Opinions of Preschool and Classroom Teachers on Using Music in Mathematics Teaching*

Article History: Purpose: The present study aims to examine the opinions of preschool and classroom teachers about the use of music in mathematics teaching. Research Methods: This research was conducted using a case study method and the data were obtained through semi-structured face-to-face interviews consisting of open-ended questions. In this study, 30 teachers, of whom 15 were classroom teachers and 15 were preschool teachers participated. The obtained data were analysed using a content analysis method. Findings: Findings obtained in this study showed that students' attitudes towards mathematics were high. However, teachers faced difficulties in teaching abstract topics in maths and they suggested that Received: 21 Jan 2020 Received in revised form: 5 Mar. 2021 Accepted: 31 Mar. 2021 DOİ: 10.14689/ejer.2021.94.15

Introduction
In line with the current developments in technology and scientific aspects, innovation in the education system is constantly needed. Depending on the modernization efforts, it is an important task to arrange the education and training programs, which constitute an important strategic dimension within the education system, according to the needs of the age in terms of providing social and individual development (Fabry & Higgs, 1997;Gunes, 2016;Yildiz, 2020). The realization of the learning activities taking place within the education system and providing an environment for the development of individuals from every aspect also requires approaching education within a wide frame, that is, from different angles (Benešová & Tupa 2017;Yavuz & Coskun, 2008;Yildiz, 2020. In the light of this logic, it is essential that in the face of the dynamics of the changing world, one should not be indifferent to this change in education and training and should benefit from this change in a positive way. At this point, it is necessary to present education and training not only with the subject areas of interest, but to transfer different subjects in a more meaningful manner by creating a synthesis, that is to say, from a disciplinary structure to an interdisciplinary structure, and to handle them in an interdisciplinary perspective. According to Edelson and Johnson (2003), today, it is observed that education and other sciences can meet on common ground and that they are influenced by and contribute to each other in this way. The use of an "interdisciplinary" teaching style has recently become a new term in the educational community.
In the process of revealing new ideas and products, to further develop human creativity, the power and thought of establishing a bond between the disciplines is an approach that needs attention. When examining the lives of people who are recognized by others in various aspects and whose work can be spoken about even today, it is seen that they have characteristics by which they can behave and think in multiple ways and integrate these into their working lives. For example, what makes Leonardo da Vinci known as a genius is the result of his work as a painter, musician, inventor, sculptor, engineer, geologist and astronomer. Even centuries later, Albert Einstein considered philosophy and music as a way of discovering physics, although he was primarily a physicist (James, 1991). Music contains an important structure and supporting power to look at life from a scientific and artistic perspective. It is also understood that the power of music is used for certain purposes; especially in education, it has an important place in the existing sciences and has been associated with mathematics since ancient times (Harkleroad, 2006;Wilson et al., 2003).
In this context, mathematics and music had a strong bond in ancient Greece. When number relations, ratios and proportions are considered, music is considered as a real mathematical discipline. There is also a term, "quadrivium", which constituted the curriculum of the Pythagorean School and formed an important part of the teaching in ancient Greece. The discipline of music had a similar place to the branches of arithmetic, geometry and astronomy in the quadrivium.
According to Wollenberg (2006), mathematics and music are characteristically closely linked. The 17th century is seen as an important turning point for music by historians due to the transformation of music from a scientific to an artistic discipline and to its transition from a theoretical to a practical subject. There were many connections between science and music in this period. In the 19th and 20th centuries, the development of the science of music and the mathematical approaches in composition widened the connections between the two fields. Music has a special position within the existing link between art and music. In this connection between music and art, mathematics also plays an important role (Papadopoulos, 2014).
When the general definitions of mathematics and music are compared, it is understood that these two disciplines are in different structures. When they are examined, it can be seen that while mathematics is a scientific subject that is full of rules, can be counted and can be calculated; music can assume the duties of being artistic and a way of expression within it. Although these two disciplinary frameworks show a separate structure, they are actually interdependent, and this connection has been maintained for more than two thousand years. In fact, music is very mathematical, and mathematics is one of the basic structures within music theory. Like other disciplines, music theorists use mathematics to develop, express, and communicate ideas (Shah, 2010).
In support of the view of interdisciplinary education, it is seen that the National Council of Teachers of Mathematics, which is an important mathematical institution in the world and supports the process of teaching and learning high-quality mathematics, calls on teachers to help students make mathematical connections in contexts other than mathematics, and emphasizes that these mathematical connections may be related to other subject areas and disciplines as well as to students' daily lives (National Council of Teachers of Mathematics [NCTM], 2000). In this study, it is stated that the school should provide the students with materials that allow mathematics to be learned through calculation, measurement, playing, story listening, drama, music and art activities. Although teachers of children in the early childhood period have been teaching with an interdisciplinary approach for many years, it is clear that the link between two separates but fundamentally common disciplines, such as mathematics and music, needs to be further strengthened. By linking music and mathematics, teachers will be able to play a role in helping children achieve national and state learning standards in the field of mathematics through creative arts . Childhood is a period when development is very rapid in the field of mathematics as in every field. This period is a very critical period when the child actively acquires many basic concepts, such as counting, patterns, measurement, shape, time and space for mathematics (Erdogan & Baran, 2005). In the relevant literature, it is seen that there are studies stating that the basic concepts of mathematics can be taught to children through musical activities in this critical period (Aysu et al., 2018;Dogan & Tecimer, 2019;Kabatas, 2017;Volchegorskaya & Nogina, 2014). According to Karsal (2004), musical activities positively affect children's math performance. According to Dikici (2002), music education given by the Orff method contributes positively to the development of children's mathematical ability. It is possible to see patterns and the relationships between patterns, which are important concepts of mathematics education in early childhood, in music and art (Akman, 2002). Again, Arslan (1997) stated that music activities provide suitable opportunities for children to support basic mathematical skills and that mathematical thinking can be improved by supporting children to use the language of mathematics through music activities. He highlighted that games with songs, finger games and rhythm exercises are very suitable for teaching basic mathematical concepts. He also stated that many mathematical concepts, such as number, shape, time, spatial concepts, matching and sequencing can be taught through song and rhythm. Aktas (2002) noted that there are many songs that contain mathematical concepts and that teaching numbers with rhythm and melodies can make it easier for the child to learn the concept of numbers. In this vein, in order for the mathematics lessons included in the early childhood education curricula to be carried out in a more efficient and memorable way, the use of music, which is at the core of the mathematics discipline, should be considered in classroom activities. This interdisciplinary perspective, using the mathematical dynamics of music to make mathematics more understandable in early childhood education, can be the equivalent of an innovative and contemporary teaching style.
Students need an effective and experiential learning style to develop complex thinking skills and problem-solving behaviors. In this respect, teachers can use music to increase students' understanding of difficult mathematical concepts and increase their mathematical skills . Mathematical thinking and musical perception can be supported by mathematical elements embedded in music. In this sense, the rhythmic elements of music provide rich opportunities for exploring mathematical concepts through the experience of musical components, such as beat, measure, duration of sounds, rhythmic patterns and tempo (Aktas, 2002;Arslan, 1997). These opportunities offered to students to explore mathematical concepts through music will take place in a musical perception system, such as beat, measure, duration of sounds, rhythmic patterns and tempo. Thus, this may pave the way for students to be interested in mathematical concepts and skills. These musical experiences can be used as concrete tools to discover, transfer and transform meanings and relationships in music and mathematics.
According to Hamilton et al. (2018), one of the issues that support the relationship between music and mathematics is fractions. Fractions are closely related to musical rhythms. Musical rhythm can be produced using clapping and percussion instruments that do not require special training to play. The rhythm is easily accessible and is accessible at all levels of studies related to music. In addition, the mathematics teacher is not obliged to have professional music education in order to use rhythms in the lessons. Figure 1 illustrates how the semibreve, which is the longest note in general use in music, is divided into a "circle," a geometric figure, and music staff by simulating mathematics and music. (Hamilton et al., 2018, p. 927).

Figure 1. Expressing the Semibreve Value in Fractions by Division in the Staff and Circle
When examined in Figure 1 (a), a measure can be divided into multiple beats according to the musical notation system in music. A single measure represents the whole. Each beat or half-beat divides the whole into pieces. In the above measure, the eighth note represents 1/8 of the semibreve value, while each quarter note represents 1/4 of the semibreve value. When examined in Figure 1 (b), the mathematical equivalent of the semibreve value in music is taken as a circle and this circle is divided into 3x 1/4 and 2x 1/8 ratios. Using the simulation of dividing a whole into fractions, it is ensured that the fractions are taught to students who participate in the production of fractions and rhythms by playing percussion instruments both in visual and auditory terms (Hamilton et al., 2018).
Music can be seen as one of the branches that can be used in interdisciplinary studies since it contains melodic and rhythmic elements and thus facilitates teaching. Teaching mathematics more effectively with different approaches will make it easier for students to understand this subject. The type of example in Figure 1 above can be applied in a variety of dimensions during the teaching of mathematical concepts. In this respect, it may be appropriate to make use of musical support in the field of education. As  states, the natural inclusion of musical activities into children's studies of mathematics provides a way to develop children's logical/mathematical and musical/rhythmic intelligence in a dimension that may previously have been unthinkable.
As can be understood from the ideas mentioned above, music and mathematics have been associated with each other since ancient times and the connection between them has been tried to be revealed. This relationship between music and mathematics is reflected in today's education and training programs and has an important place in interdisciplinary literature. As seen in the examples given above, it is thought that the use of music, which has an important place in the literature, in childhood mathematics education environments may be functionally beneficial. Thus, in this study, it was tried to determine the opinions of pre-school and classroom teachers regarding the use of music in mathematics teaching. The determination of these opinions is considered important in terms of revealing the use of music in mathematics teaching in educational environments, determining the problems that may arise during use, and developing curricula for the use of music in mathematics teaching.
The main purpose of this study is to investigate the opinions of preschool and classroom teachers about the use of music in mathematics teaching. In the light of the general purpose of this research, answers to the following questions were also sought in the research: 1. What are the teachers' opinions about students' attitudes towards mathematics?
2. What are the problems faced by teachers in mathematics teaching and the solutions to these problems?
3. What are the opinions of teachers about the use of music in mathematics teaching?
4. What are the views of teachers about the influence of using music in mathematics lessons on students' learning?
5. What are the opinions of teachers about their competence in using music in mathematics lessons?

Research Design
A qualitative research approach was used in this study, in which pre-school and classroom teachers' opinions on the use of music in mathematics classes were examined. Qualitative approaches are often used to discover new events and to obtain individuals' thoughts, feelings, or interpretations about meaning and process (Given, 2008). Thus, a qualitative approach was used to examine and make sense of teachers' experiences, emotions, thoughts and interpretations regarding the use of music in mathematics classes.
The case study method was used to obtain in-depth information about the subject to be examined in this research. This requires careful and complete observation of a social unit, a person within that social unit, a family, an institution, a cultural group and even the whole society. The case study method attaches importance to the full analysis of a small number of events, situations and their interrelationships. As a result, case study method is based on a detailed examination of a unit under investigation (Kothari, 2004). Since this research was conducted in pre-school and primary schools, and due to the in-depth analysis of the use of music in mathematics teaching, the case study method was preferred in this research.

Research Sample
The "purposeful sampling method" was used to determine the study group of this study. According to Ekiz (2009), the purposeful sampling method is not the direct generalization of the research results to the population for the purpose of the different sample types in this sampling method within the scope of the population and sample relationship; on the contrary, it is an in-depth description and understanding of the people or situations under investigation. The purposeful sampling method is divided into sub-groups. In this study, the "homogeneous sampling method" was used. The homogeneous sampling method describes the selection of a similar subgroup, situation, and case related to the research problem from the population (Buyukozturk et al. 2016). From this perspective, in this study, in which only preschool and classroom teachers' opinions on the use of music in mathematics education were examined, the teachers were selected according to the homogeneous sampling method.
This study was conducted with 30 teachers, of whom 15 were classroom teachers and 15 were preschool teachers, who were working in public schools in the 2018-2019 academic year. Demographic information about the teachers participating in this research is given in Table 1. To protect the confidentiality of information about the teachers, who have an important place in research ethics in transferring data, the classroom teachers were coded as CT1, CT2, CT3 ……CT15, and the preschool teachers were coded as PT16, PT17, PT18 ………PT30. Demographic information about the teachers participating in this research is as follows:

Research Instruments and Procedures
In this study, the data were collected by semi-structured interview technique, which is one of the qualitative data collection techniques. In the semi-structured interview technique, the interviewer has an interview guide that includes a checklist of topics related to the scope, default statements and the order of the questions. However, in general, the sequence of statements and questions is shaped by the flow of the interview. In addition, to continue what the interviewee says, unplanned questions may be asked (Robson, 2017). This technique combines both fixed-choice questions and in-depth exploration of the relevant field. The semi-structured interview technique has advantages, such as ease of analysis, the possibility of self-expression by the interviewee and providing in-depth information as needed (Buyukozturk et al. 2016).
The semi-structured interview form was prepared by the researchers by searching the related literature. The interview form consisted of two parts. In the first part of the form, teachers were asked questions about demographic information, such as the school they graduated from, their education levels, the school they worked in, their terms of duty and job descriptions, their state of receiving music education in undergraduate education, their state of taking part in any in-service training, seminars or private lessons related to music, and their state of playing instruments and using the instruments they played in lessons. Then, in the second part of the form, the teachers were asked questions about the purpose and sub-objectives of the research. Face-to-face interviews were recorded on a voice recorder and then written down by the researchers.

Data Analysis
The data obtained from this research were subjected to content analysis. Using content analysis, it is aimed to identify the data and reveal facts that may be hidden in the data. The main process of content analysis is to bring together similar data within the framework of certain concepts and themes and to interpret them in a way that the reader can understand (Yildirim & Simsek, 2013). In content analysis, categories and sub-categories are created by applying a series of codes (Ekiz, 2009). In this context, the data obtained from this study were coded concerning similarities and presented under various categories. The following steps were followed in the data collection and analysis processes: 1.
In accordance with the main and sub-objectives of this research, the interview questions were developed by the researchers.

2.
The pre-school and classroom teachers to participate in this study were selected.

3.
The interviews were conducted with the teachers and recorded.

4.
The recorded interviews were written down to be analyzed.

5.
The answers related to the same subject were written one under the other and coded.

6.
The codes were categorized and presented in the form of tables.

7.
The data presented in the tables were supported by direct citations from teachers' speeches.

Validity and Reliability Studies
Taking the necessary measures to access the right information (validity) and describing the research process and data in a clear and detailed manner, i.e., in a way that allows another researcher to evaluate them (reliability), are among the important criteria that should be included in a qualitative research study. Given that validity significantly guarantees reliability, the importance given to validity should also be perceived as a measure to ensure reliability (Yildirim & Simsek, 2013).
In qualitative research, validity and reliability can be provided by various methods. In this study, a semi-structured interview form was used. While preparing the semi-structured interview form, the opinions of five experts consisting of assessment and evaluation, language and field experts were consulted on whether the appropriate language was used, whether the interview questions covered the subject being researched, and the response time. Presenting the research findings with rich descriptions and direct quotations from teacher conversations can be considered as the measures taken to increase the reliability of the study.

Results
In this section, the findings and interpretations obtained from the interviews with the preschool and classroom teachers about the use of music in mathematics teaching are given. The findings were examined in eight themes under subheadings, which were elucidated below.

Teachers' opinions on students' attitudes towards mathematics
Firstly, the teachers were asked what their opinions about students' attitudes towards mathematics were. The findings for the teachers' opinions on this subject are presented in Table 2 below. Although Table 2 reveals different opinions, most of the teachers stated that their students' attitudes, interests, motivation and liking towards mathematics were generally good. Examining the table further, teachers stated that students' attitudes towards mathematics increased when drama, Orff, games and materials supporting the subject were used. Accordingly, it can be said that using different methods and techniques other than traditional methods increased the positive attitude towards mathematics. According to some teachers, the mathematics lesson was based on visuality and not focused on reading increased students' positive attitude. According to this opinion, today's students utilize visual-based technological tools in their learning habits and show less interest in reading may cause them to be interested in mathematics courses with more visual content. Apart from these statements, a few teachers stated that boys were more successful in mathematics than girls. Students were interested but failed to solve problems. The new curriculum and course were effective in improving students' attitudes, and that prejudices against mathematics had negative effects on attitude. Some of the teachers' opinions about students' attitudes towards mathematics are as follows: My students are very positive about mathematics. I can even say it is their favourite lesson. They are very interested and highly motivated. I can say that the most successful course in the 3C class that I attend is mathematics. How do we know that? We have measurement and evaluation activities as a group after completing the topics to cover the whole year, once a month or every 40 days, and periodically to cover the whole group, we carry out measurement and evaluation activities for the achievements. I say this according to the results; the sentence I have established is not a sentence I say for no reason. The success of my class is up to 85%, 86% or even in the 90 (CT5).
My students are very good, interested, and their motivation is also very good, and they love it because I try to make it as enjoyable as I can. I think that games and Orff activities help in mathematics (PT19).
There is a lot of difference between the mathematics lessons I took in my own time and the mathematics lessons of our time. Students now love mathematics more because they think it's not based on reading, and there are more visuals. They already love the math lesson, which is visually rich because it is a generation of tablets. The best course for my own students is mathematics, but they cannot use these skills when asked a diffuse understanding problem (CT1).

The Problems Encountered by Teachers in Mathematics Teaching and Solutions to These Problems
Participant teachers were asked the following questions: "How do you think your students' attitudes (interests, motivations, love) towards mathematics lesson? Can you explain briefly?" In response to these questions, teachers expressed their opinions as presented in Table 3 below.  When Table 3 is examined, most of the teachers stated that the main problems faced by students in mathematics were abstract subjects, such as length measurements, rhythmic counting, multiplication tables and geometry. The solution suggestions that teachers stated for them included concretization, dramatization, making use of videos, performing group work, plenty of practice, using different examples and materials for thinking, producing songs suitable for the subject and approach from simple to difficult. According to this, it is understood that most of the teachers used practices that enable the learning to be permanent and centered on the students. Again, most of the teachers stated that the individual differences of the students were one of the problems encountered in mathematics. Teachers presented solutions to this problem, such as approach from simple to difficult, one-to-one work, gamification, nursery rhymes, family awareness and education. Accordingly, the proposed solutions can be seen as an aid in overcoming the problems arising from the individual differences of the students. Some teachers also stated that problems that require reasoning, being able to write numbers, social prejudice, transferring what is learned to daily life, ensuring the permanence of what is learned, problems arising from the program, vocabulary weaknesses and difficulties in attention studies (such as connecting the dots, robotic coding) were the problems they faced. Teachers proposed solutions to these problems, such as concretization, dramatization, approach from simple to difficult, increasing the course hours, using different examples and materials for thinking, one-to-one work, using music, plenty of practice, gamification, practicing nursery rhymes, practicing rhythm and using different examples and materials for thinking. One of the opinions of the teachers on the problem of teaching abstract concepts, which were one of the problems they faced in mathematics teaching, and the solution of this problem, is as follows: We have some difficulty in relating mathematics to everyday life, so it is more difficult for children to learn things because there are many abstract concepts. Teaching mathematics using concretization and gamification makes it more permanent for the children. We solve problems by associating them with daily life. Then, we try to explain with visuals and do animation and drama activities (CT4).
One of the opinions of the teachers towards the problem of individual differences, which was one of the problems that teachers face in mathematics teaching, is as follows: Mathematics is a critical issue for children, meaning that the mathematical level of each child and the mathematical threshold of each child do not develop at the same time. Some students learn mathematics very early, while others learn later. For this reason, we try to get to know the children, and mainly the individual differences between the children cause difficulties for us. We try to get to know the child in the first place to overcome these. Each child has a different level of learning, so we simplify the subject to determine how s/he understands the topic first, we work individually, then when we learn how s/he understands, and later we transfer the information to him/her that way (PT23).

Teachers' Views on the Use of Music in Mathematics Teaching
"Do you think music can be used as a tool in mathematics teaching? How? What are your views on this? Please explain briefly." These questions were directed to teachers in this study. The findings obtained from the opinions of the teachers on this subject are presented in Table 4 below. When Table 4 is examined, teachers stated that music could be used in mathematics teaching in various ways. The most emphasized among these statements is using songs as a tool to ensure the realization and permanence of learning in mathematics. Again, according to teachers' opinions, learning could be realized by establishing a relationship between rhythms and mathematics. According to this, it can be thought that the rhythm element, which is an important element of songs and music, is an important factor in realizing learning and ensuring the permanence of learning. Some teachers stated that there was a pattern that includes mathematical concepts in music, that music made mathematics fun, that music had remarkable and motivating features, that note values were related to mathematics, and that mathematics should be started with music education. Some of the teachers' opinions on the use of music in mathematics teaching are as follows: I think it can be used very much, it's very effective at that point. Let me give you an example from the multiplication table: when we passed on to the multiplication topic, I taught the multiplication table with music; that is, I taught it with rhythm. I told the children to study and come to school like that, but it didn't work, so we studied in the classroom, which also didn't work, and then we worked with music and they perceived it very nicely. The children perceive it better because the songs and rhythms are used at that point (CT15).
Music is used in mathematics teaching and can be used in all kinds of ways. We do mathematical operations, such as adding, subtracting, counting, and rhythmic counting using music and singing, and in this way, when we teach in this way, it becomes even more beautiful and fun (PT18). Table 5 shows the findings of the questions asked to teachers about whether they make use of music in mathematics. When Table 5 is examined, it is seen that the teachers who use music in mathematics are predominant. In addition to this, it is determined that there are also teachers who rarely use music or who never use music in their classes.

Teachers' Opinions on When and How They Make Use of Music in Mathematics
Teachers were asked for their opinions on when and how they make use of music in mathematics. The findings of these opinions are given in Table 6. When Table 6 is examined, most teachers stated that they used music for reinforcement in mathematics lessons. When the opinions about the stage in which mathematics had been used were examined, it was seen that music was generally preferred in the middle of the lesson and then at the beginning and end of the lesson, respectively. Finally, when the opinions about the subjects in which music is used in the mathematics class were examined, it was seen that music is used in rhythmic counting, teaching addition and subtraction, teaching geometry, teaching multiplication tables, teaching fractions, teaching patterns, solving problems, teaching length measurements and teaching the concept of quantity. Some of the expressions indicating teachers' state of utilizing music in mathematics classes are as follows: Well, I use music in almost every lesson, and I am a teacher who believes in active learning. In active learning methods, the student must eventually produce a product and present it to the class or society. This is one of the principles of active learning. Since they are generally in a small age group, our products can be poems, songs, musical movements and displays. For example, at the end of a lesson, I can get a little nursery rhyme about what they understand and have it linked to the rhythm. It can be performed in geometry very well, as they can both use their bodies and the music, and music can be fully used in the pattern because when you create a pattern, you can make great things out of sounds or tools in the classroom. It can be used for reinforcing purposes; it can be used in every sense, especially in arousing curiosity, and at the application stage and evaluation stage (CT12).
I use it. When we have both mathematics and music periods, we do rhythm exercises and then we use them. We use them, especially in numbers. While teaching the concepts of quantity, we also use them. We adjust the use of music according to the subject of the course, I use some of them at the end of the course, others at the beginning, and I can also use it for reinforcement (PT21).

Teachers' Views on the Positive and Negative Effects of Using Music in Mathematics Lesson on Students
What kind of effects can the use of music as a teaching tool in mathematics lessons have on students' learning? Can you explain by giving an example?" The answers they gave to the question are presented in Table 7 and Table 8.  Table 7 is examined, most of the teachers stated that the use of music in mathematics teaching might have positive contributions to the students. According to the teachers' opinions, music was a tool that enables permanence in mathematics teaching. From this point of view, the general opinion was that using music in mathematics teaching increases permanence, which is one of the important goals of learning and enables the use of knowledge throughout life. The teachers stated that with the use of music in mathematics classes, the student liked the lesson more, that his/her attention was concentrated, that prejudices against mathematics were eliminated, that the lesson became fun and easy to apply by the teacher, that motivation towards the lesson increased and that the preparation for the lesson became easier. Some of the teachers' opinions about the positive effects on students of using music in mathematics are as follows: The students couldn't remember what they learned easily when I was teaching counting, but it was more memorable when I taught rhythmic counting, especially with funny words and songs, and they still say it that way (CT10).
I support teaching in the form of one-to-one transfer. I am more in favor of learning by doing and experiencing it with children. For example, when you mention mathematics, children have a question mark in their minds: "Is it difficult? Is it easy?" But the prejudices are destroyed when you teach it with music or with pictures and they are more motivated in this way (PT19).

Teachers' Opinions About the Possible Negative Effects on Students of Using Music in Mathematics
Possible negative effects Teachers f Teacher's lack of classroom management and command of the subject matter CT3, CT5, CT11, PT23, PT25 5 Problems in special children (e.g., with autism) and children who do not like music PT16, PT18, PT26 3 Distractions of non-related musical activities PT27, PT29 2 Children's excitement when they see musical instruments PT24 1 When Table 8 is examined, most of the teachers stated that the use of music in mathematics classes had no negative effects. From this point of view, it can be mentioned that there is a positive effect of mathematics teaching with music, which is handled concerning an interdisciplinary approach, by teachers. Further examination of the table, however, reveals the mentioned negative effects of the use of music in mathematics teaching, which are as follows: Negative effects due to teacher's lack of classroom management and command of the subject matter, possible problems in special children (e.g., with autism) and children who do not like music, distractions of non-related musical activities and children's excitement when they see musical instruments. One of the opinions of the teachers who stated that the use of music in mathematics classes did not have any negative effects on the students is as follows: I don't think it can have a negative effect. What could it be? Music is the beginning of everything; if there is music, everything is there. In my opinion, the child will be spiritually fulfilled and his/her motivation can be increased. Well, s/he can be more enthusiastic and more eager to learn (CT6).
One of the teachers' opinions that the use of music in mathematics classes might have negative effects on students is as follows: The negative effects can be as follows: there are special needs children in the classroom. I have also worked with special children, and for example, children with autism or a different syndrome can sometimes react differently. For example, a child with autism will not like the music at that moment, maybe a child who has been traumatized will perceive that music as noisy, maybe s/he will not like it, that change will not be pleasant to him/her; I think maybe there might be differences about it. I think that different studies can be done about the children with special needs (PT16).

Teachers' Opinions on Their Competence in Using Music in Mathematics
In this research, teachers were asked for their opinions about their competence in using music in mathematics and the findings obtained from the teachers' opinions on this subject are presented in Table 9.

Table 9
Teachers' Opinions on Their Competence in Using Music in Mathematics Their competence in using music Teachers f I don't regard myself as competent.
CT7 1 When Table 9 is examined, most of the teachers stated that they did not consider themselves competent enough to utilize music in the mathematics class. The reason for this is that the music education given to pre-school and classroom teachers in undergraduate education is far from being an interdisciplinary approach and that their education is given within the framework of general music education. Regarding the second statement, the reason why teachers considered themselves generally competent enough to utilize music in mathematics can be individual efforts, in-service training and private lessons taken, according to the teachers' statements. In other statements, it is stated that teachers' competences can be increased by getting a better music education, that individual effort can be effective on this issue and that the intensity of the curriculum is an obstacle in this subject. Some of the teachers' opinions on their competence in using music in mathematics classes are as follows: I don't regard myself as competent, I want to be more competent, I do not think that the music education we received in undergraduate education is fully sufficient, and the more I can develop myself, the more useful I will be to children, so I'm trying to get training (CT10). I don't consider myself competent in anything, so I try to improve myself constantly because time passes so quickly, children's needs and desires are very different, and if we stay in the old times, we can't make progress, so we try to participate in in-service training and strive to learn (PT18).
If I had stopped my development at university, that is, if I were content with the information I received in undergraduate education, I certainly wouldn't be competent, but I developed myself through social networks, with the help of music teachers near me or through seminars. I'm not 100% competent, but I consider myself 40% competent, and if it was just university, I'd say absolutely not (PT27).

Discussion, Conclusion and Recommendations
In line with the findings of this study, most of the teachers stated that their students' attitudes, motivations, interest and love for mathematics were generally good. From this perspective, it can be thought that the lesson is not based on reading and is visually richer than before, as stated by teachers in the interviews, as the reason why students love mathematics.
Most of the teachers explained that the main problems that students faced in mathematics were abstract subjects, such as length measurements, rhythmic counting, multiplication tables and geometry. The teachers explained the reason for the difficulty in abstract concepts as that general information cannot be associated with daily life by the students. According to Hamilton et al. (2018), many students have difficulty in transferring mathematical concepts into their daily lives and cannot make sense of their symbolic nomenclature. Thus, this can be a major obstacle for many students to continue their mathematical studies. When the solution suggestions related to these abstract concepts are examined, it is seen that teachers implemented such things as concretization, dramatization, making use of videos, doing group work, plenty of practice, using different examples and materials for thinking, producing songs suitable for the subject, and approach from simple to difficult.
When the opinions of teachers about the use of music in mathematics teaching are examined, it is understood that teachers expressed positive opinions about using music in the lessons and that basically, they suggested that music makes mathematics learning more permanent. In line with the teachers' opinions, it is seen that the positive effects of using music in mathematics lessons are permanence, increasing love for mathematics and attracting attention. In the study by An, Capraro and Tillman (2013), it was concluded that music activities were applied regularly in the first and third grades of primary school for five weeks and that the lessons given in the relationship between music and mathematics had positive effects on multiple mathematics skills.
According to the opinions of most teachers, the use of music in mathematics teaching has positive contributions concerning motivation, permanence, participation in class and the elimination of prejudices and negative attitudes towards the lesson. In this sense, some of the opinions that support the results of the study are as follows: according to , the use of music in mathematics teaching can affect the development of students' spatial-temporal skills (e.g., arithmetic, attention and focus). Brock and Lambeth (2013) stated that students' participation in mathematics teaching with music increased compared to the lessons not conducted with music. All these results show that teaching mathematics with music can make positive contributions to the students.
When the negative effects of using music in mathematics teaching by teachers were examined, most of the teachers stated that it would not have a negative effect. In addition, they stated that the negative situations that can appear may arise depending on the individual characteristics of the teacher and the student. Teachers think that the teacher's competence in classroom management and knowledge about the subject play a leading role, especially in the use of music in mathematics teaching, and specified that students' special situations (e.g., autism) affect the process.
In the opinion of most teachers, it is seen that they made use of music in mathematics classes. In addition to this opinion, a few teachers stated that they did not use music in mathematics classes. Teachers who made use of music in mathematics classes stated that they built up their experiences with various courses, seminars and in-service training. From these statements, it is seen that the pre-school and classroom teachers did not receive music education according to the interdisciplinary approach in their undergraduate education and that they mostly approached the subject with their individual efforts. Besides, it can be said that the teachers had a general idea about interdisciplinary music and mathematics teaching.
Teachers who used music in mathematics classes stated that they used music for reinforcing purposes, preferred it at every stage of the course and used it in subjects, such as rhythmic counting, addition and subtraction, geometry, multiplication tables, fractions, patterns, problem solving, length and quantity.
When the teachers' opinions about their competence in using music in mathematics were examined, it was determined that a relatively large number of them tried to do so but did not consider themselves competent. In addition, teachers emphasized that starting from undergraduate education, a music education program should be maintained in accordance with the interdisciplinary education approach as well as general music education. This should be supported by in-service training in all teaching processes. An, Ma and Capraro (2011) stated that mathematics courses in which music is used have a positive effect on pre-service teachers' attitudes, beliefs, participation and self-confidence towards learning and teaching mathematics.
In this context, it is recommended that prospective teachers receive a bachelor's degree with an interdisciplinary approach. In addition to general music education, pre-school and classroom teachers can be trained to use music in other fields and classes. Within the Ministry of National Education, courses, in-service training and seminars for the use of music in mathematics courses can be organized. Similarly, teachers can be encouraged to participate in seminars, courses and in-service training aimed at using music in mathematics lessons to make mathematics learning more effective. Providing activities for using music in mathematics lessons in the Ministry of Education textbooks will guide teachers. Finally, mathematics teaching activities with music can be designed and applied, and whether these activities affect students' attitudes and achievement can be investigated by experimental methods.

Research and Publication Statement
The legal permissions required to conduct this research have been approved by the Trabzon Provincial Directorate of National Education with the letter dated 13/05/2019 and numbered 82434636-605.99-E9414027.


s2fieldsofstudy: Education Medicine

text:
A Survey of Attitudes and Beliefs about Care, Compassion and Communities Networks in Palliative Care. A Preliminary Study for the Development of a Compassionate University

The aim of this study was to know the level of knowledge, sensitivities and training needs regarding care of people at the end of life in medicine, nursing and psychology students/academic and administration university personnel; and to identify skills to perceive and expressed values related to compassion it in their living environment. Method: a descriptive observational study was conducted among undergraduate medical, nursing and psychologist students, academic and administration personnel of the University of Bogotá in Colombia the survey was based on a web-based questionnaire (November 2019–April 2020). Levels of knowledge and sensitivities about care of people at the end of life, educational needs and compassion were assessed. Descriptive and comparative measures and statistical significance tests used, Student’s t and ANOVA (α = 0.05). Results: 465 people answered the survey; students (82.4%), academic (13.1%) and administration personnel (4.5%). 81.6% knew about palliative care concepts. 64.7% had not cared for other people with advanced or terminal illness. 44.7% talked about death without problems. The most evaluated training competences were humanity, dignity and compassion. Mean levels for compassion by Gilbert’s scale were 70.55 for self-compassion, 72.61 for compassion for others and 60.47 for compassion from others. Significant differences were found by age and gender in self-compassion values. Conclusions: the level of knowledge, sensitivities and training needs regarding care of people at the end of life in the University and the values related to compassion enables the development of Compassionate Universities.

Introduction
Care, compassion and community are considered essential elements for the care of people with advanced disease and/or at the end of life and it's necessary to incorporate these concepts progressively in the Universities that also affect the quadruple aim in health from the benefits of compassion: patients benefits, population health, professional's wellbeing's and effective organizations. [1,2]. As expressed by Lown et al. [3] "care without compassion cannot be provided and compassion without an element of empathy and help towards the other cannot be well applied". Community involvement is an essential element for person-centered care where care can be redistributed among a range of members involved in care [4].
University is an institution that seeks to generate a series of competencies towards the best practices of professional development and in its relationship with people. In recent years, training in palliative care has been gradually implemented in Universities in Latin America [5]. Among the main topics included in the curricular proposals for the training of doctors, nurses and psychologists in Palliative Care (PC) are: (1) basics concepts of PC, (2) pain and symptom management, (3) psychosocial and spiritual aspects, (4) ethical and legal issues, (5) communication and (6) teamwork and self-reflection [6]. Being fundamental elements of the curriculum, there is a lack of knowledge about students and professionals perceptions about palliative care, its relationship with death, its will to care for someone close to them or if they have skills to be empathetic or compassionate with people around them [5].
A "Compassionate University" is an organization that is committed to developing and facilitating the practice of compassion in students and health professionals for the creation of more humane, dignified and compassionate health systems.
"Compassion" can be defined as a sensitivity to the suffering of self and others with a commitment to prevent it and relieve it. As a complex and multifaceted response to suffering, compassion involves sensitivity, recognition, understanding, emotional resonance, empathic concern and distress tolerance for another's pain or suffering, coupled with motivation and relational action to ameliorate it [2]. So, as starting point, it is necessary to identify how each of us relates to care, compassion and community involvement. The best way to build ourselves as compassionate beings is to have our own experience that we are going to die, that we are going to need to be cared for and that surely in our lives we are going to have to take care of a relative or some other close person.
A recent study carried out in Ecuador has shown that the identification of these factors and the actions implemented to promote compassion in the university and create a compassionate university have been beneficial in terms of greater satisfaction of students and teachers thanks to the skills and values acquired during this stage at the University [7].
From this perspective, it is essential to offer students and professionals the best tools and skills to provide this quality care, incorporating these concepts into the curriculum and developing awareness-raising actions towards care that are spread throughout the educational community.
The Sanitas University Foundation of Bogotá, Colombia is committed not only to the quality of teaching, but also to the dignity of people, humanization and compassion. Thus they decided to launch a project of "Compassionate University" together with the New Health Foundation, which has its own methodology for the development of Compassionate Communities (All with you ® method) [8] which is also being applied to Universities with the main objective of building a University that recognize for its culture of cultivating empathy, compassion and caring for people who face difficult situations inside and outside the organization, as well as fostering the development of community networks at the University to help from within and without those who are with a situation of advanced disease and/or at the end of life.
Based on this objective of becoming a Compassionate University, a preliminary study has been carried out with the purpose of:

•
Identifying the level of knowledge and sensitivities that professionals and students have regarding the care and attention of people at the end of life. • Detecting the training needs-according main topics included in the curricular proposals for the training of doctors, nurses and psychologists in Palliative Care-, within the university teaching programs related to the care of people with advanced disease and/or at the end of life.

•
Identifying the abilities of professionals and students to perceive values related to compassion and express it in their life environment.

Study Design and Population
Descriptive observational study. A 63-item web-based questionnaire was design by New Health Foundation. An invitation letter with the link to the survey were emailed to all undergraduate medical, nursing and psychologist students from first to sixth year of education, academics and professionals of the University (N = 650). Data collection was carried out Since November 2019 to April 2020.

Variables and Measures
The survey was designed in 4 blocks:

Statistical Analysis
Descriptive and comparative frequency measures were used by blocks of contents of the survey and by type of profile of respondents. Student's t-statistical significance tests and one-way ANOVA were performed to compare the mean values on the compassion scale in the distribution by sex, age and professional profile. An α value of 0.05 was established to determine statistical significance. The SPSS program was used for statistical analyzes.
All respondents agreed to the use and treatment of the data for the research.

Ethical Considerations
Participation and acceptance of the survey was requested through written consent for the use of the data for research purposes, guaranteeing the anonymity and confidentiality of the information to all participants. The study took into account the Declaration of Helsinki and resolution 008430 of the Ministry of Health [10]. The data used were for the exclusive use of the investigation and the identity of the individuals was protected according to Law 1581 [11].

Sociodemographic and Academic Characterization of the Study Population
A total of 465 surveys corresponding to university students, academics and professionals of University were collected, representing a response rate of 71.5%. 74% women, 26% men. Mean age: 24 years (standard deviation: 10,003). 74.6% couple without children.
The highest participation in the surveys were students with a total of 383 participants (82.4%). 167 were nursing students (43.6%), 128 medical students (33.4%) and 77 psychology students (20.2%). The highest representation of students corresponded to first-year students (48.8% of cases), followed by third-year students (20.6%).
The university academics and others professionals were represented by 61 academics (13.1% of the population), of which 26.2% were nursing academics, 24.6% psychology academics and 23% medicine academics. The professional corresponding to administration represented 4.5% of the professionals. The Mean dedication of the academics at the university was 4.5 years. The sociodemographic and academic characterization of study population is represented in Table 1.

Level of Knowledge and Sensitivities of the Population about Care of People at the End of Life
363 people (81.6%) knew palliative care concepts, most of them as part of their university education or their profession (67.2%), followed by family members (13.6%), friends (9.1%), social media (8.8%), personal experience (7.4%) or other reasons (3.1%).
The people who reported knowing how to give a definition of palliative care associated this concept with the provision of palliative care for adults and pediatric population in a situation of chronic, advanced and/or end-of-life disease, to the decrease in suffering, improvement of the quality of life, state of agony and end of life, and the privilege of caring and being cared for people.
72.9% (339 people) reported having had previous contact with palliative care due to the experiences of patients or close relatives. Of these, 255 (77.3%) received palliative care. In 79.3% of the cases, they were valued as useful both for the person at the end of their life and for their family and their entire care network.
64.7% of the study population had not cared for people with advanced or terminal illness. 91.2% would be willing to take care of a person who was not a relative or close friend. 50.8% of those surveyed indicated that they felt capable of accompanying a person at the end of their life.
Among the 465 people who answered the question: "How many people do you think would be able to take care of you if an illness were to overtake you at this time in your life?" 67.5% (313) indicated that fewer than 5 people would be involved in their care, 24.6% (114) between 5 and 9 people and 7.9% (38) more than 10 people.
49.2% did not feel capable of accompanying a person at the end of their life. Those who indicated feeling capable were those who had received some training in CP.
44.7% of those surveyed (n = 208) referred to talking about death without a problem, 24.5% do so very rarely, 20.9% sometimes, but with people from the environment and professional profile, 6.7% when it occurs in a way close and 3.2% never.
The level of knowledge and sensitivities of the population about the care of people at the end of life is represented in Table 2.  The highest training in Palliative Care at the University was received by nursing students (50%), followed by medical students (26.7%) and psychology students (13%).
Nursing students indicated that they would prefer to dedicate themselves professionally to PC (58.1%), followed by medicine (43%) and very closely by psychology (42.9%).
The subjects received in palliative care and the interest in receiving training in these subjects among the students of the different faculties and the professors are represented in the Table 3.
The training competences most valued by students, academics and professionals of the university was Humanity, Dignity and Compassion, which was considered by 70.5% of those surveyed as a high priority. (Figure 1).    Men scored higher on self-compassion (Mean 73.04), compassion for others (73) and compassion from others (61.30).
Self-compassion, compassion for others and compassion from others were most valued in people aged 60 and over.
Compassion for others was the most valued among psychology students (74.94), selfcompassion the most valued among teachers (73.77) and compassion from others among nursing students (61.82).
Significant differences were found for gender and age in self-compassion values (p = 0.028, p = 0.039, respectively). No significant differences were obtained in the values of compassion by academic profile. The results of the compassion and p-values surveys are represented in Table 4.

Discussion
We offer some data on compassion and palliative care among university students, academics and other professionals that can help on improving the skills and self-awareness of future health care professionals [12]. One of two doctors and patients reports that care is not compassionate despite being a preferred element in the care and relief of suffering [13]. The practice of compassion is beneficial and even more so in the most vulnerable moments such as advanced disease and at the end of life. The benefits of compassion in PC have been evidenced by Brito and Librada [2], impacting the quadruple health goal: patients benefits, population health, professional's wellbeing's and effective organizations. In this way, the University is the most suitable environment to create compassionate professionals and leaders who act through a more humane, dignified and compassionate treatment in the care of people, especially at the end of life.
This study has been carried out with the objective of identifying the sensitivities and knowledge of the university community towards care, compassion and the community. The development of this baseline diagnosis in students, academics and professionals of the University it s the first stages for the development of a Compassionate University. Results will allow designing actions at the University aimed at raising awareness, training and research in this field.
Training in Palliative Care is an essential component in the faculties of health sciences, even more so when death is a natural process of life that all people are going to encounter. According to Latin American Atlas of PC [14], only 30% of the Universities in Latin American countries teach these topics, and there is also a disproportion of the contents taught or teaching hours. In our study, the greatest knowledge about palliative care in students comes from studies at the University. Even so, up to 18.4% of those surveyed indicated that they did not know what palliative care is, associating this concept in a greater proportion with death, with the state of agony and care. Those who expressed having knowledge in PC, associated it with the decrease in suffering, the improvement of the quality of life, care and to a lesser extent with the state of agony and death [15]. 91.2% of those surveyed would be willing to take care of a person who was not a relative or close friend, although up to 49.2% indicated that they would not feel capable of doing so. Sometimes half of the graduates do not feel prepared to attend the end of life as shown by the studies by Fraser et al. [16]. There are also references that up to 35% of medical students have not observed a patient at the end of life [13]. This can cause fear in students in the face of death due to the feeling of not having enough tools to deal with this situation. This question was deliberately asked to reflect later with the students in these analyzes and to emphasize that care should not be directly related to the profession, but to the willingness and commitment to help, which is an inherent condition of the human being.
In the same way, it is worth highlighting the answer to the question, how many people do you think would be able to take care of you if an illness were to overtake you at this point in your life? This question is being asked by the New Health Foundation to all types of people of all age groups and usually the Mean number of people who identify themselves is 4 people. In our population, up to 67.5% indicated that less than 5. The concept of care is usually related to the development of tasks related to the basic activities of daily life and with first and second degree people involved in care. In a study carried out on 99 terminally ill people, other profiles that may be involved in caring for people at the end of life were identified and that they can develop other types of tasks [17]. In this way, as Julian Abel expresses in his model of care circle [4], it is necessary to sensitize the population to the presence of other profiles (friends, co-workers, neighbors, etc.) that can carry out tasks that are complementary to those of a main caregiver. The increase in these care networks improves the quality of life of the person, reduces the burden of the main caregiver and improves the satisfaction of patients and their families. These results are already being analyzed in a community intervention process through the RedCuida protocol for the creation and management of care networks [18,19].
Death is not entirely present in the Universities. 44.7% of those surveyed indicated that they talk about it without problem. However, professional practice should bring us closer to talking about death since experiences with patients can bring us closer to these sensitivities towards it. Not talking about death makes us not empathize with the death of the other, and this has caused health professionals frustrations on many occasions. In other studies, carried out on the approach to death of students, communication needs about death with close people, patients or children have also been identified [20]. It s necessary to implement in the University themes about death and programs such as Death Café [21] in the university are being implemented along this line to bring together not only health sciences students, but also the rest of the university community.
The topics least covered in the faculties of medicine, psychology and nursing are Management and Organization, Public Policies, Pediatric Palliative Care, Network Management and Compassion. These results coincide with those of Billings et al. [22] in 1455 medical students where the lack of communication and compassion aspects is expressed in the training curriculum in end of life care. There is a tendency to focus the topics on the most specialized areas of the profession, leaving vacant topics related to organization, management, research, death, emotional skills and values of humanization, compassion and dignity. Therefore, the results of this first study indicate that these areas must be reinforced in the curriculum and in the rest of the awareness-raising actions that are carried out at the university and that have to do with the development of the Compassionate University.
Humanization, dignity and compassion were the skills most valued by the students. 70.5% considered it a high priority for adequate care of people at the end of life. These results coincide with those of Borgstrom et al. [23], Centeno et al. [24] and Hurwitz et al. [25] that indicate the competences of dedicated time with patients, learning about wider elements of treatment and holistic care, communications skills and learning about themselves through reflective writing.
The Gilbert Compassion Scale [9] applied to students and professionals it values components of action and commitment of compassion towards oneself, towards others and the compassion that we receive from others. The survey has been applied with the aim of evaluating compassion on a personal level, although the students may have been conditioned in their responses according to the career they were studying or their personal relationship with palliative care.
The results are remarkable in each one of the blocks, being the least valued the one of compassion of the others. In the interpretations made later at the University with the professors and students about these answers, it was concluded that we usually relate more with the help to the other than with the help we receive from the other. As expressed by Brito et al. [2], the benefits of compassion in palliative care can bring us closer to improving care for people at the end of life.
The results of this first diagnosis at the University coincide with those of Dávalos et al. [7], where the same research was carried out within the framework of the Compassionate University for a sample of 459 students and 77 members of the University. The development of this line of research is allowing Universities to advance in response to a series of needs and motivations in students and professors: there is a willingness to care, the values of compassion are notable in the students and professors of the faculties of health sciences and it is necessary to include more topics on care, compassion and the community as transversal axes of training in the curriculum.
This study has been carried out with the objective of knowing the sensitivities and knowledge towards the end of life at a personal rather than an academic level and from here to propose a training curriculum together with a series of complementary actions in the development of a Compassionate University. It integrates the elements of care, compassion and community to work from its analysis in the development of a Compassionate University based on its own methodology of diagnosis, research and action that is being applied to other universities in Spain and Latin America. Thanks to the methodology and the results that are extracted from this study, the development of a Compassionate University is allowed since the surveys and analyzes of training needs regarding care, compassion and the community allow the development of initiatives that make a Compassionate University.

Limitations
The surveys that were carried out in this first diagnosis were carried out anonymously, so it has not been possible to make a comparison before and after launching a series of actions at the University that promote the values of care.

Conclusions
The development of this survey, which contains a high reflective component on care, compassion and the way we behave with our own environment at the end of life, has allowed students to approach the knowledge of the subject in a way closer and compassionate, mobilized by action and not considered as a theoretical subject.
Thanks to the results of this first diagnostic study, a Compassionate University project is being developed at the University that sensitizes, trains and mobilizes students and professionals to develop care networks around people at the end of life.
Compassion must be extended beyond professional competencies, making care for the people around us extend from the University.


Better Writing in Scientific Publications Builds Reader Confidence and Understanding

Scientific publications are the building blocks of discovery and collaboration, but their impact is limited by the style in which they are traditionally written. Recently, many authors have called for a switch to an engaging, accessible writing style. Here, we experimentally test how readers respond to such a style. We hypothesized that scientific abstracts written in a more accessible style would improve readers’ reported readability and confidence as well as their understanding, assessed using multiple-choice questions on the content. We created a series of scientific abstracts, corresponding to real publications on three scientific topics at four levels of difficulty—varying from the difficult, traditional style to an engaging, accessible style. We gave these abstracts to a team of readers consisting of 170 third-year undergraduate students. Then, we posed questions to measure the readers’ readability, confidence, and understanding with the content. The scientific abstracts written in a more accessible style resulted in higher readability, understanding, and confidence. These findings demonstrate that rethinking the way we communicate our science may empower a more collaborative and diverse industry.

INTRODUCTION
Scientists belong to a global culture, and we are transforming our sector into one that is diverse, inclusive and equitable. We are moving beyond narrow fields and collaborating across disciplines to address the world's biggest problems. And we are making science relevant and useful to medical practitioners, policy makers, and innovators to name just a few. Unfortunately, however, stubborn gaps persist in this age of diversity. Women and non-binary and transgender people remain underrepresented in science and senior positions (Beemyn, 2015;Leslie et al., 2015), scientists still have trouble communicating across disciplines (Winowiecki et al., 2011), and the uptake of science by the general public remains limited and skewed (Suleski and Ibaraki, 2010;Herrando-Perez et al., 2019).
Scientific publications are the building blocks of knowledge and collaboration. Understanding them builds a reader's confidence-both within a scientific discipline, and in their own ability to explore new frontiers across disciplines. Building confidence could also help reduce persistent gender gaps in science (Leslie et al., 2015), reduce language barriers to people speaking English as a second language (Hanauer and Englander, 2011), and assist people with learning disabilities like dyslexia, who also need the energy and determination that comes from the confidence of understanding (Vellutino et al., 2004).
More accessible writing can help. Science has the opportunity to move beyond the traditional scientific writing style (Pinker, 2015;Freeling et al., 2019). The traditional writing style strives for objectivity and distance from the subject, but also remains dense, formulaic and difficult to read. Similar to a pay-wall, it acts as a linguistic-wall. In a time of intense policy debate over open access publishing (Tofield, 2019), we should also consider policies that build reader confidence and linguistic access to science (Jeschke et al., 2019).
Scientific writing is explored in countless guides and manuals (e.g., Montgomery, 2003;Sword, 2012;Pinker, 2015). These books differ on many points, but they all agree that the essential characteristic of scientific writing is clarity (Heard, 2014). However, clear scientific papers are rare. One study on over 7,00,000 scientific papers published in life, medical, social, and multidisciplinary sciences between 1881 and 2015 documented a rise in technical jargon; in fact, over one fifth of scientific abstracts were written at a level that even a college graduate would struggle to comprehend (Plavén-Sigray et al., 2017). This study was successfully replicated using data on around 28,000 abstracts published in management research between 1991 and 2019 (Graf-Vlachy, 2021). A similar study, which assessed around 12 million scientific abstracts from a multidisciplinary collection of publications from 1900 to 2018, also found that papers are becoming more difficult to read (Vergoulis et al., 2019). Also, an analysis of 24 million article titles and 18 million abstracts published in health and medicine between 1950 and 2019 found an increasing use of obscure acronyms (Barnett and Doubleday, 2020). The rise in jargon and reading difficulty may reflect the trend toward writing styles that are specific to, and isolated within, single disciplines (Ngai et al., 2018).
This increasing impenetrability of science presents a paradox: peer-reviewed publications are the universal currency for creating and communicating scientific knowledge, but the language is increasingly ill-suited to this purpose . Some solutions have been offered, such as lay-reader summaries for clinical findings in medical journals (Kuehne and Olden, 2015). However, inaccessible language threatens the accessibility and reproducibility of new scientific findings (Plavén-Sigray et al., 2017). Difficult-to-read papers can compromise readers' ability to understand information and can threaten their support for new ideas (Bullock et al., 2019). Furthermore, accessible information is critical for making decisions that depend on coordinating knowledge from multiple fields (Millgram, 2015).
To address this problem, many scientists now advocate for an alternative: a scientific writing style that is clear and accessible.  promote scientific language that is clear, accessible, and even inspiring, while maintaining the objectivity critical to science. Sand Jensen (2007) argues that accessible language can attract scientists, unify our understanding, and promote timely debate and discussion. Hartley et al. (2002) write that clear scientific writing can encourage exchanges between researchers, practitioners, and the general public, and that making science accessible is actually the duty of taxpayer-supported scientists. Empirical studies also provide support for accessible scientific writing, with several studies finding correlations between writing style and impact (Weinberger et al., 2015;Hillier et al., 2016;Freeling et al., 2019).
Is this boost in influence a result of how readers respond to more accessible writing? Indeed, in educational research it has long been established that more readable writing is more easily understood (Dale and Chall, 1949), which, in turn, boosts a reader's confidence in the message (Galbraith and Alexander, 2005).
So, this study aimed to measure how more accessible scientific publications stimulate reader understanding and confidence. Specifically, we tested the hypotheses that better writing in scientific publications can enhance readability, reader confidence, and reader understanding.

Experimental Manipulation
To test the effect of reading style on readability, confidence, and understanding, we performed an experimental manipulation with randomized participants. We created a series of scientific abstracts corresponding to real, recent, peer-reviewed publications in three research topics: social anxiety (health sciences), solar cells (physics), and populist politics (social sciences). We used abstracts as a proxy for full articles, as abstracts follow a relatively consistent structure and reflect the content and writing style of the full publications (Plavén-Sigray et al., 2017;Freeling et al., 2019).
Each abstract was manipulated to create four variants, ranging in readability from very difficult to very easy. We achieved this variation in difficulty by including different systematic combinations of nine measurable components known to affect writing style (Table 1). We selected these components as a measure of clear, creative writing style following a recent observational study, which derived them from findings in psychology, English, and science communication literature (Freeling et al., 2019). That study used a set of 11 measurable components, and here we adopted the nine that can be objectively manipulated when constructing new versions of the same abstract. Table 1 contains definitions for each component, and further details and references are provided in that study (Freeling et al., 2019). The nine components signal either clear and inspiring writing, as with signposting and setting, or awkward and obscure prose that worsens the cognitive load on the reader, as with acronyms or extra words that dilute the central message (Pinker, 2015;Freeling et al., 2019). (We excluded "consistent language" and "parallel phrasing" from Freeling et al. (2019), as those two components cannot be readily added to abstracts without altering the flow of content and logic).
We took care to keep the range of writing components within the range that we have recorded from real-world publications.  The first five components make for clear, engaging writing, while the latter four are typical of the traditional style and make for a dull, confusing read (Freeling et al., 2019).
We also retained all content and logical flow across the different writing styles, meaning that the level of detail is the same across all styles for a given topic. This way, we generated writing styles that ranged from the traditional to the accessible, with two intermediate styles, while crossing each of the four styles orthogonally across the three topics. An example of the writing styles is given in Supplementary Table 1.

Participants
We then asked teams of volunteer readers to read the abstracts.
To obtain readers who were consistent in scientific background and age group, we approached four classes of third-year undergraduate science students (173 students in total). We offered all participants the opportunity to participate, and participants were permitted to opt out either verbally or by selecting the appropriate option on the consent form.
Each participant completed up to three readings. For a given participant, the topics and difficulty levels were randomly assigned using a random number generator, with the condition that the readings be of different topics ensuring that students could not learn any abstract content between readings. Participants were not made aware that there were multiple levels of difficulty.
We approached 173 individuals for participation in the full experiment, 170 of whom began the experiment. Thus, the data analysis included responses from 170 participants, meaning that we analyzed 347 responses for each of readability and confidence and 628 responses for understanding. We excluded the models from any observation with incomplete data for each model variable. The detailed participant flow is charted in Figure 1. 87.1% of participants were native English speakers.

Measures
We asked our readers to read each abstract. Readers then answered two questions on a scale from one to five: "how easy was this abstract to read?" (readability) and "how confident are you that you understood the information present in the abstract?" (confidence). Each reader was then independently tested with two multiple-choice questions about the content of the abstract (understanding). Those multiple-choice questions were "Why was this research conducted?" and "What is the take-home message of this research?"; the multiple-choice answers differed depending on the topic (example in Supplementary Table 1). We acknowledge that the use of 1-2 questions for each variable is a limitation; we chose to ask fewer questions to allow us to obtain multiple readings from each participant, as the statistical power of the study was a priority. Using this approach, we could determine how writing style affected readability, confidence, and understanding, while also accounting for topic.

Procedure
Ethics approval was obtained from the School of Psychology Human Research Ethics Committee at the University of Adelaide (approval number H-2019/18).
Each reader was given 5 min to read the abstract and answer the questions, although no reader used the entire duration. In total, we received 347 valid responses for each of readability and confidence, and 628 valid responses for understanding.
The experiment was performed during normal teaching hours in March 2019 and in March 2021. The experimental procedure differed between the 2 years only in that participants completed up to two readings each in 2019, and up to three in 2021. Prior to the experiment, we conducted a pilot run, used to estimate the effect size and calculate an appropriate sample size for the full study. We chose our sample size as 300 observations for each of reading and confidence and 600 for understanding, given the effect sizes for each response variable observed in our pilot study, yields a power above 0.99 at the significance level of 0.05. This calculation was performed using the R package simr (Green and MacLeod, 2016), which uses Monte Carlo simulations to perform power analysis for generalized linear mixed models. Each session lasted approximately 30 min.

Data Analysis
We expressed each of the four levels of reading difficulty as a continuous variable. This continuous variable was calculated using a method from previous research on readability (Hillier et al., 2016;Freeling et al., 2019). Firstly, we performed principal component analysis to reduce the nine writing components in each level of difficulty to a series of uncorrelated axes. Then, we identified which of these axes correlated positively with the "good" writing components and negatively with the "bad" components. This axis (the first-which also explained most of the variation in the writing components) was used as a continuous variable representing reading difficulty.
Mean confidence, readability, and understanding for each level of difficulty, averaged across all topics, is provided in Table 2. For readability and confidence, we rescaled the predicted values to percentages (1.0 = 0; 5.0 = 100%). For understanding, we converted each multiple-choice question to a binary response (0 = incorrect; 1 = correct). We then rescaled the probabilities of obtaining a correct response to percentages.
To estimate the effect of reading difficulty on confidence and readability, we generated linear mixed models. We used linear mixed models to account for the correlation that arises from taking multiple measurements from each participant (Jostins et al., 2012). We included terms for fixed effects of reading difficulty and topic, and for random effects of participant. This random effect captures the effect of specific participants, which might include characteristics such as reading strength and familiarity with the topic, on the response variables. We allowed for random effects in the intercept, but not the slope, as there were only a few measurements from each participant. For the effect of reading difficulty on understanding, the response was binary. So, we generated a generalized linear mixed model using the binomial family with a logit link function. All data analysis was performed in R (R Core Team, 2020). Models were generated using the R package lme4 (Bates et al., 2015) and tabulated using the package sjPlot (Lüdecke, 2020). We performed significance tests on the coefficients using the package lmerTest, which uses Satterthwaite's degrees of freedom method (Kuznetsova et al., 2017).

RESULTS
So, what does better writing mean for the reader? When we presented readers with abstracts written in the most traditional scientific writing style, mean readability was 44.4% (SD: 29.4%). In contrast, when we presented readers with abstracts written in an accessible, engaging style, mean readability was 66.3% (SD: 29.9%) (Figure 2). A similar effect was found for understanding, which resulted in a mean of 47.9% (SD: 50.1%) for the traditional style and 57.9% (SD: 49.5%) for the accessible style. Likewise, confidence ratings were 44.1% (SD: 23.7%) and 58.3% (SD: 32.3%), respectively, for the traditional and accessible styles, respectively. The mean scores of readability and confidence increased consistently from the most difficult to the easiest writing styles.
The models ( Table 3) revealed statistically significant effects of writing style on readability, understanding, and confidence. The differences between each level of writing style, after accounting for the effects of topic and reader, are revealed by the effect sizes. For readability, the slope was 2.91 (confidence interval: 1.79-4.03), indicating that a one-unit increase in writing style was associated with a 2.91% increase in readability. For understanding, the odds ratio was 1.08 (1.01-1.15), indicating that a one-unit increase in writing style was associated with a 1.08-fold increase in odds of successful understanding. For confidence, the slope was 1.87 (0.75-2.99), indicating that a oneunit increase was associated with a 1.87% increase in confidence. As a continuous variable, writing style spanned approximately 5 units; as such, one can readily see how moving from the most difficult style to the most accessible style can boost readability, understanding, and confidence quite substantially. Likewise, the effect of topic was statistically significant on readability, understanding, and confidence. Alternative models found no evidence of an interaction between topic and difficulty, and no evidence of an effect of English as a second language (Supplementary Table 2).

DISCUSSION
In this study, we sought to measure how accessible scientific writing can stimulate reader understanding and confidence. The findings reveal that writing in a more accessible style can enhance readability of and confidence with scientific publications, as well as understanding of the content. This study extends previous research on readability and confidence (e.g., Galbraith and Alexander, 2005) to the context of scientific publications. Furthermore, this study provides evidence that more readable writing is more easily understood (Dale and Chall, 1949). So, the evidence supports the hypotheses that better writing in scientific publications can enhance readability, reader understanding, and reader confidence.
The magnitude of the effect is quite striking. The finding that mean reader confidence, for example, was 62% for the accessible style (compared to 49% for the traditional style) illustrates that  the way publications are written can cause readers to be far more confident when digesting scientific advances. Indeed, the research described in the abstracts was complex, as scientific advances tend to be. With that in mind, it is easy to recognize the valuable opportunity before us.
Just as we aim to hone our science, we can also further that goal by honing our writing-in essence, writing with the comprehension of the reader in mind . These findings indicate that we all have a concrete opportunity to boost the confidence of our readers and promote access to science through simple stylistic choices. Specifically, a setting can help ground the research in time and space; first-person narration can enhance clarity; punctuation marks can help guide the reader's attention; conjunctions can help to link complex ideas; and the judicious use of signposts can help order and structure a piece of writing. Likewise, avoiding acronyms can ease the reader's mental load; breaking up noun chunks can help the reader digest ideas; and hedging only where necessary can help emphasize the message (Montgomery, 2003;Sand Jensen, 2007;Sword, 2012;Lindsay, 2013;Pinker, 2015;Weinberger et al., 2015;Hillier et al., 2016;Freeling et al., 2019;Barnett and Doubleday, 2020).
Future research can complement the subjective measures we report here by collecting further measures. In particular, since readability, confidence and understanding were collected from self-reported questions, objective measures could shine further light on how readers respond to different abstracts. For example, objective measures could be calculated from the time that readers take to read texts (Maksymski et al., 2015); from existing metrics of writing style such as the Flesch Reading Ease (Flesch, 1948) or the Dale-Chall Readability Formula (Chall and Dale, 1995); and from more detailed tests on abstract content. Also, subjective measures could enable participants to report their attitudes and feelings toward the content (Olney et al., 1991). These measures can enable future researchers to delve deeper into how readers respond to better scientific writing. Furthermore, this study detected no difference of lower readability, understanding or confidence for participants for whom English as a second language. These readers likely experience a greater burden in reading and writing research articles (Hanauer and Englander, 2011), although this study and sample was not designed to test that question. A future study could replicate our analysis using a larger sample of readers for whom English is a second language; this would reveal how the findings here could reduce the burden on those readers.
Evidence can be a powerful motivator for the scientific community to revise the way they communicate science. This study signals two compelling avenues for research inquiry. First, it would be progressive to recognize the relative extent to which different disciplines benefit from writing in a more accessible style. Where readability is improved, to what extent does greater reader confidence and understanding also improve a scientist's willingness to make connections between concepts, methods and interpretations? It is likely that progress, particularly in interdisciplinary research, will be more rapid where those searching for solutions have the confidence to engage with alternate approaches (e.g., disciplines) (Brandt et al., 2013). Second, we may benefit from recognizing how more accessible writing benefits the spectrum of expertise among science readers. Our study involved a sample of one particular audience of scientific publications-specifically, third-year undergraduate students. Students represent one group of readers of scientific papers, and so replicating the study with samples from different audiences (e.g., post-doctorate researchers, senior scientists, policymakers) would enable us to see whether the findings are generalizable to all readers (Zahedi et al., 2014;Mohammadi et al., 2015). If society is to perceive science as relevant to their wellbeing, then scientific uptake not only relies on science literacy (Ryder, 2001), but also the readability of science. Whilst there is a variety of science forums, namely those for members of the public and other non-expert groups, it would be insightful to research whether greater readability results in greater inclusion of readers from diverse groups.
Securing the boost in readability and confidence would mean updating the practice and teaching of scientific writing. Journal policies and university courses have, traditionally, promoted a writing style that is distant and formulaic . But there is a wiser way. As we have found here, a boost in confidence can be made through better writing. Journal editors and teaching staff who encourage readable, accessible writing may help the new generation of scientists explore new topics and collaborate more easily across disciplines. Indeed, recent advances in this area have stimulated discussion on writing policy in scientific journals (e.g., Allen, 2019;Chaffey, 2019;Sayer, 2019). And there are published style guides that give instruction on writing scientific publications in an inspired way (e.g., Montgomery, 2003;Sword, 2012;Pinker, 2015). Our evidence suggests that the widespread adoption of these style guides could boost the confidence of people who read scientific publications.
By cultivating reader confidence in understanding, we could empower a more diverse readership, making science both more inclusive and connected. Developing our writing style to one that is more accessible and inclusive requires a bold and proactive approach. We are trying to open up access from behind the paywall through bold initiatives, such as Plan S which aims to ensure that publicly funded research is published in publicly accessible journals (Tofield, 2019); likewise, we also need to open up access from behind the linguistic-wall . We believe that scientists who write with the reader in mind will empower their readers to build confidence and challenge new boundaries. With a growing diversity of bright minds in research, we will be in the best position to develop major advances in the twenty-first century.

DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

ETHICS STATEMENT
The studies involving human participants were reviewed and approved by H-2019/18. The patients/participants provided their written informed consent to participate in this study.

AUTHOR CONTRIBUTIONS
BF and SC performed investigation. BF performed data curation and formal analysis and wrote original draft. All authors contributed to review, editing, conceptualization, and methodology.

ACKNOWLEDGMENTS
We would like to acknowledge the experimental participants for contributing their time and effort, as well as the facilitators for contributing to the smoothly run experimental sessions.