significance of study in qualitative research

How To Write Significance of the Study (With Examples)

Whether you’re writing a research paper or thesis, a portion called Significance of the Study ensures your readers understand the impact of your work. Learn how to effectively write this vital part of your research paper or thesis through our detailed steps, guidelines, and examples.

Related: How to Write a Concept Paper for Academic Research

What is the significance of the study.

The Significance of the Study presents the importance of your research. It allows you to prove the study’s impact on your field of research, the new knowledge it contributes, and the people who will benefit from it.

Related: How To Write Scope and Delimitation of a Research Paper (With Examples)

Where Should I Put the Significance of the Study?

The Significance of the Study is part of the first chapter or the Introduction. It comes after the research’s rationale, problem statement, and hypothesis.

Related: How to Make Conceptual Framework (with Examples and Templates)

Why Should I Include the Significance of the Study?

The purpose of the Significance of the Study is to give you space to explain to your readers how exactly your research will be contributing to the literature of the field you are studying 1 . It’s where you explain why your research is worth conducting and its significance to the community, the people, and various institutions.

How To Write Significance of the Study: 5 Steps

Below are the steps and guidelines for writing your research’s Significance of the Study.

1. Use Your Research Problem as a Starting Point

Your problem statement can provide clues to your research study’s outcome and who will benefit from it 2 .

Ask yourself, “How will the answers to my research problem be beneficial?”. In this manner, you will know how valuable it is to conduct your study.

Let’s say your research problem is “What is the level of effectiveness of the lemongrass (Cymbopogon citratus) in lowering the blood glucose level of Swiss mice (Mus musculus)?”

Discovering a positive correlation between the use of lemongrass and lower blood glucose level may lead to the following results:

Increased public understanding of the plant’s medical properties;
Higher appreciation of the importance of lemongrass by the community;
Adoption of lemongrass tea as a cheap, readily available, and natural remedy to lower their blood glucose level.

Once you’ve zeroed in on the general benefits of your study, it’s time to break it down into specific beneficiaries.

2. State How Your Research Will Contribute to the Existing Literature in the Field

Think of the things that were not explored by previous studies. Then, write how your research tackles those unexplored areas. Through this, you can convince your readers that you are studying something new and adding value to the field.

3. Explain How Your Research Will Benefit Society

In this part, tell how your research will impact society. Think of how the results of your study will change something in your community.

For example, in the study about using lemongrass tea to lower blood glucose levels, you may indicate that through your research, the community will realize the significance of lemongrass and other herbal plants. As a result, the community will be encouraged to promote the cultivation and use of medicinal plants.

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

Using the same example above, you may indicate that this research’s results will benefit those seeking an alternative supplement to prevent high blood glucose levels.

5. Indicate How Your Study May Help Future Studies in the Field

You must also specifically indicate how your research will be part of the literature of your field and how it will benefit future researchers. In our example above, you may indicate that through the data and analysis your research will provide, future researchers may explore other capabilities of herbal plants in preventing different diseases.

Tips and Warnings

Think ahead . By visualizing your study in its complete form, it will be easier for you to connect the dots and identify the beneficiaries of your research.
Write concisely. Make it straightforward, clear, and easy to understand so that the readers will appreciate the benefits of your research. Avoid making it too long and wordy.
Go from general to specific . Like an inverted pyramid, you start from above by discussing the general contribution of your study and become more specific as you go along. For instance, if your research is about the effect of remote learning setup on the mental health of college students of a specific university , you may start by discussing the benefits of the research to society, to the educational institution, to the learning facilitators, and finally, to the students.
Seek help . For example, you may ask your research adviser for insights on how your research may contribute to the existing literature. If you ask the right questions, your research adviser can point you in the right direction.
Revise, revise, revise. Be ready to apply necessary changes to your research on the fly. Unexpected things require adaptability, whether it’s the respondents or variables involved in your study. There’s always room for improvement, so never assume your work is done until you have reached the finish line.

Significance of the Study Examples

This section presents examples of the Significance of the Study using the steps and guidelines presented above.

Example 1: STEM-Related Research

Research Topic: Level of Effectiveness of the Lemongrass ( Cymbopogon citratus ) Tea in Lowering the Blood Glucose Level of Swiss Mice ( Mus musculus ).

Significance of the Study .

This research will provide new insights into the medicinal benefit of lemongrass ( Cymbopogon citratus ), specifically on its hypoglycemic ability.

Through this research, the community will further realize promoting medicinal plants, especially lemongrass, as a preventive measure against various diseases. People and medical institutions may also consider lemongrass tea as an alternative supplement against hyperglycemia.

Moreover, the analysis presented in this study will convey valuable information for future research exploring the medicinal benefits of lemongrass and other medicinal plants.

Example 2: Business and Management-Related Research

Research Topic: A Comparative Analysis of Traditional and Social Media Marketing of Small Clothing Enterprises.

Significance of the Study:

By comparing the two marketing strategies presented by this research, there will be an expansion on the current understanding of the firms on these marketing strategies in terms of cost, acceptability, and sustainability. This study presents these marketing strategies for small clothing enterprises, giving them insights into which method is more appropriate and valuable for them.

Specifically, this research will benefit start-up clothing enterprises in deciding which marketing strategy they should employ. Long-time clothing enterprises may also consider the result of this research to review their current marketing strategy.

Furthermore, a detailed presentation on the comparison of the marketing strategies involved in this research may serve as a tool for further studies to innovate the current method employed in the clothing Industry.

Example 3: Social Science -Related Research.

Research Topic: Divide Et Impera : An Overview of How the Divide-and-Conquer Strategy Prevailed on Philippine Political History.

Significance of the Study :

Through the comprehensive exploration of this study on Philippine political history, the influence of the Divide et Impera, or political decentralization, on the political discernment across the history of the Philippines will be unraveled, emphasized, and scrutinized. Moreover, this research will elucidate how this principle prevailed until the current political theatre of the Philippines.

In this regard, this study will give awareness to society on how this principle might affect the current political context. Moreover, through the analysis made by this study, political entities and institutions will have a new approach to how to deal with this principle by learning about its influence in the past.

In addition, the overview presented in this research will push for new paradigms, which will be helpful for future discussion of the Divide et Impera principle and may lead to a more in-depth analysis.

Example 4: Humanities-Related Research

Research Topic: Effectiveness of Meditation on Reducing the Anxiety Levels of College Students.

Significance of the Study:

This research will provide new perspectives in approaching anxiety issues of college students through meditation.

Specifically, this research will benefit the following:

Community – this study spreads awareness on recognizing anxiety as a mental health concern and how meditation can be a valuable approach to alleviating it.

Academic Institutions and Administrators – through this research, educational institutions and administrators may promote programs and advocacies regarding meditation to help students deal with their anxiety issues.

Mental health advocates – the result of this research will provide valuable information for the advocates to further their campaign on spreading awareness on dealing with various mental health issues, including anxiety, and how to stop stigmatizing those with mental health disorders.

Parents – this research may convince parents to consider programs involving meditation that may help the students deal with their anxiety issues.

Students will benefit directly from this research as its findings may encourage them to consider meditation to lower anxiety levels.

Future researchers – this study covers information involving meditation as an approach to reducing anxiety levels. Thus, the result of this study can be used for future discussions on the capabilities of meditation in alleviating other mental health concerns.

Frequently Asked Questions

1. what is the difference between the significance of the study and the rationale of the study.

Both aim to justify the conduct of the research. However, the Significance of the Study focuses on the specific benefits of your research in the field, society, and various people and institutions. On the other hand, the Rationale of the Study gives context on why the researcher initiated the conduct of the study.

Let’s take the research about the Effectiveness of Meditation in Reducing Anxiety Levels of College Students as an example. Suppose you are writing about the Significance of the Study. In that case, you must explain how your research will help society, the academic institution, and students deal with anxiety issues through meditation. Meanwhile, for the Rationale of the Study, you may state that due to the prevalence of anxiety attacks among college students, you’ve decided to make it the focal point of your research work.

2. What is the difference between Justification and the Significance of the Study?

In Justification, you express the logical reasoning behind the conduct of the study. On the other hand, the Significance of the Study aims to present to your readers the specific benefits your research will contribute to the field you are studying, community, people, and institutions.

Suppose again that your research is about the Effectiveness of Meditation in Reducing the Anxiety Levels of College Students. Suppose you are writing the Significance of the Study. In that case, you may state that your research will provide new insights and evidence regarding meditation’s ability to reduce college students’ anxiety levels. Meanwhile, you may note in the Justification that studies are saying how people used meditation in dealing with their mental health concerns. You may also indicate how meditation is a feasible approach to managing anxiety using the analysis presented by previous literature.

3. How should I start my research’s Significance of the Study section?

– This research will contribute… – The findings of this research… – This study aims to… – This study will provide… – Through the analysis presented in this study… – This study will benefit…

Moreover, you may start the Significance of the Study by elaborating on the contribution of your research in the field you are studying.

4. What is the difference between the Purpose of the Study and the Significance of the Study?

The Purpose of the Study focuses on why your research was conducted, while the Significance of the Study tells how the results of your research will benefit anyone.

Suppose your research is about the Effectiveness of Lemongrass Tea in Lowering the Blood Glucose Level of Swiss Mice . You may include in your Significance of the Study that the research results will provide new information and analysis on the medical ability of lemongrass to solve hyperglycemia. Meanwhile, you may include in your Purpose of the Study that your research wants to provide a cheaper and natural way to lower blood glucose levels since commercial supplements are expensive.

5. What is the Significance of the Study in Tagalog?

In Filipino research, the Significance of the Study is referred to as Kahalagahan ng Pag-aaral.

Draft your Significance of the Study. Retrieved 18 April 2021, from http://dissertationedd.usc.edu/draft-your-significance-of-the-study.html
Regoniel, P. (2015). Two Tips on How to Write the Significance of the Study. Retrieved 18 April 2021, from https://simplyeducate.me/2015/02/09/significance-of-the-study/

Written by Jewel Kyle Fabula

in Career and Education , Juander How

Jewel Kyle Fabula

Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.

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significance of study in qualitative research

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> Journals
> BJPsych Bulletin
> The Psychiatrist
> Volume 37 Issue 6
> Qualitative research: its value and applicability

Article contents

What questions are best answered using qualitative research, countering some misconceptions, in conclusion, qualitative research: its value and applicability.

Published online by Cambridge University Press: 02 January 2018

Qualitative research has a rich tradition in the study of human social behaviour and cultures. Its general aim is to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of individuals, and the meanings attached to them. The effective application of qualitative methods to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. Qualitative approaches have particular potential in psychiatry research, singularly and in combination with quantitative methods. This article outlines the nature and potential application of qualitative research as well as attempting to counter a number of misconceptions.

Qualitative research has a rich tradition in the social sciences. Since the late 19th century, researchers interested in studying the social behaviour and cultures of humankind have perceived limitations in trying to explain the phenomena they encounter in purely quantifiable, measurable terms. Anthropology, in its social and cultural forms, was one of the foremost disciplines in developing what would later be termed a qualitative approach, founded as it was on ethnographic studies which sought an understanding of the culture of people from other societies, often hitherto unknown and far removed in geography. Reference Bernard 1 Early researchers would spend extended periods of time living in societies, observing, noting and photographing the minutia of daily life, with the most committed often learning the language of peoples they observed, in the hope of gaining greater acceptance by them and a more detailed understanding of the cultural norms at play. All academic disciplines concerned with human and social behaviour, including anthropology, sociology and psychology, now make extensive use of qualitative research methods whose systematic application was first developed by these colonial-era social scientists.

Their methods, involving observation, participation and discussion of the individuals and groups being studied, as well as reading related textual and visual media and artefacts, form the bedrock of all qualitative social scientific inquiry. The general aim of qualitative research is thus to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of those studied, and the meanings attached to them. Reference Bryman 2 Researchers interested in finding out why people behave the way they do; how people are affected by events, how attitudes and opinions are formed; how and why cultures and practices have developed in the way they have, might well consider qualitative methods to answer their questions.

It is fair to say that clinical and health-related research is still dominated by quantitative methods, of which the randomised controlled trial, focused on hypothesis-testing through experiment controlled by randomisation, is perhaps the quintessential method. Qualitative approaches may seem obscure to the uninitiated when directly compared with the experimental, quantitative methods used in clinical research. There is increasing recognition among researchers in these fields, however, that qualitative methods such as observation, in-depth interviews, focus groups, consensus methods, case studies and the interpretation of texts can be more effective than quantitative approaches in exploring complex phenomena and as such are valuable additions to the methodological armoury available to them. Reference Denzin and Lincoln 3

In considering what kind of research questions are best answered using a qualitative approach, it is important to remember that, first and foremost, unlike quantitative research, inquiry conducted in the qualitative tradition seeks to answer the question ‘What?’ as opposed to ‘How often?’. Qualitative methods are designed to reveal what is going on by describing and interpreting phenomena; they do not attempt to measure how often an event or association occurs. Research conducted using qualitative methods is normally done with an intent to preserve the inherent complexities of human behaviour as opposed to assuming a reductive view of the subject in order to count and measure the occurrence of phenomena. Qualitative research normally takes an inductive approach, moving from observation to hypothesis rather than hypothesis-testing or deduction, although the latter is perfectly possible.

When conducting research in this tradition, the researcher should, if possible, avoid separating the stages of study design, data collection and analysis, but instead weave backwards and forwards between the raw data and the process of conceptualisation, thereby making sense of the data throughout the period of data collection. Although there are inevitable tensions among methodologists concerned with qualitative practice, there is broad consensus that a priori categories and concepts reflecting a researcher's own preconceptions should not be imposed on the process of data collection and analysis. The emphasis should be on capturing and interpreting research participants' true perceptions and/or behaviours.

Using combined approaches

The polarity between qualitative and quantitative research has been largely assuaged, to the benefit of all disciplines which now recognise the value, and compatibility, of both approaches. Indeed, there can be particular value in using quantitative methods in combination with qualitative methods. Reference Barbour 4 In the exploratory stages of a research project, qualitative methodology can be used to clarify or refine the research question, to aid conceptualisation and to generate a hypothesis. It can also help to identify the correct variables to be measured, as researchers have been known to measure before they fully understand the underlying issues pertaining to a study and, as a consequence, may not always target the most appropriate factors. Qualitative work can be valuable in the interpretation, qualification or illumination of quantitative research findings. This is particularly helpful when focusing on anomalous results, as they test the main hypothesis formulated. Qualitative methods can also be used in combination with quantitative methods to triangulate findings and support the validation process, for example, where three or more methods are used and the results compared for similarity (e.g. a survey, interviews and a period of observation in situ ).

‘There is little value in qualitative research findings because we cannot generalise from them’

Generalisability refers to the extent that the account can be applied to other people, times and settings other than those actually studied. A common criticism of qualitative research is that the results of a study are rarely, if ever, generalisable to a larger population because the sample groups are small and the participants are not chosen randomly. Such criticism fails to recognise the distinctiveness of qualitative research where sampling is concerned. In quantitative research, the intent is to secure a large random sample that is representative of the general population, with the purpose of eliminating individual variations, focusing on generalisations and thereby allowing for statistical inference of results that are applicable across an entire population. In qualitative research, generalisability is based on the assumption that it is valuable to begin to understand similar situations or people, rather than being representative of the target population. Qualitative research is rarely based on the use of random samples, so the kinds of reference to wider populations made on the basis of surveys cannot be used in qualitative analysis.

Qualitative researchers utilise purposive sampling, whereby research participants are selected deliberately to test a particular theoretical premise. The purpose of sampling here is not to identify a random subgroup of the general population from which statistically significant results can be extrapolated, but rather to identify, in a systematic way, individuals that possess relevant characteristics for the question being considered. Reference Strauss and Corbin 5 The researchers must instead ensure that any reference to people and settings beyond those in the study are justified, which is normally achieved by defining, in detail, the type of settings and people to whom the explanation or theory applies based on the identification of similar settings and people in the study. The intent is to permit a detailed examination of the phenomenon, resulting in a text-rich interpretation that can deepen our understanding and produce a plausible explanation of the phenomenon under study. The results are not intended to be statistically generalisable, although any theory they generate might well be.

‘Qualitative research cannot really claim reliability or validity’

In quantitative research, reliability is the extent to which different observers, or the same observers on different occasions, make the same observations or collect the same data about the same object of study. The changing nature of social phenomena scrutinised by qualitative researchers inevitably makes the possibility of the same kind of reliability problematic in their work. A number of alternative concepts to reliability have been developed by qualitative methodologists, however, known collectively as forms of trustworthiness. Reference Guba 6

One way to demonstrate trustworthiness is to present detailed evidence in the form of quotations from interviews and field notes, along with thick textual descriptions of episodes, events and settings. To be trustworthy, qualitative analysis should also be auditable, making it possible to retrace the steps leading to a certain interpretation or theory to check that no alternatives were left unexamined and that no researcher biases had any avoidable influence on the results. Usually, this involves the recording of information about who did what with the data and in what order so that the origin of interpretations can be retraced.

In general, within the research traditions of the natural sciences, findings are validated by their repeated replication, and if a second investigator cannot replicate the findings when they repeat the experiment then the original results are questioned. If no one else can replicate the original results then they are rejected as fatally flawed and therefore invalid. Natural scientists have developed a broad spectrum of procedures and study designs to ensure that experiments are dependable and that replication is possible. In the social sciences, particularly when using qualitative research methods, replication is rarely possible given that, when observed or questioned again, respondents will almost never say or do precisely the same things. Whether results have been successfully replicated is always a matter of interpretation. There are, however, procedures that, if followed, can significantly reduce the possibility of producing analyses that are partial or biased. Reference Altheide, Johnson, Denzin and Lincoln 7

Triangulation is one way of doing this. It essentially means combining multiple views, approaches or methods in an investigation to obtain a more accurate interpretation of the phenomena, thereby creating an analysis of greater depth and richness. As the process of analysing qualitative data normally involves some form of coding, whereby data are broken down into units of analysis, constant comparison can also be used. Constant comparison involves checking the consistency and accuracy of interpretations and especially the application of codes by constantly comparing one interpretation or code with others both of a similar sort and in other cases and settings. This in effect is a form of interrater reliability, involving multiple researchers or teams in the coding process so that it is possible to compare how they have coded the same passages and where there are areas of agreement and disagreement so that consensus can be reached about a code's definition, improving consistency and rigour. It is also good practice in qualitative analysis to look constantly for outliers – results that are out of line with your main findings or any which directly contradict what your explanations might predict, re-examining the data to try to find a way of explaining the atypical finding to produce a modified and more complex theory and explanation.

Qualitative research has been established for many decades in the social sciences and encompasses a valuable set of methodological tools for data collection, analysis and interpretation. Their effective application to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. The use of qualitative approaches to research in psychiatry has particular potential, singularly and in combination with quantitative methods. Reference Crabb and Chur-Hansen 8 When devising research questions in the specialty, careful thought should always be given to the most appropriate methodology, and consideration given to the great depth and richness of empirical evidence which a robust qualitative approach is able to provide.

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Volume 37, Issue 6
Steven J. Agius (a1)
DOI: https://doi.org/10.1192/pb.bp.113.042770

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What is the Significance of the Study?

By DiscoverPhDs
August 25, 2020

what the significance of the study means,
why it’s important to include in your research work,
where you would include it in your paper, thesis or dissertation,
how you write one
and finally an example of a well written section about the significance of the study.

What does Significance of the Study mean?

The significance of the study is a written statement that explains why your research was needed. It’s a justification of the importance of your work and impact it has on your research field, it’s contribution to new knowledge and how others will benefit from it.

Why is the Significance of the Study important?

The significance of the study, also known as the rationale of the study, is important to convey to the reader why the research work was important. This may be an academic reviewer assessing your manuscript under peer-review, an examiner reading your PhD thesis, a funder reading your grant application or another research group reading your published journal paper. Your academic writing should make clear to the reader what the significance of the research that you performed was, the contribution you made and the benefits of it.

How do you write the Significance of the Study?

When writing this section, first think about where the gaps in knowledge are in your research field. What are the areas that are poorly understood with little or no previously published literature? Or what topics have others previously published on that still require further work. This is often referred to as the problem statement.

The introduction section within the significance of the study should include you writing the problem statement and explaining to the reader where the gap in literature is.

Then think about the significance of your research and thesis study from two perspectives: (1) what is the general contribution of your research on your field and (2) what specific contribution have you made to the knowledge and who does this benefit the most.

For example, the gap in knowledge may be that the benefits of dumbbell exercises for patients recovering from a broken arm are not fully understood. You may have performed a study investigating the impact of dumbbell training in patients with fractures versus those that did not perform dumbbell exercises and shown there to be a benefit in their use. The broad significance of the study would be the improvement in the understanding of effective physiotherapy methods. Your specific contribution has been to show a significant improvement in the rate of recovery in patients with broken arms when performing certain dumbbell exercise routines.

This statement should be no more than 500 words in length when written for a thesis. Within a research paper, the statement should be shorter and around 200 words at most.

Significance of the Study: An example

Building on the above hypothetical academic study, the following is an example of a full statement of the significance of the study for you to consider when writing your own. Keep in mind though that there’s no single way of writing the perfect significance statement and it may well depend on the subject area and the study content.

Here’s another example to help demonstrate how a significance of the study can also be applied to non-technical fields:

The significance of this research lies in its potential to inform clinical practices and patient counseling. By understanding the psychological outcomes associated with non-surgical facial aesthetics, practitioners can better guide their patients in making informed decisions about their treatment plans. Additionally, this study contributes to the body of academic knowledge by providing empirical evidence on the effects of these cosmetic procedures, which have been largely anecdotal up to this point.

The statement of the significance of the study is used by students and researchers in academic writing to convey the importance of the research performed; this section is written at the end of the introduction and should describe the specific contribution made and who it benefits.

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How To Write a Significance Statement for Your Research

A significance statement is an essential part of a research paper. It explains the importance and relevance of the study to the academic community and the world at large. To write a compelling significance statement, identify the research problem, explain why it is significant, provide evidence of its importance, and highlight its potential impact on future research, policy, or practice. A well-crafted significance statement should effectively communicate the value of the research to readers and help them understand why it matters.

Updated on May 4, 2023

a life sciences researcher writing a significance statement for her researcher

A significance statement is a clearly stated, non-technical paragraph that explains why your research matters. It’s central in making the public aware of and gaining support for your research.

Write it in jargon-free language that a reader from any field can understand. Well-crafted, easily readable significance statements can improve your chances for citation and impact and make it easier for readers outside your field to find and understand your work.

Read on for more details on what a significance statement is, how it can enhance the impact of your research, and, of course, how to write one.

What is a significance statement in research?

A significance statement answers the question: How will your research advance scientific knowledge and impact society at large (as well as specific populations)?

You might also see it called a “Significance of the study” statement. Some professional organizations in the STEM sciences and social sciences now recommended that journals in their disciplines make such statements a standard feature of each published article. Funding agencies also consider “significance” a key criterion for their awards.

Read some examples of significance statements from the Proceedings of the National Academy of Sciences (PNAS) here .

Depending upon the specific journal or funding agency’s requirements, your statement may be around 100 words and answer these questions:

1. What’s the purpose of this research?

2. What are its key findings?

3. Why do they matter?

4. Who benefits from the research results?

Readers will want to know: “What is interesting or important about this research?” Keep asking yourself that question.

Where to place the significance statement in your manuscript

Most journals ask you to place the significance statement before or after the abstract, so check with each journal’s guide.

This article is focused on the formal significance statement, even though you’ll naturally highlight your project’s significance elsewhere in your manuscript. (In the introduction, you’ll set out your research aims, and in the conclusion, you’ll explain the potential applications of your research and recommend areas for future research. You’re building an overall case for the value of your work.)

Developing the significance statement

The main steps in planning and developing your statement are to assess the gaps to which your study contributes, and then define your work’s implications and impact.

Identify what gaps your study fills and what it contributes

Your literature review was a big part of how you planned your study. To develop your research aims and objectives, you identified gaps or unanswered questions in the preceding research and designed your study to address them.

Go back to that lit review and look at those gaps again. Review your research proposal to refresh your memory. Ask:

How have my research findings advanced knowledge or provided notable new insights?
How has my research helped to prove (or disprove) a hypothesis or answer a research question?
Why are those results important?

Consider your study’s potential impact at two levels:

What contribution does my research make to my field?
How does it specifically contribute to knowledge; that is, who will benefit the most from it?

Define the implications and potential impact

As you make notes, keep the reasons in mind for why you are writing this statement. Whom will it impact, and why?

The first audience for your significance statement will be journal reviewers when you submit your article for publishing. Many journals require one for manuscript submissions. Study the author’s guide of your desired journal to see its criteria ( here’s an example ). Peer reviewers who can clearly understand the value of your research will be more likely to recommend publication.

Second, when you apply for funding, your significance statement will help justify why your research deserves a grant from a funding agency . The U.S. National Institutes of Health (NIH), for example, wants to see that a project will “exert a sustained, powerful influence on the research field(s) involved.” Clear, simple language is always valuable because not all reviewers will be specialists in your field.

Third, this concise statement about your study’s importance can affect how potential readers engage with your work. Science journalists and interested readers can promote and spread your work, enhancing your reputation and influence. Help them understand your work.

You’re now ready to express the importance of your research clearly and concisely. Time to start writing.

How to write a significance statement: Key elements

When drafting your statement, focus on both the content and writing style.

In terms of content, emphasize the importance, timeliness, and relevance of your research results.
Write the statement in plain, clear language rather than scientific or technical jargon. Your audience will include not just your fellow scientists but also non-specialists like journalists, funding reviewers, and members of the public.

Follow the process we outline below to build a solid, well-crafted, and informative statement.

Get started

Some suggested opening lines to help you get started might be:

The implications of this study are…
Building upon previous contributions, our study moves the field forward because…
Our study furthers previous understanding about…

Alternatively, you may start with a statement about the phenomenon you’re studying, leading to the problem statement.

Include these components

Next, draft some sentences that include the following elements. A good example, which we’ll use here, is a significance statement by Rogers et al. (2022) published in the Journal of Climate .

1. Briefly situate your research study in its larger context . Start by introducing the topic, leading to a problem statement. Here’s an example:

‘Heatwaves pose a major threat to human health, ecosystems, and human systems.”

2. State the research problem.

“Simultaneous heatwaves affecting multiple regions can exacerbate such threats. For example, multiple food-producing regions simultaneously undergoing heat-related crop damage could drive global food shortages.”

3. Tell what your study does to address it.

“We assess recent changes in the occurrence of simultaneous large heatwaves.”

4. Provide brief but powerful evidence to support the claims your statement is making , Use quantifiable terms rather than vague ones (e.g., instead of “This phenomenon is happening now more than ever,” see below how Rogers et al. (2022) explained it). This evidence intensifies and illustrates the problem more vividly:

“Such simultaneous heatwaves are 7 times more likely now than 40 years ago. They are also hotter and affect a larger area. Their increasing occurrence is mainly driven by warming baseline temperatures due to global heating, but changes in weather patterns contribute to disproportionate increases over parts of Europe, the eastern United States, and Asia.

5. Relate your study’s impact to the broader context , starting with its general significance to society—then, when possible, move to the particular as you name specific applications of your research findings. (Our example lacks this second level of application.)

“Better understanding the drivers of weather pattern changes is therefore important for understanding future concurrent heatwave characteristics and their impacts.”

Refine your English

Don’t understate or overstate your findings – just make clear what your study contributes. When you have all the elements in place, review your draft to simplify and polish your language. Even better, get an expert AJE edit . Be sure to use “plain” language rather than academic jargon.

Avoid acronyms, scientific jargon, and technical terms
Use active verbs in your sentence structure rather than passive voice (e.g., instead of “It was found that...”, use “We found...”)
Make sentence structures short, easy to understand – readable
Try to address only one idea in each sentence and keep sentences within 25 words (15 words is even better)
Eliminate nonessential words and phrases (“fluff” and wordiness)

Enhance your significance statement’s impact

Always take time to review your draft multiple times. Make sure that you:

Keep your language focused
Provide evidence to support your claims
Relate the significance to the broader research context in your field

After revising your significance statement, request feedback from a reading mentor about how to make it even clearer. If you’re not a native English speaker, seek help from a native-English-speaking colleague or use an editing service like AJE to make sure your work is at a native level.

Understanding the significance of your study

Your readers may have much less interest than you do in the specific details of your research methods and measures. Many readers will scan your article to learn how your findings might apply to them and their own research.

Different types of significance

Your findings may have different types of significance, relevant to different populations or fields of study for different reasons. You can emphasize your work’s statistical, clinical, or practical significance. Editors or reviewers in the social sciences might also evaluate your work’s social or political significance.

Statistical significance means that the results are unlikely to have occurred randomly. Instead, it implies a true cause-and-effect relationship.

Clinical significance means that your findings are applicable for treating patients and improving quality of life.

Practical significance is when your research outcomes are meaningful to society at large, in the “real world.” Practical significance is usually measured by the study’s effect size . Similarly, evaluators may attribute social or political significance to research that addresses “real and immediate” social problems.

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The purpose of qualitative research

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Janice M. Morse 3 &
Peggy Anne Field 4

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Research fills a vital and important role in society: it is the means by which discoveries are made, ideas are confirmed or refuted, events controlled or predicted and theory developed or refined. All of these functions contribute to the development of knowledge. However, no single research approach fulfills all of these functions, and the contribution of qualitative research is both vital and unique to the goals of research in general. Qualitative research enables us to make sense of reality, to describe and explain the social world and to develop explanatory models and theories. It is the primary means by which the theoretical foundations of social sciences may be constructed or re-examined.

Research is to see what everybody has seen and to think what nobody has thought. (Albert Szent-Gyorgy)

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1 University of Nebraska Medical Center
2 GDB Research and Statistical Consulting
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PMID: 29262162
Bookshelf ID: NBK470395

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. 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." Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. 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. 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.

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What is the Significance of a Study? Examples and Guide

Significance of a study graphic, showing a female scientist reading a book

If you’re reading this post you’re probably wondering: what is the significance of a study?

No matter where you’re at with a piece of research, it is a good idea to think about the potential significance of your work. And sometimes you’ll have to explicitly write a statement of significance in your papers, it addition to it forming part of your thesis.

In this post I’ll cover what the significance of a study is, how to measure it, how to describe it with examples and add in some of my own experiences having now worked in research for over nine years.

If you’re reading this because you’re writing up your first paper, welcome! You may also like my how-to guide for all aspects of writing your first research paper .

Looking for guidance on writing the statement of significance for a paper or thesis? Click here to skip straight to that section.

What is the Significance of a Study?

For research papers, theses or dissertations it’s common to explicitly write a section describing the significance of the study. We’ll come onto what to include in that section in just a moment.

However the significance of a study can actually refer to several different things.

Graphic showing the broadening significance of a study going from your study, the wider research field, business opportunities through to society as a whole.

Working our way from the most technical to the broadest, depending on the context, the significance of a study may refer to:

Within your study: Statistical significance. Can we trust the findings?
Wider research field: Research significance. How does your study progress the field?
Commercial / economic significance: Could there be business opportunities for your findings?
Societal significance: What impact could your study have on the wider society.
And probably other domain-specific significance!

We’ll shortly cover each of them in turn, including how they’re measured and some examples for each type of study significance.

But first, let’s touch on why you should consider the significance of your research at an early stage.

Why Care About the Significance of a Study?

No matter what is motivating you to carry out your research, it is sensible to think about the potential significance of your work. In the broadest sense this asks, how does the study contribute to the world?

After all, for many people research is only worth doing if it will result in some expected significance. For the vast majority of us our studies won’t be significant enough to reach the evening news, but most studies will help to enhance knowledge in a particular field and when research has at least some significance it makes for a far more fulfilling longterm pursuit.

Furthermore, a lot of us are carrying out research funded by the public. It therefore makes sense to keep an eye on what benefits the work could bring to the wider community.

Often in research you’ll come to a crossroads where you must decide which path of research to pursue. Thinking about the potential benefits of a strand of research can be useful for deciding how to spend your time, money and resources.

It’s worth noting though, that not all research activities have to work towards obvious significance. This is especially true while you’re a PhD student, where you’re figuring out what you enjoy and may simply be looking for an opportunity to learn a new skill.

However, if you’re trying to decide between two potential projects, it can be useful to weigh up the potential significance of each.

Let’s now dive into the different types of significance, starting with research significance.

Research Significance

What is the research significance of a study.

Unless someone specifies which type of significance they’re referring to, it is fair to assume that they want to know about the research significance of your study.

Research significance describes how your work has contributed to the field, how it could inform future studies and progress research.

Where should I write about my study’s significance in my thesis?

Typically you should write about your study’s significance in the Introduction and Conclusions sections of your thesis.

It’s important to mention it in the Introduction so that the relevance of your work and the potential impact and benefits it could have on the field are immediately apparent. Explaining why your work matters will help to engage readers (and examiners!) early on.

It’s also a good idea to detail the study’s significance in your Conclusions section. This adds weight to your findings and helps explain what your study contributes to the field.

On occasion you may also choose to include a brief description in your Abstract.

What is expected when submitting an article to a journal

It is common for journals to request a statement of significance, although this can sometimes be called other things such as:

Impact statement
Significance statement
Advances in knowledge section

Here is one such example of what is expected:

Impact Statement: An Impact Statement is required for all submissions. Your impact statement will be evaluated by the Editor-in-Chief, Global Editors, and appropriate Associate Editor. For your manuscript to receive full review, the editors must be convinced that it is an important advance in for the field. The Impact Statement is not a restating of the abstract. It should address the following: Why is the work submitted important to the field? How does the work submitted advance the field? What new information does this work impart to the field? How does this new information impact the field? Experimental Biology and Medicine journal, author guidelines

Typically the impact statement will be shorter than the Abstract, around 150 words.

Defining the study’s significance is helpful not just for the impact statement (if the journal asks for one) but also for building a more compelling argument throughout your submission. For instance, usually you’ll start the Discussion section of a paper by highlighting the research significance of your work. You’ll also include a short description in your Abstract too.

How to describe the research significance of a study, with examples

Whether you’re writing a thesis or a journal article, the approach to writing about the significance of a study are broadly the same.

I’d therefore suggest using the questions above as a starting point to base your statements on.

Why is the work submitted important to the field?
How does the work submitted advance the field?
What new information does this work impart to the field?
How does this new information impact the field?

Answer those questions and you’ll have a much clearer idea of the research significance of your work.

When describing it, try to clearly state what is novel about your study’s contribution to the literature. Then go on to discuss what impact it could have on progressing the field along with recommendations for future work.

Potential sentence starters

If you’re not sure where to start, why not set a 10 minute timer and have a go at trying to finish a few of the following sentences. Not sure on what to put? Have a chat to your supervisor or lab mates and they may be able to suggest some ideas.

This study is important to the field because…
These findings advance the field by…
Our results highlight the importance of…
Our discoveries impact the field by…

Now you’ve had a go let’s have a look at some real life examples.

Statement of significance examples

A statement of significance / impact:

Impact Statement This review highlights the historical development of the concept of “ideal protein” that began in the 1950s and 1980s for poultry and swine diets, respectively, and the major conceptual deficiencies of the long-standing concept of “ideal protein” in animal nutrition based on recent advances in amino acid (AA) metabolism and functions. Nutritionists should move beyond the “ideal protein” concept to consider optimum ratios and amounts of all proteinogenic AAs in animal foods and, in the case of carnivores, also taurine. This will help formulate effective low-protein diets for livestock, poultry, and fish, while sustaining global animal production. Because they are not only species of agricultural importance, but also useful models to study the biology and diseases of humans as well as companion (e.g. dogs and cats), zoo, and extinct animals in the world, our work applies to a more general readership than the nutritionists and producers of farm animals. Wu G, Li P. The “ideal protein” concept is not ideal in animal nutrition. Experimental Biology and Medicine . 2022;247(13):1191-1201. doi: 10.1177/15353702221082658

And the same type of section but this time called “Advances in knowledge”:

Advances in knowledge: According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders. Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change. Size changes of at least 6 mm or more in T 1 weighted or T 2 weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change. Wennmann M, Grözinger M, Weru V, et al. Test-retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma [published online ahead of print, 2023 Apr 12]. Br J Radiol . 2023;20220745. doi: 10.1259/bjr.20220745

Other examples of research significance

Moving beyond the formal statement of significance, here is how you can describe research significance more broadly within your paper.

Describing research impact in an Abstract of a paper:

Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration. Conclusions section of the abstract in my first paper .

In the Discussion section of a paper:

We report for the utility of a standard laboratory micro-CT scanner to visualise and quantify features of the chondrocyte population within intact articular cartilage in 3D. This study represents a complimentary addition to the growing body of evidence supporting the non-destructive imaging of the constituents of articular cartilage. This offers researchers the opportunity to image chondrocyte distributions in 3D without specialised synchrotron equipment, enabling investigations such as chondrocyte morphology across grades of cartilage damage, 3D strain mapping techniques such as digital volume correlation to evaluate mechanical properties in situ , and models for 3D finite element analysis in silico simulations. This enables an objective quantification of chondrocyte distribution and morphology in three dimensions allowing greater insight for investigations into studies of cartilage development, degeneration and repair. One such application of our method, is as a means to provide a 3D pattern in the cartilage which, when combined with digital volume correlation, could determine 3D strain gradient measurements enabling potential treatment and repair of cartilage degeneration. Moreover, the method proposed here will allow evaluation of cartilage implanted with tissue engineered scaffolds designed to promote chondral repair, providing valuable insight into the induced regenerative process. The Discussion section of the paper is laced with references to research significance.

How is longer term research significance measured?

Looking beyond writing impact statements within papers, sometimes you’ll want to quantify the long term research significance of your work. For instance when applying for jobs.

The most obvious measure of a study’s long term research significance is the number of citations it receives from future publications. The thinking is that a study which receives more citations will have had more research impact, and therefore significance , than a study which received less citations. Citations can give a broad indication of how useful the work is to other researchers but citations aren’t really a good measure of significance.

Bear in mind that us researchers can be lazy folks and sometimes are simply looking to cite the first paper which backs up one of our claims. You can find studies which receive a lot of citations simply for packaging up the obvious in a form which can be easily found and referenced, for instance by having a catchy or optimised title.

Likewise, research activity varies wildly between fields. Therefore a certain study may have had a big impact on a particular field but receive a modest number of citations, simply because not many other researchers are working in the field.

Nevertheless, citations are a standard measure of significance and for better or worse it remains impressive for someone to be the first author of a publication receiving lots of citations.

Other measures for the research significance of a study include:

Accolades: best paper awards at conferences, thesis awards, “most downloaded” titles for articles, press coverage.
How much follow-on research the study creates. For instance, part of my PhD involved a novel material initially developed by another PhD student in the lab. That PhD student’s research had unlocked lots of potential new studies and now lots of people in the group were using the same material and developing it for different applications. The initial study may not receive a high number of citations yet long term it generated a lot of research activity.

That covers research significance, but you’ll often want to consider other types of significance for your study and we’ll cover those next.

Statistical Significance

What is the statistical significance of a study.

Often as part of a study you’ll carry out statistical tests and then state the statistical significance of your findings: think p-values eg <0.05. It is useful to describe the outcome of these tests within your report or paper, to give a measure of statistical significance.

Effectively you are trying to show whether the performance of your innovation is actually better than a control or baseline and not just chance. Statistical significance deserves a whole other post so I won’t go into a huge amount of depth here.

Things that make publication in The BMJ impossible or unlikely Internal validity/robustness of the study • It had insufficient statistical power, making interpretation difficult; • Lack of statistical power; The British Medical Journal’s guide for authors

Calculating statistical significance isn’t always necessary (or valid) for a study, such as if you have a very small number of samples, but it is a very common requirement for scientific articles.

Writing a journal article? Check the journal’s guide for authors to see what they expect. Generally if you have approximately five or more samples or replicates it makes sense to start thinking about statistical tests. Speak to your supervisor and lab mates for advice, and look at other published articles in your field.

How is statistical significance measured?

Statistical significance is quantified using p-values . Depending on your study design you’ll choose different statistical tests to compute the p-value.

A p-value of 0.05 is a common threshold value. The 0.05 means that there is a 1/20 chance that the difference in performance you’re reporting is just down to random chance.

p-values above 0.05 mean that the result isn’t statistically significant enough to be trusted: it is too likely that the effect you’re showing is just luck.
p-values less than or equal to 0.05 mean that the result is statistically significant. In other words: unlikely to just be chance, which is usually considered a good outcome.

Low p-values (eg p = 0.001) mean that it is highly unlikely to be random chance (1/1000 in the case of p = 0.001), therefore more statistically significant.

It is important to clarify that, although low p-values mean that your findings are statistically significant, it doesn’t automatically mean that the result is scientifically important. More on that in the next section on research significance.

How to describe the statistical significance of your study, with examples

In the first paper from my PhD I ran some statistical tests to see if different staining techniques (basically dyes) increased how well you could see cells in cow tissue using micro-CT scanning (a 3D imaging technique).

In your methods section you should mention the statistical tests you conducted and then in the results you will have statements such as:

Between mediums for the two scan protocols C/N [contrast to noise ratio] was greater for EtOH than the PBS in both scanning methods (both p < 0.0001) with mean differences of 1.243 (95% CI [confidence interval] 0.709 to 1.778) for absorption contrast and 6.231 (95% CI 5.772 to 6.690) for propagation contrast. … Two repeat propagation scans were taken of samples from the PTA-stained groups. No difference in mean C/N was found with either medium: PBS had a mean difference of 0.058 ( p = 0.852, 95% CI -0.560 to 0.676), EtOH had a mean difference of 1.183 ( p = 0.112, 95% CI 0.281 to 2.648). From the Results section of my first paper, available here . Square brackets added for this post to aid clarity.

From this text the reader can infer from the first paragraph that there was a statistically significant difference in using EtOH compared to PBS (really small p-value of <0.0001). However, from the second paragraph, the difference between two repeat scans was statistically insignificant for both PBS (p = 0.852) and EtOH (p = 0.112).

By conducting these statistical tests you have then earned your right to make bold statements, such as these from the discussion section:

Propagation phase-contrast increases the contrast of individual chondrocytes [cartilage cells] compared to using absorption contrast. From the Discussion section from the same paper.

Without statistical tests you have no evidence that your results are not just down to random chance.

Beyond describing the statistical significance of a study in the main body text of your work, you can also show it in your figures.

In figures such as bar charts you’ll often see asterisks to represent statistical significance, and “n.s.” to show differences between groups which are not statistically significant. Here is one such figure, with some subplots, from the same paper:

Figure from a paper showing the statistical significance of a study using asterisks

In this example an asterisk (*) between two bars represents p < 0.05. Two asterisks (**) represents p < 0.001 and three asterisks (***) represents p < 0.0001. This should always be stated in the caption of your figure since the values that each asterisk refers to can vary.

Now that we know if a study is showing statistically and research significance, let’s zoom out a little and consider the potential for commercial significance.

Commercial and Industrial Significance

What are commercial and industrial significance.

Moving beyond significance in relation to academia, your research may also have commercial or economic significance.

Simply put:

Commercial significance: could the research be commercialised as a product or service? Perhaps the underlying technology described in your study could be licensed to a company or you could even start your own business using it.
Industrial significance: more widely than just providing a product which could be sold, does your research provide insights which may affect a whole industry? Such as: revealing insights or issues with current practices, performance gains you don’t want to commercialise (e.g. solar power efficiency), providing suggested frameworks or improvements which could be employed industry-wide.

I’ve grouped these two together because there can certainly be overlap. For instance, perhaps your new technology could be commercialised whilst providing wider improvements for the whole industry.

Commercial and industrial significance are not relevant to most studies, so only write about it if you and your supervisor can think of reasonable routes to your work having an impact in these ways.

How are commercial and industrial significance measured?

Unlike statistical and research significances, the measures of commercial and industrial significance can be much more broad.

Here are some potential measures of significance:

Commercial significance:

How much value does your technology bring to potential customers or users?
How big is the potential market and how much revenue could the product potentially generate?
Is the intellectual property protectable? i.e. patentable, or if not could the novelty be protected with trade secrets: if so publish your method with caution!
If commercialised, could the product bring employment to a geographical area?

Industrial significance:

What impact could it have on the industry? For instance if you’re revealing an issue with something, such as unintended negative consequences of a drug , what does that mean for the industry and the public? This could be:

Reduced overhead costs
Better safety
Faster production methods
Improved scaleability

How to describe the commercial and industrial significance of a study, with examples

Commercial significance.

If your technology could be commercially viable, and you’ve got an interest in commercialising it yourself, it is likely that you and your university may not want to immediately publish the study in a journal.

You’ll probably want to consider routes to exploiting the technology and your university may have a “technology transfer” team to help researchers navigate the various options.

However, if instead of publishing a paper you’re submitting a thesis or dissertation then it can be useful to highlight the commercial significance of your work. In this instance you could include statements of commercial significance such as:

The measurement technology described in this study provides state of the art performance and could enable the development of low cost devices for aerospace applications. An example of commercial significance I invented for this post

Industrial significance

First, think about the industrial sectors who could benefit from the developments described in your study.

For example if you’re working to improve battery efficiency it is easy to think of how it could lead to performance gains for certain industries, like personal electronics or electric vehicles. In these instances you can describe the industrial significance relatively easily, based off your findings.

For example:

By utilising abundant materials in the described battery fabrication process we provide a framework for battery manufacturers to reduce dependence on rare earth components. Again, an invented example

For other technologies there may well be industrial applications but they are less immediately obvious and applicable. In these scenarios the best you can do is to simply reframe your research significance statement in terms of potential commercial applications in a broad way.

As a reminder: not all studies should address industrial significance, so don’t try to invent applications just for the sake of it!

Societal Significance

What is the societal significance of a study.

The most broad category of significance is the societal impact which could stem from it.

If you’re working in an applied field it may be quite easy to see a route for your research to impact society. For others, the route to societal significance may be less immediate or clear.

Studies can help with big issues facing society such as:

Medical applications : vaccines, surgical implants, drugs, improving patient safety. For instance this medical device and drug combination I worked on which has a very direct route to societal significance.
Political significance : Your research may provide insights which could contribute towards potential changes in policy or better understanding of issues facing society.
Public health : for instance COVID-19 transmission and related decisions.
Climate change : mitigation such as more efficient solar panels and lower cost battery solutions, and studying required adaptation efforts and technologies. Also, better understanding around related societal issues, for instance this study on the effects of temperature on hate speech.

How is societal significance measured?

Societal significance at a high level can be quantified by the size of its potential societal effect. Just like a lab risk assessment, you can think of it in terms of probability (or how many people it could help) and impact magnitude.

Societal impact = How many people it could help x the magnitude of the impact

Think about how widely applicable the findings are: for instance does it affect only certain people? Then think about the potential size of the impact: what kind of difference could it make to those people?

Between these two metrics you can get a pretty good overview of the potential societal significance of your research study.

How to describe the societal significance of a study, with examples

Quite often the broad societal significance of your study is what you’re setting the scene for in your Introduction. In addition to describing the existing literature, it is common to for the study’s motivation to touch on its wider impact for society.

For those of us working in healthcare research it is usually pretty easy to see a path towards societal significance.

Our CLOUT model has state-of-the-art performance in mortality prediction, surpassing other competitive NN models and a logistic regression model … Our results show that the risk factors identified by the CLOUT model agree with physicians’ assessment, suggesting that CLOUT could be used in real-world clinicalsettings. Our results strongly support that CLOUT may be a useful tool to generate clinical prediction models, especially among hospitalized and critically ill patient populations. Learning Latent Space Representations to Predict Patient Outcomes: Model Development and Validation

In other domains the societal significance may either take longer or be more indirect, meaning that it can be more difficult to describe the societal impact.

Even so, here are some examples I’ve found from studies in non-healthcare domains:

We examined food waste as an initial investigation and test of this methodology, and there is clear potential for the examination of not only other policy texts related to food waste (e.g., liability protection, tax incentives, etc.; Broad Leib et al., 2020) but related to sustainable fishing (Worm et al., 2006) and energy use (Hawken, 2017). These other areas are of obvious relevance to climate change… AI-Based Text Analysis for Evaluating Food Waste Policies

The continued development of state-of-the art NLP tools tailored to climate policy will allow climate researchers and policy makers to extract meaningful information from this growing body of text, to monitor trends over time and administrative units, and to identify potential policy improvements. BERT Classification of Paris Agreement Climate Action Plans

Top Tips For Identifying & Writing About the Significance of Your Study

Writing a thesis? Describe the significance of your study in the Introduction and the Conclusion .
Submitting a paper? Read the journal’s guidelines. If you’re writing a statement of significance for a journal, make sure you read any guidance they give for what they’re expecting.
Take a step back from your research and consider your study’s main contributions.
Read previously published studies in your field . Use this for inspiration and ideas on how to describe the significance of your own study
Discuss the study with your supervisor and potential co-authors or collaborators and brainstorm potential types of significance for it.

Now you’ve finished reading up on the significance of a study you may also like my how-to guide for all aspects of writing your first research paper .

Writing an academic journal paper

I hope that you’ve learned something useful from this article about the significance of a study. If you have any more research-related questions let me know, I’m here to help.

To gain access to my content library you can subscribe below for free:

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What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on June 22, 2023.

Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analyzing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, history, etc.

How does social media shape body image in teenagers?
How do children and adults interpret healthy eating in the UK?
What factors influence employee retention in a large organization?
How is anxiety experienced around the world?
How can teachers integrate social issues into science curriculums?

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, other interesting articles, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography , action research , phenomenological research, and narrative research. They share some similarities, but emphasize different aims and perspectives.

Qualitative research approaches
Approach	What does it involve?
Grounded theory	Researchers collect rich data on a topic of interest and develop theories .
	Researchers immerse themselves in groups or organizations to understand their cultures.
Action research	Researchers and participants collaboratively link theory to practice to drive social change.
Phenomenological research	Researchers investigate a phenomenon or event by describing and interpreting participants’ lived experiences.
Narrative research	Researchers examine how stories are told to understand how participants perceive and make sense of their experiences.

Note that qualitative research is at risk for certain research biases including the Hawthorne effect , observer bias , recall bias , and social desirability bias . While not always totally avoidable, awareness of potential biases as you collect and analyze your data can prevent them from impacting your work too much.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

Observations: recording what you have seen, heard, or encountered in detailed field notes.
Interviews: personally asking people questions in one-on-one conversations.
Focus groups: asking questions and generating discussion among a group of people.
Surveys : distributing questionnaires with open-ended questions.
Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
You take field notes with observations and reflect on your own experiences of the company culture.
You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves “instruments” in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analyzing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

Prepare and organize your data. This may mean transcribing interviews or typing up fieldnotes.
Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorize your data.
Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analyzing qualitative data. Although these methods share similar processes, they emphasize different concepts.

Qualitative data analysis
Approach	When to use	Example
	To describe and categorize common words, phrases, and ideas in qualitative data.	A market researcher could perform content analysis to find out what kind of language is used in descriptions of therapeutic apps.
	To identify and interpret patterns and themes in qualitative data.	A psychologist could apply thematic analysis to travel blogs to explore how tourism shapes self-identity.
	To examine the content, structure, and design of texts.	A media researcher could use textual analysis to understand how news coverage of celebrities has changed in the past decade.
	To study communication and how language is used to achieve effects in specific contexts.	A political scientist could use discourse analysis to study how politicians generate trust in election campaigns.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

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Researchers must consider practical and theoretical limitations in analyzing and interpreting their data. Qualitative research suffers from:

Unreliability

The real-world setting often makes qualitative research unreliable because of uncontrolled factors that affect the data.

Subjectivity

Due to the researcher’s primary role in analyzing and interpreting data, qualitative research cannot be replicated . The researcher decides what is important and what is irrelevant in data analysis, so interpretations of the same data can vary greatly.

Limited generalizability

Small samples are often used to gather detailed data about specific contexts. Despite rigorous analysis procedures, it is difficult to draw generalizable conclusions because the data may be biased and unrepresentative of the wider population .

Labor-intensive

Although software can be used to manage and record large amounts of text, data analysis often has to be checked or performed manually.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Chi square goodness of fit test
Degrees of freedom
Null hypothesis
Discourse analysis
Control groups
Mixed methods research
Non-probability sampling
Quantitative research
Inclusion and exclusion criteria

Research bias

Rosenthal effect
Implicit bias
Cognitive bias
Selection bias
Negativity bias
Status quo bias

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

There are five common approaches to qualitative research :

Grounded theory involves collecting data in order to develop new theories.
Ethnography involves immersing yourself in a group or organization to understand its culture.
Narrative research involves interpreting stories to understand how people make sense of their experiences and perceptions.
Phenomenological research involves investigating phenomena through people’s lived experiences.
Action research links theory and practice in several cycles to drive innovative changes.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organizations.

There are various approaches to qualitative data analysis , but they all share five steps in common:

Prepare and organize your data.
Review and explore your data.
Develop a data coding system.
Assign codes to the data.
Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

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Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images. In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).

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Introduction to NVivo Have you just collected your data and wondered what to do next? Come join us for an introductory session on utilizing NVivo to support your analytical process. This session will only cover features of the software and how to import your records. Please feel free to attend any of the following sessions below: April 25th, 2024 12:30 pm - 1:45 pm Green Library - SVA Conference Room 125 May 9th, 2024 12:30 pm - 1:45 pm Green Library - SVA Conference Room 125
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Home » Background of The Study – Examples and Writing Guide

Background of The Study – Examples and Writing Guide

Table of Contents

Background of The Study

Definition:

Background of the study refers to the context, circumstances, and history that led to the research problem or topic being studied. It provides the reader with a comprehensive understanding of the subject matter and the significance of the study.

The background of the study usually includes a discussion of the relevant literature, the gap in knowledge or understanding, and the research questions or hypotheses to be addressed. It also highlights the importance of the research topic and its potential contributions to the field. A well-written background of the study sets the stage for the research and helps the reader to appreciate the need for the study and its potential significance.

How to Write Background of The Study

Here are some steps to help you write the background of the study:

Identify the Research Problem

Start by identifying the research problem you are trying to address. This problem should be significant and relevant to your field of study.

Provide Context

Once you have identified the research problem, provide some context. This could include the historical, social, or political context of the problem.

Review Literature

Conduct a thorough review of the existing literature on the topic. This will help you understand what has been studied and what gaps exist in the current research.

Identify Research Gap

Based on your literature review, identify the gap in knowledge or understanding that your research aims to address. This gap will be the focus of your research question or hypothesis.

State Objectives

Clearly state the objectives of your research . These should be specific, measurable, achievable, relevant, and time-bound (SMART).

Discuss Significance

Explain the significance of your research. This could include its potential impact on theory , practice, policy, or society.

Finally, summarize the key points of the background of the study. This will help the reader understand the research problem, its context, and its significance.

How to Write Background of The Study in Proposal

The background of the study is an essential part of any proposal as it sets the stage for the research project and provides the context and justification for why the research is needed. Here are the steps to write a compelling background of the study in your proposal:

Identify the problem: Clearly state the research problem or gap in the current knowledge that you intend to address through your research.
Provide context: Provide a brief overview of the research area and highlight its significance in the field.
Review literature: Summarize the relevant literature related to the research problem and provide a critical evaluation of the current state of knowledge.
Identify gaps : Identify the gaps or limitations in the existing literature and explain how your research will contribute to filling these gaps.
Justify the study : Explain why your research is important and what practical or theoretical contributions it can make to the field.
Highlight objectives: Clearly state the objectives of the study and how they relate to the research problem.
Discuss methodology: Provide an overview of the methodology you will use to collect and analyze data, and explain why it is appropriate for the research problem.
Conclude : Summarize the key points of the background of the study and explain how they support your research proposal.

How to Write Background of The Study In Thesis

The background of the study is a critical component of a thesis as it provides context for the research problem, rationale for conducting the study, and the significance of the research. Here are some steps to help you write a strong background of the study:

Identify the research problem : Start by identifying the research problem that your thesis is addressing. What is the issue that you are trying to solve or explore? Be specific and concise in your problem statement.
Review the literature: Conduct a thorough review of the relevant literature on the topic. This should include scholarly articles, books, and other sources that are directly related to your research question.
I dentify gaps in the literature: After reviewing the literature, identify any gaps in the existing research. What questions remain unanswered? What areas have not been explored? This will help you to establish the need for your research.
Establish the significance of the research: Clearly state the significance of your research. Why is it important to address this research problem? What are the potential implications of your research? How will it contribute to the field?
Provide an overview of the research design: Provide an overview of the research design and methodology that you will be using in your study. This should include a brief explanation of the research approach, data collection methods, and data analysis techniques.
State the research objectives and research questions: Clearly state the research objectives and research questions that your study aims to answer. These should be specific, measurable, achievable, relevant, and time-bound.
Summarize the chapter: Summarize the chapter by highlighting the key points and linking them back to the research problem, significance of the study, and research questions.

How to Write Background of The Study in Research Paper

Here are the steps to write the background of the study in a research paper:

Identify the research problem: Start by identifying the research problem that your study aims to address. This can be a particular issue, a gap in the literature, or a need for further investigation.
Conduct a literature review: Conduct a thorough literature review to gather information on the topic, identify existing studies, and understand the current state of research. This will help you identify the gap in the literature that your study aims to fill.
Explain the significance of the study: Explain why your study is important and why it is necessary. This can include the potential impact on the field, the importance to society, or the need to address a particular issue.
Provide context: Provide context for the research problem by discussing the broader social, economic, or political context that the study is situated in. This can help the reader understand the relevance of the study and its potential implications.
State the research questions and objectives: State the research questions and objectives that your study aims to address. This will help the reader understand the scope of the study and its purpose.
Summarize the methodology : Briefly summarize the methodology you used to conduct the study, including the data collection and analysis methods. This can help the reader understand how the study was conducted and its reliability.

Examples of Background of The Study

Here are some examples of the background of the study:

Problem : The prevalence of obesity among children in the United States has reached alarming levels, with nearly one in five children classified as obese.

Significance : Obesity in childhood is associated with numerous negative health outcomes, including increased risk of type 2 diabetes, cardiovascular disease, and certain cancers.

Gap in knowledge : Despite efforts to address the obesity epidemic, rates continue to rise. There is a need for effective interventions that target the unique needs of children and their families.

Problem : The use of antibiotics in agriculture has contributed to the development of antibiotic-resistant bacteria, which poses a significant threat to human health.

Significance : Antibiotic-resistant infections are responsible for thousands of deaths each year and are a major public health concern.

Gap in knowledge: While there is a growing body of research on the use of antibiotics in agriculture, there is still much to be learned about the mechanisms of resistance and the most effective strategies for reducing antibiotic use.

Edxample 3:

Problem : Many low-income communities lack access to healthy food options, leading to high rates of food insecurity and diet-related diseases.

Significance : Poor nutrition is a major contributor to chronic diseases such as obesity, type 2 diabetes, and cardiovascular disease.

Gap in knowledge : While there have been efforts to address food insecurity, there is a need for more research on the barriers to accessing healthy food in low-income communities and effective strategies for increasing access.

Examples of Background of The Study In Research

Here are some real-life examples of how the background of the study can be written in different fields of study:

Example 1 : “There has been a significant increase in the incidence of diabetes in recent years. This has led to an increased demand for effective diabetes management strategies. The purpose of this study is to evaluate the effectiveness of a new diabetes management program in improving patient outcomes.”

Example 2 : “The use of social media has become increasingly prevalent in modern society. Despite its popularity, little is known about the effects of social media use on mental health. This study aims to investigate the relationship between social media use and mental health in young adults.”

Example 3: “Despite significant advancements in cancer treatment, the survival rate for patients with pancreatic cancer remains low. The purpose of this study is to identify potential biomarkers that can be used to improve early detection and treatment of pancreatic cancer.”

Examples of Background of The Study in Proposal

Here are some real-time examples of the background of the study in a proposal:

Example 1 : The prevalence of mental health issues among university students has been increasing over the past decade. This study aims to investigate the causes and impacts of mental health issues on academic performance and wellbeing.

Example 2 : Climate change is a global issue that has significant implications for agriculture in developing countries. This study aims to examine the adaptive capacity of smallholder farmers to climate change and identify effective strategies to enhance their resilience.

Example 3 : The use of social media in political campaigns has become increasingly common in recent years. This study aims to analyze the effectiveness of social media campaigns in mobilizing young voters and influencing their voting behavior.

Example 4 : Employee turnover is a major challenge for organizations, especially in the service sector. This study aims to identify the key factors that influence employee turnover in the hospitality industry and explore effective strategies for reducing turnover rates.

Examples of Background of The Study in Thesis

Here are some real-time examples of the background of the study in the thesis:

Example 1 : “Women’s participation in the workforce has increased significantly over the past few decades. However, women continue to be underrepresented in leadership positions, particularly in male-dominated industries such as technology. This study aims to examine the factors that contribute to the underrepresentation of women in leadership roles in the technology industry, with a focus on organizational culture and gender bias.”

Example 2 : “Mental health is a critical component of overall health and well-being. Despite increased awareness of the importance of mental health, there are still significant gaps in access to mental health services, particularly in low-income and rural communities. This study aims to evaluate the effectiveness of a community-based mental health intervention in improving mental health outcomes in underserved populations.”

Example 3: “The use of technology in education has become increasingly widespread, with many schools adopting online learning platforms and digital resources. However, there is limited research on the impact of technology on student learning outcomes and engagement. This study aims to explore the relationship between technology use and academic achievement among middle school students, as well as the factors that mediate this relationship.”

Examples of Background of The Study in Research Paper

Here are some examples of how the background of the study can be written in various fields:

Example 1: The prevalence of obesity has been on the rise globally, with the World Health Organization reporting that approximately 650 million adults were obese in 2016. Obesity is a major risk factor for several chronic diseases such as diabetes, cardiovascular diseases, and cancer. In recent years, several interventions have been proposed to address this issue, including lifestyle changes, pharmacotherapy, and bariatric surgery. However, there is a lack of consensus on the most effective intervention for obesity management. This study aims to investigate the efficacy of different interventions for obesity management and identify the most effective one.

Example 2: Antibiotic resistance has become a major public health threat worldwide. Infections caused by antibiotic-resistant bacteria are associated with longer hospital stays, higher healthcare costs, and increased mortality. The inappropriate use of antibiotics is one of the main factors contributing to the development of antibiotic resistance. Despite numerous efforts to promote the rational use of antibiotics, studies have shown that many healthcare providers continue to prescribe antibiotics inappropriately. This study aims to explore the factors influencing healthcare providers’ prescribing behavior and identify strategies to improve antibiotic prescribing practices.

Example 3: Social media has become an integral part of modern communication, with millions of people worldwide using platforms such as Facebook, Twitter, and Instagram. Social media has several advantages, including facilitating communication, connecting people, and disseminating information. However, social media use has also been associated with several negative outcomes, including cyberbullying, addiction, and mental health problems. This study aims to investigate the impact of social media use on mental health and identify the factors that mediate this relationship.

Purpose of Background of The Study

The primary purpose of the background of the study is to help the reader understand the rationale for the research by presenting the historical, theoretical, and empirical background of the problem.

More specifically, the background of the study aims to:

Provide a clear understanding of the research problem and its context.
Identify the gap in knowledge that the study intends to fill.
Establish the significance of the research problem and its potential contribution to the field.
Highlight the key concepts, theories, and research findings related to the problem.
Provide a rationale for the research questions or hypotheses and the research design.
Identify the limitations and scope of the study.

When to Write Background of The Study

The background of the study should be written early on in the research process, ideally before the research design is finalized and data collection begins. This allows the researcher to clearly articulate the rationale for the study and establish a strong foundation for the research.

The background of the study typically comes after the introduction but before the literature review section. It should provide an overview of the research problem and its context, and also introduce the key concepts, theories, and research findings related to the problem.

Writing the background of the study early on in the research process also helps to identify potential gaps in knowledge and areas for further investigation, which can guide the development of the research questions or hypotheses and the research design. By establishing the significance of the research problem and its potential contribution to the field, the background of the study can also help to justify the research and secure funding or support from stakeholders.

Advantage of Background of The Study

The background of the study has several advantages, including:

Provides context: The background of the study provides context for the research problem by highlighting the historical, theoretical, and empirical background of the problem. This allows the reader to understand the research problem in its broader context and appreciate its significance.
Identifies gaps in knowledge: By reviewing the existing literature related to the research problem, the background of the study can identify gaps in knowledge that the study intends to fill. This helps to establish the novelty and originality of the research and its potential contribution to the field.
Justifies the research : The background of the study helps to justify the research by demonstrating its significance and potential impact. This can be useful in securing funding or support for the research.
Guides the research design: The background of the study can guide the development of the research questions or hypotheses and the research design by identifying key concepts, theories, and research findings related to the problem. This ensures that the research is grounded in existing knowledge and is designed to address the research problem effectively.
Establishes credibility: By demonstrating the researcher’s knowledge of the field and the research problem, the background of the study can establish the researcher’s credibility and expertise, which can enhance the trustworthiness and validity of the research.

Disadvantages of Background of The Study

Some Disadvantages of Background of The Study are as follows:

Time-consuming : Writing a comprehensive background of the study can be time-consuming, especially if the research problem is complex and multifaceted. This can delay the research process and impact the timeline for completing the study.
Repetitive: The background of the study can sometimes be repetitive, as it often involves summarizing existing research and theories related to the research problem. This can be tedious for the reader and may make the section less engaging.
Limitations of existing research: The background of the study can reveal the limitations of existing research related to the problem. This can create challenges for the researcher in developing research questions or hypotheses that address the gaps in knowledge identified in the background of the study.
Bias : The researcher’s biases and perspectives can influence the content and tone of the background of the study. This can impact the reader’s perception of the research problem and may influence the validity of the research.
Accessibility: Accessing and reviewing the literature related to the research problem can be challenging, especially if the researcher does not have access to a comprehensive database or if the literature is not available in the researcher’s language. This can limit the depth and scope of the background of the study.

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Muhammad Hassan

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Market Research

Qualitative Research: Understanding the Goal and Benefits for Effective Analysis

As market trends evolve at lightning speed in the age of digital transformation, having an intimate understanding of consumer desires and motivations is more critical than ever. Enter qualitative research – the knight in shining armor of deep-dive data analysis. In this blog post, we’ll be exploring the profound purpose and impressive benefits behind qualitative research, unveiling how it anchors effective market analysis and strategy development. Brace yourselves for a mesmerizing journey into the realm of potent insights that power consequential decisions and breed groundbreaking innovation.

The primary goal of qualitative research is to obtain insights into participants’ experiences and understanding of the world. This type of research provides rich descriptions and explanations of processes in identifiable local contexts. Qualitative research has several benefits including providing an in-depth understanding, being flexible and adaptable, and generating descriptive data that can be used to create new theories using the inductive method.

Qualitative Study’s Importance

Qualitative research holds a significant place in the realm of social science research and is integral for understanding the complexities of human behavior, experiences, and social interactions. Unlike quantitative research which focuses on numerical data and statistical analysis, qualitative research collects non-numerical data and emphasizes interpreting meaning from social contexts.

The importance of qualitative research lies in its ability to provide rich descriptions and explanations of processes in identifiable local contexts. It allows researchers to gain insights into participants’ experiences and understand the world as another person experiences it. This deeper understanding paves the way for more comprehensive analyses and the development of theories that accurately represent the intricacies of human life.

For instance, imagine a sociologist interested in studying how individuals cope with unemployment during economic downturns. By conducting qualitative research , these sociologists can immerse themselves in the lives of unemployed individuals, observe their daily routines, conduct in-depth interviews, and analyze their personal narratives. This approach goes beyond simply quantifying unemployment rates; it provides an intimate understanding of how people navigate through difficult situations and sheds light on the emotional, psychological, and societal impacts.

In addition to providing rich insight into human experiences, qualitative research offers numerous other benefits that contribute to effective analysis.

Qualitative research is essential in social science research as it allows for a deeper understanding of human behavior and social interactions. Its focus on non-numerical data collection and interpretation of meaning helps researchers gain insights into participants’ experiences and contextual factors. Qualitative research also provides rich descriptions and explanations of processes in identifiable local contexts, leading to the development of comprehensive analysis and accurate theories. Overall, qualitative research offers numerous benefits that contribute to effective analysis in social science research.

Goals & Benefits Driving Research

The goals of qualitative research are multifaceted. One primary objective is to investigate the meanings people attribute to their behavior and interactions within specific social contexts. This focus on subjective interpretations helps uncover individual perspectives that may be overlooked by quantitative methods alone. Additionally, qualitative research aims to explore social phenomena that are not easily measurable or quantifiable.

Qualitative research also generates descriptive data that requires rigorous methods of analysis. Researchers employ various techniques such as thematic analysis or grounded theory to identify patterns, themes, and categories within their data. These analytical approaches ensure systematic interpretation while maintaining the integrity of participants’ lived experiences.

Beyond these goals, qualitative research offers several benefits that aid in reliable analysis. Firstly, it provides an in-depth understanding of complex social issues by capturing the nuances and subtleties of human behavior. This depth allows researchers to generate rich descriptions and explanations that facilitate a comprehensive comprehension of social phenomena.

For example, consider a study exploring the experience of minority students in predominantly white institutions. Through qualitative research methods like interviews and focus groups, researchers can delve into the students’ lived experiences, their perceptions of inclusion or exclusion, and their strategies for navigating through institutional challenges. This level of detail paints a holistic picture that goes beyond quantitative statistics such as enrollment numbers.

Another advantage of qualitative research is its flexibility and adaptability. Researchers can modify their data collection methods to account for new insights or unexpected findings during the research process. This responsiveness allows for deeper exploration and ensures that no valuable information is left unexamined.

However, it is essential to acknowledge that qualitative research also has its limitations. These include the limited scope and generalizability of findings due to the smaller sample sizes typically used in qualitative studies. Additionally, there is a potential for researcher bias since the individuals collecting and analyzing the data play an active role in shaping the research process.

Nonetheless, while objectivity may be seen as a myth in qualitative research, researchers should be honest and transparent about their own biases and assumptions. Reflexivity, which involves acknowledging and critically examining one’s subjectivity throughout the research process, is integral to ensuring integrity and minimizing undue influence.

According to a report from the Journal of Social Issues, as of 2022, around 45% of psychological studies used qualitative methods, signaling strong recognition in the field for its unique insights into human behavior.
A study conducted by the Market Research Society confirmed that out of all market research carried out worldwide, approximately 20% utilize qualitative methodologies. This highlights its crucial role in understanding customer behaviors and motivations.
The National Center for Biotechnology Information (NCBI) indicated that nearly 70% of health research incorporates some elements of qualitative research, underscoring its importance in contributing to our understanding of complex health issues and interventions.

Comprehensive Approaches

When conducting qualitative research , adopting comprehensive approaches is essential for capturing the richness and depth of data required for effective analysis. These approaches involve a holistic perspective that considers multiple dimensions and contexts. One commonly used comprehensive approach is triangulation , which involves using multiple data sources, methods, or perspectives to cross-verify findings. By triangulating data, researchers can enhance the reliability and validity of their analysis.

Another important approach is thick description , which focuses on providing detailed and vivid accounts of participants’ experiences and contexts. This technique enables researchers to capture the nuances and complexities of social phenomena, ensuring a comprehensive understanding of the research topic. Thick descriptions typically include vivid narratives, dialogue excerpts, and detailed observations, providing readers with a rich portrayal of the study’s context.

Researchers may also adopt an iterative process in their analysis, where data collection and analysis occur simultaneously. This approach allows for constant refinement and adjustment of research questions and methods based on emerging findings. Through iteration, researchers can dive deeper into the topic, uncover unexpected insights, and explore various angles that contribute to a more comprehensive analysis.

It’s worth noting that comprehensive approaches in qualitative research require flexibility and openness to embracing emergent themes and unexpected directions. As researchers immerse themselves in the data, they should be willing to adapt their strategies accordingly.

Participant Engagement & Topic Exploration

Participant engagement plays a crucial role in qualitative research as it fosters a deeper understanding of participants’ perspectives and experiences. Effective engagement encourages open dialogue and trust between the researcher and participants, allowing for richer data collection. One way to promote participant engagement is through active listening . By attentively listening to participants’ stories, concerns, and viewpoints, researchers can demonstrate empathy and create a safe space for open expression.

Another aspect that greatly enhances participant engagement is establishing rapport . Building rapport involves creating a comfortable environment where participants feel at ease to share their thoughts and experiences. This can be achieved through transparent communication, respect for participants’ autonomy, and genuine interest in their stories. Researchers should establish a positive and respectful relationship with participants, positioning themselves as partners rather than authoritative figures.

In qualitative research, topic exploration is a dynamic and iterative process that allows researchers to uncover new insights and dimensions of the phenomenon under study. This involves probing deeper into participants’ responses, asking follow-up questions, and exploring unexpected avenues that emerge during data collection. By being open to revisiting research questions and digging deeper into topics, researchers can uncover valuable insights and gain a more comprehensive understanding of the subject matter.

It’s important to note that participant engagement and topic exploration go hand in hand. Engaged participants are more likely to provide rich and detailed responses, leading to enhanced exploration of the research topic. Conversely, skillful topic exploration can foster deeper engagement from participants by demonstrating genuine interest and curiosity in their perspectives.

Effective Data Accumulation Methods

In qualitative research, the collection of rich and meaningful data is a crucial step toward understanding the complexities of human experiences. To ensure effective analysis, researchers need to employ appropriate data accumulation methods that capture the depth of participants’ perspectives and insights. Let’s explore some strategies that can facilitate this process.

One common method used in qualitative research is participant observation. This involves immersing oneself in the research setting, actively observing, and taking detailed notes on behaviors, interactions, and cultural nuances. By being present in the natural context, researchers gain a deeper understanding of the social dynamics and can document valuable data that may go unnoticed otherwise.

For instance, imagine a researcher interested in studying the experiences of healthcare workers in a hospital. Through participant observation, they can shadow these workers, witness their daily routines, the challenges they face, and even engage in conversations during breaks. This method provides an intimate look into their lives and generates valuable insights.

Another effective technique is in-depth interviews. These interviews allow researchers to establish a personal connection with participants and delve into their thoughts, feelings, and motivations regarding the research topic. It’s crucial to create an open and comfortable environment where participants feel safe sharing their views openly.

Additionally, focus groups are utilized as a powerful data accumulation method. Bringing together a small group of individuals who share similar characteristics or experiences allows for stimulating discussions that uncover diverse perspectives. Participants can build upon each other’s ideas and provide deeper insights collectively.

Having explored effective data accumulation methods like participant observation, in-depth interviews, and focus groups, let’s now dive into another important aspect of qualitative research – harnessing sensory inputs & eliciting verbal responses.

Harnessing Sensory Inputs and Eliciting Verbal Responses

Qualitative research aims to understand phenomena from the perspective of individuals involved. One way to achieve this is by harnessing sensory inputs and eliciting verbal responses, allowing participants to express themselves fully. This approach taps into a range of human senses and encourages participants to describe their experiences vividly.

For instance, researchers might utilize photovoice techniques, where participants capture images related to the research topic using cameras or smartphones. These visual representations allow participants to share their perspectives in a unique and powerful way.

Imagine a study exploring the impact of urbanization on community well-being. Participants could be asked to take pictures of spaces they feel contribute positively or negatively to their quality of life. These images can then be used as stimuli for further discussion, sparking conversations about the emotional and sensory aspects of the built environment.

In addition to visuals, researchers can also engage participants’ sense of hearing through audio recordings. By recording interviews, focus group discussions, or even ambient sounds in a particular environment, researchers can capture subtle nuances that may not be conveyed through written transcripts alone.

By harnessing sensory inputs and giving participants the space for verbal expression, qualitative researchers foster an environment where rich and nuanced data can be collected. This multi-sensory approach enables a deeper understanding of individuals’ experiences and allows us to gain insights beyond mere words.

Parsing and Conclusion Derivation from Data

In qualitative research, one of the primary goals is to parse and derive meaningful conclusions from the collected data. Unlike quantitative research which relies on statistical analysis, qualitative research involves obtaining rich descriptions of participants’ experiences and understanding the world as another person experiences it. The process of parsing and deriving conclusions from qualitative data requires a meticulous examination of the data, identification of patterns, themes, and connections, and an inductive approach to theory development.

Qualitative researchers immerse themselves in the data collected through methods such as interviews, observations, and focus groups. They carefully analyze transcripts, field notes, or documents to identify recurring themes or significant incidents that shed light on the research question. Through this process of coding and categorizing, researchers start to make sense of the data and identify key findings that can be used to develop theories or inform specific contexts.

For example, imagine a researcher conducting an ethnographic study exploring the experiences of undocumented immigrants in their journey toward citizenship. Through interviews and participant observation, they gather compelling stories and narratives about the challenges faced by these individuals. By carefully analyzing these stories for common themes such as navigating legal systems or facing social stigma, the researcher can derive conclusions about the complex processes involved in seeking legal status.

“Analyzing qualitative data is like piecing together a puzzle. Each interview or observation provides a unique piece that contributes to the overall picture.”

However, it is important to note that deriving conclusions from qualitative data is not a simple linear process. It requires reflexivity on the part of the researcher to acknowledge their own biases and assumptions that may influence their interpretation of the data. Reflexivity encourages researchers to critically reflect on how their own subjectivity affects their analysis and conclusions.

Advantages & Drawbacks of This Research Type

Qualitative research offers several advantages that contribute to its effectiveness in providing rich insights into social phenomena. First and foremost, it allows researchers to gain an in-depth understanding of the experiences, perspectives, and meanings that individuals attribute to their behavior and interactions. This depth of understanding is often difficult to achieve through quantitative research methods alone.

Moreover, qualitative research is known for its flexibility and adaptability. Researchers can modify their research design or data collection methods as they delve deeper into the field, responding to emerging themes or new areas of investigation. The open-ended nature of qualitative research also enables participants to express themselves freely and provide nuanced responses, offering a more comprehensive view of complex social phenomena.

On the other hand, there are some drawbacks to consider when conducting qualitative research. One challenge is the limited scope and generalizability of findings. Due to the small sample sizes typically involved in qualitative studies, it can be challenging to extrapolate findings to broader populations or contexts. Additionally, there is potential for researcher bias as interpretations of qualitative data are subjective and influenced by researchers’ perspectives and assumptions.

Despite these limitations, the benefits of qualitative research outweigh its drawbacks in many cases. By providing detailed insights into participants’ experiences, qualitative research contributes valuable knowledge that can inform policy decisions, improve interventions, and enhance our understanding of social phenomena.

Unlock the power of qualitative research with Discuss

In a world driven by meaningful connections, Discuss stands at the forefront of qualitative research, empowering you to delve deeper, understand better, and innovate with confidence. Elevate your research game—choose Discuss for insights that go beyond the surface. Navigate cultural nuances effortlessly. Our platform is designed to facilitate cross-cultural research, helping you understand and appreciate the local context that shapes consumer behavior around the world.

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Open access
Published: 21 June 2024

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences

Mario López-Salas 1 ,
Antonio Yanes-Roldán 1 ,
Ana Fernández 1 ,
Ainhoa Marín 1 ,
Ana I. Martínez 1 ,
Ana Monroy 1 ,
José M. Navarro 1 ,
Marta Pino 1 ,
Raquel Gómez 1 ,
Saray Rodríguez 1 ,
Sergio Garrido 1 ,
Sonia Cousillas 1 ,
Tatiana Navas 1 ,
Víctor Lapeña 1 &
Belén Fernández 1

BMC Palliative Care volume 23 , Article number: 157 ( 2024 ) Cite this article

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Metrics details

Cancer is a disease that transcends what is purely medical, profoundly affecting the day-to-day life of both patients and family members. Previous research has shown that the consequences of cancer are greatly aggravated in patients at the end of life, at a time when they must also grapple with numerous unmet needs. The main objective of this study was to obtain more in-depth insight into these needs, primarily in patients with end-stage cancer nearing death.

Semi-structured interviews were conducted in Spain with cancer patients at the end of life ( n = 3) and their family members ( n = 12). The findings from the interviews were analyzed using qualitative thematic analysis and a grounded theory approach.

Four major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4), needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.

Conclusions

A lack of support, information and transparency during a period of immense vulnerability makes the end-of-life experience even more difficult for patients with cancer. Our findings highlight the importance of developing a more in-depth understanding of the needs of this population, so that informed efforts can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

Peer Review reports

The concept of end of life reflects both the irreversible progression of a life-limiting disease, and a life expectancy of six months or less [ 1 ]. Cancer patients in the end-stage of the disease, facing end-of-life issues, undergo significant physical, psychological and social alterations, as do family members, whose lives and environment are drastically changed during this period. It is therefore of vital importance to improve the quality of life of all of those affected by this diagnosis. During this stage, numerous needs emerge regarding the care and well-being of the cancer patient and their caregivers which are not always acknowledged or identified. Recognition and awareness of these needs can ensure early access and comprehensive treatment for cancer patients with palliative care needs, while also meeting the needs of their caregivers [ 2 , 3 ].

In regard to patients, the literature provides some insight into the needs that emerge at this stage of the disease, yet there are still many areas that require further investigation. In a review by Wang et al. [ 4 ], which analyzed patients’ unmet needs in 38 studies, the authors identified seven major categories of needs. These included physical needs and symptom control, the need to maintain functionality and day-to-day activities, the need for information, psychological needs, social and financial needs, and spiritual needs. The relationship between various sociodemographic variables and patients’ unmet needs has also been studied. Several studies found that female patients had a higher frequency of unmet physical and psychological needs than male patients [ 5 , 6 ]. Similarly, patients with a high education level reported more unmet needs in physical domains, functionality, day-to-day activities [ 7 ] and information [ 8 ]. In addition, social needs appeared to a lesser extent in high-income patients [ 9 ]. Severe symptoms of emotional stress, the presence of anxiety and/or depression, a greater lack of problem-focused coping, and poorer quality of life of caregivers were identified as negative predictors of patient satisfaction [ 10 ]. Finally, when regarding primary caregivers, patients reported more unmet needs when their caregivers were male, young, or showed high levels of emotional distress [ 6 ].

For informal (or family) caregivers, the supportive care process is physically and psychologically challenging, especially when caring for patients with advanced cancer at the end of life [ 11 ]. However, assessing the unmet needs of caregivers remains an uncommon practice. Many family members, including those who do not view care giving as a burden, suffer from a wide range of problems, including sleep alterations, anxiety, depression, difficulty balancing caregiving and daily tasks, and financial burdens [ 12 ]. Wang and colleagues [ 4 ] found that caregivers had unmet needs regarding information about the disease and its treatment [ 11 , 13 , 14 , 15 , 16 ], as well as psychological [ 17 , 18 ], economic [ 19 ] and spiritual needs [ 20 ]. Researchers also reported that younger caregivers had a higher number of unmet needs than older caregivers regarding care, information and economic needs [ 13 , 14 ]. Caregivers with physical problems experienced a greater number of unmet needs. Similarly, family caregivers reported more needs when patients suffered from anxiety, depression, or poor physical performance [ 14 ]. Family members also experienced a need for clear and reliable information that would help them prepare for their loved one’s death and the grieving process [ 21 , 22 ].

There is a genuine necessity for studies that integrate patient and caregiver needs, in part to illustrate and conceptualize a unique family unit, given that the different elements that comprise this unit interact and impact on one another. The literature clearly shows that the unmet needs of patients can increase the physical and emotional burden of the caregiver [ 23 ]. In turn, caregiver issues are closely related to patient well-being [ 24 ]. The unresolved issues or unmet needs of caregivers will not only diminish their own quality of life, but also negatively impact on patients’ health outcomes [ 25 ].

Finally, it should be noted that few studies focus on the changing needs of patients and family members at the end of life, or of bereaved caregivers coping with grief. Our research aims to help fill this gap in the literature, using qualitative methodology to identify the unmet needs and potential barriers [ 3 , 26 , 27 , 28 ] encountered by these patients and their families, and thus provide greater insight into what the end of life is, as opposed to what it could and should be, for all those involved.

An exploratory descriptive qualitative study was carried out using semi-structured interviews with patients with end-stage cancer at the end of life and their family members. Fieldwork was conducted in May and June 2023. The Charmaz grounded theory approach to thematic analysis was implemented [ 29 , 30 ]. Categories of analysis have been generated inductively and deductively, following a grounded theory approach, and then grouped into themes. This methodology allows researchers to delve into areas of knowledge and reality from a novel perspective, making it possible to explore common perceptions and experiences as part of the subjective social structure of the participants. The study was designed and developed following the consolidated criteria for reporting qualitative research (COREQ) [ 31 ].

Participants

In this study, purposive sampling was used to identify participants, and obtain the maximum variation of the designed sample. This type of sampling is a strategy used to gather participants in a given context with expertise in the study phenomenon. Participants were recruited by health and social professionals through an association of cancer patients. The health professionals in direct contact with the participants informed them about the study and its objectives. Subsequently, and after signing the written informed consent sheet, the research team contacted the participants directly via e-mail or telephone call to confirm the interview. From an initial contact with 35 participants, the research team finally conducted 11 interviews with 15 participants. The variables chosen for the participants were: phase of the disease/after death (advanced, end of life, recent bereavement, bereavement after 6 + months), place of residence (rural, urban), age (< 65 or > 65) and gender. The sample also had ample experience with palliative care services, both at home and in hospital outpatient visits.

The final sample included 15 participants: 3 patients with end-stage cancer diagnosis and 12 caregivers who cared for terminally ill family members and experienced bereavement. A total of 10 semi-structured in-depth interviews were conducted, two of them in pairs (patient and relative), and another in a group composed of three caregivers. By including relatives of different ages, marital statuses and roles within the family, different narratives can be explored through the diverse perspectives, conflicts and connections collected.

Initially, 16 participants were proposed for the sample. However, theoretical saturation was reached at 15 participants, referring to the point in the research where new interviews added nothing novel or relevant to the study objectives [ 32 ], resulting in the final inclusion of 15 subjects. Table 1 shows the sociodemographic characteristics of these participants.

Data collection

All interviews were conducted online through a videoconferencing platform, except for two that were conducted by telephone at the request of the interviewees. They were conducted by two professionals with experience in qualitative research on healthcare and palliative care who had no previous contact with the participants in order to avoid bias in data collection. The interviews were based on a broad directive script, designed by a team of oncology psychologists and social workers with extensive experience in palliative care. This script was adapted to the context and profile of each person that was interviewed. Family caregivers were asked about the needs of the patients and as well as their own needs. The main topics discussed were: (1) Perceptions about end-of-life and palliative care; (2) Difficulties in the end-of-life process and the needs detected, both met and unmet; (3) The demands and proposals at professional and institutional level for the resolution of these needs (see Supplementary Materials). Interviews lasted an average of 45 min.

The interviews were audio recorded with the consent of the participants, and later verbatim transcribed and anonymized in their entirety. Written informed consent sheet was provided to participants by the professionals who made the recruitment. In addition, the researcher who conducted the interviews asked for oral consent to the participants right before the interviews. They were also provided the opportunity to ask questions and dispel doubts before starting the interview process. No payment was offered in exchange for participation in the study. Personal data and digital rights of participants were protected in accordance with the LOPDGDD 03/2018 [ 33 ].

Data analysis

To get an overview of the information before starting with the initial coding, 5 researchers of the team read the entire transcriptions repeatedly. The transcripts were then segmented into text units relevant to the analysis, which were subsequently read by all researchers. Finally, segments from the interviews were coded based on degree of relevance. A code tree was produced, combining closed categories previously discussed by the research group with categories that emerged inductively from the collected data. This tree was tested in the coding of certain interviews and adapted throughout the field research process to improve its scope and effectiveness. Data collection and analysis occurred concurrently. The information from the codes generated was compared with each other in order to create new categories. The codes were analyzed using both an inductive and a deductive approach that identifies similar, interrelated patterns and allows the theoretic categories described in the study to emerge from the raw data itself. Analytical rigor was assured through a rigorous process of peer review, since other researchers from the team were invited to review the initial analysis, in order to confirm the consistency of the findings and to identify and diminish potential biases. All the researchers agreed with the results of the coding process and the generation of the main categories. Data analysis was performed using ATLAS.ti version 9.

The results were divided into two main sections: the needs of people diagnosed with cancer at the end of life and the needs of family caregivers during this final phase of care.

End-of-life needs for cancer patients

The main results are shown in Table 2 . The needs of these patients are modified in accordance with disease progression and proximity to death.

Physical well-being

One of the main themes that emerged from participant responses was the need to maintain a sense of physical well-being. This set of needs is aimed at improving their quality of life by monitoring the symptoms of both the disease and its treatment. The main codes indicated by participants were the need to control pain and the adverse effects of medication, to find cures and clinical procedures to ensure quality of life, and to organize the administration of medication.

“That I, her daughter, have to act as a nurse, as I watch my mother dying and being told on the phone: ‘inject this, inject that’.” P12 .

The other codes regarding physical well-being were functional problems related to care. These needs include optimal rest and sleep, adapting diet and eating habits to allay weight gain or lack of appetite, and maintaining personal hygiene and physical activity.

“Well, you have to be aware of the circumstances. In terms of strength, it depends on the day…I’ve lost a lot of weight and I don’t sleep well, but I used to sleep very well. And this, of course, limits you.” P1 .

“I have my doubts about what the best diet is. The oncologist doesn’t know. I found a nutritionist, and it’s a little clearer now, but I think I lack information. Nothing is said about the diet…” P1 .

Emotional well-being

Another theme that concerned participants was their emotional well-being. Participants put a high priority on addressing emotional needs related to illness, dependency and death, as well as having access to assistance in effectively expressing and communicating these needs.

“Nobody talks about the psychological burden that this disease can place on the patient. How your life changes, all that it entails. The pain, going to the hospital continuously, and not knowing what will happen in the near future. More help is needed so we can understand how to relate to the disease rather than confront it.” P1 .

Participants also reported the need for the care and protection of their of identity, of their roles and purpose in life, as well as their self-image and self-esteem, all of which are frequent concerns of people facing the end of life.

“So it was very difficult for him … to be aware, and lose those roles and lose the role of doctor, lose the role of father, lose the role of person… in other words, to be sick person.” P6 .

Other relevant codes included the need to maintain affective relationships by spending quality time with your loved ones, and getting support to carry out fulfilling activities, hobbies and everyday pleasures.

“I brought her home, with her granddaughter, who she was mad about, and my kitten. My mother has always loved my cat. When I brought her home on the first day in the wheelchair, the cat climbed onto her lap and gave her a kiss. And now, on her deathbed—the last days of her life—my cat will not leave her side.” P12 .

Social well-being: adapted living space and mobility and economic resources

Most of the participants reported that a well-adapted living space was essential for providing comfort and quality of life at the end of life. This corresponds to the need to adjust the living environment to the patient’s physical circumstances during the end-stage of the disease.

Participants prioritized the following codes: the need for material resources that could improve the patient’s quality of life (medical equipment and supplies, hygiene products, etc.), domestic mobility (wheelchairs, stair lifts, etc.), and comfortable living spaces adapted to the patient’s physical needs.

“Now we must hustle and bustle with a wheelchair, because I cannot walk. We requested a wheelchair and the doctor prescribed it for me, an electric wheelchair. They prescribed it for me, they accepted it and today a letter has come, saying it has been denied.” P2 .

“I have a bathtub and I couldn’t afford it… Also, I pay rent, so I couldn’t replace the bathtub with a shower. I had no time, no disposition, no money. I ultimately had to buy an orthopedic chair so I could shower her in the bathtub” P12 .

Another important aspect of social well-being highlighted by the participants was the need to have access to professional resources that cover daily tasks, mainly through the hiring of professional caregivers.

“And the aid they gave was quite small, that’s also something that could, that should be considered, right? Above all, people who need care, a lot of care. […] In the end, it’s true that you need 24 hours, 7 days a week.” Family Group, P14 .

Information and autonomy in decision-making

Needs related to informed decision-making are associated with a willingness to ensure patient inclusion and autonomy in decisions that are made throughout the end-of-life period. The interviewees emphasized that they often felt as if healthcare professionals were not honest and forthright when sharing information with them. Yet they need this information to cope with doubts and make informed decisions, information on the prognosis of their disease and therapeutic options, legal and bureaucratic procedures, psychological and social resources, and shared experiences of other patients. In addition, they expressed the need for the patient’s will and preferences to prevail.

“Learn more about the process. Like: “The degeneration will progress more and more.” Yes, but how will this degeneration take place? What exactly should I expect? I mean, I know they can’t give me a timeline, I understand that. Learn how the disease really works. You search the Internet, and then have to hope that your search is right.” P9 .

End-of-life needs for family caregivers

The daily tasks of a family caregiver together with the challenges that arise during end-of-life care for a cancer patient can overwhelm the caregiver. In most cases, caregiver overload causes severe stress and physical, emotional and mental exhaustion. Family caregivers must learn to balance caring for their loved ones with caring for themselves. This includes organizing work, home, and leisure activities, improving time management, and building a strong internal support system. Family member interviews also revealed a need for greater awareness of their own specific needs, which are often overlooked. These main results are shown in Table 3 .

Personal health and well-being

Family caregivers reported that they often overlooked their health, neglecting their nutrition and adopting inadequate sleep patterns. Those suffering from an illness also noted greater neglect of their own medical needs and treatment.

“From the time I woke up at 7:00 or 8:00, I didn’t stop, until I went to bed at 12:00. I’ve already lost a lot of weight from the stress. I’ve always said that I have to take care of myself, that I can’t be foolish and neglect myself, because if I fall, we all fall and I have 3 people under my care.” P12 .

Caregivers in the study also highlighted the need for assistance in minimizing uncertainty and emotional distress. They reported feeling overwhelmed with their caregiving responsibilities, which brought on more pressure and feelings of guilt.

Other emotional needs included managing their fear of losing a loved one and coping with grief and life changes after the death of the patient.

“I had prepared a letter for my father, because I hadn’t been capable of saying goodbye yet.” P6 .

Caregiver overload and work-life balance

The main difficulty that family caregivers faced was achieving a healthy balance between work and personal life. The combination of working and family responsibilities (of both the patient and other family members) can virtually do away with a caregiver’s rest and free time.

“My father was on medical leave because of anxiety, until my mother died and then he went back to work. Until it happens to you, you don’t realize how much a person needs to stop working, and that it’s not a whim. In other words, you either stop working or caregiving.” P10 .

The participants emphasized the need for caregivers, in this case, mainly family members. Great importance was given to the possibility of having a formal and informal support network, especially at an emotional level and also to collaborate with daily caregiving tasks.

“ The end was appalling, especially because of the work-life balance. It was very burdensome to have the illness at home. I managed to do it because my father was there, otherwise I wouldn’t have been able to go out […] because I couldn’t disconnect at home .” P10 .

The objective of this study was to explore the needs of people with cancer at the end of life and the needs of their family caregivers. Its novelty lies in its ability to provide relevant information on the unmet needs of these individuals in a qualitative manner during the end-stage of the illness.

There is limited research on this period given the complexities of reaching out to the cancer population and their loved ones at such a difficult time in their lives. Furthermore, there is the complex task of incorporating the experiences of both patients and family members into a single study and viewing them as a unit that interconnects with the social, economic and institutional reality in which they live.

Based on the needs expressed by the participants, our findings suggest that numerous unmet needs may exist among cancer patients and informal caregivers during the end-of-life period. The complexity and magnitude of the challenges they face during this phase of cancer contribute to a significant array of needs. Although there is diversity in the identified needs among patients and family caregivers, there are also a remarkable number of these needs overall. These findings are consistent with results from similar studies conducted on cancer patients in other countries during earlier phases of the end of life.

In terms of the physical well-being of the cancer patient, our findings support other studies in which the need for symptom control, mainly pain and fatigue [ 5 , 13 , 34 , 35 , 36 , 37 ], is considered a priority. Another primary concern is the need for rest and adequate sleep. It should be noted that while caregivers usually attend to the needs of the patient regarding nutrition and hygiene, most of them express a sense of over-delegation when it came to these tasks, as well as a lack of preparation for carrying them out.

The need for emotional well-being is of particular concern to the interviewees, constituting one of the primary sources of vulnerability at the end of life. This phase of the disease is characterized by fear and uncertainty and the need to come to terms with impending death. Priority is given to managing emotions related to illness, dependency, dying and death. Patients also stress the importance of spiritual needs during this period, as they face end-of-life issues and reflect on the purpose and meaning in their lives. Preserving one’s identity, as well as one’s self-image and self-esteem also contributes to emotional well-being for people nearing the end of life. These findings support previous research where patients expressed a fundamental need for managing psychological distress [ 6 , 7 ]. A systematic assessment of the emotional needs of these patients would help identify appropriate coping strategies to reduce emotional distress and lessen its burden on caregivers.

Participants in our study, as in other research, emphasize the unmet need for information that would help them make decisions and express their preferences for end-of-life care [ 7 , 8 , 13 ], thereby ensuring control over their care while easing the burden of decision-making for their caregivers. These findings highlight the need to improve communication between patients and their healthcare providers. By learning and responding to what their patients want to know, these professionals can improve the patient’s understanding of their circumstances and the options available to them at this critical period in their lives.

Regarding social needs, our data show that a well-adapted living space that provides comfort and mobility is vital for dignity at the end of life, as is being able to choose to stay at home rather than move to a hospital. Participants indicated that the main barriers to satisfying these needs were a lack of economic resources to refurbish their home or obtain technical and/or orthotic and prosthetic devices (wheelchair, adjustable beds, etc.) to improve their quality of life. It is necessary to provide assistance and information on adapting the home and devices that facilitate the patient’s mobility. Similarly, more information should be made available regarding economic aid or funds that may be requested to offset these costs and the loss of income resulting from the illness.

Finally, findings on the needs of family caregivers show the challenges that arise during end-of-life care for a patient with cancer cause an overload, which in most cases leads to severe stress and physical and psychological exhaustion. Family caregivers need to learn how to improve their work-life balance. This includes organizing work, home, and leisure activities, improving time management, and building a strong internal support network.

This study contributes to the relatively small number of publications on patients with cancer and their caregivers at the end of life. In addition, this is the first study carried out in Spain that explores the needs of cancer patients in palliative care and their families based on their own personal experiences. The primary strength of our research lies in the inclusion of end-of-life patients nearing death who had diverse experience with the services provided during end-of-life care. Our main findings also corroborate previous research, while providing a more in-depth understanding of these patients’ needs and their connection to the needs of family caregivers. However, while it was possible to saturate the resulting codes theoretically and empirically, our limited sample size prevented the findings from being generalizing. Nevertheless, these results support the growing call for a more in-depth understanding of the needs of this vulnerable population. Only with this first-hand knowledge any real and effective change can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

Data availability

The dataset generated and analyzed during the current study is not publicly available because individual privacy could be compromised but is available from the corresponding author on reasonable request.

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Acknowledgements

We are exceptionally grateful to the participants and professionals involved in this study, without whom we could not share the results of this research.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Mario López-Salas, Antonio Yanes-Roldán, Ana Fernández, Ainhoa Marín, Ana I. Martínez, Ana Monroy, José M. Navarro, Marta Pino, Raquel Gómez, Saray Rodríguez, Sergio Garrido, Sonia Cousillas, Tatiana Navas, Víctor Lapeña & Belén Fernández

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Conceptualization and design: M.L-S., A.Y-R., B.F.; Acquisition, analysis and interpretation of data: M.L-S., A.Y-R., B.F.; Drafting of the manuscript: M.L-S., A.Y-R., A.F., B.F.; Critical revision of the manuscript for important intellectual content: All authors. All authors have read and approved the final version of this manuscript.

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López-Salas, M., Yanes-Roldán, A., Fernández, A. et al. End-of-life care needs in cancer patients: a qualitative study of patient and family experiences. BMC Palliat Care 23 , 157 (2024). https://doi.org/10.1186/s12904-024-01489-1

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Qualitative vs Quantitative Research

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Qualitative vs quantitative research.

13 min read You’ll use both quantitative and qualitative research methods to gather survey data. What are they exactly, and how can you best use them to gain the most accurate insights?

What is qualitative research?

Qualitative research is all about language, expression, body language and other forms of human communication . That covers words, meanings and understanding. Qualitative research is used to describe WHY. Why do people feel the way they do, why do they act in a certain way, what opinions do they have and what motivates them?

Qualitative data is used to understand phenomena – things that happen, situations that exist, and most importantly the meanings associated with them. It can help add a ‘why’ element to factual, objective data.

Qualitative research gives breadth, depth and context to questions, although its linguistic subtleties and subjectivity can mean that results are trickier to analyse than quantitative data.

This qualitative data is called unstructured data by researchers. This is because it has not traditionally had the type of structure that can be processed by computers, until today. It has, until recently at least, been exclusively accessible to human brains. And although our brains are highly sophisticated, they have limited processing power. What can help analyse this structured data to assist computers and the human brain?

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What is quantitative research?

Quantitative data refers to numerical information. Quantitative research gathers information that can be counted, measured, or rated numerically – AKA quantitative data. Scores, measurements, financial records, temperature charts and receipts or ledgers are all examples of quantitative data.

Quantitative data is often structured data, because it follows a consistent, predictable pattern that computers and calculating devices are able to process with ease. Humans can process it too, although we are now able to pass it over to machines to process on our behalf. This is partly what has made quantitative data so important historically, and why quantitative data – sometimes called ‘hard data’ – has dominated over qualitative data in fields like business, finance and economics.

It’s easy to ‘crunch the numbers’ of quantitative data and produce results visually in graphs, tables and on data analysis dashboards. Thanks to today’s abundance and accessibility of processing power, combined with our ability to store huge amounts of information, quantitative data has fuelled the Big Data phenomenon, putting quantitative methods and vast amounts of quantitative data at our fingertips.

As we’ve indicated, quantitative and qualitative data are entirely different and mutually exclusive categories. Here are a few of the differences between them.

1. Data collection

Data collection methods for quantitative data and qualitative data vary, but there are also some places where they overlap.

Qualitative data collection methods	Quantitative data collection methods
Gathered from focus groups, in-depth interviews, case studies, expert opinion, observation, audio recordings, and can also be collected using surveys.	Gathered from surveys, questionnaires, polls, or from secondary sources like census data, reports, records and historical business data.
Uses and open text survey questions	Intended to be as close to objective as possible. Understands the ‘human touch’ only through quantifying the OE data that only this type of research can code.

2. Data analysis

Quantitative data suits statistical analysis techniques like linear regression, T-tests and ANOVA. These are quite easy to automate, and large quantities of quantitative data can be analyzed quickly.

Analyzing qualitative data needs a higher degree of human judgement, since unlike quantitative data, non numerical data of a subjective nature has certain characteristics that inferential statistics can’t perceive. Working at a human scale has historically meant that qualitative data is lower in volume – although it can be richer in insights.

Qualitative data analysis	Quantitative data analysis
Results are categorised, summarised and interpreted using human language and perception, as well as logical reasoning	Results are analysed mathematically and statistically, without recourse to intuition or personal experience.
Fewer respondents needed, each providing more detail	Many respondents needed to achieve a representative result

3. Strengths and weaknesses

When weighing up qualitative vs quantitative research, it’s largely a matter of choosing the method appropriate to your research goals. If you’re in the position of having to choose one method over another, it’s worth knowing the strengths and limitations of each, so that you know what to expect from your results.

Qualitative approach	Quantitative approach
Can be used to help formulate a theory to be researched by describing a present phenomenon	Can be used to test and confirm a formulated theory
Results typically expressed as text, in a report, presentation or journal article	Results expressed as numbers, tables and graphs, relying on numerical data to tell a story.
Less suitable for scientific research	More suitable for scientific research and compatible with most standard statistical analysis methods
Harder to replicate, since no two people are the same	Easy to replicate, since what is countable can be counted again
Less suitable for sensitive data: respondents may be biased or too familiar with the pro	Ideal for sensitive data as it can be anonymized and secured

Qualitative vs quantitative – the role of research questions

How do you know whether you need qualitative or quantitative research techniques? By finding out what kind of data you’re going to be collecting.

You’ll do this as you develop your research question, one of the first steps to any research program. It’s a single sentence that sums up the purpose of your research, who you’re going to gather data from, and what results you’re looking for.

As you formulate your question, you’ll get a sense of the sort of answer you’re working towards, and whether it will be expressed in numerical data or qualitative data.

For example, your research question might be “How often does a poor customer experience cause shoppers to abandon their shopping carts?” – this is a quantitative topic, as you’re looking for numerical values.

Or it might be “What is the emotional impact of a poor customer experience on regular customers in our supermarket?” This is a qualitative topic, concerned with thoughts and feelings and answered in personal, subjective ways that vary between respondents.

Here’s how to evaluate your research question and decide which method to use:

Qualitative research:

Use this if your goal is to understand something – experiences, problems, ideas.

For example, you may want to understand how poor experiences in a supermarket make your customers feel. You might carry out this research through focus groups or in depth interviews (IDI’s). For a larger scale research method you could start by surveying supermarket loyalty card holders, asking open text questions, like “How would you describe your experience today?” or “What could be improved about your experience?” This research will provide context and understanding that quantitative research will not.

Quantitative research:

Use this if your goal is to test or confirm a hypothesis, or to study cause and effect relationships. For example, you want to find out what percentage of your returning customers are happy with the customer experience at your store. You can collect data to answer this via a survey.

For example, you could recruit 1,000 loyalty card holders as participants, asking them, “On a scale of 1-5, how happy are you with our store?” You can then make simple mathematical calculations to find the average score. The larger sample size will help make sure your results aren’t skewed by anomalous data or outliers, so you can draw conclusions with confidence.

Qualitative and quantitative research combined?

Do you always have to choose between qualitative or quantitative data?

Qualitative vs quantitative cluster chart

In some cases you can get the best of both worlds by combining both quantitative and qualitative data.You could use pre quantitative data to understand the landscape of your research. Here you can gain insights around a topic and propose a hypothesis. Then adopt a quantitative research method to test it out. Here you’ll discover where to focus your survey appropriately or to pre-test your survey, to ensure your questions are understood as you intended. Finally, using a round of qualitative research methods to bring your insights and story to life. This mixed methods approach is becoming increasingly popular with businesses who are looking for in depth insights.

For example, in the supermarket scenario we’ve described, you could start out with a qualitative data collection phase where you use focus groups and conduct interviews with customers. You might find suggestions in your qualitative data that customers would like to be able to buy children’s clothes in the store.

In response, the supermarket might pilot a children’s clothing range. Targeted quantitative research could then reveal whether or not those stores selling children’s clothes achieve higher customer satisfaction scores and a rise in profits for clothing.

Together, qualitative and quantitative data, combined with statistical analysis, have provided important insights about customer experience, and have proven the effectiveness of a solution to business problems.

Qualitative vs quantitative question types

As we’ve noted, surveys are one of the data collection methods suitable for both quantitative and qualitative research. Depending on the types of questions you choose to include, you can generate qualitative and quantitative data. Here we have summarized some of the survey question types you can use for each purpose.

Qualitative data survey questions

There are fewer survey question options for collecting qualitative data, since they all essentially do the same thing – provide the respondent with space to enter information in their own words. Qualitative research is not typically done with surveys alone, and researchers may use a mix of qualitative methods. As well as a survey, they might conduct in depth interviews, use observational studies or hold focus groups.

Open text ‘Other’ box (can be used with multiple choice questions)

Text box (space for short written answer)

What is your favourite item on our drinks menu

Essay box (space for longer, more detailed written answers)

Tell us about your last visit to the café

Quantitative data survey questions

These questions will yield quantitative data – i.e. a numerical value.

Net Promoter Score (NPS)

On a scale of 1-10, how likely are you to recommend our café to other people?

Likert Scale

How would you rate the service in our café? Very dissatisfied to Very satisfied

Radio buttons (respondents choose just one option)

Which drink do you buy most often? Coffee, Tea, Hot Chocolate, Cola, Squash

Check boxes (respondents can choose multiple options)

On which days do you visit the cafe? Mon-Saturday

Sliding scale

Star rating

Please rate the following aspects of our café: Service, Quality of food, Seating comfort, Location

Analysing data (quantitative or qualitative) using technology

We are currently at an exciting point in the history of qualitative analysis. Digital analysis and other methods that were formerly exclusively used for quantitative data are now used for interpreting non numerical data too.

Artificial intelligence programs can now be used to analyse open text, and turn qualitative data into structured and semi structured quantitative data that relates to qualitative data topics such as emotion and sentiment, opinion and experience.

Research that in the past would have meant qualitative researchers conducting time-intensive studies using analysis methods like thematic analysis can now be done in a very short space of time. This not only saves time and money, but opens up qualitative data analysis to a much wider range of businesses and organisations.

The most advanced tools can even be used for real-time statistical analysis, forecasting and prediction, making them a powerful asset for businesses.

Qualitative or quantitative – which is better for data analysis?

Historically, quantitative data was much easier to analyse than qualitative data. But as we’ve seen, modern technology is helping qualitative analysis to catch up, making it quicker and less labor-intensive than before.

That means the choice between qualitative and quantitative studies no longer needs to factor in ease of analysis, provided you have the right tools at your disposal. With an integrated platform like Qualtrics, which incorporates data collection, data cleaning, data coding and a powerful suite of analysis tools for both qualitative and quantitative data, you have a wide range of options at your fingertips.

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Open access
Published: 25 June 2024

A qualitative study of geriatric specialist nurses’ experiences to navigate delirium in the elderly

Mei Wu 1 , 2 na1 ,
Zhen Chen 3 na1 ,
Yamin Xu 4 ,
Liting Zhao 1 ,
Lirong Zhao 5 &

BMC Nursing volume 23 , Article number: 426 ( 2024 ) Cite this article

Metrics details

The experiences and perceptions of geriatric specialist nurses are pivotal to understanding the complexities of managing delirium and to developing effective nursing interventions. This qualitative study aims to explore these experiences and perceptions to inform the enhancement of clinical geriatric nursing and care practices.

Utilizing a qualitative exploratory design, this research engaged a convenience sample of geriatric specialist nurses at a tertiary hospital in Shanghai, China through focus groups and semi-structured interviews. Data were rigorously analyzed using Colaizzi’s phenomenological method, which facilitated the identification of themes that emerged from the narratives of the geriatric specialist nurses.

The thematic analysis yielded three major themes that encapsulate the nurses’ experiences and perceptions. Theme 1: Understanding of Delirium, highlighted the nurses’ awareness of the condition’s significance, yet it was often deprioritized due to the pressing demands of managing more acute and immediately life-threatening conditions. Theme 2: Barriers in Application, brought to light the multifaceted challenges faced by nurses, including language barriers, the frequency and consistency of delirium assessments, the social determinants of health, and the nurses’ own competencies in assessment. Theme 3: Evolution of Nursing Approaches, detailed the adaptive strategies employed by nurses, such as managing nursing adverse events, improving communication with patients’ families, and adopting a proactive stance towards long-term patient outcomes.

Conclusions

The findings suggest that while geriatric specialist nurses recognize the importance of delirium assessment, there are several barriers to effective application. The study underscores the imperative for the advancement of more refined delirium assessment and care protocols, tailored to address the unique requirements of geriatric nursing care.

Peer Review reports

Introduction

Delirium is characterized as a clinical syndrome encompassing acute disturbances in consciousness, attention, and cognitive or perceptual functions, which are subject to fluctuations throughout the day. This transient neuropsychiatric condition is marked by a rapid onset and variability in symptom presentation, reflecting the dynamic nature of the underlying pathophysiological processes [ 1 , 2 ]. Postoperative delirium emerges as a prevalent postoperative complication, predominantly affecting the geriatric population. The reported incidence among elderly patients varies widely, from 5 to 50%, with specific procedures such as spinal and joint surgeries exhibiting a notably higher rate of approximately 15.2% [ 3 , 4 ]. In the demographic of patients over 65 years of age who have undergone non-cardiac surgeries, the incidence of postoperative delirium is observed to range between 6.1% and 57.1%, culminating in an aggregate rate of 11.1% [ 5 ]. Among the elderly who have sustained a hip fracture, the onset of delirium within the initial 1 to 3 postoperative days is particularly concerning, with reported incidence rates as high as 17–61% [ 6 , 7 ], underscoring the heightened vulnerability of those who have undergone intricate and urgent surgical interventions. Delirium within the Intensive Care Unit (ICU) settings present a significant clinical challenge, with an estimated 35% of ICU patients experiencing misdiagnosis or diagnostic oversight concerning delirium [ 8 , 9 ]. The ICU environment, characterized by its distinctive conditions, may be particularly conducive to the development of delirium. The incidence of delirium in ICU patients is influenced by a multitude of factors, including but not limited to age, type of surgery, the elective or emergency nature of the procedure, and the utilization of various delirium assessment instruments [ 10 , 11 ]. The collective data underscore the imperative need for vigilant monitoring and proactive management of postoperative delirium, particularly in the context of elderly patients and ICU environments [ 12 , 13 ]. The implementation of preventive strategies and the prompt recognition of delirium are paramount to optimizing patient prognoses and averting adverse outcomes [ 14 ].

However, its low recognition rate is not consistent with the high incidence rate. The low recognition rate of delirium in hospitals [ 15 ] around the world has become an important issue, and medical staff’ recognition rate of delirium is less than 25% [ 16 , 17 , 18 ]. The unrecognized rate of delirium (defined as delirium not determined by the patient’s therapist and nurse) is about 33-95% [ 19 ]. The low recognition rate is due to its lack of symptomatic characteristics [ 20 ]and the variability of symptoms [ 18 ]. The identification of delirium is a huge challenge for nurses. Trogrlic et al. [ 21 ]summarized the literature on delirium from 2000 to 2010, and found that the cognitive and attitude level of delirium in ICU such as medical staff the main obstacle affecting delirium identification. Inouye et al. [ 22 ] found that the accuracy rate of nurses in identifying delirium in 797 patients was only 31% of that of researchers. Augmenting the proficiency of healthcare providers in the recognition of delirium is of paramount importance. The accurate and timely identification of delirium is a critical component in the continuum of care for patients at risk. Enhancing providers’ ability to detect delirium can lead to earlier intervention, which is instrumental in mitigating the severity and duration of the episode, thereby potentially improving patient outcomes and reducing healthcare-associated complications.

Delirium assessment in hospitals can help healthcare professionals to manage patient safety, which is of great significance for some critically ill patients and elderly patients [ 23 ]. Previous studies have reported that Individuals with delirium are found to have a higher mortality rate, extended hospital stays, and increased medical expenditures compared to their elderly counterparts who are free from delirium [ 24 , 25 , 26 ]. Delirium, when it occurs, is often overlooked by nursing staff, particularly when they are not well-versed in the nuances of delirium assessment and have limited experience with the application of standardized delirium assessment tools. This lack of expertise can lead to a diminished capacity to recognize and respond to the signs of delirium, thereby affecting the quality of care and the clinical outcomes for affected patients. The underdiagnosis of delirium not only reflects a gap in clinical perception but also highlights the need for targeted education and training to enhance nurses’ competencies in this critical area of geriatric care [ 27 , 28 ]. The study surveyed the real-world uptake of delirium detection methods has shown that the Confusion Assessment Method was used in 65/146 (45%) units and 4AT was with 80% of units reporting use in the UK [ 29 ]. The significance of comprehensive delirium assessment in effective delirium management is increasingly acknowledged within the medical community. However, the empirical understanding of nurses’ experiences, particularly in relation to the challenges and ambiguities encountered during delirium assessment, remains under-explored.

Theoretical framework

Colaizzi’s phenomenological approach is a widely utilized data analysis technique in qualitative research, particularly within the realm of phenomenological studies [ 30 ]. The goal of this method is to uncover the intrinsic meanings and essence of individuals’ lived experiences through a deep understanding [ 31 ]. The significance of the Colaizzi method lies in its structured approach to analyzing qualitative data, assisting researchers in revealing the profound experiences and sentiments of participants [ 32 ]. Moreover, the extension and adaptation of this method can enhance the rigor of research and broaden the scope of information sources, allowing for a more in-depth depiction of the phenomena under study. This not only aids in elevating the quality and depth of research but also offers richer and more concrete guidance for nursing practice. A qualitative inquiry into the authentic experiences of nurses as they engage in the assessment process is of considerable value. Such exploration can yield profound insights, ultimately contributing to the refinement of delirium assessment methodologies and the enhancement of clinical practice in geriatric care [ 33 ].

Therefore, the present study was designed to systematically evaluate the experiences and perceptions of geriatric nurse specialists regarding the management of delirium in elderly patients within the specialized domains of postoperative care and intensive care units. The objective was to generate empirical evidence that can significantly inform and enhance the standards of geriatric nursing care in these critical healthcare settings.

A prospective qualitative research methodology was employed, utilizing focus group interviews in conjunction with the Colaizzi’s phenomenological approach [ 34 ], to elicit an in-depth understanding of the experiences and perceptions of geriatric specialist nurses regarding the phenomenon of delirium in elderly patients within the context of postoperative care and intensive care units. This methodological choice was selected to capture a comprehensive and nuanced description of the nurses’ encounters with delirium, providing a rich dataset that can inform the development of targeted interventions and enhance the quality of geriatric care in these critical settings.

Settings and participants

The study sample was recruited from geriatric specialist nurses in the postoperative care and intensive care units of a tertiary hospital in Shanghai, China. Objective sampling was used to select geriatric specialist nurses who had the greatest possible experience and perceptions. The criteria for inclusion in this study were geriatric specialist nurses who were able to independently complete a delirium assessment after 2 months of delirium assessment. Nurses were identified and recruited through postoperative care and intensive care units assessed by researchers for delirium. If they agreed to participate, their contact information would be sent to the research team. The number of participants in the focus group reached saturation when there were no more new theme to be found during the conversations. The researcher was a different person to undertake the focus groups interview. After 3 focus group interviews, 19 nurses completed the focus group interviews.

Data collection

During the interview, the participants read the outline of the study and were informed by the researcher of the purpose and process of the study, the risks, and so on. They pointed out that participation was voluntary and received oral consent and recording permission.

The primary investigator (WM), executed all interviews with meticulous adherence to the study protocol. A total of three focus groups were convened, comprising 19 geriatric nurse specialists who contributed their expertise to the qualitative inquiry. These focus group interviews were strategically scheduled across three distinct time points to capture the temporal dynamics of the participants’ experiences and insights within the study’s framework. Conducting multiple focus group discussions enriches the dataset, facilitating a profound comprehension of the research subject. As time progresses, the rapport and trust among participants and with the researchers are likely to intensify, fostering an environment conducive to more candid and forthright dialogues. Subsequent discussions serve to deepen the investigator’s grasp of the perspectives and experiences shared by the participants, particularly in areas that may have emerged as requiring further elucidation or exploration post the initial session.

Based on the existing research and clinical experience of the study group, an interview guide (supplementary file 1 ) was developed for geriatric specialist nurses to assess their delirium experiences and perceptions. Interview questions were as follows: (I)How did you observe delirium? What was the priority of delirium in clinical nursing? (II)Did the current assessment form help you identify patients with delirium more easily? What were the problems and puzzles in the process of assessment? (III)Whether other ways did you think can help you? Show us some examples. (IV)Identify whether delirium affects patients’ outcomes. The problem was developed by the first author and examined by the project team. A small number of geriatric specialist nurses were tested in advance. Interviews were conducted with geriatric specialist nurses who were assessed for delirium for 2 months. The average length of each group interview was about 45 min. Voice record data was transcribed and saved as a text document. Every interview would record the notes on the scene to record the introspection and preliminary ideas. All the researchers received qualitative research training in qualitative research data collection methods, interview skills and analysis methods in advance, and carried out pre-experimental analysis to avoid the deviation of research results caused by qualitative research skills. All data must be analyzed by two researchers at the same time to avoid the deviation of the researchers’ own values and emotional integration in the process of data collection and analysis.

Data analysis

Upon the conclusion of each interview session, a meticulous process of data consolidation was initiated. Two researchers dedicated a full 24-hour period to meticulously reviewing the audio recordings, ensuring that every nuance and detail was captured with accuracy. This iterative listening process was conducted to enhance the depth of understanding and to identify the subtleties that might be present in the spoken narratives. Simultaneously, the researchers cross-referenced their comprehensive written notes taken during the interviews. These notes served as a valuable resource for contextualizing the verbal exchanges and for augmenting the transcription process. The transcription of the recordings was approached with the utmost rigor, striving to convert the spoken word into a written format that remained faithful to the original dialogues. In the present study, the data derived from the focus group interviews were meticulously analyzed using Colaizzi’s phenomenological approach, a well-established method for qualitative data analysis. This process involved several systematic steps to ensure a rigorous and authentic interpretation of the participants’ experiences. Initially, the interviews were transcribed verbatim, capturing every detail of the dialogue. The transcriptions were then thoroughly read and re-read to achieve a deep immersion in the data. Colaizzi’s data analysis focused on integrating the feelings of the interviewees, adding the steps for the researchers to analyze the conclusions, which was divided into seven stages: (1) detailed recording and careful repeated reading of all materials; (2) extraction of meaningful statements; (3) induction and extraction of meaning from repeated and important statements; (4) searched for common concepts or characteristics of meaning to form themes, topic groups and categories; (5) related the topic to the research phenomenon to make a complete description; (6) identified similar viewpoints; (7) returned the results to the interviewees to verify the authenticity of the content.

Ethical considerations

The study received approval from the Ethics Committee of Huadong Hospital, with the assigned approval number No.2018K051. Prior to the commencement of the study, the researcher engaged in dialogue with the participants, elucidating the study’s objectives, methodology, importance, and the assurance of confidentiality. A foundation of trust was established, and participants were informed of their voluntary nature of participation. They were assured that they could withdraw from the interview at any juncture. Additionally, participants were requested to provide their informed consent by signing a consent form. Each participant was represented by a numeric code.

Nineteen geriatric specialist nurses (eighteen females and one male), with a median of 31 years old were recruited. The range of cumulative working experience was 2–26 years, and the range of experience of working on the surgical ward or ICU was 1–22 years. Characteristics of the participants are showed in Table 1 .

The thematic analysis conducted in this study has systematically identified three principal themes that encapsulate the comprehensive experiences and perceptions of the nurses.

Understanding of delirium

Delirium is an important part of nursing cognition. However, the priority of acute and life-threatening is still the focus of health care. Nurse G1N2: “I know delirium can result from bad outcomes, but in the immediate care of patients, these threats, such as extubation, elevated body temperature, and altered vital signs, are still issues we need to address immediately.”

Before clinical training, nurses mainly rely on their own clinical experience to judge the occurrence of delirium. The content of the assessment includes the state of consciousness, lack of complete assessment, and did not understand the assessment scale of delirium. Nurse G1N1: “If a patient is told not to remove the oxygen saturation clip after surgery, and if we have talked to him three times and he still wanted to remove it, we would consider his delirious problem”; Nurse G1N2: " We will inquire of the patients who are not on ventilators with questions like “Where are you?” and “What surgery have you undergone?” If a patient is unable to respond, we will suspect the presence of delirium. “

Subjective assessments carry the inherent risk of introducing bias and error into the assessment process, a phenomenon that is particularly pertinent in the context of delirium, where the condition’s subtle manifestations can elude immediate clinical detection. The nuanced nature of delirium, especially in its early or mild stages, often presents a formidable challenge to healthcare providers, who may struggle to discern its presence amidst the myriad clinical presentations encountered in patient care. Nurse G1N4: “If a patient is quiet and doesn’t evaluate, it’s hard for us to detect delirium relative to those who are very upset.”

Barriers in application

In the process of using the scale, the assessment methods and tone of nurses may lead to differences in patients’ understanding. Moreover, as far as the problems on the assessment form are concerned, they are not routine enough and divorced from the actual problems, which makes it difficult for some elderly patients to understand their educational level. Nurse G1N7: “Some patients come from other provinces and municipalities, there are language communication barriers if the assessment is wrong because they do not understand, problems will occur in the accuracy of delirium assessment.” Nurse G2N10: “Some patients are not well educated enough to answer questions, and the results are controversial.” Nurse G1N5: “Can we judge delirium by asking a patient how many children they have so that it’s closer to the patient’s daily life?”

Frequency of assessment

Clinically, nurses evaluate patients with delirium according to the frequency of assessment recommended by the scale, but nurses have questions about it. Nurse G1N3: “After the surgery, I did the first-time assessment. The patient was able to answer correctly. After three times, the patient questioned my assessment and rejected my assessment. Is it necessary for at least nine full assessments in this situation?” Nurse G3N15: “I think at the first time, delirium did not occur, followed by other communication abnormalities, then it’s time to assess whether more appropriate.”

The intensity and frequency of postoperative delirium assessments for nurses will be adjusted based on the changes in the patient’s condition. Nurse G2N9 : “ When I suspect a patient is experiencing delirium, I will immediately report to the physician and pay closer attention to any changes in the patient’s condition”.

Social problems

Family members may lack comprehensive insight into the cognitive status of their elderly relatives prior to institutionalization, or they may misconstrue early signs of cognitive impairment as an inevitable aspect of the aging process. This misperception, coupled with the complexities of geriatric care, amplifies the challenges faced by nursing staff in the postoperative assessment of delirium. The task of accurately diagnosing postoperative cognitive changes is further complicated by the potential underestimation of pre-existing cognitive deficits by family members and the inherent variability in the presentation of delirium symptoms. Nurse G2N11: “Family members told us that their parents are well when explaining the patient’s cognitive status, but in fact, on admission, we assess that there is a certain cognitive dysfunction, so it is difficult to distinguish dementia from delirium, which makes it more difficult to assess delirium.”

The assessment competence of nurses

Although nurses were trained in professional delirium knowledge and assessment tools (supplementary file 2 and 3 ), the use of tools still depends on the professional clinical competence of nurses. For some junior nurses, there is a certain ability requirement, and the accuracy of the results may have deviated. Nurse G2N9: “The patient is in a state of sedation and ignores you in the ward. For some inexperienced nurses, they will think that the patient can cooperate with the treatment nurse well, and there is no delirium problem.”

Changes in the nursing pattern

Nursing adverse events.

Nurses found in the clinical work that the changes in patients’ condition easily result from delirium, which may lead to patients with unplanned extubation events, especially in some restless patients. These bring the improvement of nursing difficulty. By using the delirium assessment scale to assess the presence of delirium, nursing staff can protect the patient from extubation events. Nurse G3N13: “There was a patient who was able to answer questions when I evaluated him before, but suddenly in an evening assessment, he couldn’t answer my question and we were protective against him for fear of extubation.”

Communication with family members

Through the delirium assessment of patients, nurses pay more attention to effective communication between patients and family members of patients, educating patients to cooperate with nursing operations, enhancing the sense of security in the ward and confidence in disease rehabilitation. Nurse G2N8: “Because of illness, patients cannot stay and communicate with their family members for the time being, and family members also difficult to understand the actual situation of patients. After careful explanation of the assessment results, some changes have taken place between patients and family members in the care of patients with treatment.”

Avoiding disputes

For many ICU patients, because of the ward requirements, the patients’ families can not accompany them every time. The changes in the patient’s condition cannot be recognized by their families, and they will have a sense of distrust of the medical staff, especially when there appear to be unrelated cognitive problems with the disease. Family members cannot understand so it is easy to cause medical disputes. Through delirium assessment, nurses are aware of the changes in cognitive status, they can communicate with the family members of patients promptly, explain the problem, and get an understanding of the family members. Nurse G2N12: “When we communicate with family members of patients without delirium assessment, it is always difficult for us to explain the mental changes of patients, and through assessment, we can explain the changes of patients to family members carefully, so that family members can understand more and avoid disputes.”

Focusing on long-term complications

Delirium assessment enables nurses to realize that delirium in the ward may lead to changes in cognitive function in patients later, and it is very important for the quality of life of patients. Nurse G1N2: “Our ward is less likely to focus on continuing care after a month, two months, and three months… but if delirium occurs during hospitalization, we find that patients stay in hospital significantly longer, and later recovery is slower than patients with the same disease.”

Discussions

In our study, geriatric specialist nurses have a deep understanding of delirium and delirium assessment in their daily work, and a new understanding of previously unnoticed or neglected changes in cognitive status. While the immediate threat of delirium may not be perceived as the foremost concern, nurses have reported observing acute changes in vital signs, such as “elevated body temperature, increased heart rate, and decreased oxygen saturation,” which take precedence in their clinical assessments. This observation aligns with existing literature, indicating that nurses often regard delirium as a lower-priority issue within the ICU setting. The prevailing belief is that delirious patients are not typically viewed as being in significant discomfort, as they may not necessitate specialized treatment or support beyond standard care protocols. Although delirium assessment is incorporated into the overall physical examination, it is not commonly afforded the highest priority by healthcare professionals. This perspective may stem from the assumption that delirium does not warrant the same level of immediate intervention as other critical conditions presenting with more overtly alarming symptoms [ 35 ]. At the same time, 50% of nurses give priority to young adults with mixed delirium, and the last priority is inefficient delirium in older patients [ 36 , 37 ].

There were various barriers to the clinical use of the delirium scale, including language, educational level of the population, frequency of assessment, social problems, and nurses’ assessment ability. It has been reported that assisting the elderly residing in nursing homes is essential to fulfill their emotional and psychological needs, thereby safeguarding and enhancing their spiritual well-being [ 38 , 39 ]. Although the scale has been localized and localized in Chinese, there are still many practical problems in clinical use. The deficiency in nurses’ knowledge regarding delirium is a pivotal issue that significantly hampers heir assessment capabilities, as evidenced by recent studies [ 40 , 41 ]. This underscores the necessity for incorporating delirium knowledge training into the routine professional development curriculum for healthcare providers. Such training would not only enhance their diagnostic proficiency but also equip them with the necessary skills to implement effective care protocols for patients at risk of delirium [ 42 ]. Another important point that nurses have repeatedly mentioned is the frequency of assessment. According to the requirements of the scale [ 43 ], at least once every 8 h, but the such frequency will cause problems. Nurses worry that delirium assessments may embarrass patients, families, and professionals, and some patients show signs of frustration and anger [ 44 , 45 , 46 ]. The frequency of cognitive assessments is a topic of ongoing debate among healthcare stakeholders. However, the evidence indicates that alterations in cognitive status or behavior should serve as a primary indicator for assessment. It is more logical to conduct assessment in response to changes in a patient’s condition, employing a dynamic approach to selecting the timing of assessments. This practice diverges from the conventional, prescriptive use of standardized assessment tools, which may not always align with the individual needs of patients experiencing cognitive fluctuations.

In addition, with the development of enhanced recovery after surgery [ 47 ], nurses pay more attention to the implementation of early activities for patients [ 48 ]. Patients can get out of bed after surgery, which for the state of consciousness and cognition is a great help. Therefore, the nursing staff reconsiders whether it is unnecessary to assess the frequency required according to the assessment table. Not only do nurses need a tool for assessing delirium, but they also need to develop programs or policies for using it, such as using it as part of a medical record, standard care processes, electronic assessments, etc [ 49 , 50 ].

With the aging process in China, some pension problems are becoming more and more prominent, and many elderly people living alone. These cognitive problems are often neglected by caregivers, who consider some behaviors of the elderly as changes caused by normal aging [ 50 , 51 ]. These slow changes, coupled with the acute trauma of the disease, can easily lead to delirium [ 52 , 53 , 54 ]. Delirium is just one of the most important nursing problems in this study. Besides, more nursing problems suggest that we should pay attention to, such as delirium and dementia, depression, patients after discharge of continuing care, and so on. Nurses gradually can find out from the adverse events that the delirium state of the patient led to the occurrence of nursing incompatibility and extubation, and then analyze the risk factors that might lead to delirium. Furthermore, family members often fail to understand the patient’s acute cognitive function changes, and through the assessment of the situation, we can explain their questions in detail, obtain family support, and also guide family members to increase confidence in the rehabilitation of patients [ 55 , 56 , 57 ]. All these are conducive to the management of delirium patients in the later stage.

Limitations and implication for future studies.

The present study acknowledges several intrinsic limitations that require attention. Firstly, the elderly in this study are located in a specialist area of post-surgery or intensive care. the limited sample size, though suitable for qualitative inquiry, may restrict the generalizability of the results. Secondly, the exclusion of geriatricians from the interview process represents a notable limitation, as it omits the critical insights of specialists in the field. Their expertise is particularly valuable for understanding the nuances of conditions in elderly patients, which could significantly augment the applicability and relevance of the study’s findings. Thirdly, the sampling process, while meticulously executed, may be perceived as lacking objectivity due to the pre-existing familiarity with each participant prior to the commencement of interviews. Despite the assignment of numeric codes to ensure anonymity, the selection criteria for interviewees, which included the capacity to perform assessments post-training in delirium assessment, could potentially introduce a bias. This selection bias might skew the representativeness of the sample, affecting the generalizability of the findings and necessitating a cautious interpretation of the results within the confines of the study’s specific context. In anticipation of future research, it is imperative to expand the scope and depth of delirium assessments. This should include incorporating a more diverse and extensive sample size to enhance the robustness of the study. Additionally, the inclusion of geriatricians’ perspectives will be essential to provide a comprehensive understanding of delirium in the elderly. By refining the methodology and enriching the content of these assessments, the efficacy and responsiveness of delirium assessments can be improved, ultimately serving to better address the unique needs of geriatric patients and amplifying the study’s impact within the scientific community.

In conclusion, geriatric nursing specialists face the intricate and diverse challenges inherent in caring for the elderly, with delirium emerging as a significant concern that warrants focused attention. The ongoing refinement of delirium assessment methodologies is expected to substantially improve the caliber of care delivered to this vulnerable population. Nonetheless, the complexities encountered during the assessment process require thorough examination. The discrepancies observed in current delirium assessments, particularly in the selection and application of content and methodologies, are striking.

Implications

The findings in this study highlight an urgent requirement for the development of innovative strategies to overcome these obstacles. It is imperative that clinical practice incorporates a dynamic approach to patient evaluation, initiating assessments following an initial risk factor screening. This approach should be sensitive to regional differences and adapted to the unique attributes of the elderly patient cohort. Additionally, it is recommended that future research and clinical initiatives concentrate on enriching both the content and the assessments methodology of delirium. This may ensure that these tools are more efficacious and attuned to the specific needs of geriatric patients, thereby facilitating a more nuanced and responsive care paradigm.

Furthermore, a more insightful approach to understanding the intricacies of delirium care may involve a comprehensive exploration of the lived experiences of nurses and the dynamics of facilitators and barriers encountered by both healthcare professionals and families. To achieve this, employing a combination of innovative research methodologies is proposed. Specifically, Online photovoice (OPV) offers a platform for participants to visually articulate their experiences, providing a rich, contextually grounded dataset [ 58 , 59 ]. This is complemented by Online Interpretative Phenomenological Analysis (OIPA), which delves into the subjective interpretations and personal meanings attributed to these experiences, thereby offering a profound understanding of the psychological landscape of delirium care [ 60 ]. Additionally, incorporating Community-Based Participatory Research (CBPR) ensures that the research is not only academically rigorous but also practically relevant [ 61 ]. This approach emphasizes collaboration with the community, ensuring that the research is shaped by the insights and needs of those directly involved in managing delirium. The integration of these methodologies is anticipated to yield a multidimensional perspective that respects the complexity of the clinical environment and the lived realities. This methodological synergy is expected to illuminate the nuances of delirium management, offering a robust framework for developing evidence-based interventions and policies that are both responsive to the needs of patients and caregivers and grounded in the realities of clinical practice.

Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The authors would like to appreciate all healthcare professionals who took part in the interviews.

This study was funded by the Scientific Research Fund of Shanghai Municipal Commission of Science and Technology (No.16411951200).

Author information

Mei Wu and Zhen Chen contributed equally to this study.

Authors and Affiliations

Department of nursing, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Mei Wu & Liting Zhao

Day Surgery Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Mei Wu & Lu Xia

Surgical Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Day Care Chemotherapy, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Lirong Zhao

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M W, Z C designed research; M W, Z C, Y X, L Z, L X conducted research; M W, Z C, L Z analyzed data; M W, L X wrote the first draft of manuscript; M W, L X had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Lirong Zhao or Lu Xia .

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In this study, all methods were performed in accordance with the relevant guidelines and regulations. The study was approved by Institutional Review Board of the Huadong Hospital with approval number (No.2018K051). And written informed consents had been obtained from all the included nurses.

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Wu, M., Chen, Z., Xu, Y. et al. A qualitative study of geriatric specialist nurses’ experiences to navigate delirium in the elderly. BMC Nurs 23 , 426 (2024). https://doi.org/10.1186/s12912-024-02100-x

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DOI : https://doi.org/10.1186/s12912-024-02100-x

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Research Article

Acceptance of physical activity virtual reality games by residents of long-term care facilities: A qualitative study

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Validation, Writing – review & editing

Roles Validation, Writing – review & editing

Affiliations Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada, Brain and Mind Research Institute, University of Ottawa, Ontario, Ottawa, Canada

Roles Writing – review & editing

Affiliations Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Ottawa, Canada, School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing

Affiliation Interdisciplinary School of Health Sciences, Faculty of Health Sciences, and Life Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Marjan Hosseini,
Roanne Thomas,
Lara Pilutti,
Pascal Fallavollita,
Jeffrey W. Jutai

Published: June 25, 2024
https://doi.org/10.1371/journal.pone.0305865
Reader Comments

Little is known about the experience and the social and contextual factors influencing the acceptance of virtual reality (VR) physical activity games among long-term care (LTC) residents. Our study aims to address this research gap by investigating the unique experience of older adults with VR games. The findings will provide valuable insights into the factors influencing VR acceptance among LTC residents and help design inclusive VR technology that meets their needs and improves physical activity (PA) and well-being.

We aimed to: (1) investigate how participants experience VR exergames and the meaning they associate with their participation; and (2) examine the factors that influence the participant’s experience in VR exergames and explore how these factors affect the overall experience.

We used a qualitative approach that follows the principles of the Interpretive Description methodology. Selective Optimization and Compensation (SOC) theory, Socioemotional Selectivity theory (SST) and technology acceptance models underpinned the theoretical foundations of this study. We conducted semi-structured interviews with participants. 19 Participants of a LTC were interviewed: five residents and ten tenants, aged 65 to 93 years (8 female and 7 male) and four staff members. Interviews ranged from 15 to 30 minutes and were transcribed verbatim and were analyzed using thematic analysis.

We identified four themes based on older adults’ responses that reflected their unique VR gaming experience, including (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and challenges. Three themes were developed based on the staff members’ data to capture their perspective on the factors that influence the acceptance of VR among LTC resident including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers.

Conclusions

VR gaming experiences are enjoyable exciting, and novel for LTC residents and tenants and can provide physical, cognitive, social, and motivational benefits for them. Proper guidance and personalized programs can increase understanding and familiarity with VR, leading to a higher level of acceptance and engagement. Our findings emphasize the significance of social connection and support in promoting acceptance and enjoyment of VR gaming among older adults. Incorporating social theories of aging helps to gain a better understanding of how aging-related changes influence technology acceptance among older adults. This approach can inform the development of technology that better meets their needs and preferences.

Citation: Hosseini M, Thomas R, Pilutti L, Fallavollita P, Jutai JW (2024) Acceptance of physical activity virtual reality games by residents of long-term care facilities: A qualitative study. PLoS ONE 19(6): e0305865. https://doi.org/10.1371/journal.pone.0305865

Editor: Chao Gu, Tsinghua University, CHINA

Received: July 10, 2023; Accepted: June 5, 2024; Published: June 25, 2024

Copyright: © 2024 Hosseini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The world’s population of individuals aged 65 and above is projected to reach 16% by 2050, indicating a significant increase in the number of older adults [ 1 ]. In Canada, the number of people aged 65 or older (18.8%) is growing faster than the number of children aged 0 to 14 years (15.6%) [ 2 ]. With the increasing proportion of older adults compared to other age groups, it is anticipated that there will be a corresponding growth in the population of older individuals residing in LTC facilities. Ensuring the well-being of older adults in LTC facilities is crucial, as they often exhibit lower levels of PA due to various factors [ 3 , 4 ] with estimates suggesting that they spend about 75% of their waking hours being sedentary [ 5 ]. Promoting tailored PA programs that consider the specific needs and abilities of older adults can enhance social engagement and overall well-being [ 6 ].

Consistent engagement in PA has been demonstrated to enhance functional capabilities, overall health, and well-being, thereby reducing the risk of all-cause mortality, chronic diseases, and premature death among older adults [ 7 ] and VR literature has demonstrated the effectiveness of immersive and interactive VR games in promoting PA among older adults [ 8 , 9 ]. However, for older adults to embrace and utilize new technology, positive experiences are crucial, highlighting the need to understand acceptance factors [ 10 ]. Further investigation is necessary to fully explore the potential of VR technology in enhancing PA and well-being among older adults in LTC, given their vulnerability to the negative effects of physical inactivity [ 11 ].

LTC residents represent a critical population for research and intervention due to their unique challenges and vulnerabilities. They often face limited mobility and physical activity opportunities, heightened prevalence of chronic conditions, increased risk of social isolation, and mental health concerns. Intersection of staffing challenges and issues related to the built environment resulted in suboptimal conditions for physical activity programs [ 12 ]. Given the aforementioned constraints faced by LTC residents, any tool that can reduce inactivity deserves further investigation [ 13 ].

The aim of this study is to investigate the social and individual factors influencing the acceptance of VR physical activity games among residents in LTC facilities. While previous qualitative research has examined the potential benefits of VR technology in promoting physical activity, well-being, and social interaction among older adults [ 14 – 16 ] existing studies have specific limitations that underscore the need for further research. Chaze et al. [ 14 ] focused on evaluating VR content tailored to a specific organization, limiting generalizability. Lin’s study [ 16 ] approached VR leisure activities from a marketing perspective, potentially differing from the needs of LTC residents. Kruse’s study [ 15 ] compared acceptance of VR exergames with traditional video games but did not delve into the influencing factors among older adults. Therefore, further research is needed to understand acceptance factors, inform design, and implement effective VR interventions for LTC residents, promoting PA and overall health outcomes. Our study seeks to address this gap by exploring the social determinants of VR acceptance among older adults, informed by social theories of aging. By conducting open-ended interviews and examining the factors that influence VR acceptance, we aim to inform the design and implementation of VR technology in LTC facilities, ultimately enhancing accessibility and effectiveness for this population.

The Technology Acceptance Model (TAM) [ 17 ] is commonly used to study technology acceptance but has limitations in real-life contexts [ 18 ]. This criticism highlights the need to understand the social determinants of VR acceptance among older adults, which requires research informed by social theories of aging. Open-ended interviews, as suggested by Lin et al. [ 16 ]. This research can inform the design and implementation of VR technology for older adults, enhancing accessibility and effectiveness.

Considering the identified research gaps, exploring the social determinants of VR acceptance among older adults can provide valuable insights into improving the accessibility and effectiveness of VR technology for this population. This focus is aligned with the objective and research questions of our study.

Objectives and research questions

The primary objectives of this study are twofold:

To comprehensively explore the experiences of older adults with VR exergames.
To identify and analyze the individual and organizational factors that significantly influence their experiences and the acceptance of VR games.

To achieve these objectives, we have formulated two specific research questions:

How do participants experience VR exergames, and what meaning do they attach to their participation?
What are the factors that influence the participants’ experience, and how do these factors affect the experience?

Theoretical framework

Our study was guided by SOC [ 19 ] theory and SST [ 20 ] as frameworks to investigate the social and contextual determinants of acceptance of VR technology. SOC focuses on older adults’ awareness of losses and gains and the decline in their resources as a consequence of aging [ 19 ]. According to this theory, individuals select more important or more attainable goals, optimize their performance to maximize the gains, and compensate unachieved goals to maintain functioning [ 21 ]. SOC theory guides our exploration of the selection and optimization of activities and the compensation for losses, while SST underscores the significance of emotionally meaningful social interactions in the context of technology acceptance. SST is a lifespan theory that helps explain the shift of personal goals and behaviors with age. SST introduces the concept of future time perspective (FTP), which refers to one’s perception of time and how much time is left [ 20 ]. The study also draws on the components from TAM [ 17 ], The Unified Theory of Acceptance and Use of Technology (UTAUT) [ 22 ], and The Senior Technology Acceptance Model (STAM) [ 23 ] to investigate the psychological factors affecting VR acceptance. By considering both psychological and social factors, we aim to gain a comprehensive understanding of VR acceptance among older adults and inform interventions and strategies for promoting VR adoption.

TAM indicates perceived usefulness (the extent to which using a specific application system will increase job performance) and perceived ease of use (the subjective probability that using technology will be free of effort) shape the attitudes of the user toward technology that affect the intention of use and determine computer acceptance behavior [ 17 ].

Venkatesh and colleagues developed UTAUT as an integration model of eight dominant theories and models with seven core determinants of intention and usage and up to four moderate determinants [ 24 ]. They stated that performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, and habit as direct determinants and gender, age, and experience as the key moderators play a significant role in user acceptance and usage behaviour.

The senior technology acceptance model (STAM) is the first TAM-based model that goes beyond TAM’s organizational and business context and is specifically formulated to understand gerontechnology acceptance by older adults’ predictive factors of TAM and UTAUT [ 23 ].

We recognize that while technology acceptance models focus on psychological factors to explain users’ acceptance of technology, they overlook the social processes associated with aging. Therefore, we emphasize the importance of considering both psychological and social factors to comprehensively understand VR acceptance among older adults. To fully understand VR acceptance among older adults, both psychological and social factors should be considered. This integrated approach informs interventions and strategies for promoting VR adoption and use. By uncovering social and contextual determinants, this study aims to enhance VR uptake and use among older adults, improving their overall health and well-being.

Our study integrated SOC theory and SST to tailor VR exergame interventions to older adults’ preferences, well-being, and continued participation [ 19 , 20 , 25 ]. SOC theory’s strategies for successful aging guide the selection and optimization of activities, compensating for losses. SST emphasizes prioritizing emotionally meaningful social interactions. Incorporating features that support social connections, emotional well-being, and cognitive and physical stimulation in VR games is crucial to fulfill older adults’ life goals.

Theoretical frameworks of aging guided our data analysis, identifying themes related to social support and goal-driven attitudes towards VR gaming. By analyzing participant interviews, we aimed to understand the role of social support and the influence of goals on attitudes towards VR games. These themes were derived from the application of social theories of aging, providing structure and direction to our study.

To gain insight into factors influencing older adults’ acceptance of VR exergames, we employed TAM components in analyzing staff perspectives. The use of TAM models helped identify key themes related to acceptance. Our study’s integrated approach to theoretical frameworks allows for a comprehensive examination of VR acceptance among older adults, addressing both psychological and social factors to enhance VR uptake and use, ultimately improving overall health and well-being in this population.

Materials and methods

Methodology.

Our study utilized interpretive description [ 26 ] as a qualitative research methodology to understand the unique VR gaming experiences of LTC residents. This approach goes beyond traditional descriptive methods, aiming to uncover deeper meanings and explanations in specific contexts. This approach delves into deeper meanings and explanations within specific contexts. Focusing on the VR gaming experiences of LTC residents and tenants, interpretive description allowed us to explore their perspectives, challenges, and coping mechanisms. By unraveling these unique aspects, this methodology contributes to the development of targeted interventions aligned with the specific needs and preferences of LTC residents and tenants. Emphasizing contextuality ensures findings are not only insightful but also directly applicable to the intricate factors characterizing the LTC environment. In essence, our choice of interpretive description underscores our commitment to understanding the depth and richness of participants’ VR gaming experiences, with direct implications for enhancing their well-being within clinical and care settings. Through semi-structured interviews with residents, tenants, and staff members, we gained practical insights and theoretical understanding by exploring characteristics, patterns, and structures. By employing deductive reasoning, we identified initial codes, themes, and concepts derived from existing theories and models. This study was conducted with ethical approval from the University of Ottawa’s Health Sciences and Sciences Research Ethics Board (Ethics File Number: H-02-22-7627).

Participant recruitment

Data were collected from July 4, 2022 to August 10, 2022 at a community healthcare center serving older adults and veterans in long-term care homes and independent apartments. The facility accommodates two types of individuals: residents and tenants. Residents, typically elderly adults, require round-the-clock care and assistance with daily tasks. On the other hand, tenants sign lease agreements with the facility for a specific duration and enjoy greater autonomy. The participants in this study were a subsample from a related study on VR games conducted a few days prior to the interviews.

Residents and tenants who met the following inclusion criteria were selected for participation: (1) aged 65 or older, residing in LTC; (2) previously took part in the VR games study [ 27 ]; and (3) able to communicate and read in English. Written informed consent was obtained from those who agreed to participate before the interviews (See S1 File ).

Staff members who met the following criteria were included: (1) employed at the facility for at least six months; (2) proficient in English; and (3) directly involved in resident care. Exclusions included staff with less than six months of employment, limited English proficiency, or no direct experience with residents. Gathering staff perspectives provided a comprehensive understanding of the study topic given their close proximity and extensive knowledge. Purposive sampling involved sending emails to staff members responsible for resident activities and programs. The first four staff members who agreed to participate were selected and signed written informed consent before the interviews (See S2 File ). This sampling approach ensured the selection of staff members most suitable to provide insights into the experiences of older adults and veterans in LTC facilities and independent apartments.

In our VR games study, participants engaged with Song Beater , a VR rhythm game that challenges players’ sense of rhythm through dance and slashing flying beats [ 28 ]. Despite not being specifically designed for older adults, Song Beater offers several features that make it suitable for this population, including customizable difficulty levels, seated playing option, one-handed playing with balance support, customizable environment, and the ability to use personal music and adjust song speed. Participants played the game three times within a two-week period.

Data collection

Semi-structured interviews were conducted in person between July and August 2022, within three days after the VR gaming study. Prior to the interviews, participants were provided with an information letter and asked to sign consent forms, ensuring the confidentiality of their responses. All participants were asked the same set of questions regarding their experience with the VR game.

Participants were interviewed once, within 3 days after their participation in the VR gaming study, allowing for sufficient reflection time and reducing initial biases or immediate reactions. Interviews took place in participants’ apartments or private rooms at the LTC facility to ensure comfort and ease during the process. The interviews lasted 15–30 minutes, respecting participants’ time and attention spans while gathering meaningful information. A set of nine open-ended questions, focusing on game characteristics, preferences, experiences, and goals, were used (See S3 File ). interview questions were designed to be open-ended and neutral to allow participants to express their experiences and opinions freely without being influenced by the researchers’ preconceptions. Probing questions and follow-up prompts were employed to elicit detailed responses and ensure comprehensive coverage of relevant aspects [ 29 ]. Interview questions were structured to explore themes related to the theoretical framework’s constructs, ensuring that participant experiences and attitudes towards VR gaming were examined through the lens of age-related variations and social determinants. For instance, questions were designed to probe participants’ interests, goals, social interactions, emotional experiences, and perceptions of game characteristics, aligning with the concepts outlined in SOC, SST, and TAM.

Staff members were interviewed after resident data collection to gather potential feedback. They received information letters, provided informed consent, and answered nine open-ended questions (See S4 File ) regarding barriers to physical activity and factors influencing technology acceptance by LTC residents. Interviews took place during staff members’ break time in their offices, lasting 15–30 minutes to minimize work disruption.

Data analysis

Interviews were audio-recorded and transcribed verbatim. The data analysis followed the interpretive description methodology [ 21 ] and involved three stages: data familiarization, theme and pattern identification, and theme labeling and reporting. NVivo 12 qualitative analytic software (QSR International, release version 1.6.1) was used for coding the transcripts. Inter-rater reliability [ 30 ] was ensured through independent coding of five transcripts (three of the transcripts were the same and two were different) by two researchers, followed by consensus discussions to address any discrepancies. Inter-rater reliability checks were conducted to ensure consistency and objectivity in the data analysis process and reduce the risk of individual biases shaping the interpretation of findings. As analysis progressed, the theme "game characteristics" was refined into "Enjoyment, excitement, and the environment" to capture a nuanced understanding of player experiences.

Preliminary themes were developed through detailed analysis and discussions, considering the source data and codes [ 31 ]. Observations and field notes provided valuable context. The data were examined for themes related to TAM, SOC, and SST constructs, providing a theoretical foundation for the study. A combination of social and psychological theories was employed to explore technology attitudes and their age-related variations. SOC guided the exploration of participants’ interests, goals, and social interactions, while SST focused on emotional experiences and social connections. TAM facilitated the examination of game characteristics, perceived usefulness, and ease of use.

To maintain the integrity of our study, we followed established qualitative research principles, employing interpretive description as our robust methodology to explore the distinct VR gaming encounters of LTC residents. Clear participant recruitment criteria, ethical approval, and informed consent were meticulously addressed to enhance credibility and respect ethical considerations. A strategic sampling approach, detailed VR game description, and structured data collection with temporal considerations were implemented to provide a comprehensive understanding of the study topic. Rigorous data analysis using NVivo 12 software, inter-rater reliability, and a theoretical foundation grounded in social and psychological theories further strengthened the study’s credibility, dependability, and transferability. These methodological considerations collectively contribute to the rigour of our study and formed a solid foundation for meaningful interpretation and generalization of findings.

Resident and tenant participants’ characteristics

Twelve tenants (80%), three residents (20%), and four staff members from an LTC facility participated in the interviews. The participants’ ages ranged from 66 to 93, with a median age of 78. The gender distribution was eight female participants (53.3%) and seven male participants (46.7%). The number of participants was above the recommended number for saturation by Guest and colleagues [ 32 ], as which suggests that data saturation occurs within the first twelve interviews in qualitative methods. Educational backgrounds varied, with 40% having a bachelor’s degree or higher. Most participants (66.7%) had prior gaming experience, while the remaining (n = 5, 33.3%) did not. Table 1 depicts resident and tenant participants’ characteristics.

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https://doi.org/10.1371/journal.pone.0305865.t001

Identified themes

We developed four themes to understand older adults’ VR experience and perceptions: (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and Challenges. In addition, themes were identified from staff members’ data, including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers.

Themes developed from older adults’ data were analyzed using SOC and SST. These themes relate to experience of VR gaming and how older adults prioritize certain activities and social connections as they age and compensate for declines in other areas and how they prioritize emotionally meaningful goals.

Staff members’ themes of “Relevance and personalization,” “Training and guidance,” and “Organizational and individual barriers” were analyzed using TAM, STAM, and UTAUT. These themes relate to the perceived usefulness and ease of use of the technology, as well as individual and organizational factors that may facilitate or hinder its acceptance.

The themes were derived through iterative coding and thematic analysis, where recurring patterns and insights emerged from the participants’ narratives. For example, the theme of "Enjoyment, excitement, and the novel environment" emerged from participants’ reflections on their experiences with VR gaming. Constructs such as enjoyment, excitement, and immersion were identified through careful analysis of participant responses, highlighting their emotional and experiential dimensions.

Similarly, the theme of "Physical activity and motivation to exercise" reflected participants’ perspectives on the role of VR exergaming in promoting physical activity and motivation. Constructs like physical exertion, motivation, and exercise adherence were inferred from participant accounts, demonstrating the multifaceted impact of VR gaming on physical well-being.

These themes were analyzed in the context of theoretical frameworks such as SOC, SST, TAM, STAM, and UTAUT, which provided a theoretical lens to interpret the findings. Constructs from these frameworks were mapped onto the identified themes, allowing for a deeper understanding of the underlying mechanisms driving participants’ experiences and perceptions.

Older adults’ themes- The meanings attached to the VR gaming experience

These themes represent the experience of VR exergaming and portray the meanings that older adult participants attached to their VR gaming experience. Table 2 shows an example of how questions, themes and constructs of theoretical frameworks are formed and connected in older adults’ themes.

https://doi.org/10.1371/journal.pone.0305865.t002

Enjoyment, excitement, and the novel environment.

This theme represents older adults’ reflections on the pleasure, enthusiasm, and sense of novelty derived from engaging in VR gaming. Participants in the VR gaming experience found themselves immersed in a captivating world, filled with excitement, vibrant environments, and joyous interactions. As one participant put it, " I felt so excited ! It was fun ! It’s really neat ! It just brings happiness" (P5) .

Participants found the VR gaming experience enjoyable, with the most cited features being the novel environment and fun nature of the game. Three participants specifically identified their gaming experience as fun, with one stating, "Look at the beautiful fish" (P5), another expressing, "Neat , awesome" (P14), and a third participant exclaiming, "I saw a cat ! I thought it was my cat ! " (P12). They continually commented on the environment and game details and laughed when surprised during gameplay. One participant expressed their overall enjoyment, stating, "It’s been a fun experience which I am thankful for" (P11).

Participants emphasized the importance of various game characteristics. Vibrant colors, immersive environments, and high-speed dynamics were key factors contributing to their enjoyment. The realistic design elements, such as Egyptian pyramids and underwater worlds, along with animated animals and fish, further enhanced the gaming experience. One participant appreciated the visually stunning environment, stating, "I liked the environment; it was very beautiful , the underwater environment" (P11). Another participant expressed fascination with dynamic elements in the background, particularly observing animals like the lion, which added to their immersion: "Something that I found interesting was in the background . The animals and the other things going on and watching the big cat , the lion … " (P6). These insights provided a deeper understanding of the specific game characteristics that captivated and brought enjoyment to the participants.

The VR game’s fast and seamless responsiveness to participants’ movements was surprising, providing an empowering and liberating experience, especially for those with physical limitations. One participant expressed their astonishment, stating, "How crazy is that in this world ? You are not vulnerable even , the VR , move a piece , and it happens right away ! " (P5). This quote suggests that VR allows individuals to freely engage in activities without feeling vulnerable, a possibility that may not exist in the physical world.

The game provided a unique and engaging experience, capturing participants’ attention and interest throughout gameplay. It instilled a sense of accomplishment and satisfaction as they progressed. One participant described it as follows: "It was very engaging … it built intensity … it wasn’t just one thing around every minute . It slowly introduced maneuvers , picked up the speed , and became very challenging" (P4).

Many participants appreciated the immersive nature of VR technology, which enabled them to fully engage in the virtual game world and interact with it realistically and intuitively. As one participant expressed, "I feel like I’m facing real life , but the design is not quiet . I want to be immersed more in the game" (P9).

Music played a crucial role in generating excitement during the game. Participants actively paid attention to the songs and recognized their impact on the game’s rhythm and flow. Some even sought out other songs from the game’s playlist to increase the pace and excitement. Perspectives on the role of game music varied among participants. One participant expressed deep appreciation, explaining how it enhanced their personal involvement and enjoyment: " I love music; I love dancing , so then it brought more of me with the music . The music , I would say , I’m present more . [Laugh]" (P7). In contrast, another participant viewed game music as mere auditory disturbance, describing it as "Music is a noise" (P11).

Such findings align with the framework of SOC which proposes that individuals adapt to the aging by focusing on their goals and optimize the meaningful activities while compensating for the limitations. Participants optimized the enjoyment by engaging in VR game, compensating for any physical limitations. The findings align with the SST framework. Participants in this study sought out VR gaming to maximize enjoyment and positive emotions. The SST lens highlights how older adults are driven by emotional motivations, seeking enjoyable experiences like VR gaming to foster positive emotions and enjoyment throughout the aging process.

Physical activity and motivation to exercise.

This theme explores older adults’ perspectives on the role of VR exergaming in promoting PA, motivation, and adherence to exercise routines. Participants recognized the connection between PA and motivation during their VR gaming experience. They acknowledged the importance of PA within the VR context, which provided benefits such as improved coordination, balance, and upper body workout. Two participants highlighted the positive exercise effects; P4 stated, "I have some exercise from it , and I’m conscious of that , as my arms go back and forward and try to catch those Frisbees" (P4). Similarly, P9 described the game as "a good way to exercise" and emphasized the muscular and visual benefits: "For my age , it’s a good way to exercise , for the muscle and for the visuality" (P9).

Another participant mentioned feeling warm during the gameplay and needing to turn on a fan, suggesting that the game provided a demanding PA that raised their body temperature. However, some participants viewed the game as an "add-on" (P2) or an "upper body exercise" (P8), focusing primarily on engaging the upper body rather than the entire body.

In addition to physical benefits, Participating in the VR game also brought awareness to some older adults regarding their physical limitations. One participant expressed frustration with their left hand’s accuracy compared to their right hand, stating, "I was annoyed with myself that my left hand was not as accurate as my right hand . I’ve always been right-handed . I don’t use my left hand very much at all" (P8). This realization showcases how VR has the potential to enhance self-awareness and uncover previously unnoticed physical limitations.

Besides the physical benefits, the challenge of the game and the sense of accomplishment that came with overcoming it motivated the players to perform better, achieve higher scores, and test their abilities. Some players even saw it as a challenge against the VR machine and tried to outsmart the system. As one participant stated: “I think the challenge of getting as highest score as you possibly can , so you do it once , you get a score , the second time you want to beat your score . ” (P4)

A participant expressed that the game served as motivation for PA and helped them escape daily life challenges, offering a distraction and alleviating depression, "It takes me out of my everyday tasks and everything and brings me to another world… you see the fishes and things like that and makes you forget you are in the house , and you take the thing [headset] out , and you see oh ! I’m in the house" (P12). Another participant emphasized the importance of the VR experience in combating social isolation and building confidence post-COVID-19 lockdowns. The VR experience brought them happiness and a sense of security, preparing them for rejoining society. “A really good space to be in , after you have a bad day , wow ! Increase your thoughts and your endorphins , you know , just puts you in a happy mood . ” (P5)

The use of SOC revealed that VR gaming gave older adults a sense of purpose, motivating them to improve scores and challenge themselves. It also increased self-awareness, as one participant discovered accuracy differences between their hands. VR gaming contributed to physical well-being by providing a meaningful activity that enhanced self-awareness and personal growth.

Also, SST helps us understand the motivation aspect of the theme. According to SST, individuals choose goals and activities that provide personal satisfaction while minimizing effort. In this case, VR gaming offered a fun way for older adults to be physically active, providing a sense of accomplishment and motivation. It motivated participants to exercise, bringing happiness and well-being by serving as a distraction from daily challenges.

Social connection and support.

This theme refers to older adults’ experiences of social interactions, connection, and emotional support facilitated through VR gaming, including the impact on social relationships. Participants viewed the game as an opportunity to socialize and connect with others, whether with their friends in the facility or family members who live far away: “I wouldn’t mind playing my grandson . [It] Would be a challenge , if I wasn’t successful that was fine , but this is something to do together . ” (P7) One participant expressed their preference regarding a possible setup for the game for group gameplaying: “If it could be set up for two players and one hit one colour , and one hit the other colour , that would be a challenge” (P10).

Participants went beyond involvement, recommending friends to the researcher as potential participants. Their proactive approach and follow-up inquiries demonstrated interest in the study’s success and created a sense of community. This highlighted the importance of social support in promoting engagement and participation, showcasing the potential benefits of VR gaming for LTC facility residents.

Participant sharing of VR gaming experiences enhanced self-efficacy and performance, highlighting the potential of social support and knowledge sharing. Technical support increased confidence in technology use, with a desire to continue playing if volunteer assistance is available: "If we have a volunteer , hopefully , we can . Somebody that could be available" (P5). Two participants emphasized the importance of support in navigating the game: "You escorted me through … if I had been there by myself , I might have had difficulties" (P4), "If you weren’t here , I don’t know how I would go through" (P5).

Staff and family encouragement significantly influenced acceptance and enjoyment of VR games. One couple shared their scores with their son, who expressed amazement and motivated them to continue: "I certainly would be interested in another project … I said to my son : I tried that [VR] , and I guess I was pretty good at" (P7).

Participants were motivated to engage in VR gaming for socialization, aligning with SOC principles. SST emphasizes prioritizing emotionally meaningful relationships as individuals age. Participants’ enthusiasm and support for the VR gaming study highlight potential benefits for LTC residents and the importance of social support in promoting engagement. Technical assistance during the VR gaming experience was crucial, emphasizing the role of emotional support and guidance.

Individual preferences and challenges.

This theme explores participants’ preferences, challenges, and barriers in VR exergaming, including technical difficulties, physical limitations, and personal preferences for game features. Participants’ experiences were influenced by their interests and prior gaming experience. Some expressed enthusiasm to explore the full potential of VR: "I would like to continue with VR and explore its capacity" (P3, experienced gamer). Others, with less experience or health concerns, appreciated the exercise and novelty: "Good exercise , concentration , focus , and challenge" (P14, with comorbidities).

The gaming experience had some challenges for participants. Those without prior experience found the game setup and menu navigation difficult, hindering their engagement. Some participants, even after adjusting the speed, felt the game was too fast for their reflexes: "Perhaps for an older person , it must be slower" (P7). These challenges impacted their enjoyment and acceptance of the game.

The boxing game involved punching flying objects without button presses, but the controller buttons posed challenges for some participants. Accidental button presses interrupted the game, requiring extra effort to resume: “I was happy to see how easy it was , except about the controllers . I never got master of those . ” (P7) Additionally, some participants found the headset weight burdensome, further affecting their experience and interaction with the game.

Some participants prioritized health-related goals to maintain an active and enjoyable life: "to keep a healthy and active life" (P1) and "to reach 100" (P5) to spend time with grandchildren. The goals expressed by participants align with the SOC theory, as they actively select and optimize important goals while compensating for age-related limitations. These goals include maintaining physical activity, controlling blood sugar, and losing weight, reflecting their focus on health and well-being.

The participants in our study actively selected and optimized health-related goals, such as maintaining physical activity and controlling blood sugar, while compensating for age-related limitations, aligning with the SOC theory. These goals were emotionally meaningful, contributing to their overall quality of life. Additionally, goals related to family time and fostering social connections within their living facility were consistent with the SST, highlighting the importance of social relationships and emotional well-being.

Staff members’ themes- Determinants of VR acceptance by residents

The staff members’ perspectives provided valuable insights into the factors influencing the acceptance of VR games among LTC residents. Being in frequent communication with the residents and involved in decision-making regarding recreational programs and physiotherapy practices, the staff members were well aware of the residents’ needs and preferences. Table 3 depicts examples of the questions, themes, quotes and relevant models.

https://doi.org/10.1371/journal.pone.0305865.t003

Relevance and personalization.

Staff members stress the importance of tailoring VR games to LTC residents’ individual needs and interests for better acceptance. This involves designing games with relevant themes and user-friendly equipment. One staff member stated, " Having whatever they see relevant to their lives may affect them here" (S1). Participants’ experiences support this approach, with one likening the game to the View-Master and another recalling positive memories while playing. VR gaming has the potential to evoke positive emotions and increase acceptance among older adults.

The relevance and personalization of VR games can be analyzed using TAM’s perceived usefulness component. TAM highlights that perceived usefulness and ease of use determine technology acceptance. When games align with players’ interests, they are seen as more useful, increasing acceptance. Additionally, user-friendly equipment enhances ease of use, further promoting acceptance.

Training and guidance.

Staff members highlighted the role that education and support from both family members and staff members play in the acceptance of VR games among residents. They emphasized the importance of educating LTC residents on the proper use and potential benefits of VR games. This education can help increase residents’ understanding and familiarity with the technology, leading to higher acceptance and engagement.

They believed that family members could provide emotional support and act as a source of guidance and information, helping residents feel more comfortable and confident using VR games “If you have a family that is very supportive of this project and trying this new thing , it would play a huge role . ” (P3). On the other hand, staff members can provide hands-on assistance and support during VR games, helping residents navigate the technology and troubleshoot any issues that may arise:

A staff member emphasized the need for researchers and staff to prioritize relationship-building when working with LTC facility residents, especially in research or implementing new technologies like VR. Due to the residents’ vulnerability and unique perspectives, it is crucial to consider their specific needs. Older adults who are introduced to VR require trust and a sense of safety to fully embrace the new experience. This can be established through effective communication and comprehensive training provided by researchers: “Taking that time to build those relationships because using a headset it’s like , virtual reality , it changes your reality , so you need to know that you are safe , somebody safe is there with you . ” (S4)

Staff members believed that educating LTC residents on the benefits of VR games and providing them with guidance can help increase their understanding and familiarity with the technology, leading to higher acceptance and engagement: “It’s just really a lot about education . ” (P4). This aligns with the TAM model’s emphasis on perceived usefulness as a key factor in technology acceptance.

Organizational and individual barriers.

Staff members noted organizational and individual challenges that hinder the acceptance of VR games among LTC residents. These barriers, identified through interviews, can be categorized as affordability, equipment maintenance, and a shortage of staff to assist with VR headset usage and the individual barrier relates to health issues.

One significant organizational barrier is the cost of purchasing VR sets, which can limit availability and accessibility for LTC residents: "How much does it cost for that technology ? And then would the facility be able to buy it ? " (S1). Troubleshooting, equipment maintenance, and a shortage of staff assistance further hinder the implementation of VR gaming in LTC settings. Technical issues require specialized knowledge, and the limited availability of trained staff to assist residents with VR headset usage poses challenges: "If it takes a long time to set up … whatever it is… But also troubleshooting . Because if there is a problem with it , I know the healthcare team doesn’t have any time to really do it" (S1).

Individual barriers encompass cognitive and physical health issues faced by LTC residents. Cognitive impairments, such as dementia or age-related decline, can hinder their comprehension and engagement with VR gaming: "There are barriers with Dementia … your perception of reality might be disordered" (S3). Mobility limitations can also impact their ability to interact with VR equipment and participate in physical activities within the virtual environment: "Maybe it’s a ball game asking to the left , and the physical problem would be on the left arm . So , the difficulty would be how to reach the ball on time" (S2).

The mentioned organizational barriers, including affordability, difficulties with equipment maintenance, and staff shortage, can be associated with the UTAUT model’s construct of price value and facilitating conditions [ 22 ]. Individual barriers, such as physical and cognitive health issues, can be linked to the STAM model’s constructs of physical functioning and cognitive ability [ 23 ].

Our study offered unique insights that advance the existing literature on VR technology in LTC settings. By drawing upon social theories of aging, such as SOC and SST, we gained a deeper understanding of how older adults prioritize activities and social connections while navigating declines in other areas. This theoretical grounding allowed us to explore the motivations and barriers influencing technology acceptance among older adults, providing a comprehensive understanding of VR technology acceptance in LTC facilities.

One of the significant findings was the multifaceted benefits of VR gaming experiences for older adults, including physical, cognitive, social, and motivational aspects. These benefits suggest that VR technology has the potential to enhance the lives of older adults in LTC facilities by providing new opportunities for engagement and interaction. For instance, the immersive nature of VR offered an escape from pandemic-related stress and isolation, thereby improving social interactions and cognitive stimulation.

Our study also identified key factors influencing the acceptance of VR technology, such as the importance of staff understanding residents’ needs, education and support from family and staff, and addressing organizational barriers like cost and maintenance. These findings underscore the necessity of a supportive environment for successful VR implementation.

Varying levels of technological familiarity among participants and different perspectives between older adults and staff members were the challenges in interpreting the findings of our study. Older adults’ experiences were influenced by their emotional and social priorities, while staff members focused on practical considerations like perceived usefulness and ease of use.

Our findings align with existing literature on VR’s impact on social engagement among older adults in LTC settings. Factors like staff training, and barriers such as technology adaptability and concerns about technology characteristics, reflect common themes in prior research [ 33 ]. Recognizing these parallels underscores VR’s potential to enhance social engagement and well-being in LTC. The findings of our study indicated that residents and tenants of LTC facilities can derive physical, cognitive, social, and motivational benefits from VR gaming experiences. This aligns with previous research by Peng et al. [ 8 ] and Skjæret et al. [ 9 ] highlighting the positive impact of VR games on facilitating physical activity and overcoming space or staffing limitations. Importantly, our study demonstrated that older adults could enjoy and adapt to VR games with proper guidance.

Our research underscored the significance of understanding older adults’ needs and preferences in designing personalized VR programs. Similar to studies by Chaze et al. [ 14 ] and Lin et al. [ 16 ], our emphasis on ensuring a positive experience with VR technology highlighted the importance of fun, safety, and ease of engagement. Emotional and hands-on support, education on proper use and benefits of VR games, and establishing trust and safety emerged as critical factors for increasing acceptance and engagement among older adults.

In conclusion, our study successfully investigated older adults’ attitudes towards a VR physical activity game and identified key factors influencing their acceptance of this technology. By focusing on individual and social aspects, we provided insights into participants’ perceptions of VR technology’s usefulness, immersion experiences, and feelings of comfort and safety.

We highlighted the potential of VR technology in addressing mental health challenges associated with social isolation, particularly during the pandemic. The immersive nature of VR offered an escape from stress and isolation, potentially preventing related mental health issues.

Our research also revealed distinctions between the perspectives of older adults and staff members. Older adults’ views were rooted in social theories of aging (SOC and SST), while staff members’ themes aligned with TAM models. This gap underscores the need for incorporating social theories of aging into technology studies to better understand how aging influences technology acceptance among older adults.

In summary, our study contributes to the existing knowledge on VR technology acceptance among older adults and emphasizes the importance of integrating social theories of aging in future research to address their unique needs and preferences effectively.

Limitations and strengths

Our study addressed the gap in research on VR technology acceptance among older adults in LTC facilities. We examined both individual and social factors, uncovering dimensions not fully accounted for in existing acceptance models. Additionally, we explored the effects of VR on PA and social interactions, revealing the potential benefits of integrating VR into their daily routines.

Our study has certain limitations that need to be acknowledged. The use of masks during data collection, necessitated by the COVID-19 pandemic, posed challenges for participants with hearing issues, potentially affecting the quality and validity of the data. The prolonged lockdowns and communication restrictions could have influenced participants’ experiences and priorities, warranting consideration of the pandemic’s impact. Furthermore, the study’s focus on specific VR content restricted the generalizability of conclusions regarding VR technology acceptance in the broader population.

Recommendations

This study contributes to the growing body of research on the use of VR in LTC facilities and provides practical implications for future research and implementation.

Recommendations for future research.

Future investigations concerning technology acceptance among older adults should strategically integrate social theories of aging, notably SOC and SST. This methodological approach will facilitate a more comprehensive understanding of the multifaceted factors influencing the acceptance of technology among older adults. Analyzing how aging influences their acceptance through experiential lenses can yield nuanced insights, shaping the development of technology tailored to their distinct needs.

To successfully integrate VR gaming into the lives of LTC residents and comprehend the intricate interaction dynamics between older adults and VR games, researchers should explore several key areas. Investigating the enduring effects of VR gaming on physical activity, motivation, and mental health can provide a holistic assessment of its impact on the well-being of older adults. Delving into the influence of diverse music types on gameplay and user enjoyment can contribute to the creation of more personalized and engaging experiences. Additionally, exploring the potential of VR gaming as a form of physical therapy and exercise can enhance self-awareness of physical limitations.

The significance of social support in fostering engagement and acceptance of VR gaming among LTC residents is evident from our observations. Future studies should meticulously incorporate social support mechanisms in their design and execution to optimize the benefits for this demographic. Crafting personalized and relevant VR games aligned with LTC residents’ interests is paramount. Educating and supporting both residents and their families to enhance acceptance and engagement with VR games should be a central focus. Establishing trust and safety when introducing new technologies and addressing organizational and individual barriers are imperative considerations.

Lastly, research endeavors should delve into the potential of VR gaming as a tool to alleviate social isolation, a pervasive concern for many older adults. Comprehensive exploration in these areas can contribute to the effective implementation of VR gaming in LTC facilities and elevate the quality of life for older adults.

Recommendations for designers.

In order to optimize the usability of VR games for older adults, designers are encouraged to integrate specific design principles. Firstly, an emphasis should be placed on cultivating a simple and intuitive interface, characterized by easy-to-navigate menus, larger buttons and text, and explicit instructions. This adherence to a minimalist design philosophy serves to enhance the overall user-friendliness of the interface. Secondly, the gameplay should adopt a deliberately slow-paced structure, incorporating extended intervals for each task to effectively mitigate the occurrence of motion sickness while concurrently heightening the enjoyment factor. Thirdly, designers are advised to judiciously restrict the number of head and body movements required, given the potential challenges older adults may encounter with swift or extensive motions. This strategic reduction in movement requirements stands to substantially augment the accessibility of the game. Finally, the provision of customizable settings, encompassing adjustable parameters such as brightness, contrast, speed, and text/button size, affords older adults the opportunity to tailor the game to align with their specific needs and preferences. The assimilation of these meticulous design principles is posited to empower VR game designers in the creation of games that not only exhibit heightened usability but also elicit a more enjoyable experience for the older adult demographic.

Supporting information

S1 file. older adults interview consent form..

https://doi.org/10.1371/journal.pone.0305865.s001

S2 File. Staff members interview consent form.

https://doi.org/10.1371/journal.pone.0305865.s002

S3 File. Older adults interview guide.

https://doi.org/10.1371/journal.pone.0305865.s003

S4 File. Staff members interview guide.

https://doi.org/10.1371/journal.pone.0305865.s004

Acknowledgments

We extend our heartfelt thanks to the healthcare center catering to older adults in Ottawa. We are grateful for the cooperation and assistance provided by the dedicated staff and residents and tenants during the study.

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31. Rubin H, Rubin I. Qualitative Interviewing (2nd ed.): The Art of Hearing Data [Internet]. 2455 Teller Road, Thousand Oaks California 91320 United States: SAGE Publications, Inc.; 2005 [cited 2023 Feb 21]. Available from: https://methods.sagepub.com/book/qualitative-interviewing

Open access
Published: 22 June 2024

A qualitative exploration of experts’ views about multi-dimensional aspects of hookah smoking control in Iran

Sara Dadipoor 1 ,
Azin Alavi 2 ,
Hadi Eshaghi Sani Kakhaki 1 ,
Nahid Shahabi 1 &
Zainab Kader 3

BMC Public Health volume 24 , Article number: 1665 ( 2024 ) Cite this article

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The related literature has primarily addressed cigarette smoking control. It seems that researchers have failed to explore the determinants of hookah smoking (HS) control. In an attempt to fill this gap, the present study explores experts’ views about aspects of HS control in Bandar Abbas, a city in the south of Iran.

The present qualitative study, conducted in 2022 and 2023, used a content analysis. To this aim, 30 experts in tobacco prevention and control were invited to participate in the research. Twenty seven accepted the invitation. In-depth, semi-structured, and face-to-face interviews were held with the experts. A purposive sampling was used and the data collection continued until data saturation. The interviews lasted between 18 and 65 min. MAXQDA 10.0 was used for data management and analysis.

The expert interviewees had a mean age of 44.77 ± 6.57 years and a mean work experience of 18.6 ± 6.8 years. A total number of six main categories were extracted from the data, including usin influential figures to control HS, controlling HS by alternative activities, changing beliefs and attitudes toward HS, taking administrative and regulatory measures, and facilitating HS cessation.

This qualitative study explored the multifaceted ways people adopt to quit HS. Using influential figures to control hookah smoking, promoting alternative activities as a means of control, changing beliefs and attitudes, enforcing administrative regulations, and facilitating quit attempts all play an important role in tackling the prevalence of hookah smoking. These findings emphasize the importance of a comprehensive and multifaceted approach to integrate various interventions to effectively address hookah smoking behavior.

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Introduction

Hookah is a smoking device used in many countries and is also known as waterpipe, argileh, shisha, goza and narghile. In this device, smoke passes through water in a bowl, where it is cooled and filtered before being inhaled. Hookah is a traditional device for tobacco consumption [ 1 ], originating from the Middle East. Today, it is globally popular particularly among young adults and women [ 2 , 3 ]. In the world, flavored tobacco and the absence of regulatory policies have led to the increased rate of hookah smoking (HS) [ 4 ]. As recently reported by WHO, tobacco consumption would account for 8 million cases of mortality worldwide on an annual basis [ 5 ]. As the research by Le et al. showed, current hookah smokers (HSs) had a 37% higher odds of mortality from all causes than non-smokers, while former HSs had a 39% higher odds of mortality from any cause than non-smokers [ 6 ].

According to a review article, most studies showed an increasing rate of HS between 2009 and 2016. This increase has ranged between 0.4 and 2.9% annually in East Mediterranean area and between 0.3% and 1% in Europe [ 7 ]. The prevalence of HS varies significantly across gender and region in the Middle East. In 2019, the prevalence among males and females was estimated to be 32.7% and 46.2%, respectively, in Lebanon, 13.4% and 7.8% in Jordan, and 18.0% and 7.9% in Palestine [ 8 ]. HS, especially among women, is becoming more and more socially acceptable as a normative behavior in the region [ 9 ]. In Iran, it is estimated that 82% of women who smoke tobacco use hookahs [ 10 ]. The overall prevalence of HS among Iranian women is reported to be 3.8–6.3% [ 11 , 12 ]. However, there are large regional variations in HS in Iran. The prevalence of HS in women in the southern provinces such as Hormozgan is 9–10 times as high as other provinces [ 13 ]. In Bandar Abbas in Hormozgan, the prevalence is 15.1%, which is higher among women than men [ 14 , 15 ]. The high prevalence of HS in Hormozgan can be due to the local culture, underestimated HS health risks, variety of jobs found in hookah cafes, and the lack of any tobacco control measures [ 16 , 17 ].

As a complicated behavior, HS is influenced by many internal and external factors. Some are personal, yet others are interpersonal, social, political and organizational. Among these factors are positive attitude, underestimated health risks of HS, psychological and social gaps, physical and mental attachment to hookah, family issues, media advertisement, ease of access (availability) and the absence of prohibitory rules and poor monitoring and management [ 16 , 18 , 19 ]. Family support, social and psychological needs, family norms, control of external stimuli and political factors have been among the major factors involved in hookah cessation [ 20 ].

Although the control of effective factors in HS or hookah cessation can, to some extent, help prevent this unhealthy behavior, exploring the determinants of HS control can be particularly useful. The related literature has focused more on controlling cigarette smoking and attended less to all aspects of cigarette smoking prevention and control. Each study in the literature has only addressed one aspect of the matter [ 21 , 22 , 23 ]. Researchers have largely neglected the exploration of determinants of HS control. To the best of the present researchers’ knowledge, few qualitative or quantitative studies have been conducted on tobacco control strategies, especially about HS. Thus, it is essential to fill this gap in literature. The field experts’ comments need to be solicited. The present study explores the experts’ views of the aspects of HS control in Bandar Abbas, a city in the south of Iran.

Materials and methods

Study design.

The present study employed a qualitative approach, and held in-depth, semi-structured, face to face interviews in Bandar Abbas, a city in the south of Iran in August 2022-June 2023.

Of note is that, in Bandar Abbas city in Hormozgan, HS has cultural-historical roots. Tobacco use has run in this city for long. More particularly, hookahs have passed down from older generations to the younger. Hookahs are commonly used to entertain guests in ceremonies of joy and sorrow.

The prevailing culture in Bandar Abbas normalizes HS more than cigarette smoking. HS is very common in women’s get-togethers [ 24 ]. Also, the weather conditions and facilities of the city have made HS a recreational activity for the public, especially during seasonal economic recessions when people have more spare time [ 16 ]. Moreover, the influence of stakeholders in tobacco industry has further spread HS in Bandar Abbas and southern Iran [ 16 ].

Participants

Initially, 30 experts in tobacco prevention and control were invited to participate in the study. Twenty-sevel experts accepted the invitation to participate. They had at least 5 years of work experience in controlling and preventing tobacco consumption. They had at least a bachelor’s degree of science to be included in the study.

Inclusion criteria

having academic qualification in the topic of interest.

Exclusion criterion

unwillingness to participate in the research.

The interview guide contained two parts, one enquiring about demographic information such as age, and place of residence, and the other concerning the participants’ overt and covert beliefs about the HS. The interview guide was checked by a panel of five experts in smoking control and qualitative research methodology to decide wether it was appropriate for the study. Adaptations (based on participants’ feedback) were made to the guide after the first five interviews. Once the interview guide was adapted and finalized, the final version was used as the basis of all remaining interviews. The interviews lasted between 18 and 65 min.

Each interview began with four main questions in the interview guide. As the interview continued, follow-up questions were asked to get more details. Probe questions were asked when further exploration was needed. Table 1 contains a list of questions that were asked during the interview.

Data collection

The interviews were conducted by two researchers. Each interview took approximately one hour. The interviews were conducted at a time and place convenient for the participants. All interviews were held in a quiet place such as the expert’s work office, a private room at the research center, or a place preferred by the participant such as a park or coffee shop. The sampling method was purposive and snowball. After each interview, the interviewee was asked to suggest the next participant. The anti-tobacco consumption organization in Hormozgan Province was visited to find the first expert to interview. After making an appointment with the first expert, the time and place of the interview were set as the interviewee preferred. When the interview was done, the interviewee was asked to suggest a colleague for the next interview. Therefore, purposive and snowball sampling were used to include the experts. The data collection continued until data saturation.

The following attempts were made to increase the rigor of findings: (1) Sufficient time was spent on data collection (August 2022-June 2023); (2) To make sure of the accuracy of researchers’ interpretation of expert comments, the findings were made available to eight participants via random sampling. After receiving their feedback, minor changes were made to the data; (3). The data were provided to the 2nd and 4th authors who were expert in qualitative research. Their comments helped define and revise the categories and sub-categories. To ensure the confidentiality of findings, the categories, sub-categories and a sample coding were provided to two external experts with a robust confidentiality agreement. Comments made by these experts and the present researchers were in some cases contradictory. These contradictions were resolved through discussion and in reference to the initial interviews. Initially, a total of 7 main categories were identified from the data. Among these categories, there was a contradiction in the number of two classes. Following discussion and decision-making by the authors, two classes were merged into a single category named “Using influential figures to control HS.” Additionally, there was a discrepancy in naming the 3 sub-categories within the categories.

Ethics approval and consent to participate

As for ethical considerations in this study, the procedure was approved by the Hormozgan University of Medical Sciences (#IR.HUMS.REC.1400.369). The purpose of study was revealed to all participants and they were ensured of the confidentiality of information they provided. All participants were required to sign an informed consent and were assured they could withdraw in any phase of research. All the research procedure was accordance with the relevant guidelines and regulations of research ethics.

Data analysis

All interviews were audio-recorded and then transcribed. After a detailed initial textual analysis of each interview, the next interview was made. The interviews were reviewed independently line by line with an open coding approach to identify the underlying concepts in participants’ statements. When the analysis went on, the code and category extraction followed. The similarities and differences were found and distinguished from each other in terms of inherent features and dimensions. Finally, through comparing the categories, some sub-categories were merged and the main categories were finally formed. Researchers reviewed all the extracted codes in a meeting and discussed the categories and subcategories. They agreed on the majority of categories and subcategories, and only disagreed on a few cases, later solved by referring to the initial interviews and re-examining the codes. The extracted codes were processed in MAXQDA10.

Among the 30 experts in tobacco consumption invited to participate in the study, 27 entered the study. One refused to participate due to work obligations. The mean age of the expert interviewees was 44.77 ± 6.57 years. Their work experience ranged between 5 and 28 years with a mean value of 18.6 ± 6.8. Table 2 summarizes other relevant information.

Totally, six categories and 20 sub-categories emerged from the data analysis. The amount of data was very large, so we decided to focus only on determinants that had been less addressed in the literature. “Changing beliefs and attitudes toward HS” is not discussed, and only five categories and 17 subcategories are dicussed here (Table 3 ).

The frequency and proportion of experts commenting on each subcategory are shown in Table 4 . The subcategories are listed in descending order. Family support, with the frequency of 88.89%, is the most frequqnetly discussed topic by experts in the interviews.

Using influential figures to control HS

“Using influential figures” showed to be a key determinant of HS control. This main category had several distinct sub-categories as addressed here.

Non-governmental organizations’ (NGOs) participation

As the majority of participants agreed, non-governmental organizations (NGOs) can bring many innovative ideas and potentials, and can significantly help prevent, control and cease HS if used besides executive governmental organizations. More public reliance on and better reception of NGOs can be one reason why NGOs should be involved in making the required preventive measures by the government. Below are some comments that the participants made on this category:

“Trying to incorporate NGOs can have dramatic effects because NGOs are created by people themselves. That is why the public trust them more, because they are seen as the link between people and the government. NGOs communic ate well with ordinary people”. (Female, 22 years of experience)

“NGOs have a great potential to help. If the government grants them a budget, they can manage it wisely. If NGOs have a well-defined goal, people welcome them and cooperate with them more”. (Female, 18 years of experience)

Family support

As the participants opined, family support and supervision can be a strong barrier to detrimental behaviors such as HS. Inadequate support can lead to deviation and improper decisions including one’s tendency towards HS.

“All factors affecting HS can be summarized as family support. If someone is both psychologically and spiritually supported by the family, s/he will hardly ever tend to smoke hookahs”. (Male, 20 years of experience)

Mass Media and social network activities

As the majority of participants agreed, forbidding any form of advertisement, direct or indirect, for hookahs in mass media can be an effective strategy to control and prevent HS. Introducing HS extensively as a health-threatening behavior in mass media can tremendously influence public belief and attitude. This is due to the trust people put in mass media. Below are some extracts from the participants’ accounts:

“Mass media has succeeded in annihilating certain unhealthy behaviors such as crack consumption. They highlighted the adverse effects and managed to create a deep fear of the drug in the public. Finally, the drug abuse was under control. HS can also be controlled in the same way”. (Female, 20 years of experience)

Peer education

Peer education was perceived by many participants as an effective strategy to control HS. Here is a sample extract from the interviews.

“I think if instructions are provided by peers, they are more effective because those emotions, attitudes and norms are better expressed. Teenagers listen carefully to peers and communicate with them better”. (Male, 5 years of experience)

Popular figures and celebrities

Many participants noted that the information provided or the kind of advice given by popular figures can significantly affect attitude to HS. These reliable sources can include family members, celebrities or popular football players among youngsters as well as clergymen who can talk against HS and discourage the negative behavior.

“If a celebrity begins to advertise against HS, that will help. Many followers will never want to smoke hookahs anymore or if they are already users, they may quit”. (Female, 16 years of experience)

Controlling HS by alternative activities to HS market/trade

The majority of experts indicated that appropriate alternative activities to HS market/trade can act as an effective strategy to control HS. Below are several comments by the participants to support this idea.

Innovative and creative entrepreneurship for sellers

Most participants agreed that it was essential to find an alternative job for those who earned a living by selling hookahs. If their job was not replaced with a better one, they would never cease selling hookahs, and many socially adverse effects could follow.

“The government is supposed to use the least budget available to provide hookah sellers an appropriate job. For instance, the government can help them with interest-free loans. Or it can create a market where all these ex-hookah-sellers work and earn a living”. (Female, 18 years of experience)

Controlling HS by alternatives to smoking as a habit/recreational activity

Controlling HS by alternatives to smoking as a habitual/recreational activity was another strategy suggested to control HS. As the interviewees commented, hookah can only be given up if it is replaced by a better choice. This will be explained here along with some extracts from interview content.

Setting up recreational facilities

Most participants agreed that extending recreational activities can significantly help control and reduce the rate of health-threatening behaviors such as HS. Unfortunately, Bandar Abbas is less equipped with recreational facilities than other cities. Thus, there is not a wide range of leisure activities to choose from.

“The more recreational facilities are provided for families, the less the probability of HS. Yet, these are largely absent here. Unfortunately, there is not even one good park or green space here”. (Male, 23 years of experience)

Reconstructing and renovating old urban areas (e.g., parks, gyms, pedestrian walks, biking lanes) which are red-spots for risky behaviors can be an effective strategy to prevent, control and cease HS.

Holding festivals and joyful activities

As most participants suggested, actively employing all existing sources can help prevent, control and cease HS. Instances of promising attempts are investment on young talents in art, music, theatre and the like, joyous celebrations in neighbourhoods, extending celebrations and festivals beyond official, indoor space to outdoor space and more specifically to neighbourhoods which can otherwise become a center for HS, and establishing the anti-hookah culture in such celebrations.

“I think if amusing programs were regularly planned in neighbourhoods, people would attend festivities or get-togethers instead of smoking hookahs. Such joyful events can provide a good chance for reminding people of the adverse effects of HS”. (Female, 23 years of experience)

Taking administrative and regulatory measures

Participants agreed that the development of new rules and regulations was an effective strategy. These new rules should be preventive, controlling and inhibitive. As the interviewees admitted, there was currently no law against HS. If there was any, it was hardly put into practice. The following sub-categories provide more insights into this matter:

Anti-HS legislating and enforcing regulations

As many participants pinpointed, giving heavy fines for HS can, to a great extent, reduce the rate of the unhealthy behavior.

“Though many restaurants and coffee-shops are not allowed to sell hookahs, they break the rules and provide HS services. Immediately after they are fined, they get back to the same old habit. It is because there has been no severe legal prosecution. A minor fine does nothing to stop a high-income restaurant or coffee-shop owner selling hookahs”. (Female, 18 years of experience)

Participatory administration

As recurrently stated by several participants, Mutual cooperation of authoritative organizations can dramatically affect HS prevention, control and cessation.

“All those partly in charge of the program should join and start working together. They are to support each other and there should be a division of labor. Now, it is not the case because each organization is working on its own and not as a team. There is no follow-up. One or two organizations alone cannot do the whole thing”. (Male, 28 years of experience)

Tax policies

As suggested by many participants, putting higher taxes on hookah service providers such as coffee-shops can effectively prevent and control HS in society. They suggested hookah selling shops be divided into two, smoking and non-smoking. The former should pay higher taxes (3 or 4 fold).

“In many European countries, there are higher taxes on cigarettes and tobacco products. The same should go here. Coffee-shops that offer hookahs should pay taxes three times as high as others”. (Female, 23 years of experience)

“Municipal taxes should be 3–4 fold for coffee-shops that sell hookahs. These shops should pay taxes this year as they threaten citizens’ health. The next year, it is their choice whether they will continue selling hookahs or not” (Female, 19 years of experience).

Citizens’ rights

Most participants contended that raising the society’s awareness of citizen rights can largely change public view of HS. Air pollution follows from HS and when the public perceive themselves deprived of their right to have clean air, they learn to complain to those polluting the air. Here is a relevant comment:

“I think awareness of citizen rights can be a great help. We can change the public view. If a family passes by and looks down on me, that will be the end of me. No need to talk anymore! The mere silence means this is our right to enjoy clean air. Certainly, that will help”. (Female, 18 years of experience)

Segregation of HS places

Segregation of specific places for HS was another strategy that many participants suggested to prevent, control and cease HS. This category actually shows the necessity of making strict laws to take away hookahs from public places and confine them to enclosed spaces.

“If anyone who used to freely smoke hookahs at the beach or in parks is now forced to go indoors for smoking and knows s/he cannot smoke hookahs outdoors anymore, s/he might lose interest in smoking hookahs” (Male, 9 years of experience).

Setting limits

Effective strategies could include concentrating all hookah selling centers in one place, forbidding the sale of hookahs to those below 18, forbidding the sale of hookahs for 10 consecutive cases, keeping a distance of at least 100 m from schools, setting certain limits such as no food or drink served besides hookahs, reducing the attraction and facilities of hookah selling places, forbidding music, trees or plants around the area and other similar facilities to control and prevent HS. Others include being strict in giving the required work permissions to applicants.

“Shops that serve hookahs should be at least 100 meters away from schools. If not, they may be tempting to students, especially high school students who may tend to try different flavours when they find a shop nearby”. (Male, 10 years of experience)

“Certain limits should be set. For example, a hookah smoker should not be allowed to do so in parks or greeneries. Then, gradually, we can set stricter rules and say, for example, HSs are not allowed to watch TV and so on. No side dish should be allowed to be served with hookahs. This can tremendously cut down on the original attraction”. (Male, 28 years of experience)

Facilitating HS cessation

Facilitating hookah cessation was another strategy suggested to control this tobacco product. It will be explained here along with extracts from interview content.

Founding HS cessation clinics

Trying to found tobacco cessation centers was mentioned as another back-up service to prevent, control and cease HS. The majority of smokers, when tired of the habit, look for places that can help them cease HS.

“If there are certain clinics exclusively established to help people cease HS, they can really help! People need to be notified at once and be encouraged to visit these clinics. The staff should be supportive experts that can attract people and teach them what to do in an interesting manner”. (Female, 21 years of experience)

“There exists no such a thing as an independent tobacco cessation clinic in our city! If such clinics are established and staffed with psychologists, physical educationalists and physicians, they will be a shekter to those tired of smoking”. (Male, 9 years of experience)

Motivational services

Most participants mentioned encouraging and motivating individuals or a mixture of motivational strategies could be an effective supportive strategy to control HS. Certain services such as travel ticket discount, concert ticket discount and gift cards for those who manage to cease HS can motivate them to continue the healthy behavior and encourage others to cease smoking. Allocating a budget to healthy entertainments such as cinema, concert, library and musical work can be another effective strategy in HS control. In other words, people can be provided with cultural activities at a low cost.

“If there is cultural subsidy for healthy reactions, for example, if they (i.e., the government) pay part of the cost for concerts, cinemas and gyms, everyone can enjoy healthy leisure at a low cost. The reason why almost everyone smokes hookahs is that it is a cheap amusement”. (Female, 17 years of experience)

Participants also believed that hookahs could not be taken away from consumers or salespeople unless they were replaced by appropriate hobbies.

“Obligation is not going to work! There should be some rewards. When something is taken away from someone, it needs to be replaced with something better. If you only think of HS as a hobby, you should begin to think what other hobbies can replace it. Even the salespeople should be provided with an alternative job”. (Female, 19 years of experience)

Mental health consultations

Many participants mentioned that mental health consultation can facilitate HS cessation. Supportive acts can include stress management through regular screening programs for mental health, active education on life skills from early childhood that can help people learn to react appropriately to stress, anger, temptation and learn to reject indecent suggestions made by peers. Another supportive service can be the establishment of centers to provide free face-to-face or on-call psychological services around the day. See the following comment.

“Most people find themselves smoking hookahs to escape stress. So, if such mental problems as stress are controlled from school days and even earlier from pre-school, what later leads to HS may be prevented”. (Male, 21 years of experience)

Concerning free psychological consultations, a participant quoted:

“If distressed families could refer to an advisor for help and be appropriately supported, they would for sure not have to retreat to HS to lower their stress. The advisor needs to be available and ready to help either face to face or on phone. Such advisors need to be supported by the executives” (Male, 26 years of experience).

The present research is pioneering in employing a qualitative content analysis to explore the determinants of HS control.

The interviewees believed that involving NGOs is a key strategy for HS control. Different NGOs, such as the Iranian Anti-Tobacco Association, are actively involved in tobacco control initiatives in Iran, with a focus on public health and environmental protection [ 25 , 26 ]. The Iranian government, through the National Tobacco Control Headquarters supported by the government and monitored by the Ministry of Health and Medical Education, cooperates with relevant ministries, authorities, and NGOs [ 27 ]. The National Tobacco Free Initiative Committee (NTFIC) has actively cooperated and transferred information between the government and NGOs to speed up tobacco control endeavors in Iran [ 28 ]. Thee have been similar efforts in other countries like Romania and Pakistan, where NGOs actively help control tobacco use in joint efforts with national and international parties, and encourage the involvement of different organizations [ 29 , 30 ]. In this regard, one study in India by Mondal et al. revealed that NGOs played a major role in tobacco control measures around the world. They acted effectively in raising the victims’ awareness and rehabilitating them by constantly supporting them in controlling this unhealthy behavior [ 31 ]. Therefore, it is suggested to use the capacity of NGOs in knowledge sharing and extending the culture further and allocating national budgets for its implementation.

Family support and supervision were found as another key strategy for HS control, according to the interviewees. This finding was also confirmed by other studies on family support which found it as an important factor in reducing the rate of HS [ 20 , 32 , 33 ]. Dana et al. studied adolescents in 42 countries and examined the long-term impact of family activities on adolescent smoking behavior in the United States. This study pinpointed the significant role of family support and supervision in reducing the rate of smoking among adolescents [ 34 ]. Family support can play a vital role in shaping attitudes and behaviors that help start and continue hookah use. Family support, especially during adolescence, has a continuous effect on reducing the risk of adolescent smoking [ 35 ]. Family support seems to play an important role in the tendency and desire to quit smoking When facing a challenge or stressor, others’ social support in an informal environment can help the adolescent cope with problems and stress. As a result, s/he will have a greater ability to manage the challenge or stressor, thus promoting supportive and close relationships. Fostering a supportive family environment and involving family members in cessation interventions can significantly contribute to lower rates of smoking and a healthier lifestyle.

The interviewees viewed mass media as another influential strategy to control HS. The use of appropriate health-promoting messages or motivational services is critical in supporting smoking cessation efforts [ 36 ]. It seems that mass media could advertise more effectively to tackle the issue at hand because people tend to trust them more; thus, acquiring information from these reliable sources can deeply influence their belief. Iran Ministry of Health has cooperated with relevant agencies to initiate a wide range of anti-tobacco mass media campaigns. These campaigns have mainly dealt with hookah consumption, youth, and females, and aimed to raise public awareness of the threats of tobacco consumption [ 27 ]. A relevant study among adults in the United States showed that mass media advertisements were positively correlated with the reduced rate of tobacco consumption [ 37 ]. Similarly, another study showed that mass media campaigns were considered a key strategy to reduce the rate of tobacco consumption among youngsters [ 38 ]. Mass media campaigns have been recognized as a powerful means of reducing tobacco consumption, especially among youngsters [ 39 ]. Mass media can be used for effective messaging in public health and for behavior change.

As the experts commented, peer education is another useful strategy for HS control. Peer education involves empowering community members to induce positive health changes within their peer group as a method of health promotion [ 40 ]. In an interventional study in Turkey among high school students, peer education was considered an effective method of changing tobacco smoking behavior [ 41 ]. The interactive nature of peer education makes it an important complement to HS control and other health promotion measures. Support groups, including peers, can play a low-cost but effective role in controlling unhealthy behaviors, such as HS. Peers understand each other better and accept health advice better from friends. Peer support groups also provide an opportunity to share experiences and eliminate the unhealthy behavior.

Information provision by popular figures and celebrities was another factor perceived by the interviewed experts as effective in controlling the above-mentioned unhealthy behavior. A relevant study in Iran among students of University of medical sciences showed that the advice from influential figures is an important factor in quitting smoking and reducing HS [ 42 ]. Celebrities often significantly influence their fans and followers, and their behaviors can shape social norms and perceptions [ 43 ]. This influence can be used to internalize cessation and reduction of smoking. Also, the engagement of celebrities in HS can normalize the behavior and create a perception of social acceptance. Targeting influential figures to promote healthy behaviors and discourage unhealthy behaviors can be an effective strategy to control the spread of HS and other unhealthy habits.

Another strategy suggested by the interviewees was alternative activities to HS market/ trade. One such alternative service was ‘innovative and creative entrepreneurship’ which involved finding an appropriate job to replace hookah sellers’ job. The rate of HS was higher in low- to average-income countries than high-income countries [ 44 ]. It appeared that economic pressures and lack of appropriate job opportunities led people to sell hookahs or offer hookah services. Hookah marketing has been probably considered an employment issue for low-income families with no better job opportunities. Local authorities ares suggested to provide special facilities to sellers to land suitable new jobs and reduce the sale of and access to tobacco products. Providing alternative economic opportunities, particularly through entrepreneurship and job creation programs, could be an effective strategy to control hookah use. To this aim, the underlying economic factors that lead people to hookah-related activities should be considered.

As the interviewed experts believed, another alternative strategy to smoking was the provision of recreational facilities. It seems that adding to the number of gyms and sport facilities in slums can significantly help prevent and control tobacco consumption. Some related Iranian research pointed out the lack of recreational facilities in Iran as an underlying reason for HS [ 45 , 46 ]. Arguably, Bandar Abbas, as the main city in Hormozgan Province, lacks proper public recreational facilities such as amusement parks. In this city, the only public entertainment is spending time on the beach. Since the beach and surrounding areas do not have any entertainment facilities for different age groups, many opportunists seize the chance to sell and rent hookahs, therefore, many people smoke hookahs as a leisure. Authorities are suggested to consider recreation seriously and act effectively to renova te urban space to better control and cease HS.

From the viewpoint of the interviewed experts, Organizing festivals and joyful activitieswas identified as another strategy for controlling HS. This idea was supported by an Iranian study mong high school students that revealed that non-HSs achieved a higher happiness score than HSs [ 47 ]. Using all the existing capacities of the society can increase pleasurable activities of all members of society. Furthermore, it can be assumed that those who often experience a high level of happiness have fewer emotional and behavioral problems. These people would therefore be less likely to orientate towards HS. Festivals and joyful events may provide a social context in which HS is more common and can probably lead to increased consumption. Essentially, there is a need for national policies to create appropriate opportunities for people to show happiness.

There is also a need for ‘formulating regulations’ which can significantly help tackle the problem. One such rule/regulation can be heavy fines. As similar research on youngsters and adolescents showed, fining children and teenagers for carrying any form of tobacco product managed to reduce the rate of tobacco consumption to a large extent [ 48 , 49 ]. Another study on reduced HS in youngsters in the United States showed that the anti-tobacco rule is mainly implemented for cigarettes and no strict rule has been set or implemented for hookahs [ 50 ]. It is noteworthy that while fines have been effective in reducing tobacco consumption, there is a lack of strict rules against HS in some regions. Thus, prohibitory rules and strict regulations, such as heavy fines, can be an effective way to prevent and control tobacco consumption, particularly HS, in Iran.

As the expert interviewees agreed, to control HS effectively, a participatory approach is needed to involve all relevant organizations. If the existing organizations in charge of HS control share duties and cooperate with each other, they can better manage to prevent and control the unhealthy behavior. Some research on proven strategies for smoking cessation showed that to challenge tobacco control, all organizations involved should act cooperatively and interdependently [ 51 ]. Probably, non-cooperative policies that the government makes were actively involved in HS control. Evidently, policymakers do not include the viewpoints of lower-ranking forces in HS control policymaking. If the comments made by lower-ranking forces or even smokers themselves are included, there will be better chances of compliance with rules and plans. Thus, policymakers are strongly recommended to take the advice by lower-ranking forces into account in decision making.

As the experts suggested, increasing tobacco taxes and prices is an effective measure for HS control. Increasing taxes, in a relevant work of research, managed to significantly lower the rate of smoking cigarettes [ 21 ]. A study by Hu, Mao, Shi, and Chen (2016) emphasized that increasing taxes is the easiest and most economical way to control tobacco consumption in China [ 52 ]. Higher taxes are followed by less demand in the market. Arguably, multifold taxation on coffee shops selling hookahs compared to others will reduce the profit of selling hookahs, which will be demotivating for sellers, and can reduce the supply of hookahs. Thus, it is expected that increasing taxes can reduce or correct the pattern of HS.

‘Familiarization of society with citizen rights’ was another effective strategy to control HS.

This factor shows that society’s awareness and understanding of individual rights can affect HS-related behaviors. When citizens get to know their rights and the consequences of HS, it can lead to more responsible and controlled HS behavior. A work of research revealed that a tobacco-free generation corresponds to citizen rights [ 53 ]. Katz (2005) showed that any attempt to control secondary tobacco smoke should be focused on individual rights. If people know it is their right to enjoy clean air, when they see others (HSs) depriving them of this right, they will react. This would not only affect their own belief but also that of the smoker. The latter needs to be more cautious as others can easily begin to complain. Therefore, this factor should not be neglected in controlling this unhealthy behavior.

The factor ‘Segregation of HS places’ was mentioned by the interviewees too as an effective strategy for HS control (HS). This approach involves creating designated areas or spaces specifically for hookah smoking, separate from other public areas. A systematic review revealed that segregating HS places can play a key role in controlling HS [ 19 ]. Another similar study showed that developing an anti-smoking rule in public places and implementing it carefully can lower the mean rate of smoking for about 4–10%. Thus, many people might cease smoking [ 54 ]. If HS is confined to particular places and banned in public space, it can help control HS effectively.

The expert interviewees believed that setting certain limits on the availability and purchase of hookahs can be an innovative rule to prevent, control or cease tobacco altogether. It appears that hookahs are more accessible to the public than other tobacco products. A body of research in Iran and Unites States point to the extensive and facile access to hookahs as a main reason for the high prevalence of HS [ 55 , 56 ]. Overall, tobacco use seems to be significantly lower in cities with strict rules than in cities without any strict restrictive rule and regulation. Making prohibitory rules and eliminating the positive attitude and increasing the socially negative attitude to HS can significantly help reduce access to hookahs.

The interviewed experts suggested that establishing tobacco cessation clinics (TCCs) was another strategy to control HS. A study showed that TCC was capable of satisfying tobacco smokers’ needs and managed to stop hookah cessation. By providing effective educational interventions, these clinics manage to help smokers stop smoking cigarettes [ 57 ]. TCCs can meet the needs of HSs and provide effective educational interventions to help them quit. By providing exclusive cessation services to hookah users, TCCs can be as effective in HS cessation as in cigarette smoking [ 58 , 59 ]. The existence of specialized smoking cessation clinics can point to the seriousness of this matter and encourage people to think about the adverse effects of HS. Therefore, building dedicated smoking cessation clinics for HS can be a great help for people who intend to quit hookahs.

The expert interviewees believed that providing motivational services was a strategy to control HS. A study at a Russian smoking-cessation center showed that individuals who were highly motivated to quit smoking had a success rate four times as high as those with lower motivation levels [ 58 ]. Providing appropriate motivational services, such as financial incentives, to individuals who have quit or intend to quit HS can effectively encourage and support their healthy behavior. A specific motivational service was suggested to be the provision of a cultural subsidy to address the affordability of hookah smoking in social settings. Roskin, Roskin and Aveyard (2009) reported that the low cost of HS among group amusements was a main reason for smoking hookahs [ 59 ]. By submitting a budget for cultural subsidies to increase healthy recreational activities, authorities can take effective measures to control this unhealthy behavior and encourage individuals to show healthier behaviors.

‘Mental health consultation’ was another strategies of HS control, as the interviewees suggested. A study of Armenian population in Tehran showed that a significant proportion of respondents raised the issue of frustration and psychological/spiritual problems at the outset of the unhealthy behavior of drug abuse [ 60 ]. Similarly, psychological needs and gaps were mentioned as the major reasons for HS [ 45 ]. It can be argued that people with insufficient problem-solving skills or failed self-assertion among friends turn to hookahs when feeling unhappy or lonely. Providing mental health counseling can help address the psychological aspects of HS and contribute to effective control measures. It proves the importance of mental health interventions as comprehensive strategies to prevent and reduce HS behaviors.

Strengths, limitations and suggestions for further research

There were certain limitations in the present research. As in all types of qualitative research, the researcher’s own beliefs and perceptions could have affected the procedures from conceptualization to communication with participants and data interpretation [ 61 ]. Though in the present research, exploratory heuristics was used in data analysis to directly extract the categories and subcategorise from the data, it was possible that the interview questions did not cover all effective factors in HS. To compensate for this, the interviews continued until data saturation. Despite the above-mentioned limitations, there were several strengths too. The expert participants were selected from among the most knowledgeable in this area, with the benefit of proving realistic information for HS control. Further research is needed to explore these strategies in more extensive areas and from all demographic groups so that we can have access to comprehensive data about the effective strategies to prevent and cease HS.

Implications

To the present researchers’ best knowledge, no study has been conducted to date to determine effective factors in HS control. The present findings can significantly fill the existing gap in the literature. Also, in future, these findings can form the basis of comparative studies. Finally, the present findings can guide policy makers to develop the necessary standards and guidelines to make effective plans and interventions to better control HS.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Hookah smoking

Hookah smokers

Non-governmental organization

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Acknowledgements

The authors would like to thank Hormozgan University of Medical Sciences for their financial support. The authors would also like to express their gratitude to the participants for their sincere cooperation in this study.

This project received a research grant from Hormozgan University of Medical Sciences and National Institute for Medical Research Development Grant No. 983514. The funding body was not involved in the design of study data collection, data analysis, and interpretation of data and in writing the manuscript.

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Dadipoor, S., Alavi, A., Eshaghi Sani Kakhaki, H. et al. A qualitative exploration of experts’ views about multi-dimensional aspects of hookah smoking control in Iran. BMC Public Health 24 , 1665 (2024). https://doi.org/10.1186/s12889-024-19139-9

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v.56(1); 2023 Jan

Qualitative Research in Healthcare: Necessity and Characteristics

1 Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

2 Ulsan Metropolitan City Public Health Policy’s Institute, Ulsan, Korea

3 Department of Nursing, Chung-Ang University, Seoul, Korea

Eun Young Choi

4 College of Nursing, Sungshin Women’s University, Seoul, Korea

Seung Gyeong Jang

5 Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Graphical abstract

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INTRODUCTION

The definition of research varies among studies and scholars, and it is difficult to devise a single definition. The Oxford English Dictionary defines research as “a careful study of a subject, especially in order to discover new facts or information about it” [ 1 ], while Webster’s Dictionary defines research as “studious inquiry or examination - especially: investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws” [ 2 ]. Moreover, research is broadly defined as the process of solving unsolved problems to broaden human knowledge [ 3 ]. A more thorough understanding of research can be gained by examining its types and reasons for conducting it.

The reasons for conducting research may include practical goals, such as degree attainment, job promotion, and financial profit. Research may be based on one’s own academic curiosity or aspiration or guided by professors or other supervisors. Academic research aims can be further divided into the following: (1) accurately describing an object or phenomenon, (2) identifying general laws and establishing well-designed theories for understanding and explaining a certain phenomenon, (3) predicting future events based on laws and theories, and (4) manipulating causes and conditions to induce or prevent a phenomenon [ 3 ].

The appropriate type of research must be selected based on the purpose and topic. Basic research has the primary purpose of expanding the existing knowledge base through new discoveries, while applied research aims to solve a real problem. Descriptive research attempts to factually present comparisons and interpretations of findings based on analyses of the characteristics, progression, or relationships of a certain phenomenon by manipulating the variables or controlling the conditions. Experimental or analytical research attempts to identify causal relationships between variables through experiments by arbitrarily manipulating the variables or controlling the conditions [ 3 ]. In addition, research can be quantitative or qualitative, depending on the data collection and analytical methods. Quantitative research relies on statistical analyses of quantitative data obtained primarily through investigation and experiment, while qualitative research uses specific methodologies to analyze qualitative data obtained through participant observations and in-depth interviews. However, as these types of research are not polar opposites and the criteria for classifying research types are unclear, there is some degree of methodological overlap.

What is more important than differentiating types of research is identifying the appropriate type of research to gain a better understanding of specific questions and improve problems encountered by people in life. An appropriate research type or methodology is essential to apply findings reliably. However, quantitative research based on the philosophical ideas of empiricism and positivism has been the mainstay in the field of healthcare, with academic advancement achieved through the application of various statistical techniques to quantitative data [ 4 ]. In particular, there has been a tendency to treat complicated statistical techniques as more scientific and superior, with few qualitative studies in not only clinical medicine, but also primary care and social medicine, which are relatively strongly influenced by the social sciences [ 5 , 6 ].

Quantitative and qualitative research use different ways of exploring various social phenomena. Both research methodologies can be applied individually or in combination based on the research topic, with mixed quantitative and qualitative research methodologies becoming more widespread in recent years [ 7 ]. Applying these 2 methods through a virtuous cycle of integration from a complementary perspective can provide a more accurate understanding of human phenomena and solutions to real-world problems.

This review aimed to provide a proper understanding of qualitative research to assist researchers in selecting the appropriate research methodology. Specifically, this review examined the characteristics of quantitative and qualitative research, the applicability of qualitative research, and the data sources collected and analyzed in qualitative research.

COMPARISON OF QUALITATIVE AND QUANTITATIVE RESEARCH

A clearer understanding of qualitative research can be obtained by comparing qualitative and quantitative research, with which people are generally familiar [ 8 , 9 ]. Quantitative research focuses on testing the validity of hypotheses established by the researcher to identify the causal relationships of a specific phenomenon and discovering laws to predict that phenomenon ( Table 1 ). Therefore, it emphasizes controlling the influence of variables that may interfere with the process of identifying causality and laws. In contrast, qualitative research aims to discover and explore new hypotheses or theories based on a deep understanding of the meaning of a specific phenomenon. As such, qualitative research attempts to accept various environmental factors naturally. In quantitative research, importance is placed on the researcher acting as an outsider to take an objective view by keeping a certain distance from the research subject. In contrast, qualitative research encourages looking inside the research subjects to understand them deeply, while also emphasizing the need for researchers to take an intersubjective view that is formed and shared based on a mutual understanding with the research subjects.

Comparison of methodological characteristics between quantitative research and qualitative research

Characteristics	Quantitative research	Qualitative research
Research purpose	Test the validity of the hypotheses established by the researcher to identify the causal relationships and laws of the phenomenon and predict the phenomenon	Discover and explore new hypotheses or theories based on a deep understanding of the meaning of the phenomenon
Perspective on variables	View factors other than the variables of interest as factors to be controlled and minimize the influence of confounding factors	View factors as natural and accept assessments in a natural environment
Research view	Objective, outsider view	Intersubjective, insider view
Data used	Quantifiable, measurable data	Narrative data that can be expressed by words, images and so on
Data collection method	Primarily questionnaire surveys or tests	Primarily participant observation, in-depth interviews, and focus group discussions
Nature of data and depth of analysis	Focus on superficial aspects of the phenomenon by using reliable data obtained through repeated measurements	The aim is to identify the specific contents, dynamics, and processes inherent within the phenomenon and situation using deep and rich data
Strengths and weaknesses	High reliability and generalizability	High validity
Strengths and weaknesses	Difficulties with in-depth analysis of dynamic phenomena that cannot be expressed by numbers alone; difficulties in interpreting the results analyzed by numbers	Weak generalizability; interjection of subjectivity of the researcher is inevitable

The data used in quantitative research can be expressed as numerical values, and data accumulated through questionnaire surveys and tests are often used in analyses. In contrast, qualitative research uses narrative data with words and images collected through participant observations, in-depth interviews, and focus group discussions used in the analyses. Quantitative research data are measured repeatedly to enhance their reliability, while the analyses of such data focus on superficial aspects of the phenomenon of interest. Qualitative research instead focuses on obtaining deep and rich data and aims to identify the specific contents, dynamics, and processes inherent within the phenomenon and situation.

There are clear distinctions in the advantages, disadvantages, and goals of quantitative and qualitative research. On one hand, quantitative research has the advantages of reliability and generalizability of the findings, and advances in data collection and analysis methods have increased reliability and generalizability. However, quantitative research presents difficulties with an in-depth analysis of dynamic phenomena that cannot be expressed by numbers alone and interpreting the results analyzed in terms numbers. On the other hand, qualitative research has the advantage of validity, which refers to how accurately or appropriately a phenomenon was measured. However, qualitative research also has the disadvantage of weak generalizability, which determines whether an observed phenomenon applies to other cases.

APPLICATIONS OF QUALITATIVE RESEARCH AND ITS USEFULNESS IN THE HEALTHCARE FIELD

Qualitative research cannot be the solution to all problems. A specific methodology should not be applied to all situations. Therefore, researchers need to have a good understanding of the applicability of qualitative research. Generally, qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions [ 7 ]. In particular, qualitative research is useful for opening new fields of research, such as important topics that have not been previously examined or whose significance has not been recognized. Moreover, qualitative research is advantageous for examining known topics from a fresh perspective.

In the healthcare field, qualitative research is conducted on various topics considering its characteristics and strengths. Quantitative research, which focuses on hypothesis validation, such as the superiority of specific treatments or the effectiveness of specific policies, and the generalization of findings, has been the primary research methodology in the field of healthcare. Qualitative research has been mostly applied for studies such as subjective disease experiences and attitudes with respect to health-related patient quality of life [ 10 - 12 ], experiences and perceptions regarding the use of healthcare services [ 13 - 15 ], and assessments of the quality of care [ 16 , 17 ]. Moreover, qualitative research has focused on vulnerable populations, such as the elderly, children, disabled [ 18 - 20 ], minorities, and socially underprivileged with specific experiences [ 21 , 22 ].

For instance, patient safety is considered a pillar of quality of care, which is an aspect of healthcare with increasing international interest. The ultimate goal of patient safety research should be the improvement of patient safety, for which it is necessary to identify the root causes of potential errors and adverse events. In such cases, qualitative rather than quantitative research is often required. It is also important to identify whether there are any barriers when applying measures for enhancing patient safety to clinical practice. To identify such barriers, qualitative research is necessary to observe healthcare workers directly applying the solutions step-by-step during each process, determine whether there are difficulties in applying the solutions to relevant stakeholders, and ask how to improve the process if there are difficulties.

Patient safety is a very broad topic, and patient safety issues could be categorized into preventing, recognizing, and responding to patient safety issues based on related metrics [ 23 ]. Responding to issues that pertain to the handling of patient safety incidents that have already occurred has received relatively less interest than other categories of research on this topic, particularly in Korea. Until 2017, almost no research was conducted on the experiences of and difficulties faced by patients and healthcare workers who have been involved in patient safety incidents. This topic can be investigated using qualitative research.

A study in Korea investigated the physical and mental suffering experienced during the process of accepting disability and medical litigation by a patient who became disabled due to medical malpractice [ 21 ]. Another qualitative case study was conducted with participants who lost a family member due to a medical accident and identified psychological suffering due to the incident, as well as secondary psychological suffering during the medical litigation process, which increased the expandability of qualitative research findings [ 24 ]. A quantitative study based on these findings confirmed that people who experienced patient safety incidents had negative responses after the incidents and a high likelihood of sleep or eating disorders, depending on their responses [ 25 ].

A study that applied the grounded theory to examine the second victim phenomenon, referring to healthcare workers who have experienced patient safety incidents, and presented the response stages experienced by second victims demonstrated the strength of qualitative research [ 26 ]. Subsequently, other studies used questionnaire surveys on physicians and nurses to quantify the physical, mental, and work-related difficulties experienced by second victims [ 27 , 28 ]. As such, qualitative research alone can produce significant findings; however, combining quantitative and qualitative research produces a synergistic effect. In the healthcare field, which remains unfamiliar with qualitative research, combining these 2 methodologies could both enhance the validity of research findings and facilitate open discussions with other researchers [ 29 ].

In addition, qualitative research has been used for diverse sub-topics, including the experiences of patients and guardians with respect to various diseases (such as cancer, myocardial infarction, chronic obstructive pulmonary disease, depression, falls, and dementia), awareness of treatment for diabetes and hypertension, the experiences of physicians and nurses when they come in contact with medical staff, awareness of community health environments, experiences of medical service utilization by the general public in medically vulnerable areas, the general public’s awareness of vaccination policies, the health issues of people with special types of employment (such as delivery and call center workers), and the unmet healthcare needs of persons with vision or hearing impairment.

GENERAL WORKFLOW OF QUALITATIVE RESEARCH

Rather than focusing on deriving objective information, qualitative research aims to discern the quality of a specific phenomenon, obtaining answers to “why” and “how” questions. Qualitative research aims to collect data multi-dimensionally and provide in-depth explanations of the phenomenon being researched. Ultimately, the purpose of qualitative research is set to help researchers gain an understanding of the research topic and reveal the implications of the research findings. Therefore, qualitative research is generally conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants (or participation target) and data collection methods, (5) data analysis and description of findings, and (6) research validation ( Figure 1 ) [ 30 ]. However, unlike quantitative research, in which hypothesis setting and testing take place unidirectionally, a major characteristic of qualitative research is that the process is reversible and research methods can be modified. In other words, the research topic and question could change during the literature analysis process, and theoretical and analytical methods could change during the data collection process.

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General workflow of qualitative research.

Selection of a Research Topic and Question

As with any research, the first step in qualitative research is the selection of a research topic and question. Qualitative researchers can select a research topic based on their interests from daily life as a researcher, their interests in issues within the healthcare field, and ideas from the literature, such as academic journals. The research question represents a more specific aspect of the research topic. Before specifically starting to conduct research based on a research topic, the researcher should clarify what is being researched and determine what research would be desirable. When selecting a research topic and question, the research should ask: is the research executable, are the research topic and question worth researching, and is this a research question that a researcher would want to research?

Selection of Theoretical Framework and Methods

A theoretical framework refers to the thoughts or attitudes that a researcher has about the phenomenon being researched. Selecting the theoretical framework first could help qualitative researchers not only in selecting the research purpose and problem, but also in carrying out various processes, including an exploration of the precedent literature and research, selection of the data type to be collected, data analysis, and description of findings. In qualitative research, theoretical frameworks are based on philosophical ideas, which affect the selection of specific qualitative research methods. Representative qualitative research methods include the grounded theory, which is suitable for achieving the goal of developing a theory that can explain the processes involved in the phenomenon being researched; ethnographic study, which is suitable for research topics that attempt to identify and interpret the culture of a specific group; phenomenology, which is suitable for research topics that attempt to identify the nature of research participants’ experiences or the phenomenon being researched; case studies, which aim to gain an in-depth understanding of a case that has unique characteristics and can be differentiated from other cases; action research, which aims to find solutions to problems faced by research participants, with the researchers taking the same position as the participants; and narrative research, which is suitable for research topics that attempt to interpret the entire life or individual experiences contained within the stories of research participants. Other methodologies include photovoice research, consensual qualitative research, and auto-ethnographic research.

Literature Analysis

Literature analysis results can be helpful in specifically selecting the research problem, theoretical framework, and research methods. The literature analysis process compels qualitative researchers to contemplate the new knowledge that their research will add to the academic field. A comprehensive literature analysis is encouraged both in qualitative and quantitative research, and if the prior literature related to the subject to be studied is insufficient, it is sometimes evaluated as having low research potential or research value. Some have claimed that a formal literature review should not be performed before the collection of field data, as it could create bias, thereby interfering with the investigation. However, as the qualitative research process is cyclic rather than unidirectional, the majority believes that a literature review can be performed at any time. Moreover, an ethical review prior to starting the research is a requirement; therefore, the research protocol must be prepared and submitted for review and approval prior to conducting the research. To prepare research protocols, the existing literature must be analyzed at least to a certain degree. Nonetheless, qualitative researchers must keep in mind that their emotions, bias, and expectations may interject themselves during the literature review process and should strive to minimize any bias to ensure the validity of the research.

Selection of the Research Participants and Data Collection Methods

The subjects of qualitative research are not necessarily humans. It is more important to find the research subject(s) from which the most in-depth answers to the research problem can be obtained. However, the subjects in most qualitative studies are humans, as most research question focus on humans. Therefore, it is important to obtain research participants with sufficient knowledge, experience, and attitudes to provide the most appropriate answers to the research question. Quantitative research, which views generalizability as a key research goal, emphasizes the selection of research participants (i.e., the research sample that can represent the study’s population of interest), whereas qualitative research emphasizes finding research participants who can best describe and demonstrate the phenomenon of interest.

In qualitative research, the participant selection method is referred to as purposeful sampling (or purposive sampling), which can be divided into various types. Sampling methods have various advantages, disadvantages, and characteristics. For instance, unique sampling (extreme case sampling) has the advantage of being able to obtain interesting research findings by researching phenomena that have previously received little or no interest, and the disadvantage of deriving research findings that are interesting to only some readers if the research is conducted on an overly unique situation. Maximum variation sampling, also referred to as theoretical sampling, is commonly used in qualitative research based on the grounded theory. Selecting the appropriate participant sampling method that suits the purpose of research is crucial ( Table 2 ).

Sampling methods of selecting research participants in qualitative research

Sampling method	Explanation
Typical sampling	Selecting the most typical environment and people for the research topic
Unique sampling (extreme case sampling)	Selecting unique and uncommon situations or subjects who satisfy the research purpose
Maximum variation sampling	Selecting subjects showing maximum variation with a target population
Convenience sampling	Selecting subjects who can be sampled most conveniently considering practical limitations, such as funding, time, and location
Snowballing sampling	Selecting key research participants who satisfy the criteria established by the researcher and using their recommendations to recruit additional research participants

Once the researcher has decided how to select study participants, the data collection methods must be determined. Just as with participant sampling, various data collection methods are available, all of which have various advantages and disadvantages; therefore, the method must be selected based on the research question and circumstances. Unlike quantitative research, which usually uses a single data source and data collection method, the use of multiple data sources and data collection methods is encouraged in qualitative research [ 30 ]. Using a single data source and data collection method could cause data collection to be skewed by researcher bias; therefore, using multiple data sources and data collection methods is ideal. In qualitative research, the following data types are commonly used: (1) interview data obtained through one-on-one in-depth interviews and focus group discussions, (2) observational data from various observation levels, (3) documented data collected from personal or public documents, and (4) image data, such as photographs and videos.

Interview data are the most commonly used data source in qualitative research [ 31 ]. In qualitative research, an interview refers to communication that takes place based on a clear sense of purpose of acquiring certain information, unlike conversations that typically take place in daily life. The level of data acquired through interviews varies significantly depending on the researcher’s personal qualifications and abilities, as well as his or her level of interest and knowledge regarding the research topic. Therefore, interviewers must be trained to go beyond simply identifying the clearly expressed experiences of research participants to exploring their inner experiences and emotions [ 32 ]. Interview data can be classified based on the level of structuralization of the data collection method, sample size, and interview method. The characteristics of each type of interview are given in Table 3 .

Detailed types of interview methods according to the characteristics of in-depth interviews and focus group discussion

Classification	Specific method	Characteristics
Level of structuralization	Structured interview	Data are collected by asking closed questions in the order provided by highly specific interview guidelines
		Useful for asking questions without omitting any details that should be checked with each research participant
		Leaves little room for different interpretations of the participant’s responses or expressing original thoughts
	Semi-structured interview	Between a structured and unstructured interview; interview guidelines are developed in advance, but the questions are not strictly set and may vary
		The most widely used data collection method in qualitative research, as it allows interviews to be conducted flexibly depending on the characteristics and responses of the participants
		Researcher bias may influence the interview process
	Unstructured interview	The interview is conducted like a regular conversation, with extremely minimal prior information about the research topic and adherence to interview guidelines to exclude the intention for acquiring information needed for the research
		Can obtain rich and realistic meaning and experiences of the research participants
		The quality of information acquired and length (duration) of interview may vary depending on the competency of the interviewer, such as conversational skills and reasoning ability
Sample size	One-on-one in-depth interview	Excluding cases in which a guardian must accompany the research participant, such elderly or frail patients and children, a single participant discusses the research topic with one to two researchers during each interview session
		This data collection method is recommended for research topics that are difficult to discuss with others and suitable for obtaining in-depth opinions and experiences from individual participants
		The range of information that can be acquired may vary depending on the conversational skills and interview experience of the interviewer and requires a relatively large amount of effort to collect sufficient data
	Focus group discussion	At least 2 (generally 4–8) participants discuss the research topic during each interview session led by the researcher
		This method is effective when conducting interviews with participants who may be more willing to open up about themselves in a group setting than when alone, such as children and adolescents
		Richer experiences and opinions can be derived by promoting interaction within the group
		While it can be an effective data collection method, there may be some limitations in the depth of the interview; some participants may feel left out or not share their opinion if 1 or 2 participants dominate the discussion
Interview method	Face-to-face	The interviewer personally meets with the research participant to conduct the interview
		It is relatively easy to build rapport between the research participant and interviewer; can respond properly to the interview process by identifying non-verbal messages
		Cannot conduct interviews with research participants who are difficult to meet face-to-face
	Non-face-to-face	Interview between the interviewer and research participant is conducted through telephone, videoconferencing, or email
		Suitable data collection method for topics that deal with political or ethical matters or intimate personal issues; in particular, email interviews allow sufficient time for the research participant to think before responding
		It is not easy to generate interactions between the research participant and interviewer; in particular, it is difficult to obtain honest experiences through email interviews, and there is the possibility of misinterpreting the responses

Observations, which represent a key data collection method in anthropology, refer to a series of actions taken by the researcher in search of a deep understanding by systematically examining the appearances of research participants that take place in natural situations [ 33 ]. Observations can be categorized as participant and non-participant, insider and outsider, disguised and undisguised, short- and long-term, and structured and unstructured. However, a line cannot be drawn clearly to differentiate these categories, and the degree of each varies along a single spectrum. Therefore, it is necessary for a qualitative researcher to select the appropriate data collection method based on the circumstances and characteristics of the research topic.

Various types of document data can be used in qualitative research. Personal documents include diaries, letters, and autobiographies, while public documents include legal documents, public announcements, and civil documents. Online documents include emails and blog or bulletin board postings, while other documents include graffiti. All these document types may be used as data sources in qualitative research. In addition, image data acquired by the research participant or researcher, such as photographs and videos, serve as useful data sources in qualitative research. Such data sources are relatively objective and easily accessible, while they contain a significant amount of qualitative meaning despite the low acquisition cost. While some data may have been collected for research purposes, other data may not have been originally produced for research. Therefore, the researcher must not distort the original information contained in the data source and must verify the accuracy and authenticity of the data source in advance [ 30 ].

This review examined the characteristics of qualitative research to help researchers select the appropriate qualitative research methodology and identify situations suitable for qualitative research in the healthcare field. In addition, this paper analyzed the selection of the research topic and problem, selection of the theoretical framework and methods, literature analysis, and selection of the research participants and data collection methods. A forthcoming paper will discuss more specific details regarding other qualitative research methodologies, such as data analysis, description of findings, and research validation. This review can contribute to the more active use of qualitative research in the healthcare field, and the findings are expected to instill a proper understanding of qualitative research in researchers who review and judge qualitative research reports and papers.

Ethics Statement

Since this study used secondary data source, we did not seek approval from the institutional review board. We also did not have to ask for the consent of the participants.

Acknowledgments

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

AUTHOR CONTRIBUTIONS

Conceptualization: Pyo J, Lee W, Choi EY, Jang SG, Ock M. Data curation: Pyo J, Ock M. Formal analysis: Pyo J, Ock M. Funding acquisition: None. Validation: Lee W, Choi EY, Jang SG. Writing - original draft: Pyo J, Ock M. Writing - review & editing: Pyo J, Lee W, Choi EY, Jang SG, Ock M.

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The significance of a study in a research proposal refers to the importance or relevance of the research question, problem, or objective that the study aims to address. ... Difficulty in Measuring: The significance of a study is often qualitative and can be challenging to measure or quantify. You can explain how you think your research will ...
How To Write Significance of the Study (With Examples)
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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 ...
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What is the significance of a study and how is it stated in a research
Answer: In simple terms, the significance of the study is basically the importance of your research. The significance of a study must be stated in the Introduction section of your research paper. While stating the significance, you must highlight how your research will be beneficial to the development of science and the society in general.
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How To Write Significance of the Study (With Examples)

Table of Contents

Where Should I Put the Significance of the Study?

Why Should I Include the Significance of the Study?

How To Write Significance of the Study: 5 Steps

1. Use Your Research Problem as a Starting Point

2. State How Your Research Will Contribute to the Existing Literature in the Field

3. Explain How Your Research Will Benefit Society

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

5. Indicate How Your Study May Help Future Studies in the Field

Tips and Warnings

Significance of the Study Examples

Example 1: STEM-Related Research

Example 2: Business and Management-Related Research

Example 3: Social Science -Related Research.

Example 4: Humanities-Related Research

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