Sci Eng Ethics
https://doi.org/10.1007/s11948-018-0057-x
REVIEW PAPER

Integrity in Biomedical Research: A Systematic Review
of Studies in China
Nannan Yi1   · Benoit Nemery2   · Kris Dierickx1 

Received: 27 June 2017 / Accepted: 1 April 2018
© Springer Science+Business Media B.V., part of Springer Nature 2018

Abstract  Recent empirical evidence has demonstrated that research misconduct
occurs to a substantial degree in biomedical research. It has been suggested that
scientific integrity is also of concern in China, but this seems to be based largely
on anecdotal evidence. We, therefore, sought to explore the Chinese situation, by
making a systematic review of published empirical studies on biomedical research
integrity in China. One of our purposes was also to summarize the existing body of
research published in Chinese. We searched the China National Knowledge Infrastructure, Wanfang Data, PubMed and Web of Science for potentially relevant studies, and included studies meeting our inclusion criteria, i.e. mainly those presenting
empirically obtained data about the practice of research in China. All the data was
extracted and synthesized using an inductive approach. Twenty-one studies were
included for review. Two studies used qualitative methods (interviews) and nineteen
studies used quantitative methods (questionnaires). Studies involved mainly medical
postgraduates and nurses and they investigated awareness, attitudes, perceptions and
experiences of research integrity and misconduct. Most of the participants in these
21 studies reported that research integrity is of great importance and that they obey
academic norms during their research. Nevertheless, the occurrence of research misbehaviors, such as fabrication, falsification, plagiarism, improper authorship and
duplicate submission was also reported. Strengthening research integrity training,
Electronic supplementary material  The online version of this article (https​://doi.org/10.1007/
s1194​8-018-0057-x) contains supplementary material, which is available to authorized users.
*	 Kris Dierickx
	kris.dierickx@kuleuven.be
1

Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU
Leuven - University of Leuven, Kapucijnenvoer 35, Blok D, Box 7001, 3000 Leuven, Belgium

2

Centre for Environment and Health, Department of Public Health and Primary Care, KU
Leuven - University of Leuven, O&N 1, Herestraat 49, Box 706, 3000 Leuven, Belgium

	
	

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N. Yi et al.

developing the governance system and improving the scientific evaluation system
were areas of particular attention in several studies. Our review demonstrates that a
substantial number of articles have been devoted to research integrity in China, but
only a few studies provide empirical evidence. With more safeguard measures of
research integrity being taken in China, it would be crucial to conduct more research
to explore researchers’ in-depth perceptions and evaluate the changes.
Keywords  Research integrity · Research misconduct · Academic integrity ·
Academic morality · Academic misconduct · Biomedical research · China

Introduction
Scientific research has been regarded as the scientists’ behavior of pursuing the truth
and should be conducted following the principle of integrity (Engel 2015; “Integrity
mentors” 2014; Lins and Carvalho 2014). However, according to numerous reports in
the past decades, this principle is not always followed, thus possibly hindering scientific progress throughout the world (Gardner et al. 2005; Hawkes 2014; Patnaik 2016;
Okonta and Rossouw 2014; Steen 2011). As reported, research misconduct also exists
in medical research, which is even more worrying than other areas (Fanelli 2009; Sabir
et al. 2015; Steneck 2006).
With the rapid economic development in the past decades, China has made considerable efforts in biomedical scientific research (Guo 2010; Xie et al. 2014). With this
huge investment, China is expected to produce research achievements of good quality
(Grayson 2015; Wang 2015). However, like many other countries, China is also facing the challenge of research misconduct (Jia 2006; Yang 2013). In recent years, a lot
of attention from the international scientific community has been paid to the issue of
research misconduct in China, which not only curbs Chinese devotion to the world’s
scientific development, but also harms the mutual trust and international collaboration
with other countries (Baždarić et al. 2012; Tang 2010; Xin 2006). Nonetheless, Chinese biomedical researchers’ perception on this issue remains understudied. It has been
claimed that scientific integrity is also of concern in China, and that research misconduct in China has its own reasons and appearance, which differs from those in some
other countries (Hu and Wu 2013; Hvistendahl 2013; Li 2013; Tucker et  al. 2011).
However, this has not been systematically established.
This article presents a systematic review of published empirical studies about
research integrity and misconduct in Chinese biomedical research. Through this review,
we aim at getting a comprehensive view of existing research that has been conducted
in China about the awareness, attitudes, perceptions and experiences of biomedical
researchers regarding research integrity and misconduct.

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Integrity in Biomedical Research: A Systematic Review of Studies…

Methods
Data Sources
A literature search was performed using the following databanks: China National
Knowledge Infrastructure (CNKI), Wanfang Data (Wanfang), PubMed and Web
of Science (WoS). Key words of disciplines in the biomedical domain were combined with words related to research integrity and misconduct, that are widely
used in Chinese or English (Table 1) (Cao 2007; Fang et al. 2014; Yi et al. 2017).
The document type was restricted to (journal) articles. The search was conducted
in May and June 2016.
Inclusion and Exclusion
The retrieved articles were first screened on the basis of titles and abstracts. For
articles whose titles and abstracts could not provide enough information for inclusion or exclusion, the full texts were read. If it was unclear whether an article met
the inclusion criteria, an agreement was reached between Nannan Yi (NY) and
Kris Dierickx (KD).
Inclusion Criteria
Studies included in the review had to meet the following requirements:
(1) To explore the perception and experiences of research integrity and misconduct, (2) to be confined to a biomedical area, (3) to be based on empirical
research (i.e. with quantitative or qualitative research methods used to collect primary data) and (4) to be peer-reviewed.
The term “academic misconduct” has two meanings in China: one meaning
concerns misbehavior by students in the classroom, cheating at examinations and
so on; the other meaning includes fabrication, falsification, or plagiarism (FFP)
and other misbehaviors in scientific research. In general, Chinese scholars agree
on the second meaning (Cao 2005; Chen 2011; Liu 2011), but some scholars also
use “academic misconduct” to refer to both meanings (Fan et  al. 2013). In this
review, we used only the second meaning to include studies.
Exclusion Criteria
Following articles were excluded:
(1) articles outside our research question, (2) articles without primary data (i.e.
editorials, opinions, recommendations, etc.).

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N. Yi et al.

Table 1  Search strategy applied in China National Knowledge Infrastructure (CNKI) (a), Wanfang Data
(Wanfang) (b), PubMed (c) and Web of Science (WoS) (d)
(a) Search strategy applied in CNKI
主题: (‘医学’+‘医科’+‘医生’+‘医师’+‘药学’+‘药师’+‘药士’+‘生物医学’+‘中医’+‘中药’+‘中西医’+‘护
理’+‘护士’+‘护师’)*(‘学术道德’+‘科研道德’+‘科学道德’+‘学术规范’+‘科研规范’+‘学术诚信’+‘科研
诚信’+‘科学诚信’+‘学术失范’+‘科研失范’+‘科学失范’+‘学术不端’+‘科研不端’+‘科学不端’+‘学术失
信’+‘科研失信’+‘学术造假’+‘科研造假’+‘科学造假’+‘学术腐败’+‘科研腐败’+‘科学腐败’+‘学术不良
行为’)
跨库选择:期刊、特色期刊、学术辑刊
Translated to English: SUBJECT=(“medicine” OR “medical” OR “physician” OR “pharmac*” OR “pharmacist” OR “biomedic*” OR “Traditional Chinese Medicine” OR “Chinese herbs” OR “Traditional Chinese
and Western Medicine” OR “nursing” OR “nurse”) AND (“academic morality” OR “research morality” OR
“scientific morality” OR “academic norm(s)” OR ”research norm(s)” OR ”academic integrity” OR “research
integrity” OR “scientific integrity” OR “academic anomie” OR “research anomie” OR “scientific anomie” OR
“academic misconduct” OR “research misconduct” OR “scientific misconduct” OR “academic dishonesty”
OR “research dishonesty” OR “academic fraud” OR “research fraud” OR “scientific fraud” OR “academic
corruption” OR “research corruption” OR “scientific corruption” OR “academic misbehavior”)
Selection of databases: periodical, characteristic periodical and academic proceeding
(b) Search strategy applied in Wanfang
主题: (‘医学’+‘医科’+‘医生’+‘医师’+‘药学’+‘药师’+‘药士’+‘生物医学’+‘中医’+‘中药’+‘中西医’+‘护
理’+‘护士’+‘护师’)*(‘学术道德’+‘科研道德’+‘科学道德’+‘学术规范’+‘科研规范’+‘学术诚信’+‘科研
诚信’+‘科学诚信’+‘学术失范’+‘科研失范’+‘科学失范’+‘学术不端’+‘科研不端’+‘科学不端’+‘学术失
信’+‘科研失信’+‘学术造假’+‘科研造假’+‘科学造假’+‘学术腐败’+‘科研腐败’+‘科学腐败’+‘学术不良
行为’)
文献类型:期刊论文
Translated to English: SUBJECT=(“medicine” OR “medical” OR “physician” OR “pharmac*” OR “pharmacist” OR “biomedic*” OR “Traditional Chinese Medicine” OR “Chinese herbs” OR “traditional chinese
and western medicine” OR “nursing” OR “nurse”) AND (“academic morality” OR “research morality” OR
“scientific morality” OR “academic norm(s)” OR ”research norm(s)” OR ”academic integrity” OR “research
integrity” OR “scientific integrity” OR “academic anomie” OR “research anomie” OR “scientific anomie” OR
“academic misconduct” OR “research misconduct” OR “scientific misconduct” OR “academic dishonesty”
OR “research dishonesty” OR “academic fraud” OR “research fraud” OR “scientific fraud” OR “academic
corruption” OR “research corruption” OR “scientific corruption” OR “academic misbehavior”)
Document type: periodical article
(c) Search strategy applied in PubMed
Title/Abstract=(“research integrity” OR “academic integrity” OR “scientific integrity” OR “research misconduct”
OR “academic misconduct” OR “scientific misconduct” OR “academic dishonesty” OR “scientific dishonesty”
OR “research fraud” OR “scientific fraud” OR “academic fraud” OR “responsible conduct of research” OR
“academic corruption” OR “research dishonesty” OR “research corruption” OR “scientific corruption” OR
“questionable research practice” OR “academic misbehavior” OR “research misbehavior” OR “scientific misbehavior” OR “academic morality” OR “research morality” OR “scientific morality” OR “academic disintegrity”
OR “ scientific disintegrity”) AND (“China” OR “Chinese”)
Filters: Journal Article
(d) Search strategy applied in WoS
TS=((“medic*” OR “pharmac*” OR “biolog*” OR “clinic*” OR “nurs*” OR “biomedic*” OR “physician” OR
“surgeon”) AND (“research integrity” OR “academic integrity” OR “scientific integrity” OR “research misconduct” OR “academic misconduct” OR “scientific misconduct” OR “research dishonesty” OR “academic
dishonesty” OR “scientific dishonesty” OR “research fraud” OR “scientific fraud” OR “academic fraud”
OR “responsible conduct of research” OR “academic corruption” OR “research corruption” OR “scientific
corruption” OR “questionable research practice” OR “academic misbehavior” OR “research misbehavior”
OR “scientific misbehavior” OR “academic morality” OR “research morality” OR “scientific morality” OR
“research disintegrity” OR “academic disintegrity” OR “ scientific disintegrity”) AND (“China” OR “Chinese”))
Document type: article

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Integrity in Biomedical Research: A Systematic Review of Studies…

Data Extraction and Synthesis
For each publication, characteristics including author(s), study design, sampling
method and year of publication were extracted. The study results were extracted
and classified according to different themes defined using an inductive approach.
Figures (e.g. prevalence data) retrieved from quantitative studies were summarized with ranges (minimum value-maximum value). Quotes from the qualitative
research were originally in Chinese, and they were translated to English by NY.
Critical Appraisal
The quality of the included studies was assessed using the criteria developed by
Kmet et  al. (2004). These criteria include two separate scoring lists for quantitative studies and qualitative studies, respectively. The score represents the degree to
which the specific criteria were met (“yes” = 2, “partial” = 1, “no” = 0). For quantitative or qualitative studies, quality was assessed with the corresponding scoring lists.
For studies using mixed research methods, quality was assessed with the two scoring
lists separately and then the average score was calculated.

Results
Study Selection
The search in the four databases identified 1578 records, which was reduced to 1311
records after removal of duplicates (Fig. 1). Most of these publications did not fit with

Records identified in CNKI, Wanfang,
PubMed and WoS: 1578

Records after duplicates removed: 1311

Records excluded on basis of titles and abstracts
Outside research question: 524
Non-empirical articles: 729

Records retained: 58

Records excluded on basis of full texts
Outside research question: 1
Non-empirical articles: 36

Articles included: 21

Fig. 1  The process of study selection

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N. Yi et al.

our inclusion criteria: 335 were journal notifications of application of anti-plagiarism software, 182 were announcements promoting research integrity or prohibiting
research misconduct, including national guidelines and journal statements, etc. Many
publications were not based on empirical data, but on theoretical considerations. In the
end, based on our inclusion and exclusion criteria, we identified 21 studies containing empirical data, all written in Chinese. Most of these studies (18) used quantitative
research methods (surveys), two studies were based on qualitative research, and one
“mixed method” studied used both approaches.
Study Characteristics
The characteristics including author(s), study design, sampling method and year of
publication are shown in Table 2.
The included studies contained a broad variety of participants (Table 2): the authors
of one medical journal, postgraduates (majoring in western medicine, traditional
Chinese medicine, pharmacy, nursing and others), clinical nurses and supervisors of
medical postgraduates. These participants had been recruited from universities, hospitals and other institutions in more than 10 cities throughout China. (Some studies
did not specify the institution of the participants or they just listed a few geographical
locations.)
Quality Assessment
Results of the quality assessment are shown in Tables 3 and 4. The scores [according
to Kmet et al. (2004)] of the quantitative studies ranged between 0.64 and 0.93, with a
mean of 0.87. The scores of the two qualitative studies were both 0.70. The score of the
study with mixed methods was 0.44 (average of 0.58 and 0.30).
We defined four main themes: (1) the perception of academic norms and research
misconduct, (2) perceived prevalence of research misconduct, (3) attitudes towards
research misconduct, and (4) suggestions to promote research integrity.
In these studies, different keywords were used. For instance,“学术诚信 (academic
integrity)” and “学术道德 (academic morality)” were used to refer to issues related
to research integrity, while “学术不端 (academic misconduct)”, “科研中的失信行为
(dishonest behavior(s) in research)”, “学术失范 (academic anomie)” and “违反学术
规范 (violations of academic norms)” were used to refer to issues related to research
misconduct. Considering the different concepts and terms used in Chinese and English
and to be consistent in the words (Yi et  al. 2017), we used “research integrity” and
“research misconduct” to replace relevant phrases in included studies, respectively.
Academic Norms and Research Misconduct
Awareness of Academic Norms
In general, according to four studies, a majority of the respondents (63–99.5%)
indicated awareness of the academic norms (Fan and Yi 2015; Guo et  al. 2015;

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Wu, X, et al.

Xu, Z, et al.

Song, D, et al.

Nursing Postgraduate
Students’ Recognition and Attitude
Toward Research
Integrity

护理学专业研究生
Survey of Status
学术失范现状调查
Quo of Academic
Misconduct of
Graduates in Nursing Profession

七年制本硕医学生
Survey and Analysis
学术诚信状况调查
of the state quos of
与分析
academic integrity
among medical students of seven-year
program*

护理硕士研究生对
科研诚信的认识
与态度

Sampling method

Logitudinal study of
medical students
(seven-year program) in Guangxi
Medical University

Logitudinal survey
and in-depth interview of nursing
postgraduates in a
university

Descriptive survey:
effective response
rate 71.8%
(467/650)

Unstated

Unstated
Descriptive survey:
survey(effective
response rate 96%
(96/100)) + indepth interview
with 12 participants

Interview study: face- Purposive sampling
to-face non-structured interviews
with 10 participants

Study design

Logitudinal study of Interview study: face- Purposive sampling
to-face in-depth
Master’s Students
interviews with 12
in Nuring (those
participants
who have taken
courses related to
nursing research) in
School of Nursing
in a university

Qualitative Research Zheng, Z, et al. Logitudinal study
of nurses (clinical
on the Writer’s Cogworking stanition and Behavior
tus + with at least
of Academic Mis2 publications) in
conduct
a grade A tertiary
hospital

Setting

作者学术不端认知
和行为情况的质
性研究

Authors

Title (English)

Table 2  Characteristics of included studies

Title

Unclear

Unstated

–

–

Survey administration method

2015

2013

2014

2014

Year of
publication

Integrity in Biomedical Research: A Systematic Review of Studies…

13

13

Title (English)

Authors

医学研究生学术不
Survey Analysis and Wusiman, A
端行为的调查分析
Countermeasure
及对策研究—以新
Research on Aca疆医科大学为例
demic Misconducts of Medical
Graduates-Taking
Xinjiang Medical
University as a
Example
高等中医院校研究
Fan, X, et al.
Study of Academic
生学术廉洁文化
Integrity Culture
调查与建设路径
Survey and Con探究—以福建中医
struction Path of
药大学为例
Graduate of TCM—
Based on the Survey
of Fujian University
of Traditional Chinese Medicine
导师视角下的研究
Guo, L, et al.
An Investigation of
生学术道德规范教
Post Graduates’
育现况调查
Ethics Education
From the Perspective of a Thesis
Advisor

Title

Table 2  (continued)

Unstated

Unstated

Random sampling

Unstated

Logitudinal study of Descriptive survey:
effective response
medical postgradurate 93.0%
ates in Fujiang
(465/500)
University of
Traditional Chinese
Medicine

Logitudinal survey of Descriptive survey:
effective response
medical promoters
rate 84.7%
in Peking Univer(375/443)
sity Health Science
Center

Survey administration method
Unstated

Sampling method

Random sampling

Study design

Descriptive survey:
Logitudinal study
effective response
of second-year
rate 93.3%
Master’s Students
(280/300)
in Xinjiang Medical
University

Setting

2015

2015

2015

Year of
publication

	
N. Yi et al.

Table 2  (continued)

Title (English)

Authors

Zhao, S, et al.

药学研究生学术道
德培养与保障体
系研究

Academic moral
training system
research and
security research of
pharmacognosy

Long, L, et al.

医学研究生学术不
Survey and analysis
端行为的调查分析
of academic
misconduct among
medical postgraduate

研究生学术规范认
Chen, H, et al.
Investigating and
知及学术失范行为
analyzing the cogni的调查分析
tive of academic
criterion and
the behavior of
academic anomie in
graduate students
综合性大学医学研
Lin, Q, et al.
Investigation and
究生学术道德现状
analysis of medical
调查与分析
postgraduates’
academic moral
status quo

Title

Logitudinal study of
medical postgraduates in Shenyang
Pharmaceutical
University

Descriptive survey:
effective response
rate 92.4%
(462/500)

Logitudinal survey of Descriptive
survey: effecmedical posttive response rate
graduates trained
90.9%(120/132)
in Xinjiang Uiger
Municipal People’s
Hospital

Unstated

Unstated

Handed out + online

Unstated

Unstated

Unstated

Descriptive survey:
effective response
rate 96.9%
(483/500)

Logitudinal study of
medical postgraduates in First
School of Clinical
Medicine, Wuhan
University

Survey administration method
Unstated

Sampling method

Unstated
Descriptive survey:
response rate 92.3%
(277/300)

Study design

Logitudinal study of
Master’s Students
in the First Affiliated Hospital of
Wenzhou Medical
University

Setting

2014

2014

2014

2014

Year of
publication

Integrity in Biomedical Research: A Systematic Review of Studies…

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13

Survey of Academic
Literacy and Academic Standardization Among Medical Postgraduates*

医学研究生学术素
养及学术规范情
况调查

Li, L, et al.

Authors

《武警医学》作者
Li, X, et al.
Survey on Cogni学术不端认知与行
tion and Behavior
为调查分析
About Academic
Misconduct Among
Authors of Medical Journal of the
Chinese People’s
Armed Police
Forces
临床护士对科研诚
Liu, M, et al.
Investigation of
信认识及科研规
the cognition of
范了解度的调查
scientific research
分析
integrity and know
status of scientific
research standard
among clinical
nurses
医科研究生学术道
Lu, J, et al.
Surveying Medical
德失范行为的调查
Graduate Students’
Behaviors Against
Academic Morals

Title (English)

Title

Table 2  (continued)
Study design

Descriptive survey:
effective response
rate 87.0%
(296/340)

Convenience sampling

Unstated
Descriptive survey:
response rate 71.5%
(261/365)

Cluster sampling

Sampling method

Cluster sampling
Logitudinal survey of Descriptive survey:
response rate 98.9%
medical postgradu(1173/1186)
ates in a military
medical university

Logitudinal survey
of clinical nurses
(working experience ≥ 5y + with
publication) in 13
grade A tertiary
hospitals of 7 cities

Logitudinal survey
of authors of the
Medical Journal of
the Chinese People’s Armed Police
Forces (publishing
in the last 2 years)

Logitudinal survey of Descriptive survey:
effective response
medical postgradurate 95.2%
ates in a medical
(762/800)
university

Setting

2013

2013

Year of
publication

Unstated

2012

Handed out by the
2013
nursing department

Email

Handed out

Survey administration method

	
N. Yi et al.

Liu, M, et al.

Li, Y, et al.

Nursing Research
13所三级甲等医院
Integrity Among
308名临床护士护
308 Clinical Nurses
理科研诚信状况调
查分析

医学院校研究生科
Reasons and Solu研诚信缺失的原因
tions of Dishonesty
与对策研究
in Research Among
Postgraduates in
Medical Colleges
and Universities*

Lu, J, et al.

Liu, M, et al.

A Survey on Medical
Graduate Students’
Attitudes Toward
Academic Ethical
Misconducts

医科研究生对学术
道德失范的态度
调查

Authors

临床护士科研诚信
Investigation on
意识调查及影响因
Research Integrity
素分析
Awareness Among
Clinical Nurses and
Influencing Factors

Title (English)

Table 2  (continued)

Title

Study design

Unstated

Handed out by the
counselors

2012

2012
Handed out by the
nursing administrative department
Convenience sampling

Descriptive survey:
effective response
rate 90.6%
(308/340)

2012

Year of
publication

2012
Handed out by the
nursing administrative department

Unstated

Survey administration method

Convenience sampling

Cluster sampling

Sampling method

Descriptive survey:
effective response
rate 89.1%
(286/321)

Logitudinal survey of Descriptive survey:
effective response
medical postgradurate 96.6%
ates in Shanghai
(338/350)
University of
Traditional Chinese
Medicine

Logitudinal survey
of clinical nurses
(working experience ≥ 5y + with
publication) in 13
grade A tertiary
hospitals of 7 cities

Logitudinal survey
of clinical nurses
(working experience ≥ 5y + with
publication) in 13
grade A tertiary
hospitals of 7 cities

Logitudinal survey of Descriptive survey:
effective response
medical postgradurate 98.9%
ates in a medical
(1173/1186)
university

Setting

Integrity in Biomedical Research: A Systematic Review of Studies…

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Title (English)

Study design

Sampling method

Random sampling
Logitudinal survey of Descriptive survey:
effective response
medical postrate 98.0% (98/100)
graduates in Third
Military Medical
University

Setting

Cluster sampling
Wang, Q, et al. Logitudinal survey of Descriptive survey:
response rate 92.4%
final-year medical
(424/459)
postgraduates in
Peking University
Health Science
Center

Peng, Z, et al.

Authors

*There is no English translation in the original article. The English title was translated by NY

浅谈医学研究生科
Analysis of the
研诚信存在的问题
Academic Honesty
及对策
Among the Medical Postgraduate
Students and Its
Strategies
北京大学医学部研
Academia criterion
究生学术规范教育
education of gradu的调查分析
ated students in
Pekjng University
Health Science
Center

Title

Table 2  (continued)

Unstated

Handed out

Survey administration method

2007

2010

Year of
publication

	
N. Yi et al.

1

2

Method of
1
subject/
comparison group
selection or
source of
information/input
variables
described
and appropriate?

Subject (and 0
comparison
group, if
applicable)
characteristics
sufficiently
described?

3

4

2

Study design N/A
evident and
appropriate?

2

2

1

Question/
objective
sufficiently
described?

2

2

2

2

2

2

2

2

2

1

2

2

2

1

2

2

2

1

2

2

2

1

2

2

0

1

2

1

2

2

2

2

2

1

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

Guo
Chen Lin
Long Zhao
Li
Li
Liu
Lu
Lu
Liu
Liu
Xu
Song
Wusi- Fan
(2015) (2015) (2014a) (2014) (2014) (2014) (2013a) (2013b) (2013) (2012a) (2012b) (2012a) (2012b)
(2013) (2015) man
(2015)

Scores

1

Criteria

Table 3  Quality of quantitative studies and mixed-methods studies

2

1

2

2

2

2

2

1

Li
Peng
(2012) (2010)

2

2

2

2

Wang
(2007)

Integrity in Biomedical Research: A Systematic Review of Studies…

13

13

N/A

N/A

If interventional and
blinding of
investigators was
possible,
was it
reported?

If intervenN/A
tional and
blinding
of subjects
was possible, was it
reported?

6

7

N/A

N/A

If intervenN/A
tional and
random
allocation
was possible, was it
described?

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Guo
Chen Lin
Long Zhao
Li
Li
Liu
Lu
Lu
Liu
Liu
Xu
Song
Wusi- Fan
(2015) (2015) (2014a) (2014) (2014) (2014) (2013a) (2013b) (2013) (2012a) (2012b) (2012a) (2012b)
(2013) (2015) man
(2015)

Scores

5

Criteria

Table 3  (continued)

N/A

N/A

N/A

N/A

N/A

N/A

Li
Peng
(2012) (2010)

N/A

N/A

N/A

Wang
(2007)

	
N. Yi et al.

N/A

N/A

N/A

Analytic
methods
described/
justified
and appropriate?

N/A
Some
estimate of
variance is
reported for
the main
results?

11

N/A

10

N/A

Sample size
appropriate?

9

2

Outcome
2
and (if
applicable)
exposure
measure(s)
well
defined and
robust to
measurement/misclassification bias?
means of
assessment
reported?

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

2

N/A

N/A

N/A

1

N/A

N/A

N/A

2

Guo
Chen Lin
Long Zhao
Li
Li
Liu
Lu
Lu
Liu
Liu
Xu
Song
Wusi- Fan
(2015) (2015) (2014a) (2014) (2014) (2014) (2013a) (2013b) (2013) (2012a) (2012b) (2012a) (2012b)
(2013) (2015) man
(2015)

Scores

8

Criteria

Table 3  (continued)

N/A

N/A

N/A

2

N/A

N/A

N/A

1

Li
Peng
(2012) (2010)

N/A

N/A

N/A

2

Wang
(2007)

Integrity in Biomedical Research: A Systematic Review of Studies…

13

13

Results
reported in
sufficient
detail?

Conclusions
supported
by the
results?

13

14

Summary score

Controlled
for confounding?

12

Criteria

2

2

0.86

1

1

0.58

N/A

N/A

0.93

2

1

N/A

0.93

2

1

N/A

0.86

2

1

N/A

0.86

2

1

N/A

0.86

2

1

N/A

0.86

2

1

N/A

0.64

2

1

N/A

0.93

2

1

N/A

0.86

2

1

N/A

0.93

2

1

N/A

0.93

2

1

N/A

0.93

2

1

N/A

0.86

2

1

N/A

0.93

2

1

N/A

Guo
Chen Lin
Long Zhao
Li
Li
Liu
Lu
Lu
Liu
Liu
Xu
Song
Wusi- Fan
(2015) (2015) (2014a) (2014) (2014) (2014) (2013a) (2013b) (2013) (2012a) (2012b) (2012a) (2012b)
(2013) (2015) man
(2015)

Scores

Table 3  (continued)

0.86

2

1

N/A

0.78

2

1

N/A

Li
Peng
(2012) (2010)

0.93

2

1

N/A

Wang
(2007)

	
N. Yi et al.

Integrity in Biomedical Research: A Systematic Review of Studies…
Table 4  Quality of qualitative studies and mixed-methods studies
Criteria

Scores
Zheng (2014)

Wu (2014)

Xu (2013)

1. Question/objective sufficiently described?

2

2

1

2. Study design evident and appropriate?

2

2

1

3. Context for the study clear?

2

2

1

4. Connection to a theoretical framework/wider body of
knowledge?

1

1

1

5. Sampling strategy described, relevant and justified?

2

2

0

6. Data collection methods clearly described and systematic?

1

1

0

7. Data analysis clearly described and systematic?

2

2

0

8. Use of verification procedure(s) to establish credibility?

0

0

0

9. Conclusions supported by the results?

2

2

2

10. Reflexivity of the account?

0

0

0

Summary score

0.70

0.70

0.30

Li et al. 2013a; Wusiman 2015). However, when asked about the national or university guidelines, most of those surveyed stated that they were unaware of these
guidelines. In one survey of 280 medical postgraduates, the majority of participants (98%) reported to be unaware of “Opinions on Strengthening Academic
Morality (关于加强学术道德建设的若干意见)” published by the Ministry of
Education (Wusiman 2015). Many postgraduates (61%) indicated to know that
the university had relevant guidelines but they had no idea of their content (Song
et al. 2015). About one-third of the supervisors reported to be unaware of how the
university dealt with research misconduct (Guo et al. 2015).
Perception of Research Misconduct
Based on a study of 120 postgraduates, Long et al. found that most postgraduates
(69%) reported to be aware or relatively aware of the definition of research misconduct. The higher the number of years into training, the higher the awareness
was (Long and Yang 2014). Specifically, the awareness varied for different forms
of research misconduct. In a survey of authors of scientific articles, fabrication,
falsification and plagiarism (FFP) were identified as research misconduct by the
majority (88%) of the scientific authors, whilst improper authorship (62%), duplicate submission (56%), salami publication (56%), improper citation (30%) were
considered to be research misconduct by fewer scientific authors (Li et al. 2013b).
In another study, fewer medical students considered using others’ results without citation (17%), coauthorship without contribution (9%), duplicate submission
(20%) as forms of research misconduct (Song et al. 2015).

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N. Yi et al.

Perception of Factors Responsible for Research Misconduct
Several studies (Chen et  al. 2014a; Li et  al. 2012; Lin et  al. 2014; Liu and Zhou
2012a; Long and Yang 2014; Wusiman 2015; Xu et al. 2013) have attempted to find
out how research misconduct may occur, at least as perceived by various categories of researchers. In summary, the main factors that were perceived responsible
for research misconduct included the unhealthy atmosphere of the society/institution
(22–38%), insufficient research ability (7–26%), insufficient knowledge of academic
norms (14–19%), limitations of the education/evaluation system (12–87%), lack of
heteronomy/supervision (10–67%), lack of guidance/training (in both research skills
and research integrity) (8–37%), lack of self-discipline (12–18%), too much pressure
to publish (23–24%) and others.
Awareness of Measures Safeguarding Research Integrity
Four studies (Long and Yang 2014; Song et al. 2015; Wang et al. 2007; Wusiman
2015) dealt with the main approaches to safeguard research integrity. Thus medical postgraduates reported to have learnt about the knowledge of academic norms
and research misconduct through courses, lectures or campus dissemination of the
university (16–37%), guidelines of the university (14–29%), online study (16–42%),
supervisor’s or senior postgraduates’ emphasis (12–36%), the (good) examples
nearby (6%) and other means.
Perceived Prevalence of Research Misconduct
Self‑evaluation and Perception of the General Research Practices
With regard to general research practices, two aspects, including the awareness of
academic norms and practices of research misconduct, were investigated by asking
participants about their own behaviors and their perception of the general research
environment.
On one hand, in terms of self-report, more than half of the medical postgraduates indicated that they had the academic norms in mind during their research and
the writing process of their thesis (Li et  al. 2013a; Xu et  al. 2013). A small portion (18%) of the 338 postgraduates in one study reported that their awareness of
research integrity was weak (Li et  al. 2012). According to three studies, 10–32%
of postgraduates admitted that they had committed research misconduct (Li et  al.
2013a; Lin et al. 2014; Lu and Zhou 2012).
On the other hand, the perception of the general research environment was
explored among nurses, postgraduates and supervisors. Generally, based on four
studies, the majority of the respondents were satisfied with the general environment
(Guo et al. 2015; Li et al. 2013a; Liu and Zhou 2012a; Wang et al. 2007). Nevertheless, when asked about the perception of research misconduct, paradoxically, a number of supervisors from the same study indicated that research misconduct was serious among postgraduates (48%) and teachers (35%) (teachers here included those

13

Integrity in Biomedical Research: A Systematic Review of Studies…

professors, associate professors, lecturers and teaching assistants in universities who
were also involved in scientific research) (Guo et al. 2015). In addition, according to
six other studies, a considerable proportion of the respondents (30–60%) stated to be
aware of the existence of research misconduct among their peers (Chen et al. 2014a;
Li et al. 2013b; Liu and Zhou 2012a; Long and Yang 2014; Wang et al. 2007; Wusiman 2015).
Perceived Prevalence of Specific Forms of Research Misbehavior
Eight studies gave examples of research misconduct and reported their prevalence.
The most mentioned forms of research misconduct in these reviewed studies include
fabrication and falsification of data (self-report prevalence 2–19%, observed prevalence among others 15%), plagiarism (self-report prevalence 2–11%, observed
prevalence 10%), improper authorship (observed prevalence 11%), duplicate submission (self-report prevalence 16%, observed prevalence 7%), duplicate publication
(observed prevalence 4%) and improper citation (18%) (Chen et al. 2014a; Li et al.
2013b; Lin et al. 2014; Lu and Zhou 2012; Peng et al. 2010; Wang et al. 2007). In
addition, some other behaviors were also reported, such as providing or using false
certificate(s) (2%), ghost writer/transaction of academic products (7–8%), making a
new article based on the pieces of others’ publications (2–20%), writing papers for
others or having others write for one’s self (6%), interfering with the editor during
submission (2%), imitating supervisors’ signature (in application for scholarships,
funds and so on) (Guo et al. 2015; Lin et al. 2014; Lu and Zhou 2012; Wang et al.
2007; Xu et al. 2013).
Attitudes Towards Research Misconduct
Respondents’ opinions of research misconduct were mixed. Opinions included
objection (“feeling ashamed for those who misbehaved”, “cannot tolerate research
misconduct”, “object to research misconduct firmly” or “sticking to academic norms
is extremely important and compulsory”) (39–79%), acceptance (“can accept/understand/forgive research misconduct” or “sticking to academic norms is relatively
important but sometimes flexible”) (7–43%) and indifference (“It doesn’t matter” or
“It is not so important”.) (1–22%) (Chen et al. 2014a; Li et al. 2013a, b; Lin et al.
2014; Long and Yang 2014; Lu et al. 2012; Wusiman 2015).
Regarding the opinions on research misconduct, a challenging paradox was
observed. On the one hand, at the principle level, nursing postgraduates generally
opposed research misconduct. As some students stated, “Plagiarism is a reflection of
irresponsibility towards yourself and others” (Wu et al. 2014). Also, in one quantitative study, 79% of the medical postgraduates indicated “obeying academic norms is
very important and compulsory” (Li et al. 2013a). Nevertheless, on the other hand,
at the practical level, some of them showed understanding attitudes. Thus, some
nursing postgraduates held these views: “For the first time to hear (research misconduct), I found it was unbelievable, and then I found everyone did that, so it’s OK, it’s
somewhat understandable” (Wu et al. 2014). Moreover, when asked about specific

13

	

N. Yi et al.

forms of research misconduct- (plagiarism and data fabrication), in comparison to
the attitudes towards general research misconduct reported above, only 51% of the
medical postgraduates indicated “cannot tolerate” (Li et  al. 2013a). This paradox
illustrates how attitudes may differ between principles and practice.
Some studies went beyond just asking about opinions, they also enquired about
responses to research misconduct. A small group of postgraduates (11–27%)
reported that they would take measures against research misconduct or report it,
while a majority of postgraduates indicated indulgence: they would not report or
they held an indifferent attitude (Chen et al. 2014a; Lin et al. 2014). Nevertheless,
concerning their own research, most of the respondents (82–92%) indicated that they
would take measures to protect their own publications or research results against
plagiarism or other misbehaviors (Chen et al. 2014a; Liu and Zhou 2012a), which
might be a sign of higher concerns of their own rights.
Suggestions to Improve Research Integrity
In addition to the perception and attitude toward research integrity and misconduct,
some suggestions to promote research integrity were also sought in these studies,
from both the study participants and investigators. Efforts were expected to improve
the governance system, the evaluation system and training.
Suggestions by the Participants
Improvement of four aspects were suggested by the participants.
Firstly, to develop the governance system, some specific measures were suggested: developing the guidelines and policies, application of the academic misconduct detection system(s), building up a management department of research integrity (70%), signing a research integrity pledge (75%), strengthening supervisors’
supervision (11%), creating a bank of authors who misbehaved, absolute blind peer
review, audit after publication, request for necessary original data, punishing serious
misconduct, etc. (Chen et al. 2014a; Guo et al. 2015; Li et al. 2013b; Li et al. 2012;
Wusiman 2015).
Secondly, in order to improve the scientific evaluation system, the emphasis on
the number of publications and the excessive publication pressure shoud be reduced
(Chen et al. 2014a; Guo et al. 2015; Li et al. 2013b; Wusiman 2015). In addition,
hospitals should not require members of their staff to publish scientific papers for
evaluation and promotion (Li et al. 2013b).
Thirdly, the respondents also suggested to enhance the training of researchers
(Chen et  al. 2014a; Guo et  al. 2015). They stated that research integrity training
could be added to the curriculum of postgraduates (43–76%) and the pre-enrollment
training (81%), and that focused activities of research integrity training (81%) could
also be organized (Guo et al. 2015; Li et al. 2012; Wusiman 2015). In addition, the
training of supervisors should be enhanced as well (13%) (Guo et al. 2015). In more
detail, research integrity training should include relevant laws/guidelines (74%),
case analysis (55%) (especially mentioned by young supervisors), punishment of

13

Integrity in Biomedical Research: A Systematic Review of Studies…

research misconduct (54%), detailed guidance on article writing (46%) (Guo et al.
2015). Moreover, specific sections on research integity in scientific journals could
improve the awareness and knowledge of research integrity (Li et al. 2013b).
Furthermore, a well respected academic atmosphere was believed to be one
important factor for ensuring research integrity (Chen et al. 2014a; Guo et al. 2015;
Li et al. 2013b).
Suggestions by the Investigators
Based on the empirical data, the authors of these 21 studies also proposed suggestions to promote research integrity.
Firstly, as suggested by 20 out of the 21 included studies, training should be
organized on: (1) the research ability (Fan and Yi 2015; Liu and Zhou 2012a, b), (2)
the scientific spirit (Fan and Yi 2015; Li et al. 2013a; Liu and Zhou 2012b, 2013)
and (3) research integrity (Chen et al. 2014a; Fan and Yi 2015; Guo et al. 2015; Li
et al. 2013a; Li et al. 2012; Lin et al. 2014; Liu and Zhou 2012a, b, 2013; Long and
Yang 2014; Lu et al. 2012; Lu and Zhou 2012; Peng et al. 2010; Song et al. 2015;
Wang et al. 2007; Wu et al. 2014; Wusiman 2015; Xu et al. 2013; Zhao and Jia 2014;
Zheng et  al. 2014). The definitions and examples of good research practices, the
good practices of some prestigious senior researchers, the laws related to research
practices, as well as the definitions of research misconduct, procedures for handling
research misconduct and punishment for misconduct should be presented during the
training (Long and Yang 2014; Song et al. 2015). And 12 studies proposed various
forms of research integrity training (e.g. courses and lectures), tailored to different
target groups, tied to the specific profession and daily research practices (Guo et al.
2015; Li et al. 2013a; Li et al. 2012; Liu and Zhou 2012a, b; Long and Yang 2014;
Lu et al. 2012; Peng et al. 2010; Song et al. 2015; Wang et al. 2007; Xu et al. 2013;
Zheng et al. 2014).
Secondly, the current academic evaluation system needs to be reformed. The evaluation should give more emphasis to the research process rather than on the number
of publications. In other words, the pressure to publish should be reduced. A multiple-indexed evaluation system should be developed (Fan and Yi 2015; Guo et al.
2015; Long and Yang 2014; Peng et al. 2010; Wang et al. 2007; Xu et al. 2013).
Thirdly, some solutions were proposed to improve governance: guidelines and
policies must be developed to oversee and tackle research misconduct (mentioned by
8 out of 21 studies) (Fan and Yi 2015; Li et al. 2012; Liu and Zhou 2013; Long and
Yang 2014; Lu and Zhou 2012; Wang et al. 2007; Wu et al. 2014; Xu et al. 2013),
specialized departments should be established to promote research integrity and
deal with research misconduct (Fan and Yi 2015; Wang et al. 2007; Xu et al. 2013),
an (academic) credit system could be set up (Fan and Yi 2015; Song et al. 2015),
and laws on research integrity are needed (Long and Yang 2014; Peng et al. 2010;
Zhao and Jia 2014). To monitor research misconduct, detection technology could
be applied (Li et al. 2013b; Zhao and Jia 2014). Once research misconduct has been
identified, there should be punishments proportional to the magnitude of misconduct
(Li et al. 2012; Liu and Zhou 2012a; Lu and Zhou 2012; Wang et al. 2007; Xu et al.

13

	

N. Yi et al.

2013). In addition, an appropriate model of research integrity could help to lead to
acceptable research practices (Fan and Yi 2015).
Further suggestions were raised for two main populations in these studies (medical postgraduates and nurses).
For postgraduates, suggestions concerning supervisors’ mentoring were made.
The following reasons emphasized the role of supervisors: Firstly, supervisors, being
senior researchers, are expected to influence postgraduates positively by words and
deeds (Guo et  al. 2015; Long and Yang 2014; Song et  al. 2015; Wu et  al. 2014;
Zhao and Jia 2014). Secondly, in addition to being role models, supervisors should
train and supervise postgraduates in research integrity (Guo et al. 2015; Long and
Yang 2014; Peng et al. 2010; Wusiman 2015; Xu et al. 2013; Zhao and Jia 2014),
research skills (Peng et  al. 2010; Xu et  al. 2013) and scientific spirit (Long and
Yang 2014; Peng et al. 2010). As a consequence, in addition to improve the aspects
above, the selection, appraisal and training (on research skills and research integrity)
of supervisors should be enhanced (Chen et al. 2014a; Guo et al. 2015; Long and
Yang 2014; Wusiman 2015; Zhao and Jia 2014). Moreover, supervisors should bear
the joint liability when research misconduct by their postgraduates is identified (Guo
et al. 2015; Zhao and Jia 2014).
For nurses, efforts are expected to: (1) boost the investment in nursing research
and (2) improve the governance of nursing research (Liu and Zhou 2012a, b, 2013).
Additional data are given in Online Resource 1.

Discussion
The goal of our systematic review was to uncover what has been studied in China
about biomedical researchers’ awareness, perceptions, attitudes and experiences of
research integrity and misconduct. After systematic search and screening, we identified 21 studies that collected information from various populations using quantitative and qualitative methods. Interestingly, our review indicates that research integrity among nurses has been studied more in China than elsewhere. The reasons for
this are not clear; this could be due to the specific requirement of having to publish
article(s) to qualify for promotion, the higher salary and allowances of nurses in
China, whereas this is not so frequent in other countries (Fanelli 2009; Okonta and
Rossouw 2014; Sabir et al. 2015).
In general, most of these studies share a common interest in (1) the perceived
importance and compliance of academic norms, (2) the perceived definition and attitudes of research misconduct, (3) the forms, prevalence and responsible factors of
research misconduct, as well as (4) solutions to promote research integrity.
Forms and Prevalence of Biomedical Research Misconduct in China
We conducted this systematic review as a first endeavor to establish whether biomedical research integrity in China is really of more concern than elsewhere (“China’s medical research integrity questioned” 2015). Our review does not give a formal

13

Integrity in Biomedical Research: A Systematic Review of Studies…

answer to this question (this would require a comparative analysis), but it does provide an idea of the state of empirical research about scientific integrity in China.
The available evidence suggests that Chinese researchers involved in these studies
generally have a valid appreciation of academic norms (Fan and Yi 2015; Guo et al.
2015; Li et  al. 2013a; Wusiman 2015; Xu et  al. 2013). Nevertheless, this review
also documents that research misbehaviors, such as fabrication and falsification of
data, plagiarism, inappropriate authorship, duplicate submission, improper citation
and using false certificate(s), transaction of academic products, exist in China (Chen
et al. 2014a; Fan and Yi 2015; Guo et al. 2015; Li et al. 2013b; Lin et al. 2014; Lu
and Zhou 2012; Peng et al. 2010; Wang et al. 2007; Xu et al. 2013). Some of these
forms of misconduct have been reported before (Hu and Wu 2013; Xinhua News
Agency 2009), but some features might differ from other regions, especially transaction of academic products is less reported in other countries (Hvistendahl 2013; Lins
and Carvalho 2014; Okonta and Rossouw 2014).
Regarding the prevalence of misbehaviors, the prevalence range proved to be
wide, which might be related to the broad variation in participants and institutions
included in the studies. The self-reported prevalence of fabrication and falsification
of data (2–19%) and plagiarism (2–11%) in the Chinese studies appears to be higher
than the average prevalence reported by Fanelli, who concluded mainly on the basis
of studies in the US and the UK (Fanelli 2009), that “A pooled weighted estimate of
1.97% of scientists admitted to have fabricated, falsified or modified data or results”.
However, the prevalence in China was lower than in one study in Nigeria, where
42.2% researchers admitted to have committed “falsification of data, falsification
of biosketch, resume and plagiarism” (Okonta and Rossouw 2013). Nevertheless,
owing to the differences in the methodological approaches and the sample sizes,
we cannot draw firm conclusions. Moreover, it has been demonstrated that research
misconduct in medicine is more prelvalent than in other domains (Fanelli 2009).
Consequently, we need more evidence to situate the state of the integrity of Chinese
biomedical research internationally.
In general, the more serious the misconduct is, the lower its prevalence, which is
consistent with the results of other studies (Ana et al. 2013; Fanelli 2009). However,
the difference between the self-reported prevalence and the observed prevalence is
not as marked as the difference observed by Fanelli (1.97% self-report prevalence of
data or result fabrication, falsification or modification vs. 14.12% observed prevalence of falsification) (Fanelli 2009). This could be attributed to the factor that the
background of the respondents in these studies is diverse and that they come from
different universities, hospitals and other institutions, which may influence their perception of research integrity and their research practices. Again, it might be inappropriate to simply compare the percentages among these studies. As mentioned by
Fanelli, reports on research misconduct might be biased by the way in which surveys
are conducted, the influence of social expectations and the explicit use of the terms
“fabrication”, “falsification” (Fanelli 2009). Hence, the reported prevalence in our
study might also be a conservative estimate.
The attitudes towards research misconduct are mixed. Most participants in these
21 studies found research misconduct objectionable, while others held an understanding or indifferent attitude. Regarding attitudes towards specific misbehaviors,

13

	

N. Yi et al.

the existence of making a new article based on the pieces of others’ publications
(Chen et  al. 2014a; Lin et  al. 2014; Peng et  al. 2010; Wang et  al. 2007) might be
an indicator of higher tolerance of plagiarism, although these studies did not document obvious differences on the attitudes towards plagiarism and data fabrication or
falsification.
Concerning the current academic environment in China, quite a number of those
surveyed did not have a positive evaluation (Li et al. 2013a; Liu and Zhou 2012a),
which is in accordance with the CAST report (Xinhua News Agency 2009). The
current social and research atmosphere, where a substantial number of researchers
held an indifferent or even indulging attitude towards research misconduct (Chen
et  al. 2014a; Lin et  al. 2014), is regarded as the breeding ground for misconduct.
One included study revealed that senior postgraduates had higher tolerance for
research misconduct than junior researchers (Lu et  al. 2012), which is consistent
with the study referred to by Cyranoski where the students’ tolerance of misconduct
increased with the time they stayed in the education system (Cyranoski 2012). With
such an environment they study and work in, it is difficult to build honest culture in
research (Binder et al. 2015; Grinnell 2014).
The Scientific Evaluation System
The pressure to publish is usually believed to be one of the main factors responsible for research misconduct (Luther 2010; Steneck 2002). Quantitative metrics of
publication have been applied for graduation, promotion, fund allocation and salaries in many Chinese biomedical institutions (“China’s medical research integrity
questioned” 2015; Peng et al. 2010). As Suo stated, “The current assessment system
is not perfect but appropriate in China”. In Suo’s opinion, the current assessment of
researchers’ academic performance in China is based on their publications, but both
the quantity and quality are considered (Suo 2016). Although the quality of accepted
papers is not completely controlled by the impact factor of the journal, compared
to other indexes, SCI (Science Citation Index) papers and journal’s impact factor
are more objective and fair (Suo 2016). Nevertheless, the current evaluation system
remains of doubtful value and multiple criteria are expected to work (Chen et  al.
2014b; Hvistendahl 2013; Xu et  al. 2013). Currently, a reform is taking place at
the Chinese Academy of Sciences (CAS), where the process of scientific research is
given more attention (Huang 2015).
Another dilemma is that some Chinese researchers, such as nurses, experience
the pressure to publish, although they have hardly received systematic training
on research methods and skills. This gap may contribute to certain misbehaviors.
Unfortunately, this problem also exists in some other countries and regions (Ryan
et al. 2012).
Research Integrity Training
This review has shown that most participants in the included studies have only a
vague impression of the definition of research integrity and misconduct. Most

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Integrity in Biomedical Research: A Systematic Review of Studies…

participants in these studies stated to be aware of academic norms or the university
guidelines, but not in detail (Li et al. 2013a; Song et al. 2015). The knowledge of
research misconduct was mainly limited to fabrication, falsification, or plagiarism
(FFP), while some other practices, such as improper authorship and duplicate submission were not always recognized as research misconduct (Guo et  al. 2015; Li
et al. 2013b). Therefore, systematic training in research integrity may be needed to
fill gaps in knowledge and awareness. Though the effectiveness of training in achieving changes of attitudes and practices needs further research (Schmaling and Blume
2009), it has proved to increase at least the knowledge of research integrity and misconduct (Anderson 2007; Fanelli et al. 2015; Jordan and Gray 2013; Li et al. 2012;
Liu and Zhou 2012b).
Besides, guideline and policy documents at both national and institutional levels cannot play the expected role because of inadequate publicity and training. In
the last decades, the Chinese government and research institutions have published
a series of policies and documents of research integrity, ranging from several-page
guidelines to hundred-page manuals (Fudan University 2014; National Health and
Family Planning Commission of the People’s Republic of China 2014; Ren 2012;
Zeng and Resnik 2010). However, emphasis on the dissemination of these guidelines is still lacking (Cyranoski 2012; Michel 2010).
In addition, junior researchers have poor knowledge of research integrity and
misconduct (Li et al. 2013a), and many postgraduates appear to learn about research
integrity from their supervisors and senior students. However, senior researchers do
not necessarily have a precise knowledge of research integrity and misconduct and
they are not immune from committing misconduct (Wiwanitkit 2016), especially
when some questionable research practices are not deemed questionable. Therefore,
formal training on research integrity is essential at all levels to spread the correct
knowledge and avoid unintended misbehaviors.
Additional Studies in the Last 2 Years
Following a first review of our article, we checked in the databases (now including
Google Scholar, the search strategy is given in Online Resource 2) whether important articles had been published between the completion of our search (June 2016)
and January 2018. This, admittedly, less rigorous search identified 8 relevant articles
(1 in English, 7 in Chinese), addressing the same issues as our previously included
articles, such as knowledge of academic norms, prevalence of and attitudes towards
research misconduct as well as suggestions to improve research integrity (Gao et al.
2016; Guo et al. 2017; Li et al. 2016; Li and Zhang 2017; Liao et al. 2017; Miao
et al. 2017; J. Wang and Jiang 2017; Wu et al. 2016). This update does not affect our
conclusions.
Interestingly, from a survey of biomedical researchers, Liao et  al. (2017) concluded that perceptions towards academic misconduct had not significantly changed
between 2010 and 2015. To our knowledge, this is the first English language article
in which Chinese biomedical research integrity has been investigated empirically.
This study also shows that most participants believed that the attention Chinese

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N. Yi et al.

authorities paid to academic misconduct was not sufficient and that the sanctions for
academic misconduct were not appropriate or severe enough (Liao et al. 2017). In
addition, the academic assessment system was deemed as the most important factor
responsible for academic misconduct, which is also in accordance with our results
above (Liao et al. 2017).
Moreover, whereas our first search had identified 21 studies over a period of
about 10  years (2007–May 2016), this update search yielded 8 more studies over
less than 2 years. This is indicative of a rising interest in the topic of biomedical
research integrity among Chinese scholars, and of more attention to the application
of empirical research methods.
Limitations
Firstly, the studies we reviewed were a mix of qualitative and quantitative research,
the data from which could be heterogeneous, thus complicating the pooling of the
information. Besides, bearing the goal to give a more comprehensive impression
of Chinese studies in mind, we did not exclude any study based on their quality,
although we made a quality appraisal of studies. Nevertheless, these studies of lower
quality would more or less weaken the strength of this evidence. Furthermore, these
21 studies were conducted in different settings, with different goals and using different investigation tools, as a consequence, there was inevitably information loss in
the process of data synthesis. In addition, considering the vast territory and imbalanced distribution of resources and populations in China, the generalizability of our
review might be limited.
Future Research Directions
Our review indicates that biomedical research integrity studies in China have been
mainly conducted among postgraduates and nurses. Nevertheless, more attention of
future research should also be paid to senior researchers and professors, who play a
leading role in scientific research.
Besides, in terms of the administration, some surveys in this review were distributed and collected by the administrative staff who were in charge of the department
or even the whole institution, in the format of paper–pencil survey, which might also
influence the result to some extent. Therefore, to decrease study bias, future research
could apply other tools or techniques, such as web-based surveys, the randomized
response technique (Kays et  al. 2012; Krumpal 2013). Moreover, considering the
fact that the wording used to define misbehavior could affect the findings (Fanelli
2009), the way to present questions is worth considering (Krumpal 2013).

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Integrity in Biomedical Research: A Systematic Review of Studies…

Conclusion
During the search process of our review, we found that a large number of research
integrity studies has been conducted in China, but empirical evidence is still limited.
These 21 empirical studies we identified, using surveys and interviews, all made
efforts to explore Chinese biomedical researchers’ awareness, attitudes, perceptions
and experiences of research integrity and misconduct. China is one of the countries
with the highest output of scientific publications. However, like many other countries and regions, Chinese scientific research is threatened by research misconduct,
the existence and harm of which has been recognized by China and international
scientific communities.
As our review indicates, numerous studies have been conducted, especially in
the last decade. The importance of research integrity has been realized by more and
more Chinese scholars. So far, the Chinese government and universities have taken
measures, such as releasing policies and guideline documents, organizing research
integrity training to promote research integrity, however, according to our review,
the effects remain to be demonstrated in the long term. Besides, with more and
more safeguard measures being taken, it would be crucial to perform more research
in order to explore in-depth perceptions of this issue and if possible, analyze the
changes. One added value of conducting reseach on research integrity shouldn’t be
forgotten as well: by these questions answered or discussed, the awareness of the
importance of research integrity and the reflection of this issue among these participants were raised. Moreover, it would be important to make improvements on
other aspects, for example by disseminating guideline documents, and by developing
diverse integrity training.
Acknowledgements  We would like to acknowledge Prof. Nicolas Standaert in Sinology Research Unit,
KU Leuven for his comments that greatly improved our work. We appreciate the financial support of the
China Scholarship Council (Grant No. 201406090164).

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