (87); implication of a wider scope of meaning, application or significance (123); opposition to a better concept (156); field of use (177); temporal lifecycle (198).Intersectionality as Buzzword; Innovation: The History of a Buzzword; Buzzword: Green Fatigue; The Buzzword is “Espirit” and the like, containing only general informative wordings revealing no marked characterisation or attitudinal disposition whatsoever. In fact, the low percentage of unmarked occurrences may on its own be viewed as a telling argument suggesting that the term “buzzword” proper was rarely free of the superimposed assessments reflected in the immediately approximate language units in the sample.The unmarked occurrences comprised as few as 34 examples which amounts to only 4.7% of the sample. These included neutral titles such as Three Buzzwords for Maintaining Ethical Hourly Billing, or A Buzzword to Enhance Storymaking.Grouped in terms of the frequency of occurrence, 6 out of the 11 allocated categories did not exceed the 10% threshold having surfaced up to 54 times. The least represented is the Intended Purpose category with only 4 examples (0.6%) registered in the sample. These were allocated as directly describing the intentions behind introducing or using a buzzword, as in right, worth remembering, big, the biggest, important, well-known, popular, money-making, global, effective, good, and favourite. A single occurrence in the category – missing – appeared remarkable as the only one suggesting that a certain crucial buzzword is missing from the professional discourse and needs to be introduced into it: Fault-Tolerance: Java's Missing Buzzword.The next poorly represented category is Positiveness incorporating only 17 examples and amounting to 2.4% of the sample. The co-occurrences in this category included language units either bearing a straightforwardly positive connotation or at least not directly implying any negative meaning, as in buzzword approach, buzzword bingo, buzzword prediction ability and buzzword detection, all referring to a specific concept treated as a subject of scholarly interest.While individual buzzwords do live up to their name being associated with intrigue and newness, the term proper has also given rise to catchy coinage. The study registered 19 instances of Coined Terms amounting to 2.6% of the sample and including nomenclature such as Why It's Time to Retire “Disruption”, Silicon Valley's Emptiest Buzzword), “fill with” (e.g. Filling a Buzzword with Life), “make the most of” (e.g. Making the Most of the Latest Buzzword), “hype” (e.g. Hyping the New Media Buzzword), “avoid” (e.g. Lawmakers Avoid Buzzwords on Climate Change Bills), “overcome” (e.g. Overcoming Buzzwords and Variability Through a Nurse EBP Mentor Program), “catch” (e.g. Catching the Buzzwords), “predict” (e.g. Finding Prophets in the Blogosphere: Bloggers Who Predicted Buzzwords Before They Became Popular), turn into (e.g. Turning Buzzwords into a Process) and monitor (e.g. A System Approach to Monitor Buzzwords in Plain English Publications). In the latter – more vividly emphatic – case, the encouragement to denounce buzzwords appeared exceedingly overt with imperative sentences urging the reader to forget, ban, stop using, say no to, tear down or steer clear of buzzwords. Some of the more over-the-edge instances can also be described as slogans that might just as well be part of an agitation campaign, as in Death to Buzzwords; Enough with the Buzzwords; Please, No More Buzzwords; Please, Business Instead of Buzzwords; Do not Let IRM Become Another Buzzword, etc.The Taking Action or Call to Action category incorporated 29 occurrences (4% of the sample) whereby the term “buzzword” was accompanied by a verb or a verbal construction that either referred to a buzzword-related action or straightforwardly encouraged one (in the titles of imperative type). In the former case, the action was rendered through the verbs and verbal constructions such as “retire”  is represented by the “from – to” pattern suggesting that a buzzword is going through a certain transformation, be it in terms of the meaning attached to it, or its ultimate status within a specific field of use. Some of the more recurrent examples include Dispelling the Myths About One of Publishing's Hottest Buzzwords; Sorting Out a Meaning for a Confusing Buzzword; Finding a Way to Define the New Buzzword; Demystifying the Buzzword; Exploring the Meaning of an Internet-Born Digital Marketing Buzzword; Rethinking Buzzwords, etc.), this category also included the words guide, dictionary and glossary as recurrent co-occurrences, as in A Quick Guide to Social Change Buzzwords; A Dictionary of Business Buzzwords; A Buzzword Glossary. Since these did not actually present guides, dictionaries and glossaries in the conventional sense, the implication was that the study or article was aimed at clarifying and structuring the available information on the buzzword or buzzwords in question.7.5% of the sample (54 examples) incorporated the occurrences that implied the idea of the Need for Clarification, Explanation or Definition. Apart from the direct nomination of a clarifying action , semantic insufficiency  and general critique of buzzwords .The next category containing 87 examples and amounting to 12.1% of the sample was labelled as Downgrading and Critique and consisted of occurrences that implied a varying degree of negative connotation bestowed on the term. The category is represented by co-occurrences such as Partnership: More Than a Buzzword), “behind” (e.g. Innovation: Behind the Buzzword), and “beyond” . This kind of wording suggests that there's something more to a buzzword beyond its on-the-surface attributes so that something bigger can be unearthed if one goes the extra mile and digs a little deeper.According to frequency calculations, Implication of a Wider Scope of Meaning, Application or Significance is a yet more voluminous category incorporating 123 examples amounting to 17.1% of the sample. The category is represented exclusively by three recurrent patterns accompanying the term “buzzword”: “more than”  or community .Field of Use appeared as one of the most representative categories having incorporated 177 examples amounting to 24.6% of the sample. The category included co-occurrences referring to vogue words reserved for a specific institution  and the general temporal and trend-dependent characteristics as the key features of buzzwords . The category is represented by 198 examples amounting to 27.5% of the sample.The hottest on the list is the Temporal Lifecycle category referring to the endurability of a buzzword from conception to decay  of neutral titles containing no marked linguistic units to characterise the term “buzzword” was in itself an indicator signalling the feasibility of the adopted approach: the fact that the term rarely appeared as a stand-alone item, devoid of any adjoining attributive descriptive language tokens and the attitudinal appraisal that came along with them, verified the controversial nature of the term as a far-from-neutral concept. While the nomenclature of the allocated categories and the functional interpretation of their content is very much consistent with the observations presented in the literature review, frequency calculations coupled with the analysis of recurrent co-occurrences are what might be considered a staging ground for valuable inferences.Yet Another Buzzword to Hide our Confusion, or The Buzzword to Ensure Occupational Safety and Health.Thus, for example, the lack of a straightforward purpose behind buzzwords can be deduced from the poorly represented category of Intended Purpose that incorporates as few as 4 examples referencing the purposeful application of buzzwords, as in right, important, well-known, good, etc., and criticism communicated via much more toxic descriptive elements such as hackneyed, ugly and annoying.The 2.4% of occurrences referring to the positive features of buzzwords alongside the 21.1% of occurrences transferring the meaning of downgrading and critique, present statistical data reflecting the prevailing attitudes towards the notion of vogue words. At that, the attitudinal aspect is also clearly reflected in the language chosen to express the idea of positive assessment and criticism, which differs strikingly in terms of the register being used, with positive features explicated through commonplace adjectives such as retire, hype, avoid, ban, overcome, predict, monitor, forget, stop using, say no to, steer clear of, tear down, etc., the content of the category Taking Action or Call to Action attests to the so far consistent idea of disapproval. Some of the more appellative examples of the call to action include Message to New Government: Please Ban Buzzwords; Just Say No to Buzzwords; Make “Trust” a Cornerstone, not a Buzzword; Steer Clear of Buzzwords; Forget All the Expert's Buzzwords, etc.The action-related occurrences that either referred to some buzzword-related action or explicitly encouraged one are valuable insofar as the immediate verbal context accompanying the term “buzzword” in the titles can also vividly illuminate the nature of activity most commonly linked to it. Seeing that the co-occurring verbs and verbal constructions in this category include buzzword approach , buzzword bingo , buzzword prediction ability (an ability to predict whether a certain word will become a buzzword in the future) and buzzword detection (spotting of “buzzworthy” language units functioning in different types of discourse).Yet despite – or maybe due to – this controversial nature of buzzwords, the study revealed that as a subject of scholarly interest they might just be on the fast track of becoming a fruitful source for coinage. The topic of buzzwords generated coined terms such as •(From) Buzzword (to) Reality•(From) Buzzword (to) Practice•(From) Buzzword (to) Best Practice•(From) Buzzword (to) Strategy•(From) Buzzword (to) a Definition•(From) Buzzword (to) Business Strategy•(From) Buzzword (to) Action•(From) Old Buzzword (to) New Praxis•(From) Buzzword (to) Theory•(From) Buzzword (to) Non-negotiable Limits•(From) Buzzword (to) Value Creation•(From) Buzzword (to) Real Responsibility•(From) Buzzword (to) A Useful Concept•(From) Global Buzzword (to) Specific Solution•(From) Buzzword (to) A Life Sciences Approach•(From) Buzzword (to) Research Priority•(From) Marketing Buzzword (to) Market Relevance•(From) Buzzword (to) Strategic Imperative•(From) Buzzword (to) Business Practice•(From) Buzzword (to) Payoff•(From) Buzzword (to) Instrument•(From) Buzzword (to) Managerial Tool•(From) Buzzword (to) Necessity•(From) Buzzword (to) Weapon•(From) Buzzword (to) Critical Psychology•(From) Buzzword (to) Managerial Tool•(From) Buzzword (to) Megatrend•(From) Buzzword (to) Implementation of Learning Analytics•(From) Buzzword (to) A Social Construction of Competency•(From) Buzzword (to) Pro-Environmental Behaviour Change•(From) Buzzword (to) Mainstream Web RealityChange in Perception, Implementation or Connotation, although relatively insignificant with only 50 examples (7% of the sample) fitting into its semantic scope, triggered some valuable inferences which was mostly due the consistently used language pattern in the corresponding titles. As the “from – to” construction signified the process of transformation, whereby the term “buzzword” was marked as the starting point for the change (Marker 1), the following juxtaposition was effectuated to compare it to the ultimate point of “destination” (Marker 2) in this kind of transitioning, as in:Thus, the retrieved examples either opposed the term to something “real”, “new”, “better”, or “useful”, or encouraged to see it as a thing of the past that now has to give way to “behaviour change”, “construction of competency”, “research priority”, and “value creation”.dispelling the myths about/understanding/rethinking/unravelling/sorting out a meaning for/defining/finding a way to define/demystifying/exploring/mapping out buzzwords; buzzwords explained/defined, etc. Some titles transferred the same meaning through declarative statements thus making the idea stand out a little bit more, as in “Analytics” Buzzword Needs Careful Definition, or Globalization Is a Buzzword that Has No Precise Definition, or Riding the Waves of “Web 2.0”: More Than a Buzzword, But Still Not Easily Defined. The same is true for titles in this category formulated in the interrogative from, as in “Student Experience” Is the New Buzzword: But What Does It Mean?; Putting the Science Back in C2: What Do the Buzzwords Really Mean?; “Agency” is the Buzzword, But Where Does It Work?, etc.A yet more representative category amounting to 7.5% of the sample referred to the need to clarify, explain or provide a clearer definition of a buzzword. The choice of wording in this case was very much straightforward, as in Asset Management is Much More than an Annoying Buzzword; Omnichannel: More Than a Digital Transformation Buzzword; Beyond the Buzzword: The Three Meanings of “Grand Strategy”; Behind the Buzzword: Employability, etc. Although 10 out of 123 examples were formulated as questions, these were still included as bearing the same implication, as in Software Reuse: What's Behind the Buzzword?; Turnaround Management: More Than a Buzzword?; Is MOOC More Than Just a Buzzword?A much more generous proportion of examples referred to the implication of buzzwords' wider scope of meaning, application or significance with the category represented by the pattern “more than” and lexical units “beyond” and “behind”, as in financial buzzword) or communities using the vogue word (as in urban buzzword), while the latter made use of versatile linguistic context to indicate time-dependent properties of the term, as in half-life of a buzzword, today's buzzword, this year's buzzword, buzzword of the decade, buzzword of a post-PC era, new, latest, next, old buzzword, etc.The largest three categories were examined more scrupulously as the most representative. Consistently with the observations provided in the literature review, the categories of the Field of Use and Temporal Lifecycle were the top two categories providing for 24.6% and 27.5% of the sample, respectively. The former was represented by references to institutions  that proved the most illuminating. Similar to the titles that referred to the process of change in perception, implementation or connotation of buzzwords, the opposition category highlighted the idea that the term is all too often contrasted with a better, more promising or viable alternative. The buzzword was most recurrently opposed to reality, relevant concept, new paradigm, innovation, best practice and breakthrough, as in 6The paper proposed and applied an alternative approach to studying buzzwords, whereby the occurrences of the term within a clearly defined sample were analysed instead of traditional examination of individual buzzwords. While the “shortcut” approach did not allow to track down the intricate features of buzzwords – such as their expediency in avoiding criticism, instilling a sense of authority or bolstering political agenda – it did allow to single out the same key features as those mentioned in the texts dealing with individual buzzwords. It also proved useful in listing the most recurrently credited features of buzzwords as per their frequency-based rating. The study showed that while the greatest emphasis is being placed on the field of use and temporal lifecycle of buzzwords, the attitudes towards them can be best of all described by examining the place of the term in oppositions. As illustrated in the paper, these oppositions reflect the idea of the term's inferior status by opposing it to more favourable concepts. At that, the tendencies in representing buzzwords' less frequently credited features have also attested to the general trend whereby the term and the notions behind it are associated with a far-fetched, opportune and often meaningless rhetoric having little to do with reality.This study contrasts with much of the work in the literature review in that it analysed buzzwords in a limited context, typically a phrase or short sentence, and drew inferences as to their function from their syntactical role or collocational characteristics. The advantage of this approach is that it allows a large quantity of data to be analysed across a wide range of contexts so that the results are representative of the buzzword phenomenon. The majority of studies have taken a narrower and deeper direction, typically tracing the function of a specific buzzword in one text type at the level of discourse. This approach is of course no less valid but the present study represents a meta-analysis of buzzwords which is not dependent on their individual usage.Elena N. Malyuga & Wayne Rimmer: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Data included in article/supplementary material/referenced in article.The authors declare no conflict of interest.No additional information is available for this paper.