In plain language
Most psychology research comes from a small, wealthy slice of the world. This paper asks what science loses when studies from lower- and middle-income countries (LMICs) are overlooked. The authors used Acceptance and Commitment Therapy (ACT) as a test case, because LMICs have produced a large body of ACT randomized controlled trials — over 45% of the world’s ACT RCTs — yet much of that work appears in journals that are not indexed in the major databases researchers typically search.
The team applied structural topic modeling, an unsupervised machine learning method, to 457 English abstracts of ACT trials published in LMIC journals between 2011 and 2023. They also compared study sizes and citation counts across indexed and nonindexed journals from high-income countries (HICs) and LMICs. The topic modeling revealed 30 topics, spanning chronic pain, diabetes, cancer, adolescent mental health, family and marital functioning, resilience, and more. Crucially, when only indexed journals were analyzed, at least six substantive topics — such as mothers of special-needs children, resilience and adjustment, and family functioning — effectively disappeared from view.
Lack of indexing, not lack of quality, appeared to be the barrier: study size did not predict whether an LMIC study was indexed, but indexing strongly predicted citations. The authors conclude that scientific associations, indexing companies, and researchers need to take affirmative steps so that LMIC research is conducted, known, indexed, and used — otherwise evidence-based intervention science will keep missing the cultural and contextual diversity of most of humanity.
Key findings
- Of 457 LMIC ACT trial abstracts analyzed, 86.21% were published in nonindexed journals; meta-analyses relying only on indexed studies would miss about 86% of LMIC research but only 16% of HIC research.
- Structural topic modeling identified 30 topics in LMIC ACT research; when the analysis was restricted to indexed sources, at least six substantive topics (e.g., Mothers of Special Needs Children, Resilience and Adjustment, Family Functioning) vanished.
- Study size (participants per study arm) did not predict whether an LMIC study was indexed, undercutting the assumption that nonindexed LMIC research is simply lower quality; indexed HIC studies, however, had two to three times more participants per arm than other studies.
- Indexing drove visibility: indexed LMIC articles received on average 410% more citations than nonindexed ones, and indexed HIC articles received 482% more than nonindexed ones, while country type itself did not predict citations.
- Within HIC papers, larger sample size predicted more citations, but within LMIC papers it did not — suggesting quality signals from LMIC studies are not being rewarded with visibility.
- Topics gaining popularity over time in LMIC ACT research included ACT compared to other therapies, self-efficacy or self-esteem, and relationship studies, while topics such as adolescent mental health and ACT combination treatments were declining.
How to cite
APA
Sahdra, B. K., King, G., Payne, J. S., Ruiz, F. J., Kolahdouzan, S. A., Ciarrochi, J., & Hayes, S. C. (2024). Why research from lower- and middle-income countries matters to evidence-based intervention: A state of the science review of ACT research as an example. Behavior Therapy, 55, 1348–1363. https://doi.org/10.1016/j.beth.2024.06.003
BibTeX
@article{sahdra2024why,
author = {Sahdra, Baljinder K. and King, Grant and Payne, Jennifer S. and Ruiz, Francisco J. and Kolahdouzan, Seyed Ali and Ciarrochi, Joseph and Hayes, Steven C.},
title = {Why Research From Lower- and Middle-Income Countries Matters to Evidence-Based Intervention: A State of the Science Review of ACT Research as an Example},
journal = {Behavior Therapy},
year = {2024},
volume = {55},
pages = {1348--1363},
doi = {10.1016/j.beth.2024.06.003}
}
Related work
- All publications by Joseph Ciarrochi (searchable, with free PDFs)
- Process-Based Therapy & Idionomic Analysis
Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version via the DOI above.