qualitative research with a focus on qualitative data analysis

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The Importance of Qualitative Data Analysis in Research: A Comprehensive Guide

August 29th, 2024

Qualitative data analysis, in essence, is the systematic examination of non-numerical information to uncover patterns, themes, and insights.

This process is crucial in various fields, from product development to business process improvement.

Key Highlights

• Defining qualitative data analysis and its importance
• Comparing qualitative and quantitative research methods
• Exploring key approaches: thematic, grounded theory, content analysis
• Understanding the qualitative data analysis process
• Reviewing CAQDAS tools for efficient analysis
• Ensuring rigor through triangulation and member checking
• Addressing challenges and ethical considerations
• Examining future trends in qualitative research

Introduction to Qualitative Data Analysis

Qualitative data analysis is a sophisticated process of examining non-numerical information to extract meaningful insights.

It’s not just about reading through text; it’s about diving deep into the nuances of human experiences, opinions, and behaviors.

This analytical approach is crucial in various fields, from product development to process improvement , and even in understanding complex social phenomena.

Importance of Qualitative Research Methods

The importance of qualitative research methods cannot be overstated. In my work with companies like 3M , Dell , and Intel , I’ve seen how qualitative analysis can uncover insights that numbers alone simply can’t reveal.

These methods allow us to understand the ‘why’ behind the ‘what’, providing context and depth to our understanding of complex issues.

Whether it’s improving a manufacturing process or developing a new product, qualitative research methods offer a rich, nuanced perspective that’s invaluable for informed decision-making.

Comparing Qualitative vs Quantitative Analysis

While both qualitative and quantitative analyses are essential tools in a researcher’s arsenal, they serve different purposes.

Quantitative analysis, which I’ve extensively used in Six Sigma projects, deals with numerical data and statistical methods.

It’s excellent for measuring, ranking, and categorizing phenomena. On the other hand, qualitative analysis focuses on the rich, contextual data that can’t be easily quantified.

It’s about understanding meanings, experiences, and perspectives.

Key Approaches in Qualitative Data Analysis

Explore essential techniques like thematic analysis, grounded theory, content analysis, and discourse analysis.

Understand how each approach offers unique insights into qualitative data interpretation and theory building.

Thematic Analysis Techniques

Thematic analysis is a cornerstone of qualitative data analysis. It involves identifying patterns or themes within qualitative data.

In my workshops on Statistical Thinking and Business Process Charting , I often emphasize the power of thematic analysis in uncovering underlying patterns in complex datasets.

This approach is particularly useful when dealing with interview transcripts or open-ended survey responses.

The key is to immerse yourself in the data, coding it systematically, and then stepping back to see the broader themes emerge.

Grounded Theory Methodology

Grounded theory is another powerful approach in qualitative data analysis. Unlike methods that start with a hypothesis, grounded theory allows theories to emerge from the data itself.

I’ve found this particularly useful in projects where we’re exploring new territory without preconceived notions.

It’s a systematic yet flexible approach that can lead to fresh insights and innovative solutions.

The iterative nature of grounded theory, with its constant comparison of data, aligns well with the continuous improvement philosophy of Six Sigma .

Content Analysis Strategies

Content analysis is a versatile method that can be both qualitative and quantitative.

In my experience working with diverse industries, content analysis has been invaluable in making sense of large volumes of textual data.

Whether it’s analyzing customer feedback or reviewing technical documentation, content analysis provides a structured way to categorize and quantify qualitative information.

The key is to develop a robust coding framework that captures the essence of your research questions.

Discourse Analysis Approaches

Discourse analysis takes a deeper look at language use and communication practices.

It’s not just about what is said, but how it’s said and in what context. In my work on improving communication processes within organizations , discourse analysis has been a powerful tool.

It helps uncover underlying assumptions, power dynamics, and cultural nuances that might otherwise go unnoticed.

This approach is particularly useful when dealing with complex organizational issues or when trying to understand stakeholder perspectives in depth.

The Qualitative Data Analysis Process

Navigate through data collection, coding techniques, theme development, and interpretation. Learn how to transform raw qualitative data into meaningful insights through systematic analysis.

Data collection methods (interviews, focus groups, observation)

The foundation of any good qualitative analysis lies in robust data collection. In my experience, a mix of methods often yields the best results.

In-depth interviews provide individual perspectives, focus groups offer insights into group dynamics, and observation allows us to see behaviors in their natural context.

When working on process improvement projects , I often combine these methods to get a comprehensive view of the situation.

The key is to align your data collection methods with your research questions and the nature of the information you’re seeking.

Qualitative Data Coding Techniques

Coding is the heart of qualitative data analysis. It’s the process of labeling and organizing your qualitative data to identify different themes and the relationships between them.

In my workshops, I emphasize the importance of developing a clear, consistent coding system.

This might involve open coding to identify initial concepts, axial coding to make connections between categories, and selective coding to integrate and refine the theory.

The goal is to transform raw data into meaningful, analyzable units.

Developing Themes and Patterns

Once your data is coded, the next step is to look for overarching themes and patterns. This is where the analytical magic happens.

It’s about stepping back from the details and seeing the bigger picture. In my work with companies like Motorola and HP, I’ve found that visual tools like mind maps or thematic networks can be incredibly helpful in this process.

They allow you to see connections and hierarchies within your data that might not be immediately apparent in text form.

Data Interpretation and Theory Building

The final step in the qualitative data analysis process is interpretation and theory building.

This is where you bring together your themes and patterns to construct a coherent narrative or theory that answers your research questions.

It’s crucial to remain grounded in your data while also being open to new insights. In my experience, the best interpretations often challenge our initial assumptions and lead to innovative solutions.

Tools and Software for Qualitative Analysis

Discover the power of CAQDAS in streamlining qualitative data analysis workflows. Explore popular tools like NVivo, ATLAS.ti, and MAXQDA for efficient data management and analysis .

Overview of CAQDAS (Computer Assisted Qualitative Data Analysis Software)

Computer Assisted Qualitative Data Analysis Software (CAQDAS) has revolutionized the way we approach qualitative analysis.

These tools streamline the coding process, help manage large datasets, and offer sophisticated visualization options.

As someone who’s seen the evolution of these tools over the past two decades, I can attest to their transformative power.

They allow researchers to handle much larger datasets and perform more complex analyses than ever before.

Popular Tools: NVivo, ATLAS.ti, MAXQDA

Among the most popular CAQDAS tools are NVivo, ATLAS.ti, and MAXQDA.

Each has its strengths, and the choice often depends on your specific needs and preferences. NVivo , for instance, offers robust coding capabilities and is excellent for managing multimedia data.

ATLAS.ti is known for its intuitive interface and powerful network view feature. MAXQDA stands out for its mixed methods capabilities, blending qualitative and quantitative approaches seamlessly.

Ensuring Rigor in Qualitative Data Analysis

Implement strategies like data triangulation, member checking, and audit trails to enhance credibility. Understand the importance of reflexivity in maintaining objectivity throughout the research process.

Data triangulation methods

Ensuring rigor in qualitative analysis is crucial for producing trustworthy results.

Data triangulation is a powerful method for enhancing the credibility of your findings. It involves using multiple data sources, methods, or investigators to corroborate your results.

In my Six Sigma projects, I often employ methodological triangulation, combining interviews, observations, and document analysis to get a comprehensive view of a process or problem.

Member Checking for Validity

Member checking is another important technique for ensuring the validity of your qualitative analysis.

This involves taking your findings back to your participants to confirm that they accurately represent their experiences and perspectives.

In my work with various organizations, I’ve found that this not only enhances the credibility of the research but also often leads to new insights as participants reflect on the findings.

Creating an Audit Trail

An audit trail is essential for demonstrating the rigor of your qualitative analysis.

It’s a detailed record of your research process, including your raw data, analysis notes, and the evolution of your coding scheme.

Practicing Reflexivity

Reflexivity is about acknowledging and critically examining your own role in the research process. As researchers, we bring our own biases and assumptions to our work.

Practicing reflexivity involves constantly questioning these assumptions and considering how they might be influencing our analysis.

Challenges and Best Practices in Qualitative Data Analysis

Address common hurdles such as data saturation , researcher bias, and ethical considerations. Learn best practices for conducting rigorous and ethical qualitative research in various contexts.

Dealing with data saturation

One of the challenges in qualitative research is knowing when you’ve reached data saturation – the point at which new data no longer brings new insights.

In my experience, this requires a balance of systematic analysis and intuition. It’s important to continuously review and compare your data as you collect it.

In projects I’ve led, we often use data matrices or summary tables to track emerging themes and identify when we’re no longer seeing new patterns emerge.

Overcoming Researcher Bias

Researcher bias is an ever-present challenge in qualitative analysis. Our own experiences and preconceptions can inadvertently influence how we interpret data.

To overcome this, I advocate for a combination of strategies. Regular peer debriefing sessions , where you discuss your analysis with colleagues, can help uncover blind spots.

Additionally, actively seeking out negative cases or contradictory evidence can help challenge your assumptions and lead to more robust findings.

Ethical Considerations in Qualitative Research

Ethical considerations are paramount in qualitative research, given the often personal and sensitive nature of the data.

Protecting participant confidentiality, ensuring informed consent, and being transparent about the research process are all crucial.

In my work across various industries and cultures, I’ve learned the importance of being sensitive to cultural differences and power dynamics.

It’s also vital to consider the potential impact of your research on participants and communities.

Ethical qualitative research is not just about following guidelines, but about constantly reflecting on the implications of your work.

The Future of Qualitative Data Analysis

As we look to the future of qualitative data analysis, several exciting trends are emerging.

The increasing use of artificial intelligence and machine learning in qualitative analysis tools promises to revolutionize how we handle large datasets.

We’re also seeing a growing interest in visual and sensory methods of data collection and analysis, expanding our understanding of qualitative data beyond text.

In conclusion, mastering qualitative data analysis is an ongoing journey. It requires a combination of rigorous methods, creative thinking, and ethical awareness.

As we move forward, the field will undoubtedly continue to evolve, but its fundamental importance in research and decision-making will remain constant.

For those willing to dive deep into the complexities of qualitative data, the rewards in terms of insights and understanding are immense.

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How to analyze the data in qualitative research?

How to Analyze Data in Qualitative Research: A Step-by-Step Guide

Qualitative research is a methodology that seeks to uncover the meaning and significance of a particular phenomenon by collecting and analyzing non-numerical data, such as text, images, and observations. Analyzing data in qualitative research is a complex and nuanced process that requires a systematic and structured approach to ensure the accuracy and reliability of the findings. In this article, we will provide a step-by-step guide on how to analyze data in qualitative research.

Step 1: Familiarize Yourself with the Data

Before beginning your analysis, it is essential to totally immerse yourself in the data . This involves a detailed reading and re-reading of the data, taking notes, and identifying key phrases, sentences, and passages that stand out. This process helps you to gain a deeper understanding of the data and identify potential themes, codes, and patterns.

Step 2: Identify Initial Coding Categories

Coding is the process of assigning meaning to the data by identifying and labeling themes, patterns, and concepts. Begin with open coding , where you Identify and label the data without prior assumptions or biases. This helps to ensure that the data is coded in a systematic and transparent manner.

Table 1: Initial Coding Categories

Step 3: Refine and Collaborate

As you continue to code the data, refine and refine your codes , ensuring that they are clear, concise, and unambiguous. It is also essential to collaborate with colleagues or peers to validate your findings and ensure that your analysis is robust and reliable.

Step 4: Identify Emerging Themes

As the data is coded, emerging themes begin to emerge. These themes are the core of your analysis, and it is crucial to identify them accurately and label them clearly.

Table 2: Emerging Themes

Step 5: Analyze and Interpret

✨ Analyze and interpret the findings : This involves examining the data at a deeper level, identifying relationships between codes and themes, and drawing conclusions.

✨ Identify patterns and connections : Identify patterns and connections between the data, and analyze how these patterns and connections contribute to the overall understanding of the phenomenon.

Step 6: Document and Report

Document and report your findings : Keep a record of your analysis, including:

• Research design and methodology
• Data collection and analysis procedures
• Emerging themes and codes
• Findings and conclusions
• Limitations and implications

Tips for Effective Data Analysis

• Be systematic and transparent : Ensure that your analysis is systematic and transparent, with clear and concise notes and records.
• Use a team or peer debriefing session : Discuss your findings with colleagues or peers to validate and refine your analysis.
• Use diagrams and visual aids : Use diagrams, flowcharts, and visual aids to help illustrate complex concepts and relationships.
• Consider multiple sources : Consider multiple sources of data, such as interviews, surveys, and observations, to gain a comprehensive understanding of the phenomenon.

Common Challenges in Data Analysis

• Information overload : Too much data can be overwhelming, making it difficult to identify key themes and patterns.
• Biases and Assumptions : Unconscious biases and assumptions can influence the analysis, leading to inaccurate or incomplete findings.
• Limited Resources : Insufficient resources, including time, funding, or expertise, can hinder the analysis and impact the quality of the findings.

Analyzing data in qualitative research is a challenging and complex process that requires a systematic and structured approach. By following the steps outlined in this article, you can ensure a thorough and robust analysis, leading to valuable insights and meaningful findings. Remember to be systematic, transparent, and collaborative, and to be aware of the potential challenges and limitations.

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• CDC Field Epidemiology Manual Chapters

Collecting and Analyzing Qualitative Data

At a glance.

Chapter 10 of The CDC Field Epidemiology Manual

Introduction

Qualitative research methods are a key component of field epidemiologic investigations because they can provide insight into the perceptions, values, opinions, and community norms where investigations are being conducted 1 2 . Open-ended inquiry methods, the mainstay of qualitative interview techniques, are essential in formative research for exploring contextual factors and rationales for risk behaviors that do not fit neatly into predefined categories. For example, during the 2014–2015 Ebola virus disease outbreaks in parts of West Africa, understanding the cultural implications of burial practices within different communities was crucial to designing and monitoring interventions for safe burials (see below). In program evaluations, qualitative methods can assist the investigator in diagnosing what went right or wrong as part of a process evaluation or in troubleshooting why a program might not be working as well as expected. When designing an intervention, qualitative methods can be useful in exploring dimensions of acceptability to increase the chances of intervention acceptance and success. When performed in conjunction with quantitative studies, qualitative methods can help the investigator confirm, challenge, or deepen the validity of conclusions than either component might have yielded alone 1 2 .

Qualitative Research During the Ebola Virus Disease Outbreaks in Parts of West Africa (2014)‎

Qualitative research was used extensively in response to the Ebola virus disease outbreaks in parts of West Africa to understand burial practices and to design culturally appropriate strategies to ensure safe burials. Qualitative studies were also used to monitor key aspects of the response.

In October 2014, Liberia experienced an abrupt and steady decrease in case counts and deaths in contrast with predicted disease models of an increased case count. At the time, communities were resistant to entering Ebola treatment centers, raising the possibility that patients were not being referred for care and communities might be conducting occult burials.

To assess what was happening at the community level, the Liberian Emergency Operations Center recruited epidemiologists from the US Department of Health and Human Services/Centers for Disease Control and Prevention and the African Union to investigate the problem.

Teams conducted in-depth interviews and focus group discussions with community leaders, local funeral directors, and coffin makers and learned that communities were not conducting occult burials and that the overall number of burials was less than what they had experienced in previous years. Other key findings included the willingness of funeral directors to cooperate with disease response efforts, the need for training of funeral home workers, and considerable community resistance to cremation practices. These findings prompted the Emergency Operations Center to open a burial ground for Ebola decedents, support enhanced testing of burials in the private sector, and train private-sector funeral workers regarding safe burial practices.

Source: Melissa Corkum, personal communication

Choosing When to Apply Qualitative Methods

Similar to quantitative approaches, qualitative research seeks answers to specific questions by using rigorous approaches to collecting and compiling information and producing findings that can be applicable beyond the study population. The fundamental difference in approaches lies in how they translate real-life complexities of initial observations into units of analysis. Data collected in qualitative studies typically are in the form of text or visual images, which provide rich sources of insight but also tend to be bulky and time-consuming to code and analyze. Practically speaking, qualitative study designs tend to favor small, purposively selected samples 1 ideal for case studies or in-depth analysis. The combination of purposive sampling and open-ended question formats deprive qualitative study designs of the power to quantify and generalize conclusions, one of the key limitations of this approach.

Qualitative scientists might argue, however, that the generalizability and precision possible through probabilistic sampling and categorical outcomes are achieved at the cost of enhanced validity, nuance, and naturalism that less structured approaches offer 3 . Open-ended techniques are particularly useful for understanding subjective meanings and motivations underlying behavior. They enable investigators to be equally adept at exploring factors observed and unobserved, intentions as well as actions, internal meanings as well as external consequences, options considered but not taken, and unmeasurable as well as measurable outcomes. These methods are important when the source of or solution to a public health problem is rooted in local perceptions rather than objectively measurable characteristics selected by outside observers 3 . Ultimately, such approaches have the ability to go beyond quantifying questions of how much or how many to take on questions of how or why from the perspective and in the words of the study subjects themselves 1 2 .

Another key advantage of qualitative methods for field investigations is their flexibility 4 . Qualitative designs not only enable but also encourage flexibility in the content and flow of questions to challenge and probe for deeper meanings or follow new leads if they lead to deeper understanding of an issue 5 . It is not uncommon for topic guides to be adjusted in the course of fieldwork to investigate emerging themes relevant to answering the original study question. As discussed herein, qualitative study designs allow flexibility in sample size to accommodate the need for more or fewer interviews among particular groups to determine the root cause of an issue (see the section on Sampling and Recruitment in Qualitative Research). In the context of field investigations, such methods can be extremely useful for investigating complex or fast-moving situations where the dimensions of analysis cannot be fully anticipated.

Ultimately, the decision whether to include qualitative research in a particular field investigation depends mainly on the nature of the research question itself. Certain types of research topics lend themselves more naturally to qualitative rather than other approaches ( Table 10.1 ). These include exploratory investigations when not enough is known about a problem to formulate a hypothesis or develop a fixed set of questions and answer codes. They include research questions where intentions matter as much as actions and "why?" or "why not?" questions matter as much as precise estimation of measured outcomes. Qualitative approaches also work well when contextual influences, subjective meanings, stigma, or strong social desirability biases lower faith in the validity of responses coming from a relatively impersonal survey questionnaire interview.

The availability of personnel with training and experience in qualitative interviewing or observation is critical for obtaining the best quality data but is not absolutely required for rapid assessment in field settings. Qualitative interviewing requires a broader set of skills than survey interviewing. It is not enough to follow a topic guide like a questionnaire, in order, from top to bottom. A qualitative interviewer must exercise judgment to decide when to probe and when to move on, when to encourage, challenge, or follow relevant leads even if they are not written in the topic guide. Ability to engage with informants, connect ideas during the interview, and think on one's feet are common characteristics of good qualitative interviewers. By far the most important qualification in conducting qualitative fieldwork is a firm grasp of the research objectives; with this qualification, a member of the research team armed with curiosity and a topic guide can learn on the job with successful results.

Examples of research topics for which qualitative methods should be considered for field investigations

Research topic

Exploratory research

The relevant questions or answer options are unknown in advance

In-depth case studies Situation analyses by viewing a problem from multiple perspectives Hypothesis generation

Understanding the role of context

Risk exposure or care-seeking behavior is embedded in particular social or physical environments

Key barriers or enablers to effective response Competing concerns that might interfere with each other Environmental behavioral interactions

Understanding the role of perceptions and subjective meaning

Different perception or meaning of the same observable facts influence risk exposure or behavioral response

Why or why not questions Understanding how persons make health decisions Exploring options considered but not taken

Understanding context and meaning of hidden, sensitive, or illegal behaviors

Legal barriers or social desirability biases prevent candid reporting by using conventional interviewing methods

Risky sexual or drug use behaviors Quality-of-care questions Questions that require a higher degree of trust between respondent and interviewer to obtain valid answers

Evaluating how interventions work in practice

Evaluating What went right or, more commonly, what went wrong with a public health response Process or outcome evaluations Who benefited in what way from what perceived change in practice

‘How’ questions Why interventions fail Unintended consequences of programs Patient–provider interactions

Commonly Used Qualitative Methods in Field Investigations

Semi-structured interviews.

Semi-structured interviews can be conducted with single participants (in-depth or individual key informants) or with groups (focus group discussions [FGDs] or key informant groups). These interviews follow a suggested topic guide rather than a fixed questionnaire format. Topic guides typically consist of a limited number (10-15) of broad, open-ended questions followed by bulleted points to facilitate optional probing. The conversational back-and-forth nature of a semi-structured format puts the researcher and researched (the interview participants) on more equal footing than allowed by more structured formats. Respondents, the term used in the case of quantitative questionnaire interviews, become informants in the case of individual semi-structured in-depth interviews (IDIs) or participants in the case of FGDs. Freedom to probe beyond initial responses enables interviewers to actively engage with the interviewee to seek clarity, openness, and depth by challenging informants to reach below layers of self-presentation and social desirability. In this respect, interviewing is sometimes compared with peeling an onion, with the first version of events accessible to the public, including survey interviewers, and deeper inner layers accessible to those who invest the time and effort to build rapport and gain trust. (The theory of the active interview suggests that all interviews involve staged social encounters where the interviewee is constantly assessing interviewer intentions and adjusting his or her responses accordingly 1 . Consequently good rapport is important for any type of interview. Survey formats give interviewers less freedom to divert from the preset script of questions and formal probes.)

Individual In-Depth Interviews and Key-Informant Interviews

The most common forms of individual semi-structured interviews are IDIs and key informant interviews (KIIs). IDIs are conducted among informants typically selected for first-hand experience (e.g., service users, participants, survivors) relevant to the research topic. These are typically conducted as one-on-one face-to-face interviews (two-on-one if translators are needed) to maximize rapport-building and confidentiality. KIIs are similar to IDIs but focus on individual persons with special knowledge or influence (e.g., community leaders or health authorities) that give them broader perspective or deeper insight into the topic area (See: Identifying Barriers and Solutions to Improved Healthcare Worker Practices in Egypt ). Whereas IDIs tend to focus on personal experiences, context, meaning, and implications for informants, KIIs tend to steer away from personal questions in favor of expert insights or community perspectives. IDIs enable flexible sampling strategies and represent the interviewing reference standard for confidentiality, rapport, richness, and contextual detail. However, IDIs are time-and labor-intensive to collect and analyze. Because confidentiality is not a concern in KIIs, these interviews might be conducted as individual or group interviews, as required for the topic area.

Focus Group Discussions and Group Key Informant Interviews

FGDs are semi-structured group interviews in which six to eight participants, homogeneous with respect to a shared experience, behavior, or demographic characteristic, are guided through a topic guide by a trained moderator 6 . (Advice on ideal group interview size varies. The principle is to convene a group large enough to foster an open, lively discussion of the topic, and small enough to ensure all participants stay fully engaged in the process.) Over the course of discussion, the moderator is expected to pose questions, foster group participation, and probe for clarity and depth. Long a staple of market research, focus groups have become a widely used social science technique with broad applications in public health, and they are especially popular as a rapid method for assessing community norms and shared perceptions.

Focus groups have certain useful advantages during field investigations. They are highly adaptable, inexpensive to arrange and conduct, and often enjoyable for participants. Group dynamics effectively tap into collective knowledge and experience to serve as a proxy informant for the community as a whole. They are also capable of recreating a microcosm of social norms where social, moral, and emotional dimensions of topics are allowed to emerge. Skilled moderators can also exploit the tendency of small groups to seek consensus to bring out disagreements that the participants will work to resolve in a way that can lead to deeper understanding. There are also limitations on focus group methods. Lack of confidentiality during group interviews means they should not be used to explore personal experiences of a sensitive nature on ethical grounds. Participants may take it on themselves to volunteer such information, but moderators are generally encouraged to steer the conversation back to general observations to avoid putting pressure on other participants to disclose in a similar way. Similarly, FGDs are subject by design to strong social desirability biases. Qualitative study designs using focus groups sometimes add individual interviews precisely to enable participants to describe personal experiences or personal views that would be difficult or inappropriate to share in a group setting. Focus groups run the risk of producing broad but shallow analyses of issues if groups reach comfortable but superficial consensus around complex topics. This weakness can be countered by training moderators to probe effectively and challenge any consensus that sounds too simplistic or contradictory with prior knowledge. However, FGDs are surprisingly robust against the influence of strongly opinionated participants, highly adaptable, and well suited to application in study designs where systematic comparisons across different groups are called for.

Like FGDs, group KIIs rely on positive chemistry and the stimulating effects of group discussion but aim to gather expert knowledge or oversight on a particular topic rather than lived experience of embedded social actors. Group KIIs have no minimum size requirements and can involve as few as two or three participants.

Identifying Barriers and Solutions to Improved Healthcare Worker Practices in Egypt

Egypt's National Infection Prevention and Control (IPC) program undertook qualitative research to gain an understanding of the contextual behaviors and motivations of healthcare workers in complying with IPC guidelines. The study was undertaken to guide the development of effective behavior change interventions in healthcare settings to improve IPC compliance.

Key informant interviews and focus group discussions were conducted in two governorates among cleaning staff, nursing staff, and physicians in different types of healthcare facilities. The findings highlighted social and cultural barriers to IPC compliance, enabling the IPC program to design responses. For example,

• Informants expressed difficulty in complying with IPC measures that forced them to act outside their normal roles in an ingrained hospital culture. Response: Role models and champions were introduced to help catalyze change.
• Informants described fatalistic attitudes that undermined energy and interest in modifying behavior. Response: Accordingly, interventions affirming institutional commitment to change while challenging fatalistic assumptions were developed.
• Informants did not perceive IPC as effective. Response: Trainings were amended to include scientific evidence justifying IPC practices.
• Informants perceived hygiene as something they took pride in and were judged on. Response: Public recognition of optimal IPC practice was introduced to tap into positive social desirability and professional pride in maintaining hygiene in the work environment.

Qualitative research identified sources of resistance to quality clinical practice in Egypt's healthcare settings and culturally appropriate responses to overcome that resistance.

Source: Anna Leena Lohiniva, personal communication.

Visualization Methods

Visualization methods have been developed as a way to enhance participation and empower interviewees relative to researchers during group data collection 7 . Visualization methods involve asking participants to engage in collective problem- solving of challenges expressed through group production of maps, diagrams, or other images. For example, participants from the community might be asked to sketch a map of their community and to highlight features of relevance to the research topic (e.g., access to health facilities or sites of risk concentrations). Body diagramming is another visualization tool in which community members are asked to depict how and where a health threat affects the human body as a way of understanding folk conceptions of health, disease, treatment, and prevention. Ensuing debate and dialogue regarding construction of images can be recorded and analyzed in conjunction with the visual image itself. Visualization exercises were initially designed to accommodate groups the size of entire communities, but they can work equally well with smaller groups corresponding to the size of FGDs or group KIIs.

Sampling and Recruitment for Qualitative Research

Selecting a sample of study participants.

Fundamental differences between qualitative and quantitative approaches to research emerge most clearly in the practice of sampling and recruitment of study participants. Qualitative samples are typically small and purposive. In-depth interview informants are usually selected on the basis of unique characteristics or personal experiences that make them exemplary for the study, if not typical in other respects. Key informants are selected for their unique knowledge or influence in the study domain. Focus group mobilization often seeks participants who are typical with respect to others in the community having similar exposure or shared characteristics. Often, however, participants in qualitative studies are selected because they are exceptional rather than simply representative. Their value lies not in their generalizability but in their ability to generate insight into the key questions driving the study.

Determining Sample Size

Sample size determination for qualitative studies also follows a different logic than that used for probability sample surveys. For example, whereas some qualitative methods specify ideal ranges of participants that constitute a valid observation (e.g., focus groups), there are no rules on how many observations it takes to attain valid results. In theory, sample size in qualitative designs should be determined by the saturation principle , where interviews are conducted until additional interviews yield no additional insights into the topic of research 8 . Practically speaking, designing a study with a range in number of interviews is advisable for providing a level of flexibility if additional interviews are needed to reach clear conclusions.

Recruiting Study Participants

Recruitment strategies for qualitative studies typically involve some degree of participant self-selection (e.g., advertising in public spaces for interested participants) and purposive selection (e.g., identification of key informants). Purposive selection in community settings often requires authorization from local authorities and assistance from local mobilizers before the informed consent process can begin. Clearly specifying eligibility criteria is crucial for minimizing the tendency of study mobilizers to apply their own filters regarding who reflects the community in the best light. In addition to formal eligibility criteria, character traits (e.g., articulate and interested in participating) and convenience (e.g., not too far away) are legitimate considerations for whom to include in the sample. Accommodations to personality and convenience help to ensure the small number of interviews in a typical qualitative design yields maximum value for minimum investment. This is one reason why random sampling of qualitative informants is not only unnecessary but also potentially counterproductive.

Managing, Condensing, Displaying, and Interpreting Qualitative Data

Analysis of qualitative data can be divided into four stages 9 : data management, data condensation, data display, and drawing and verifying conclusions.

Managing Qualitative Data

From the outset, developing a clear organization system for qualitative data is important. Ideally, naming conventions for original data files and subsequent analysis should be recorded in a data dictionary file that includes dates, locations, defining individual or group characteristics, interviewer characteristics, and other defining features. Digital recordings of interviews or visualization products should be reviewed to ensure fidelity of analyzed data to original observations. If ethics agreements require that no names or identifying characteristics be recorded, all individual names must be removed from final transcriptions before analysis begins. If data are analyzed by using textual data analysis software, maintaining careful version control over the data files is crucial, especially when multiple coders are involved.

Condensing Qualitative Data

Condensing refers to the process of selecting, focusing, simplifying, and abstracting the data available at the time of the original observation, then transforming the condensed data into a data set that can be analyzed. In qualitative research, most of the time investment required to complete a study comes after the fieldwork is complete. A single hour of taped individual interview can take a full day to transcribe and additional time to translate if necessary. Group interviews can take even longer because of the difficulty of transcribing active group input. Each stage of data condensation involves multiple decisions that require clear rules and close supervision. A typical challenge is finding the right balance between fidelity to the rhythm and texture of original language and clarity of the translated version in the language of analysis. For example, discussions among groups with little or no education should not emerge after the transcription (and translation) process sounding like university graduates. Judgment must be exercised about which terms should be translated and which terms should be kept in vernacular because there is no appropriate term in English to capture the richness of its meaning.

Displaying Qualitative Data

After the initial condensation, qualitative analysis depends on how the data are displayed. Decisions regarding how data are summarized and laid out to facilitate comparison influence the depth and detail of the investigation's conclusions. Displays might range from full verbatim transcripts of interviews to bulleted summaries or distilled summaries of interview notes. In a field setting, a useful and commonly used display format is an overview chart in which key themes or research questions are listed in rows in a word processer table or in a spreadsheet and individual informant or group entry characteristics are listed across columns. Overview charts are useful because they allow easy, systematic comparison of results.

Drawing and Verifying Conclusions

Analyzing qualitative data is an iterative and ideally interactive process that leads to rigorous and systematic interpretation of textual or visual data. At least four common steps are involved:

• Reading and rereading. The core of qualitative analysis is careful, systematic, and repeated reading of text to identify consistent themes and interconnections emerging from the data. The act of repeated reading inevitably yields new themes, connections, and deeper meanings from the first reading. Reading the full text of interviews multiple times before subdividing according to coded themes is key to appreciating the full context and flow of each interview before subdividing and extracting coded sections of text for separate analysis.
• Coding. A common technique in qualitative analysis involves developing codes for labeling sections of text for selective retrieval in later stages of analysis and verification. Different approaches can be used for textual coding. One approach, structural coding , follows the structure of the interview guide. Another approach, thematic coding , labels common themes that appear across interviews, whether by design of the topic guide or emerging themes assigned based on further analysis. To avoid the problem of shift and drift in codes across time or multiple coders, qualitative investigators should develop a standard codebook with written definitions and rules about when codes should start and stop. Coding is also an iterative process in which new codes that emerge from repeated reading are layered on top of existing codes. Development and refinement of the codebook is inseparably part of the analysis.
• Analyzing and writing memos. As codes are being developed and refined, answers to the original research question should begin to emerge. Coding can facilitate that process through selective text retrieval during which similarities within and between coding categories can be extracted and compared systematically. Because no p values can be derived in qualitative analyses to mark the transition from tentative to firm conclusions, standard practice is to write memos to record evolving insights and emerging patterns in the data and how they relate to the original research questions. Writing memos is intended to catalyze further thinking about the data, thus initiating new connections that can lead to further coding and deeper understanding.
• Verifying conclusions. Analysis rigor depends as much on the thoroughness of the cross-examination and attempt to find alternative conclusions as on the quality of original conclusions. Cross-examining conclusions can occur in different ways. One way is encouraging regular interaction between analysts to challenge conclusions and pose alternative explanations for the same data. Another way is quizzing the data (i.e., retrieving coded segments by using Boolean logic to systematically compare code contents where they overlap with other codes or informant characteristics). If alternative explanations for initial conclusions are more difficult to justify, confidence in those conclusions is strengthened.

Coding and Analysis Requirements

Above all, qualitative data analysis requires sufficient time and immersion in the data. Computer textual software programs can facilitate selective text retrieval and quizzing the data, but discerning patterns and arriving at conclusions can be done only by the analysts. This requirement involves intensive reading and rereading, developing codebooks and coding, discussing and debating, revising codebooks, and recoding as needed until clear patterns emerge from the data. Although quality and depth of analysis is usually proportional to the time invested, a number of techniques, including some mentioned earlier, can be used to expedite analysis under field conditions.

• Detailed notes instead of full transcriptions. Assigning one or two note-takers to an interview can be considered where the time needed for full transcription and translation is not feasible. Even if plans are in place for full transcriptions after fieldwork, asking note-takers to submit organized summary notes is a useful technique for getting real-time feedback on interview content and making adjustments to topic guides or interviewer training as needed.
• Summary overview charts for thematic coding. (See discussion under "Displaying Data.") If there is limited time for full transcription and/or systematic coding of text interviews using textual analysis software in the field, an overview chart is a useful technique for rapid manual coding.
• Thematic extract files. This is a slightly expanded version of manual thematic coding that is useful when full transcriptions of interviews are available. With use of a word processing program, files can be sectioned according to themes, or separate files can be created for each theme. Relevant extracts from transcripts or analyst notes can be copied and pasted into files or sections of files corresponding to each theme. This is particularly useful for storing appropriate quotes that can be used to illustrate thematic conclusions in final reports or manuscripts.
• Teamwork. Qualitative analysis can be performed by a single analyst, but it is usually beneficial to involve more than one. Qualitative conclusions involve subjective judgment calls. Having more than one coder or analyst working on a project enables more interactive discussion and debate before reaching consensus on conclusions.
• Systematic coding.
• Selective retrieval of coded segments.
• Verifying conclusions ("quizzing the data").
• Working on larger data sets with multiple separate files.
• Working in teams with multiple coders to allow intercoder reliability to be measured and monitored.

The most widely used software packages (e.g., NVivo [QSR International Pty. Ltd., Melbourne, VIC, Australia] and ATLAS.ti [Scientific Software Development GmbH, Berlin, Germany]) evolved to include sophisticated analytic features covering a wide array of applications but are relatively expensive in terms of license cost and initial investment in time and training. A promising development is the advent of free or low-cost Web-based services (e.g., Dedoose [Sociocultural Research Consultants LLC, Manhattan Beach, CA]) that have many of the same analytic features on a more affordable subscription basis and that enable local research counterparts to remain engaged through the analysis phase (see Teamwork criteria). The start-up costs of computer-assisted analysis need to be weighed against their analytic benefits, which tend to decline with the volume and complexity of data to be analyzed. For rapid situational analyses or small scale qualitative studies (e.g. fewer than 30 observations as an informal rule of thumb), manual coding and analysis using word processing or spreadsheet programs is faster and sufficient to enable rigorous analysis and verification of conclusions.

Qualitative methods belong to a branch of social science inquiry that emphasizes the importance of context, subjective meanings, and motivations in understanding human behavior patterns. Qualitative approaches definitionally rely on open-ended, semistructured, non-numeric strategies for asking questions and recording responses. Conclusions are drawn from systematic visual or textual analysis involving repeated reading, coding, and organizing information into structured and emerging themes. Because textual analysis is relatively time-and skill-intensive, qualitative samples tend to be small and purposively selected to yield the maximum amount of information from the minimum amount of data collection. Although qualitative approaches cannot provide representative or generalizable findings in a statistical sense, they can offer an unparalleled level of detail, nuance, and naturalistic insight into the chosen subject of study. Qualitative methods enable investigators to “hear the voice” of the researched in a way that questionnaire methods, even with the occasional open-ended response option, cannot.

Whether or when to use qualitative methods in field epidemiology studies ultimately depends on the nature of the public health question to be answered. Qualitative approaches make sense when a study question about behavior patterns or program performance leads with why, why not , or how . Similarly, they are appropriate when the answer to the study question depends on understanding the problem from the perspective of social actors in real-life settings or when the object of study cannot be adequately captured, quantified, or categorized through a battery of closed-ended survey questions (e.g., stigma or the foundation of health beliefs). Another justification for qualitative methods occurs when the topic is especially sensitive or subject to strong social desirability biases that require developing trust with the informant and persistent probing to reach the truth. Finally, qualitative methods make sense when the study question is exploratory in nature, where this approach enables the investigator the freedom and flexibility to adjust topic guides and probe beyond the original topic guides.

Given that the conditions just described probably apply more often than not in everyday field epidemiology, it might be surprising that such approaches are not incorporated more routinely into standard epidemiologic training. Part of the answer might have to do with the subjective element in qualitative sampling and analysis that seems at odds with core scientific values of objectivity. Part of it might have to do with the skill requirements for good qualitative interviewing, which are generally more difficult to find than those required for routine survey interviewing.

For the field epidemiologist unfamiliar with qualitative study design, it is important to emphasize that obtaining important insights from applying basic approaches is possible, even without a seasoned team of qualitative researchers on hand to do the work. The flexibility of qualitative methods also tends to make them forgiving with practice and persistence. Beyond the required study approvals and ethical clearances, the basic essential requirements for collecting qualitative data in field settings start with an interviewer having a strong command of the research question, basic interactive and language skills, and a healthy sense of curiosity, armed with a simple open-ended topic guide and a tape recorder or note-taker to capture the key points of the discussion. Readily available manuals on qualitative study design, methods, and analysis can provide additional guidance to improve the quality of data collection and analysis.

• Patton MQ. Qualitative research and evaluation methods: integrating theory and practice . 4th ed. Thousand Oaks, CA: Sage; 2015.
• Hennink M, Hutter I, Bailey A. Qualitative research methods . Thousand Oaks, CA: Sage; 2010.
• Lincoln YS, Guba EG. The constructivist credo . Walnut Creek, CA: Left Coast Press; 2013.
• Mack N, Woodsong C, MacQueen KM, Guest G, Namey E. Qualitative research methods: a data collectors field guide. https://www.fhi360.org/sites/default/files/media/documents/Qualitative%20Research%20Methods%20-%20A%20Data%20Collector%27s%20Field%20Guide.pdf
• Kvale S, Brinkmann S. Interviews: learning the craft of qualitative research . Thousand Oaks, CA: Sage; 2009:230–43.
• Krueger RA, Casey MA. Focus groups: a practical guide for applied research . Thousand Oaks, CA: Sage; 2014.
• Margolis E, Pauwels L. The Sage handbook of visual research methods . Thousand Oaks, CA: Sage; 2011.
• Mason M. Sample size and saturation in PhD studies using qualitative interviews. Forum : Qualitative Social Research/Sozialforschung. 2010;11(3).
• Miles MB, Huberman AM, Saldana J. Qualitative data analysis: a methods sourcebook . 3rd ed. Thousand Oaks, CA: Sage; 2014.
• Silver C, Lewins A. Using software in qualitative research: a step-by-step guide . Thousand Oaks, CA; Sage: 2014.

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Qualitative Research – Methods, Analysis Types and Guide

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Qualitative research is a method of inquiry that seeks to understand human experiences, behaviors, and interactions by exploring them in-depth. Unlike quantitative research, which focuses on numerical data, qualitative research delves into meanings, perceptions, and subjective experiences. It is widely used in fields such as sociology, psychology, education, healthcare, and business to uncover insights that are difficult to capture through numerical data.

This article explores the methods of qualitative research, types of qualitative analysis, and a comprehensive guide to conducting a qualitative study.

Qualitative Research

Qualitative research is a non-numerical method of data collection and analysis that focuses on understanding phenomena from the perspective of participants. It prioritizes depth over breadth and aims to explore the “why” and “how” behind human behaviors and social phenomena.

For example, qualitative research might examine how individuals cope with chronic illness by conducting interviews to explore their experiences and emotions in detail.

Characteristics of Qualitative Research

• Exploratory Nature: Focuses on exploring new areas of study or understanding complex phenomena.
• Contextual Understanding: Emphasizes the importance of context in interpreting findings.
• Subjectivity: Values participants’ perspectives and experiences as central to the research.
• Flexibility: Allows for adjustments to research design based on emerging insights.
• Rich Data: Produces detailed and nuanced descriptions rather than numerical summaries.

Methods of Qualitative Research

1. interviews.

Interviews involve one-on-one conversations between the researcher and participants to gather in-depth insights.

• Types: Structured, semi-structured, or unstructured interviews.
• Example: Interviewing teachers to understand their experiences with online education.

2. Focus Groups

Focus groups consist of facilitated discussions with small groups of participants to explore shared experiences or perspectives.

• Example: Conducting a focus group with patients to understand their satisfaction with healthcare services.

3. Observation

Observation involves studying participants in their natural environment to capture behaviors, interactions, and contexts.

• Types: Participant observation (researcher participates) and non-participant observation (researcher observes without involvement).
• Example: Observing interactions in a classroom to understand teaching dynamics.

4. Case Studies

Case studies provide an in-depth examination of a single individual, group, event, or organization.

• Example: Analyzing the impact of a leadership change within a specific company.

5. Ethnography

Ethnography focuses on studying cultural practices and social norms by immersing the researcher in the community.

• Example: Exploring the cultural traditions of an indigenous group through prolonged fieldwork.

6. Document Analysis

Document analysis involves analyzing written or visual materials, such as reports, diaries, photographs, or social media posts.

• Example: Reviewing company policies to understand workplace diversity practices.

7. Narrative Research

Narrative research examines personal stories and experiences to understand individual perspectives.

• Example: Analyzing the life stories of refugees to explore their resilience and adaptation processes.

Types of Qualitative Data Analysis

1. thematic analysis.

Thematic analysis involves identifying, analyzing, and reporting patterns (themes) within qualitative data.

• Steps: Familiarization, coding, theme identification, and interpretation.
• Example: Analyzing interview transcripts to uncover themes related to work-life balance.

2. Content Analysis

Content analysis systematically categorizes textual or visual data to identify patterns and themes.

• Example: Analyzing social media comments to explore public opinions on environmental policies.

3. Grounded Theory

Grounded theory focuses on developing a theory grounded in the data collected.

• Steps: Open coding, axial coding, and selective coding.
• Example: Developing a theory about customer satisfaction based on retail feedback.

4. Narrative Analysis

Narrative analysis examines the structure and content of personal stories to uncover meaning.

• Example: Analyzing interviews with survivors of natural disasters to understand coping strategies.

5. Discourse Analysis

Discourse analysis explores how language is used in specific contexts to construct meaning and social realities.

• Example: Analyzing political speeches to identify persuasive strategies.

6. Framework Analysis

Framework analysis uses a structured approach to analyze data within a thematic framework.

• Example: Evaluating healthcare professionals’ experiences with new policies using predefined themes.

7. Phenomenological Analysis

Phenomenological analysis focuses on understanding the lived experiences of participants.

• Example: Exploring the experiences of first-time parents to understand emotional transitions.

Guide to Conducting Qualitative Research

Step 1: define the research problem.

Clearly articulate the purpose of your study and the research questions you aim to address.

• Example: “What are the experiences of remote workers during the COVID-19 pandemic?”

Step 2: Choose a Research Method

Select a method that aligns with your research objectives and the nature of the phenomenon.

• Example: Conducting semi-structured interviews to gather personal insights.

Step 3: Identify Participants

Choose participants who can provide rich and relevant data for your study.

• Example: Selecting remote workers from diverse industries to capture varied perspectives.

Step 4: Collect Data

Use the chosen method to gather detailed and context-rich data.

• Example: Conducting interviews via video calls and recording responses for analysis.

Step 5: Analyze Data

Apply an appropriate qualitative analysis method to identify patterns, themes, or insights.

• Example: Using thematic analysis to group common challenges faced by remote workers.

Step 6: Interpret Findings

Contextualize your findings within the existing literature and draw meaningful conclusions.

• Example: Comparing your findings on remote work challenges with studies conducted pre-pandemic.

Step 7: Present Results

Communicate your results clearly, using direct quotes, narratives, or visualizations to support your findings.

Advantages of Qualitative Research

• Rich Insights: Provides deep understanding of complex phenomena.
• Flexibility: Adapts to the research context and emerging findings.
• Contextual Detail: Captures the nuances of participants’ experiences and environments.
• Exploratory Nature: Ideal for exploring new or poorly understood topics.

Challenges of Qualitative Research

• Time-Intensive: Data collection and analysis can be lengthy processes.
• Subjectivity: Risk of researcher bias influencing data interpretation.
• Generalizability: Findings are context-specific and may not apply universally.
• Data Management: Handling and analyzing large volumes of qualitative data can be challenging.

Applications of Qualitative Research

• Healthcare: Understanding patient experiences with chronic illnesses.
• Education: Exploring teacher perceptions of new classroom technologies.
• Marketing: Investigating consumer attitudes toward a brand.
• Social Work: Analyzing community responses to social programs.
• Psychology: Examining coping mechanisms among individuals facing trauma.

Qualitative research is a powerful method for exploring the human experience and understanding complex social phenomena. By employing diverse methods such as interviews, focus groups, and ethnography, and using robust analytical techniques, qualitative researchers uncover rich, detailed insights that are essential for addressing real-world challenges. Although it requires careful planning, execution, and interpretation, qualitative research offers unparalleled depth and contextual understanding, making it indispensable across disciplines.

• Creswell, J. W., & Poth, C. N. (2018). Qualitative Inquiry and Research Design: Choosing Among Five Approaches . Sage Publications.
• Flick, U. (2018). An Introduction to Qualitative Research . Sage Publications.
• Denzin, N. K., & Lincoln, Y. S. (2017). The Sage Handbook of Qualitative Research . Sage Publications.
• Merriam, S. B. (2009). Qualitative Research: A Guide to Design and Implementation . Jossey-Bass.
• Braun, V., & Clarke, V. (2006). Using Thematic Analysis in Psychology . Qualitative Research in Psychology.

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• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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• Qualitative Data Analysis
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What is Qualitative Data Analysis

Qualitative Research  goes beyond the examination of who, what, when, and where, to explore the why and how. Qualitative researchers use surveys, interviews, observation, focus groups, and case studies to understand experiences, gather first hand information, and explore a topic through discussion.

Qualitative Data Analysis (QDA)  includes a range of processes used to convert collected data that is typically unstructured into accessible forms for researchers to categorize, interpret, and find meaning.

Computer Assisted Qualitative Data Analysis (CAQDAS)  software is used to assist researchers with data management, transcription analysis, coding, mapping, interpretation of text, audio, or video, and other tasks. One advantage of the tools is their ability to store the analysis in a searchable interactive format.

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How to use and assess qualitative research methods

Loraine busetto, wolfgang wick, christoph gumbinger.

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Received 2020 Jan 30; Accepted 2020 Apr 22; Collection date 2020.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.

Keywords: Qualitative research, Mixed methods, Quality assessment

The aim of this paper is to provide an overview of qualitative research methods, including hands-on information on how they can be used, reported and assessed. This article is intended for beginning qualitative researchers in the health sciences as well as experienced quantitative researchers who wish to broaden their understanding of qualitative research.

What is qualitative research?

Qualitative research is defined as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” , but excluding “their range, frequency and place in an objectively determined chain of cause and effect” [ 1 ]. This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ].

Why conduct qualitative research?

Because some research questions cannot be answered using (only) quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ]. A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors – but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed.

While qualitative research is common in other fields, it is still relatively underrepresented in health services research. The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs (...) " [ 4 ]. This focus on quantitative research and specifically randomised controlled trials (RCT) is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ]. Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand – "questions before methods" [ 2 , 7 – 9 ]. This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them. Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention – essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ] . Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, (...) are not compromises in learning how to improve; they are superior" [ 8 ].

Research problems that can be approached particularly well using qualitative methods include assessing complex multi-component interventions or systems (of change), addressing questions beyond “what works”, towards “what works for whom when, how and why”, and focussing on intervention improvement rather than accreditation [ 7 , 9 – 12 ]. Using qualitative methods can also help shed light on the “softer” side of medical treatment. For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

How to conduct qualitative research?

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. As Fossey puts it : “sampling, data collection, analysis and interpretation are related to each other in a cyclical (iterative) manner, rather than following one after another in a stepwise approach” [ 15 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.  1 , this can involve several back-and-forth steps between data collection and analysis where new insights and experiences can lead to adaption and expansion of the original plan. Some insights may also necessitate a revision of the research question and/or the research design as a whole. The process ends when saturation is achieved, i.e. when no relevant new information can be found (see also below: sampling and saturation). For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented.

Iterative research process

While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research (e.g. constructivism or interpretivism as opposed to positivism). The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ].

Data collection

The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study

Document study (also called document analysis) refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.

Observations

Observations are particularly useful to gain insights into a certain setting and actual behaviour – as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. In non-participant observations, the observer is “on the outside looking in”, i.e. present in but not part of the situation, trying not to influence the setting by their presence. Observations can be planned (e.g. for 3 h during the day or night shift) or ad hoc (e.g. as soon as a stroke patient arrives at the emergency room). During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups. Written notes can be taken during or after the observations, depending on feasibility (which is usually lower during participant observations) and acceptability (e.g. when the observer is perceived to be judging the observed). Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions. Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Semi-structured interviews

Hijmans & Kuyper describe qualitative interviews as “an exchange with an informal character, a conversation with a goal” [ 19 ]. Interviews are used to gain insights into a person’s subjective experiences, opinions and motivations – as opposed to facts or behaviours [ 13 ]. Interviews can be distinguished by the degree to which they are structured (i.e. a questionnaire), open (e.g. free conversation or autobiographical interviews) or semi-structured [ 2 , 13 ]. Semi-structured interviews are characterized by open-ended questions and the use of an interview guide (or topic guide/list) in which the broad areas of interest, sometimes including sub-questions, are defined [ 19 ]. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e.g. document study or observations. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different (blocks of) questions may differ and some questions may be skipped altogether (e.g. if the interviewee is not able or willing to answer the questions or for concerns about the total length of the interview) [ 20 ]. Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher. This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ].

Focus groups

Focus groups are group interviews to explore participants’ expertise and experiences, including explorations of how and why people behave in certain ways [ 1 ]. Focus groups usually consist of 6–8 people and are led by an experienced moderator following a topic guide or “script” [ 21 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ]. Depending on researchers’ and participants’ preferences, the discussions can be audio- or video-taped and transcribed afterwards [ 21 ]. Focus groups are useful for bringing together homogeneous (to a lesser extent heterogeneous) groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ]. Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i.e. “the sharing and comparing” among participants [ 21 ]. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ]. Moreover, attention must be paid to the emergence of “groupthink” as well as possible power dynamics within the group, e.g. when patients are awed or intimidated by health professionals.

Choosing the “right” method

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this – i.e. the “fit” between question and method [ 14 ]. It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results.

Let us assume that our research aim is to examine the (clinical) processes around acute endovascular treatment (EVT), from the patient’s arrival at the emergency room to recanalization, with the aim to identify possible causes for delay and/or other causes for sub-optimal treatment outcome. As a first step, we could conduct a document study of the relevant standard operating procedures (SOPs) for this phase of care – are they up-to-date and in line with current guidelines? Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs. These results can (and should) be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation? It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Are the physicians simply not aware of the SOPs (because their existence is limited to the hospital’s intranet) or do they actively disagree with them or does the infrastructure make it impossible to provide the care as described? Another rationale for adding interviews is that some situations (or all of their possible variations for different patient groups or the day, night or weekend shift) cannot practically or ethically be observed. In this case, it is possible to ask those involved to report on their actions – being aware that this is not the same as the actual observation. A senior physician’s or hospital manager’s description of certain situations might differ from a nurse’s or junior physician’s one, maybe because they intentionally misrepresent facts or maybe because different aspects of the process are visible or important to them. In some cases, it can also be relevant to consider to whom the interviewee is disclosing this information – someone they trust, someone they are otherwise not connected to, or someone they suspect or are aware of being in a potentially “dangerous” power relationship to them. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT. The discussion might reveal discrepancies (between SOPs and actual care or between different physicians) and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves. For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by (senior) physicians only. The resulting combination of data collection methods is shown in Fig.  2 .

Possible combination of data collection methods

Attributions for icons: “Book” by Serhii Smirnov, “Interview” by Adrien Coquet, FR, “Magnifying Glass” by anggun, ID, “Business communication” by Vectors Market; all from the Noun Project

The combination of multiple data source as described for this example can be referred to as “triangulation”, in which multiple measurements are carried out from different angles to achieve a more comprehensive understanding of the phenomenon under study [ 22 , 23 ].

Data analysis

To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts (see Fig.  3 ). Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour (e.g. laughing, crying, pausing) and with or without phonetic transcription of dialects and filler words, depending on what is expected or known to be relevant for the analysis. In the next step, the protocols and transcripts are coded , that is, marked (or tagged, labelled) with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. Jansen describes coding as “connecting the raw data with “theoretical” terms” [ 20 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources (e.g. SOPs, emergency room observations, staff and patient interview). In a process of synthesis and abstraction, the codes are then grouped, summarised and/or categorised [ 15 , 20 ]. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ]. The coding process is performed using qualitative data management software, the most common ones being InVivo, MaxQDA and Atlas.ti. It should be noted that these are data management tools which support the analysis performed by the researcher(s) [ 14 ].

From data collection to data analysis

Attributions for icons: see Fig. 2 , also “Speech to text” by Trevor Dsouza, “Field Notes” by Mike O’Brien, US, “Voice Record” by ProSymbols, US, “Inspection” by Made, AU, and “Cloud” by Graphic Tigers; all from the Noun Project

How to report qualitative research?

Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i.e. to pre-define and set in stone the research questions and primary or secondary endpoints. Rather, it is a way to describe the research methods in detail, which might not be possible in the results paper given journals’ word limits. Qualitative research papers are usually longer than their quantitative counterparts to allow for deep understanding and so-called “thick description”. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation. The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ]. It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement (e.g. “Five interviewees expressed negative feelings towards XYZ”) [ 21 ].

How to combine qualitative with quantitative research?

Qualitative methods can be combined with other methods in multi- or mixed methods designs, which “[employ] two or more different methods [ …] within the same study or research program rather than confining the research to one single method” [ 24 ]. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of (unexpected) results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 – 26 ]. The resulting designs can be classified according to when, why and how the different quantitative and/or qualitative data strands are combined. The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig.  4 .

Three common mixed methods designs

In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results. Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. Amongst other things, this would make it possible to assess whether interview respondents’ subjective impressions of patients receiving good care match modified Rankin Scores at follow-up, or whether observed delays in care provision are exceptions or the rule when compared to door-to-needle times as documented in the registry. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved. In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed. Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different (types of) hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups.

How to assess qualitative research?

A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ]. However, none of these has been elevated to the “gold standard” in the field. In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper.

Assessors should check the authors’ use of and adherence to the relevant reporting checklists (e.g. Standards for Reporting Qualitative Research (SRQR)) to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research (paper). Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ].

Reflexivity

While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research. This includes what is called reflexivity, i.e. sensitivity to the relationship between the researcher and the researched, including how contact was established and maintained, or the background and experience of the researcher(s) involved in data collection and analysis. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ]. It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

Sampling and saturation

The aim of qualitative sampling is for all variants of the objects of observation that are deemed relevant for the study to be present in the sample “ to see the issue and its meanings from as many angles as possible” [ 1 , 16 , 19 , 20 , 27 ] , and to ensure “information-richness [ 15 ]. An iterative sampling approach is advised, in which data collection (e.g. five interviews) is followed by data analysis, followed by more data collection to find variants that are lacking in the current sample. This process continues until no new (relevant) information can be found and further sampling becomes redundant – which is called saturation [ 1 , 15 ] . In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. This is generally referred to as “ purposive sampling” , in which researchers pre-define which types of participants or cases they need to include so as to cover all variations that are expected to be of relevance, based on the literature, previous experience or theory (i.e. theoretical sampling) [ 14 , 20 ]. Other types of purposive sampling include (but are not limited to) maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ]. In the above EVT example, a purposive sample could include all relevant professional groups and/or all relevant stakeholders (patients, relatives) and/or all relevant times of observation (day, night and weekend shift).

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ].

Good qualitative research is iterative in nature, i.e. it goes back and forth between data collection and analysis, revising and improving the approach where necessary. One example of this are pilot interviews, where different aspects of the interview (especially the interview guide, but also, for example, the site of the interview or whether the interview can be audio-recorded) are tested with a small number of respondents, evaluated and revised [ 19 ]. In doing so, the interviewer learns which wording or types of questions work best, or which is the best length of an interview with patients who have trouble concentrating for an extended time. Of course, the same reasoning applies to observations or focus groups which can also be piloted.

Ideally, coding should be performed by at least two researchers, especially at the beginning of the coding process when a common approach must be defined, including the establishment of a useful coding list (or tree), and when a common meaning of individual codes must be established [ 23 ]. An initial sub-set or all transcripts can be coded independently by the coders and then compared and consolidated after regular discussions in the research team. This is to make sure that codes are applied consistently to the research data.

Member checking

Member checking, also called respondent validation , refers to the practice of checking back with study respondents to see if the research is in line with their views [ 14 , 27 ]. This can happen after data collection or analysis or when first results are available [ 23 ]. For example, interviewees can be provided with (summaries of) their transcripts and asked whether they believe this to be a complete representation of their views or whether they would like to clarify or elaborate on their responses [ 17 ]. Respondents’ feedback on these issues then becomes part of the data collection and analysis [ 27 ].

Stakeholder involvement

In those niches where qualitative approaches have been able to evolve and grow, a new trend has seen the inclusion of patients and their representatives not only as study participants (i.e. “members”, see above) but as consultants to and active participants in the broader research process [ 31 – 33 ]. The underlying assumption is that patients and other stakeholders hold unique perspectives and experiences that add value beyond their own single story, making the research more relevant and beneficial to researchers, study participants and (future) patients alike [ 34 , 35 ]. Using the example of patients on or nearing dialysis, a recent scoping review found that 80% of clinical research did not address the top 10 research priorities identified by patients and caregivers [ 32 , 36 ]. In this sense, the involvement of the relevant stakeholders, especially patients and relatives, is increasingly being seen as a quality indicator in and of itself.

How not to assess qualitative research

The above overview does not include certain items that are routine in assessments of quantitative research. What follows is a non-exhaustive, non-representative, experience-based list of the quantitative criteria often applied to the assessment of qualitative research, as well as an explanation of the limited usefulness of these endeavours.

Protocol adherence

Given the openness and flexibility of qualitative research, it should not be assessed by how well it adheres to pre-determined and fixed strategies – in other words: its rigidity. Instead, the assessor should look for signs of adaptation and refinement based on lessons learned from earlier steps in the research process.

Sample size

For the reasons explained above, qualitative research does not require specific sample sizes, nor does it require that the sample size be determined a priori [ 1 , 14 , 27 , 37 – 39 ]. Sample size can only be a useful quality indicator when related to the research purpose, the chosen methodology and the composition of the sample, i.e. who was included and why.

Randomisation

While some authors argue that randomisation can be used in qualitative research, this is not commonly the case, as neither its feasibility nor its necessity or usefulness has been convincingly established for qualitative research [ 13 , 27 ]. Relevant disadvantages include the negative impact of a too large sample size as well as the possibility (or probability) of selecting “ quiet, uncooperative or inarticulate individuals ” [ 17 ]. Qualitative studies do not use control groups, either.

Interrater reliability, variability and other “objectivity checks”

The concept of “interrater reliability” is sometimes used in qualitative research to assess to which extent the coding approach overlaps between the two co-coders. However, it is not clear what this measure tells us about the quality of the analysis [ 23 ]. This means that these scores can be included in qualitative research reports, preferably with some additional information on what the score means for the analysis, but it is not a requirement. Relatedly, it is not relevant for the quality or “objectivity” of qualitative research to separate those who recruited the study participants and collected and analysed the data. Experiences even show that it might be better to have the same person or team perform all of these tasks [ 20 ]. First, when researchers introduce themselves during recruitment this can enhance trust when the interview takes place days or weeks later with the same researcher. Second, when the audio-recording is transcribed for analysis, the researcher conducting the interviews will usually remember the interviewee and the specific interview situation during data analysis. This might be helpful in providing additional context information for interpretation of data, e.g. on whether something might have been meant as a joke [ 18 ].

Not being quantitative research

Being qualitative research instead of quantitative research should not be used as an assessment criterion if it is used irrespectively of the research problem at hand. Similarly, qualitative research should not be required to be combined with quantitative research per se – unless mixed methods research is judged as inherently better than single-method research. In this case, the same criterion should be applied for quantitative studies without a qualitative component.

The main take-away points of this paper are summarised in Table 1 . We aimed to show that, if conducted well, qualitative research can answer specific research questions that cannot to be adequately answered using (only) quantitative designs. Seeing qualitative and quantitative methods as equal will help us become more aware and critical of the “fit” between the research problem and our chosen methods: I can conduct an RCT to determine the reasons for transportation delays of acute stroke patients – but should I? It also provides us with a greater range of tools to tackle a greater range of research problems more appropriately and successfully, filling in the blind spots on one half of the methodological spectrum to better address the whole complexity of neurological research and practice.

Take-away-points

Acknowledgements

Abbreviations.

Endovascular treatment

Randomised Controlled Trial

Standard Operating Procedure

Standards for Reporting Qualitative Research

Authors’ contributions

LB drafted the manuscript; WW and CG revised the manuscript; all authors approved the final versions.

no external funding.

Availability of data and materials

Not applicable.

Ethics approval and consent to participate

Consent for publication, competing interests.

The authors declare no competing interests.

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