qualitative research introduction example

How to Write an Introduction for a Qualitative Research Study

How to Write a Lab Report Conclusion

There are two different accepted methods of conducting research in social sciences. These are quantitative and qualitative research studies. Both methods can be used to test hypotheses by carrying out investigations with groups of participants, but they achieve that in different ways. Quantitative research relies solely on numbers. For instance, the researcher may give out surveys to a large number of participants and then analyze the data from their answers by looking for patterns and correlations among different variables. In these studies, numerical data are analyzed using various statistical methods, and the researcher may not have to ever talk to any participants face-to-face.

When conducting qualitative research, the researcher often relies on a smaller group of participants, often conducts individual interviews with them and is interested in hearing their perspectives. The goal of a qualitative study isn't to find wide generalizations but to identify and analyze specific examples of a certain phenomenon and consider its possible implications. Qualitative methods often include in-depth interviews, group discussions and general participant observations by the researcher.

Why an Introduction is Important

An introduction is a crucial part of your study because it gives your readers a road map of what they can expect in reading your paper. It doesn't need to be long or elaborate, but it has to include the following elements.

State the Problem

Introduce the reader to the issue that your study addresses. Provide a concise overview of the problem and mention briefly how previous studies (if any) attempted to solve it. Don't go into details here. You'll have a chance to write a more in-depth literature review later.

Describe the Methods

Give the reader a brief overview (a couple of sentences will suffice) of the methodology you employed in your study. This is where you make it clear that your study relies on qualitative research methods. Again, don't go into as much detail as you will later in the methodology section.

State the Conclusion

That’s right. State the conclusion right in the introduction. It can be tempting to keep this part a secret until the reader gets to the end (why give everything away, you may be thinking?), but remember, you’re not writing a work of fiction. Your reader doesn't want to be surprised. They want an overview of what to expect in the conclusion and how you got there.

Address the Bigger Picture

Explain why this study is important in the bigger scheme of things. Think beyond the particular problem that your study addresses. What bigger questions will it help solve?

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• University of Southern California Libraries: Organizing Your Social Sciences Research Paper: 4. The Introduction
• Though quantitative methods are often employed as an effort of supporting the results and interpretations in a qualitative research study, they are not and should not be the focus of the report. Consequently, in your explanation and justification sections of your introduction, indicate the ways in which quantitative research played a complementary role to your qualitative analysis.

Tanya Mozias Slavin is a former academic and language teacher. She writes about education and linguistic technology, and has published articles in the Washington Post, Fast Company, CBC and other places. Find her at www.tanyamoziasslavin.com

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How to Write a Research Paper Introduction (with Examples)

The research paper introduction section, along with the Title and Abstract, can be considered the face of any research paper. The following article is intended to guide you in organizing and writing the research paper introduction for a quality academic article or dissertation.

The research paper introduction aims to present the topic to the reader. A study will only be accepted for publishing if you can ascertain that the available literature cannot answer your research question. So it is important to ensure that you have read important studies on that particular topic, especially those within the last five to ten years, and that they are properly referenced in this section. 1 What should be included in the research paper introduction is decided by what you want to tell readers about the reason behind the research and how you plan to fill the knowledge gap. The best research paper introduction provides a systemic review of existing work and demonstrates additional work that needs to be done. It needs to be brief, captivating, and well-referenced; a well-drafted research paper introduction will help the researcher win half the battle.

The introduction for a research paper is where you set up your topic and approach for the reader. It has several key goals:

• Present your research topic
• Capture reader interest
• Summarize existing research
• Position your own approach
• Define your specific research problem and problem statement
• Highlight the novelty and contributions of the study
• Give an overview of the paper’s structure

The research paper introduction can vary in size and structure depending on whether your paper presents the results of original empirical research or is a review paper. Some research paper introduction examples are only half a page while others are a few pages long. In many cases, the introduction will be shorter than all of the other sections of your paper; its length depends on the size of your paper as a whole.

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Table of Contents

What is the introduction for a research paper, why is the introduction important in a research paper, craft a compelling introduction section with paperpal. try now, 1. introduce the research topic:, 2. determine a research niche:, 3. place your research within the research niche:, craft accurate research paper introductions with paperpal. start writing now, frequently asked questions on research paper introduction, key points to remember.

The introduction in a research paper is placed at the beginning to guide the reader from a broad subject area to the specific topic that your research addresses. They present the following information to the reader

• Scope: The topic covered in the research paper
• Context: Background of your topic
• Importance: Why your research matters in that particular area of research and the industry problem that can be targeted

The research paper introduction conveys a lot of information and can be considered an essential roadmap for the rest of your paper. A good introduction for a research paper is important for the following reasons:

• It stimulates your reader’s interest: A good introduction section can make your readers want to read your paper by capturing their interest. It informs the reader what they are going to learn and helps determine if the topic is of interest to them.
• It helps the reader understand the research background: Without a clear introduction, your readers may feel confused and even struggle when reading your paper. A good research paper introduction will prepare them for the in-depth research to come. It provides you the opportunity to engage with the readers and demonstrate your knowledge and authority on the specific topic.
• It explains why your research paper is worth reading: Your introduction can convey a lot of information to your readers. It introduces the topic, why the topic is important, and how you plan to proceed with your research.
• It helps guide the reader through the rest of the paper: The research paper introduction gives the reader a sense of the nature of the information that will support your arguments and the general organization of the paragraphs that will follow. It offers an overview of what to expect when reading the main body of your paper.

What are the parts of introduction in the research?

A good research paper introduction section should comprise three main elements: 2

• What is known: This sets the stage for your research. It informs the readers of what is known on the subject.
• What is lacking: This is aimed at justifying the reason for carrying out your research. This could involve investigating a new concept or method or building upon previous research.
• What you aim to do: This part briefly states the objectives of your research and its major contributions. Your detailed hypothesis will also form a part of this section.

How to write a research paper introduction?

The first step in writing the research paper introduction is to inform the reader what your topic is and why it’s interesting or important. This is generally accomplished with a strong opening statement. The second step involves establishing the kinds of research that have been done and ending with limitations or gaps in the research that you intend to address. Finally, the research paper introduction clarifies how your own research fits in and what problem it addresses. If your research involved testing hypotheses, these should be stated along with your research question. The hypothesis should be presented in the past tense since it will have been tested by the time you are writing the research paper introduction.

The following key points, with examples, can guide you when writing the research paper introduction section:

• Highlight the importance of the research field or topic
• Describe the background of the topic
• Present an overview of current research on the topic

Example: The inclusion of experiential and competency-based learning has benefitted electronics engineering education. Industry partnerships provide an excellent alternative for students wanting to engage in solving real-world challenges. Industry-academia participation has grown in recent years due to the need for skilled engineers with practical training and specialized expertise. However, from the educational perspective, many activities are needed to incorporate sustainable development goals into the university curricula and consolidate learning innovation in universities.

• Reveal a gap in existing research or oppose an existing assumption
• Formulate the research question

Example: There have been plausible efforts to integrate educational activities in higher education electronics engineering programs. However, very few studies have considered using educational research methods for performance evaluation of competency-based higher engineering education, with a focus on technical and or transversal skills. To remedy the current need for evaluating competencies in STEM fields and providing sustainable development goals in engineering education, in this study, a comparison was drawn between study groups without and with industry partners.

• State the purpose of your study
• Highlight the key characteristics of your study
• Describe important results
• Highlight the novelty of the study.
• Offer a brief overview of the structure of the paper.

Example: The study evaluates the main competency needed in the applied electronics course, which is a fundamental core subject for many electronics engineering undergraduate programs. We compared two groups, without and with an industrial partner, that offered real-world projects to solve during the semester. This comparison can help determine significant differences in both groups in terms of developing subject competency and achieving sustainable development goals.

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The purpose of the research paper introduction is to introduce the reader to the problem definition, justify the need for the study, and describe the main theme of the study. The aim is to gain the reader’s attention by providing them with necessary background information and establishing the main purpose and direction of the research.

The length of the research paper introduction can vary across journals and disciplines. While there are no strict word limits for writing the research paper introduction, an ideal length would be one page, with a maximum of 400 words over 1-4 paragraphs. Generally, it is one of the shorter sections of the paper as the reader is assumed to have at least a reasonable knowledge about the topic. 2 For example, for a study evaluating the role of building design in ensuring fire safety, there is no need to discuss definitions and nature of fire in the introduction; you could start by commenting upon the existing practices for fire safety and how your study will add to the existing knowledge and practice.

When deciding what to include in the research paper introduction, the rest of the paper should also be considered. The aim is to introduce the reader smoothly to the topic and facilitate an easy read without much dependency on external sources. 3 Below is a list of elements you can include to prepare a research paper introduction outline and follow it when you are writing the research paper introduction. Topic introduction: This can include key definitions and a brief history of the topic. Research context and background: Offer the readers some general information and then narrow it down to specific aspects. Details of the research you conducted: A brief literature review can be included to support your arguments or line of thought. Rationale for the study: This establishes the relevance of your study and establishes its importance. Importance of your research: The main contributions are highlighted to help establish the novelty of your study Research hypothesis: Introduce your research question and propose an expected outcome. Organization of the paper: Include a short paragraph of 3-4 sentences that highlights your plan for the entire paper

Cite only works that are most relevant to your topic; as a general rule, you can include one to three. Note that readers want to see evidence of original thinking. So it is better to avoid using too many references as it does not leave much room for your personal standpoint to shine through. Citations in your research paper introduction support the key points, and the number of citations depend on the subject matter and the point discussed. If the research paper introduction is too long or overflowing with citations, it is better to cite a few review articles rather than the individual articles summarized in the review. A good point to remember when citing research papers in the introduction section is to include at least one-third of the references in the introduction.

The literature review plays a significant role in the research paper introduction section. A good literature review accomplishes the following: Introduces the topic – Establishes the study’s significance – Provides an overview of the relevant literature – Provides context for the study using literature – Identifies knowledge gaps However, remember to avoid making the following mistakes when writing a research paper introduction: Do not use studies from the literature review to aggressively support your research Avoid direct quoting Do not allow literature review to be the focus of this section. Instead, the literature review should only aid in setting a foundation for the manuscript.

Remember the following key points for writing a good research paper introduction: 4

• Avoid stuffing too much general information: Avoid including what an average reader would know and include only that information related to the problem being addressed in the research paper introduction. For example, when describing a comparative study of non-traditional methods for mechanical design optimization, information related to the traditional methods and differences between traditional and non-traditional methods would not be relevant. In this case, the introduction for the research paper should begin with the state-of-the-art non-traditional methods and methods to evaluate the efficiency of newly developed algorithms.
• Avoid packing too many references: Cite only the required works in your research paper introduction. The other works can be included in the discussion section to strengthen your findings.
• Avoid extensive criticism of previous studies: Avoid being overly critical of earlier studies while setting the rationale for your study. A better place for this would be the Discussion section, where you can highlight the advantages of your method.
• Avoid describing conclusions of the study: When writing a research paper introduction remember not to include the findings of your study. The aim is to let the readers know what question is being answered. The actual answer should only be given in the Results and Discussion section.

To summarize, the research paper introduction section should be brief yet informative. It should convince the reader the need to conduct the study and motivate him to read further. If you’re feeling stuck or unsure, choose trusted AI academic writing assistants like Paperpal to effortlessly craft your research paper introduction and other sections of your research article.

1. Jawaid, S. A., & Jawaid, M. (2019). How to write introduction and discussion. Saudi Journal of Anaesthesia, 13(Suppl 1), S18.

2. Dewan, P., & Gupta, P. (2016). Writing the title, abstract and introduction: Looks matter!. Indian pediatrics, 53, 235-241.

3. Cetin, S., & Hackam, D. J. (2005). An approach to the writing of a scientific Manuscript1. Journal of Surgical Research, 128(2), 165-167.

4. Bavdekar, S. B. (2015). Writing introduction: Laying the foundations of a research paper. Journal of the Association of Physicians of India, 63(7), 44-6.

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• Knowledge Base

Methodology

• 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?

Table of contents

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.

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 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.

Prevent plagiarism. Run a free check.

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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• Knowledge Base
• Methodology
• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on 4 April 2022 by Pritha Bhandari . Revised on 30 January 2023.

Qualitative research involves collecting and analysing 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 analysing 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, and history.

• 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 organisation?
• How is anxiety experienced around the world?
• How can teachers integrate social issues into science curriculums?

Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, 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 emphasise different aims and perspectives.

Prevent plagiarism, run a free check.

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 analysing 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 organise 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 categorise 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 analysing qualitative data. Although these methods share similar processes, they emphasise different concepts.

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.

Researchers must consider practical and theoretical limitations in analysing 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 analysing 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 generalisability

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

• Labour-intensive

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

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

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

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 organisation 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 organisations.

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

• Prepare and organise 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 .

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

Bhandari, P. (2023, January 30). What Is Qualitative Research? | Methods & Examples. Scribbr. Retrieved 11 June 2024, from https://www.scribbr.co.uk/research-methods/introduction-to-qualitative-research/

Is this article helpful?

Pritha Bhandari

An Introduction to Qualitative Research

Cite this chapter.

• Robert A. Croker 3  

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Qualitative research — when you first heard the term, your initial thought might have been, ‘What do qualitative researchers actually do?’ It may come as a surprise to you that you are already familiar with many of their activities, and you actually do them yourself — every day — as you watch and listen to what happens around you, and ask questions about what you have seen and heard.

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Croker, R.A. (2009). An Introduction to Qualitative Research. In: Heigham, J., Croker, R.A. (eds) Qualitative Research in Applied Linguistics. Palgrave Macmillan, London. https://doi.org/10.1057/9780230239517_1

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Introduction to qualitative research methods – Part I

Shagufta bhangu.

Department of Global Health and Social Medicine, King's College London, London, United Kingdom

Fabien Provost

Carlo caduff.

Qualitative research methods are widely used in the social sciences and the humanities, but they can also complement quantitative approaches used in clinical research. In this article, we discuss the key features and contributions of qualitative research methods.

INTRODUCTION

Qualitative research methods refer to techniques of investigation that rely on nonstatistical and nonnumerical methods of data collection, analysis, and evidence production. Qualitative research techniques provide a lens for learning about nonquantifiable phenomena such as people's experiences, languages, histories, and cultures. In this article, we describe the strengths and role of qualitative research methods and how these can be employed in clinical research.

Although frequently employed in the social sciences and humanities, qualitative research methods can complement clinical research. These techniques can contribute to a better understanding of the social, cultural, political, and economic dimensions of health and illness. Social scientists and scholars in the humanities rely on a wide range of methods, including interviews, surveys, participant observation, focus groups, oral history, and archival research to examine both structural conditions and lived experience [ Figure 1 ]. Such research can not only provide robust and reliable data but can also humanize and add richness to our understanding of the ways in which people in different parts of the world perceive and experience illness and how they interact with medical institutions, systems, and therapeutics.

Examples of qualitative research techniques

Qualitative research methods should not be seen as tools that can be applied independently of theory. It is important for these tools to be based on more than just method. In their research, social scientists and scholars in the humanities emphasize social theory. Departing from a reductionist psychological model of individual behavior that often blames people for their illness, social theory focuses on relations – disease happens not simply in people but between people. This type of theoretically informed and empirically grounded research thus examines not just patients but interactions between a wide range of actors (e.g., patients, family members, friends, neighbors, local politicians, medical practitioners at all levels, and from many systems of medicine, researchers, policymakers) to give voice to the lived experiences, motivations, and constraints of all those who are touched by disease.

PHILOSOPHICAL FOUNDATIONS OF QUALITATIVE RESEARCH METHODS

In identifying the factors that contribute to the occurrence and persistence of a phenomenon, it is paramount that we begin by asking the question: what do we know about this reality? How have we come to know this reality? These two processes, which we can refer to as the “what” question and the “how” question, are the two that all scientists (natural and social) grapple with in their research. We refer to these as the ontological and epistemological questions a research study must address. Together, they help us create a suitable methodology for any research study[ 1 ] [ Figure 2 ]. Therefore, as with quantitative methods, there must be a justifiable and logical method for understanding the world even for qualitative methods. By engaging with these two dimensions, the ontological and the epistemological, we open a path for learning that moves away from commonsensical understandings of the world, and the perpetuation of stereotypes and toward robust scientific knowledge production.

Developing a research methodology

Every discipline has a distinct research philosophy and way of viewing the world and conducting research. Philosophers and historians of science have extensively studied how these divisions and specializations have emerged over centuries.[ 1 , 2 , 3 ] The most important distinction between quantitative and qualitative research techniques lies in the nature of the data they study and analyze. While the former focus on statistical, numerical, and quantitative aspects of phenomena and employ the same in data collection and analysis, qualitative techniques focus on humanistic, descriptive, and qualitative aspects of phenomena.[ 4 ]

For the findings of any research study to be reliable, they must employ the appropriate research techniques that are uniquely tailored to the phenomena under investigation. To do so, researchers must choose techniques based on their specific research questions and understand the strengths and limitations of the different tools available to them. Since clinical work lies at the intersection of both natural and social phenomena, it means that it must study both: biological and physiological phenomena (natural, quantitative, and objective phenomena) and behavioral and cultural phenomena (social, qualitative, and subjective phenomena). Therefore, clinical researchers can gain from both sets of techniques in their efforts to produce medical knowledge and bring forth scientifically informed change.

KEY FEATURES AND CONTRIBUTIONS OF QUALITATIVE RESEARCH METHODS

In this section, we discuss the key features and contributions of qualitative research methods [ Figure 3 ]. We describe the specific strengths and limitations of these techniques and discuss how they can be deployed in scientific investigations.

Key features of qualitative research methods

One of the most important contributions of qualitative research methods is that they provide rigorous, theoretically sound, and rational techniques for the analysis of subjective, nebulous, and difficult-to-pin-down phenomena. We are aware, for example, of the role that social factors play in health care but find it hard to qualify and quantify these in our research studies. Often, we find researchers basing their arguments on “common sense,” developing research studies based on assumptions about the people that are studied. Such commonsensical assumptions are perhaps among the greatest impediments to knowledge production. For example, in trying to understand stigma, surveys often make assumptions about its reasons and frequently associate it with vague and general common sense notions of “fear” and “lack of information.” While these may be at work, to make such assumptions based on commonsensical understandings, and without conducting research inhibit us from exploring the multiple social factors that are at work under the guise of stigma.

In unpacking commonsensical understandings and researching experiences, relationships, and other phenomena, qualitative researchers are assisted by their methodological commitment to open-ended research. By open-ended research, we mean that these techniques take on an unbiased and exploratory approach in which learnings from the field and from research participants, are recorded and analyzed to learn about the world.[ 5 ] This orientation is made possible by qualitative research techniques that are particularly effective in learning about specific social, cultural, economic, and political milieus.

Second, qualitative research methods equip us in studying complex phenomena. Qualitative research methods provide scientific tools for exploring and identifying the numerous contributing factors to an occurrence. Rather than establishing one or the other factor as more important, qualitative methods are open-ended, inductive (ground-up), and empirical. They allow us to understand the object of our analysis from multiple vantage points and in its dispersion and caution against predetermined notions of the object of inquiry. They encourage researchers instead to discover a reality that is not yet given, fixed, and predetermined by the methods that are used and the hypotheses that underlie the study.

Once the multiple factors at work in a phenomenon have been identified, we can employ quantitative techniques and embark on processes of measurement, establish patterns and regularities, and analyze the causal and correlated factors at work through statistical techniques. For example, a doctor may observe that there is a high patient drop-out in treatment. Before carrying out a study which relies on quantitative techniques, qualitative research methods such as conversation analysis, interviews, surveys, or even focus group discussions may prove more effective in learning about all the factors that are contributing to patient default. After identifying the multiple, intersecting factors, quantitative techniques can be deployed to measure each of these factors through techniques such as correlational or regression analyses. Here, the use of quantitative techniques without identifying the diverse factors influencing patient decisions would be premature. Qualitative techniques thus have a key role to play in investigations of complex realities and in conducting rich exploratory studies while embracing rigorous and philosophically grounded methodologies.

Third, apart from subjective, nebulous, and complex phenomena, qualitative research techniques are also effective in making sense of irrational, illogical, and emotional phenomena. These play an important role in understanding logics at work among patients, their families, and societies. Qualitative research techniques are aided by their ability to shift focus away from the individual as a unit of analysis to the larger social, cultural, political, economic, and structural forces at work in health. As health-care practitioners and researchers focused on biological, physiological, disease and therapeutic processes, sociocultural, political, and economic conditions are often peripheral or ignored in day-to-day clinical work. However, it is within these latter processes that both health-care practices and patient lives are entrenched. Qualitative researchers are particularly adept at identifying the structural conditions such as the social, cultural, political, local, and economic conditions which contribute to health care and experiences of disease and illness.

For example, the decision to delay treatment by a patient may be understood as an irrational choice impacting his/her chances of survival, but the same may be a result of the patient treating their child's education as a financial priority over his/her own health. While this appears as an “emotional” choice, qualitative researchers try to understand the social and cultural factors that structure, inform, and justify such choices. Rather than assuming that it is an irrational choice, qualitative researchers try to understand the norms and logical grounds on which the patient is making this decision. By foregrounding such logics, stories, fears, and desires, qualitative research expands our analytic precision in learning about complex social worlds, recognizing reasons for medical successes and failures, and interrogating our assumptions about human behavior. These in turn can prove useful in arriving at conclusive, actionable findings which can inform institutional and public health policies and have a very important role to play in any change and transformation we may wish to bring to the societies in which we work.

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Introduction to Research Methods

6 qualitative research and interviews.

So we’ve described doing a survey and collecting quantitative data. But not all questions can best be answered by a survey. A survey is great for understanding what people think (for example), but not why they think what they do. If your research is intending to understand the underlying motivations or reasons behind peoples actions, or to build a deeper understanding on the background of a subject, an interview may be the more appropriate data collection method.

Interviews are a method of data collection that consist of two or more people exchanging information through a structured process of questions and answers. Questions are designed by the researcher to thoughtfully collect in-depth information on a topic or set of topics as related to the central research question. Interviews typically occur in-person, although good interviews can also be conducted remotely via the phone or video conferencing. Unlike surveys, interviews give the opportunity to ask follow-up questions and thoughtfully engage with participants on the spot (rather than the anonymous and impartial format of survey research).

And surveys can be used in qualitative or quantitative research – though they’re more typically a qualitative technique. In-depth interviews , containing open-ended questions and structured by an interview guide . One can also do a standardized interview with closed-ended questions (i.e. answer options) that are structured by an interview schedule as part of quantitative research. While these are called interviews they’re far closer to surveys, so we wont cover them again in this chapter. The terms used for in-depth interviews we’ll cover in the next section.

6.1 Interviews

In-depth interviews allow participants to describe experiences in their own words (a primary strength of the interview format). Strong in-depth interviews will include many open-ended questions that allow participants to respond in their own words, share new ideas, and lead the conversation in different directions. The purpose of open-ended questions and in-depth interviews is to hear as much as possible in the person’s own voice, to collect new information and ideas, and to achieve a level of depth not possible in surveys or most other forms of data collection.

Typically, an interview guide is used to create a soft structure for the conversation and is an important preparation tool for the researcher. You can not go into an interview unprepared and just “wing it”; what the interview guide allows you to do is map out a framework, order of topics, and may include specific questions to use during the interview. Generally, the interview guide is thought of as just that — a guide to use in order to keep the interview focused. It is not set in stone and a skilled researcher can change the order of questions or topics in an interviews based on the organic conversation flow.

Depending on the experience and skill level of the researcher, an interview guide can be as simple as a list of topics to cover. However, for consistency and quality of research, the interviewer may want to take the time to at least practice writing out questions in advance to ensure that phrasing and word choices are as clear, objective, and focused as possible. It’s worth remembering that working out the wording of questions in advance allows researchers to ensure more consistency across interview. The interview guide below, taken from the wonderful and free textbook Principles of Sociological Inquiry , shows an interview guide that just has topics.

Alternatively, you can use a more detailed guide that lists out possible questions, as shown below. A more detailed guide is probably better for an interviewer that has less experience, or is just beginning to work on a given topic.

The purpose of an interview guide is to help ask effective questions and to support the process of acquiring the best possible data for your research. Topics and questions should be organized thematically, and in a natural progression that will allow the conversation to flow and deepen throughout the course of the interview. Often, researchers will attempt to memorize or partially memorize the interview guide, in order to be more fully present with the participant during the conversation.

6.2 Asking good Questions

Remember, the purposes of interviews is to go more in-depth with an individual than is possible with a generalized survey. For this reason, it is important to use the guide as a starting point but not to be overly tethered to it during the actual interview process. You may get stuck when respondents give you shorter answers than you expect, or don’t provide the type of depth that you need for your research. Often, you may want to probe for more specifics. Think about using follow up questions like “How does/did that affect you?” or “How does X make you feel?” and “Tell me about a time where X…”

For example, if I was researching the relationship between pets and mental health, some strong open-ended questions might be: * How does your pet typically make you feel when you wake up in the morning? * How does your pet generally affect your mood when you arrive home in the evening? * Tell me about a time when your pet had a significant impact on your emotional state.

Questions framed in this manner leave plenty of room for the respondent to answer in their own words, as opposed to leading and/or truncated questions, such as: * Does being with your pet make you happy? * After a bad day, how much does seeing your pet improve your mood? * Tell me about how important your pet is to your mental health.

These questions assume outcomes and will not result in high quality research. Researchers should always avoid asking leading questions that give away an expected answer or suggest particular responses. For instance, if I ask “we need to spend more on public schools, don’t you think?” the respondent is more likely to agree regardless of their own thoughts. Some wont, but humans generally have a strong natural desire to be agreeable. That’s why leaving your questions neutral and open so that respondents can speak to their experiences and views is critical.

6.3 Analyzing Interview Data

Writing good questions and interviewing respondents are just the first steps of the interview process. After these stages, the researcher still has a lot of work to do to collect usable data from the interview. The researcher must spend time coding and analyzing the interview to retrieve this data. Just doing an interview wont produce data. Think about how many conversations you have everyday, and none of those are leaving you swimming in data.

Hopefully you can record your interviews. Recording your interviews will allow you the opportunity to transcribe them word for word later. If you can’t record the interview you’ll need to take detailed notes so that you can reconstruct what you heard later. Do not trust yourself to “just remember” the conversation. You’re collecting data, precious data that you’re spending time and energy to collect. Treat it as important and valuable. Remember our description of the methodology section from Chapter 2, you need to maintain a chain of custody on your data. If you just remembered the interview, you could be accused of making up the results. Your interview notes and the recording become part of that chain of custody to prove to others that your interviews were real and that your results are accurate.

Assuming you recorded your interview, the first step in the analysis process is transcribing the interview. A transcription is a written record of every word in an interview. Transcriptions can either be completed by the researcher or by a hired worker, though it is good practice for the researcher to transcribe the interview him or herself. Researchers should keep the following points in mind regarding transcriptions: * The interview should take place in a quiet location with minimal background noise to produce a clear recording; * Transcribing interviews is a time-consuming process and may take two to three times longer than the actual interview; * Transcriptions provide a more precise record of the interview than hand written notes and allow the interviewer to focus during the interview.

After transcribing the interview, the next step is to analyze the responses. Coding is the main form of analysis used for interviews and involves studying a transcription to identify important themes. These themes are categorized into codes, which are words or phrases that denote an idea.

You’ll typically being with several codes in mind that are generated by key ideas you week seeking in the questions, but you can also being by using open coding to understand the results. An open coding process involves reading through the transcript multiple times and paying close attention to each line of the text to discover noteworthy concepts. During the open coding process, the researcher keeps an open mind to find any codes that may be relevant to the research topic.

After the open coding process is complete, focused coding can begin. Focused coding takes a closer look at the notes compiled during the open coding stage to merge common codes and define what the codes mean in the context of the research project.

Imagine a researcher is conducting interviews to learn about various people’s experiences of childhood in New Orleans. The following example shows several codes that this researcher extrapolated from an interview with one of their subjects.

6.4 Using interview data

The next chapter will address ways to identify people to interview, but most of the remainder of the book will address how to analyze quantitative data. That shouldn’t be taken as a sign that quantitative data is better, or that it’s easier to use interview data. Because in an interview the researcher must interpret the words of others it is often more challenging to identify your findings and clearly answer your research question. However, quantitative data is more common, and there are more different things you can do with it, so we spend a lot of the textbook focusing on it.

I’ll work through one more example of using interview data though. It takes a lot of practice to be a good and skilled interviewer. What I show below is a brief excerpt of an interview I did, and how that data was used in a resulting paper I wrote. These aren’t the only way you can use interview data, but it’s an example of what the intermediary and final product might look like.

The overall project these are drawn from was concerned with minor league baseball stadiums, but the specific part I’m pulling from here was studying the decline and rejuvenation of downtown around those stadiums in several cities. You’ll see that I’m using the words of the respondent fairly directly, because that’s my data. But I’m not just relying on one respondent and trusting them, I did a few dozen interviews in order to understand the commonalities in people’s perspectives to build a narrative around my research question.

Excerpt from Notes

Excerpt from Resulting Paper

How many interviews are necessary? It actually doesn’t take many. What you want to observe in your interviews is theoretical saturation , where the codes you use in the transcript begin to appear across conversations and groups. If different people disagree that’s fine, but what you want to understand is the commonalities across peoples perspectives. Most research on the subject says that with 8 interviews you’ll typically start to see a decline in new information gathered. That doesn’t mean you won’t get new words , but you’ll stop hearing completely unique perspectives or gain novel insights. At that point, where you’ve ‘heard it all before’ you can stop, because you’ve probably identified the answer to the questions you were trying to research.

6.5 Ensuring Anonymity

One significant ethical concern with interviews, that also applies to surveys, is making sure that respondents maintain anonymity. In either form of data collection you may be asking respondents deeply personal questions, that if exposed may cause legal, personal, or professional harm. Notice that in the excerpt of the paper above the respondents are only identified by an id I assigned (Louisville D) and their career, rather than their name. I can only include the excerpt of the interview notes above because there are no details that might lead to them being identified.

You may want to report details about a person to contextualize the data you gathered, but you should always ensure that no one can be identified from your research. For instance, if you were doing research on racism at large companies, you may want to preface people’s comments by their race, as there is a good chance that white and minority employees would feel differently about the issues. However, if you preface someones comments by saying they’re a minority manager, that may violate their anonymity. Even if you don’t state what company you did interviews with, that may be enough detail for their co-workers to identify them if there are few minority managers at the company. As such, always think long and hard about whether there is any way that the participation of respondents may be exposed.

6.6 Why not both?

We’ve discussed surveys and interviews as different methods the last two chapters, but they can also complement each other.

For instance, let’s say you’re curious to study people who change opinions on abortion, either going from support to opposition or vice versa. You could use a survey to understand the prevalence of changing opinions, i.e. what percentage of people in your city have changed their views. That would help to establish whether this is a prominent issue, or whether it’s a rare phenomenon. But it would be difficult to understand from the survey what makes people change their views. You could add an open ended question for anyone that said they changed their opinion, but many people won’t respond and few will provide the level of detail necessary to understand their motivations. Interviews with people that have changed their opinions would give you an opportunity to explore how their experiences and beliefs have changed in combination with their views towards abortion.

6.7 Summary

In the last two chapters we’ve discussed the two most prominent methods of data collection in the social sciences: surveys and interviews. What we haven’t discussed though is how to identify the people you’ll collect data from; that’s called a sampling strategy. In the next chapter

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Examples on these pages illustrate the details of reference formats. We make every attempt to show examples that are in keeping with APA Style’s guiding principles of inclusivity and bias-free language. These examples are presented out of context only to demonstrate formatting issues (e.g., which elements to italicize, where punctuation is needed, placement of parentheses). References, including these examples, are not inherently endorsements for the ideas or content of the works themselves. An author may cite a work to support a statement or an idea, to critique that work, or for many other reasons. For more examples, see our sample papers .

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Chapter 20. Presentations

Introduction.

If a tree falls in a forest, and no one is around to hear it, does it make a sound? If a qualitative study is conducted, but it is not presented (in words or text), did it really happen? Perhaps not. Findings from qualitative research are inextricably tied up with the way those findings are presented. These presentations do not always need to be in writing, but they need to happen. Think of ethnographies, for example, and their thick descriptions of a particular culture. Witnessing a culture, taking fieldnotes, talking to people—none of those things in and of themselves convey the culture. Or think about an interview-based phenomenological study. Boxes of interview transcripts might be interesting to read through, but they are not a completed study without the intervention of hours of analysis and careful selection of exemplary quotes to illustrate key themes and final arguments and theories. And unlike much quantitative research in the social sciences, where the final write-up neatly reports the results of analyses, the way the “write-up” happens is an integral part of the analysis in qualitative research. Once again, we come back to the messiness and stubborn unlinearity of qualitative research. From the very beginning, when designing the study, imagining the form of its ultimate presentation is helpful.

Because qualitative researchers are motivated by understanding and conveying meaning, effective communication is not only an essential skill but a fundamental facet of the entire research project. Ethnographers must be able to convey a certain sense of verisimilitude, the appearance of true reality. Those employing interviews must faithfully depict the key meanings of the people they interviewed in a way that rings true to those people, even if the end result surprises them. And all researchers must strive for clarity in their publications so that various audiences can understand what was found and why it is important. This chapter will address how to organize various kinds of presentations for different audiences so that your results can be appreciated and understood.

In the world of academic science, social or otherwise, the primary audience for a study’s results is usually the academic community, and the primary venue for communicating to this audience is the academic journal. Journal articles are typically fifteen to thirty pages in length (8,000 to 12,000 words). Although qualitative researchers often write and publish journal articles—indeed, there are several journals dedicated entirely to qualitative research [1] —the best writing by qualitative researchers often shows up in books. This is because books, running from 80,000 to 150,000 words in length, allow the researcher to develop the material fully. You have probably read some of these in various courses you have taken, not realizing what they are. I have used examples of such books throughout this text, beginning with the three profiles in the introductory chapter. In some instances, the chapters in these books began as articles in academic journals (another indication that the journal article format somewhat limits what can be said about the study overall).

While the article and the book are “final” products of qualitative research, there are actually a few other presentation formats that are used along the way. At the very beginning of a research study, it is often important to have a written research proposal not just to clarify to yourself what you will be doing and when but also to justify your research to an outside agency, such as an institutional review board (IRB; see chapter 12), or to a potential funder, which might be your home institution, a government funder (such as the National Science Foundation, or NSF), or a private foundation (such as the Gates Foundation). As you get your research underway, opportunities will arise to present preliminary findings to audiences, usually through presentations at academic conferences. These presentations can provide important feedback as you complete your analyses. Finally, if you are completing a degree and looking to find an academic job, you will be asked to provide a “job talk,” usually about your research. These job talks are similar to conference presentations but can run significantly longer.

All the presentations mentioned so far are (mostly) for academic audiences. But qualitative research is also unique in that many of its practitioners don’t want to confine their presentation only to other academics. Qualitative researchers who study particular contexts or cultures might want to report back to the people and places they observed. Those working in the critical tradition might want to raise awareness of a particular issue to as large an audience as possible. Many others simply want everyday, nonacademic people to read their work, because they think it is interesting and important. To reach a wide audience, the final product can look like almost anything—it can be a poem, a blog, a podcast, even a science fiction short story. And if you are very lucky, it can even be a national or international bestseller.

In this chapter, we are going to stick with the more basic quotidian presentations—the academic paper / research proposal, the conference slideshow presentation / job talk, and the conference poster. We’ll also spend a bit of time on incorporating universal design into your presentations and how to create some especially attractive and impactful visual displays.

Researcher Note

What is the best piece of advice you’ve ever been given about conducting qualitative research?

The best advice I’ve received came from my adviser, Alford Young Jr. He told me to find the “Jessi Streib” answer to my research question, not the “Pierre Bourdieu” answer to my research question. In other words, don’t just say how a famous theorist would answer your question; say something original, something coming from you.

—Jessi Streib, author of The Power of the Past and Privilege Lost 

Writing about Your Research

The journal article and the research proposal.

Although the research proposal is written before you have actually done your research and the article is written after all data collection and analysis is complete, there are actually many similarities between the two in terms of organization and purpose. The final article will (probably—depends on how much the research question and focus have shifted during the research itself) incorporate a great deal of what was included in a preliminary research proposal. The average lengths of both a proposal and an article are quite similar, with the “front sections” of the article abbreviated to make space for the findings, discussion of findings, and conclusion.

Figure 20.1 shows one model for what to include in an article or research proposal, comparing the elements of each with a default word count for each section. Please note that you will want to follow whatever specific guidelines you have been provided by the venue you are submitting the article/proposal to: the IRB, the NSF, the Journal of Qualitative Research . In fact, I encourage you to adapt the default model as needed by swapping out expected word counts for each section and adding or varying the sections to match expectations for your particular publication venue. [2]

You will notice a few things about the default model guidelines. First, while half of the proposal is spent discussing the research design, this section is shortened (but still included) for the article. There are a few elements that only show up in the proposal (e.g., the limitations section is in the introductory section here—it will be more fully developed in the conclusory section in the article). Obviously, you don’t have findings in the proposal, so this is an entirely new section for the article. Note that the article does not include a data management plan or a timeline—two aspects that most proposals require.

It might be helpful to find and maintain examples of successfully written sections that you can use as models for your own writing. I have included a few of these throughout the textbook and have included a few more at the end of this chapter.

Make an Argument

Some qualitative researchers, particularly those engaged in deep ethnographic research, focus their attention primarily if not exclusively on describing the data. They might even eschew the notion that they should make an “argument” about the data, preferring instead to use thick descriptions to convey interpretations. Bracketing the contrast between interpretation and argument for the moment, most readers will expect you to provide an argument about your data, and this argument will be in answer to whatever research question you eventually articulate (remember, research questions are allowed to shift as you get further into data collection and analysis). It can be frustrating to read a well-developed study with clear and elegant descriptions and no argument. The argument is the point of the research, and if you do not have one, 99 percent of the time, you are not finished with your analysis. Calarco ( 2020 ) suggests you imagine a pyramid, with all of your data forming the basis and all of your findings forming the middle section; the top/point of the pyramid is your argument, “what the patterns in your data tell us about how the world works or ought to work” ( 181 ).

The academic community to which you belong will be looking for an argument that relates to or develops theory. This is the theoretical generalizability promise of qualitative research. An academic audience will want to know how your findings relate to previous findings, theories, and concepts (the literature review; see chapter 9). It is thus vitally important that you go back to your literature review (or develop a new one) and draw those connections in your discussion and/or conclusion. When writing to other audiences, you will still want an argument, although it may not be written as a theoretical one. What do I mean by that? Even if you are not referring to previous literature or developing new theories or adapting older ones, a simple description of your findings is like dumping a lot of leaves in the lap of your audience. They still deserve to know about the shape of the forest. Maybe provide them a road map through it. Do this by telling a clear and cogent story about the data. What is the primary theme, and why is it important? What is the point of your research? [3]

A beautifully written piece of research based on participant observation [and/or] interviews brings people to life, and helps the reader understand the challenges people face. You are trying to use vivid, detailed and compelling words to help the reader really understand the lives of the people you studied. And you are trying to connect the lived experiences of these people to a broader conceptual point—so that the reader can understand why it matters. ( Lareau 2021:259 )

Do not hide your argument. Make it the focal point of your introductory section, and repeat it as often as needed to ensure the reader remembers it. I am always impressed when I see researchers do this well (see, e.g., Zelizer 1996 ).

Here are a few other suggestions for writing your article: Be brief. Do not overwhelm the reader with too many words; make every word count. Academics are particularly prone to “overwriting” as a way of demonstrating proficiency. Don’t. When writing your methods section, think about it as a “recipe for your work” that allows other researchers to replicate if they so wish ( Calarco 2020:186 ). Convey all the necessary information clearly, succinctly, and accurately. No more, no less. [4] Do not try to write from “beginning to end” in that order. Certain sections, like the introductory section, may be the last ones you write. I find the methods section the easiest, so I often begin there. Calarco ( 2020 ) begins with an outline of the analysis and results section and then works backward from there to outline the contribution she is making, then the full introduction that serves as a road map for the writing of all sections. She leaves the abstract for the very end. Find what order best works for you.

Presenting at Conferences and Job Talks

Students and faculty are primarily called upon to publicly present their research in two distinct contexts—the academic conference and the “job talk.” By convention, conference presentations usually run about fifteen minutes and, at least in sociology and other social sciences, rely primarily on the use of a slideshow (PowerPoint Presentation or PPT) presentation. You are usually one of three or four presenters scheduled on the same “panel,” so it is an important point of etiquette to ensure that your presentation falls within the allotted time and does not crowd into that of the other presenters. Job talks, on the other hand, conventionally require a forty- to forty-five-minute presentation with a fifteen- to twenty-minute question and answer (Q&A) session following it. You are the only person presenting, so if you run over your allotted time, it means less time for the Q&A, which can disturb some audience members who have been waiting for a chance to ask you something. It is sometimes possible to incorporate questions during your presentation, which allows you to take the entire hour, but you might end up shorting your presentation this way if the questions are numerous. It’s best for beginners to stick to the “ask me at the end” format (unless there is a simple clarifying question that can easily be addressed and makes the presentation run more smoothly, as in the case where you simply forgot to include information on the number of interviews you conducted).

For slideshows, you should allot two or even three minutes for each slide, never less than one minute. And those slides should be clear, concise, and limited. Most of what you say should not be on those slides at all. The slides are simply the main points or a clear image of what you are speaking about. Include bulleted points (words, short phrases), not full sentences. The exception is illustrative quotations from transcripts or fieldnotes. In those cases, keep to one illustrative quote per slide, and if it is long, bold or otherwise, highlight the words or passages that are most important for the audience to notice. [5]

Figure 20.2 provides a possible model for sections to include in either a conference presentation or a job talk, with approximate times and approximate numbers of slides. Note the importance (in amount of time spent) of both the research design and the findings/results sections, both of which have been helpfully starred for you. Although you don’t want to short any of the sections, these two sections are the heart of your presentation.

Fig 20.2. Suggested Slideshow Times and Number of Slides

Should you write out your script to read along with your presentation? I have seen this work well, as it prevents presenters from straying off topic and keeps them to the time allotted. On the other hand, these presentations can seem stiff and wooden. Personally, although I have a general script in advance, I like to speak a little more informally and engagingly with each slide, sometimes making connections with previous panelists if I am at a conference. This means I have to pay attention to the time, and I sometimes end up breezing through one section more quickly than I would like. Whatever approach you take, practice in advance. Many times. With an audience. Ask for feedback, and pay attention to any presentation issues that arise (e.g., Do you speak too fast? Are you hard to hear? Do you stumble over a particular word or name?).

Even though there are rules and guidelines for what to include, you will still want to make your presentation as engaging as possible in the little amount of time you have. Calarco ( 2020:274 ) recommends trying one of three story structures to frame your presentation: (1) the uncertain explanation , where you introduce a phenomenon that has not yet been fully explained and then describe how your research is tackling this; (2) the uncertain outcome , where you introduce a phenomenon where the consequences have been unclear and then you reveal those consequences with your research; and (3) the evocative example , where you start with some interesting example from your research (a quote from the interview transcripts, for example) or the real world and then explain how that example illustrates the larger patterns you found in your research. Notice that each of these is a framing story. Framing stories are essential regardless of format!

A Word on Universal Design

Please consider accessibility issues during your presentation, and incorporate elements of universal design into your slideshow. The basic idea behind universal design in presentations is that to the greatest extent possible, all people should be able to view, hear, or otherwise take in your presentation without needing special individual adaptations. If you can make your presentation accessible to people with visual impairment or hearing loss, why not do so? For example, one in twelve men is color-blind, unable to differentiate between certain colors, red/green being the most common problem. So if you design a graphic that relies on red and green bars, some of your audience members may not be able to properly identify which bar means what. Simple contrasts of black and white are much more likely to be visible to all members of your audience. There are many other elements of good universal design, but the basic foundation of all of them is that you consider how to make your presentation as accessible as possible at the outset. For example, include captions whenever possible, both as descriptions on slides and as images on slides and for any audio or video clips you are including; keep font sizes large enough to read from the back of the room; and face the audience when you are.

Poster Design

Undergraduate students who present at conferences are often encouraged to present at “poster sessions.” This usually means setting up a poster version of your research in a large hall or convention space at a set period of time—ninety minutes is common. Your poster will be one of dozens, and conference-goers will wander through the space, stopping intermittently at posters that attract them. Those who stop by might ask you questions about your research, and you are expected to be able to talk intelligently for two or three minutes. It’s a fairly easy way to practice presenting at conferences, which is why so many organizations hold these special poster sessions.

A good poster design will be immediately attractive to passersby and clearly and succinctly describe your research methods, findings, and conclusions. Some students have simply shrunk down their research papers to manageable sizes and then pasted them on a poster, all twelve to fifteen pages of them. Don’t do that! Here are some better suggestions: State the main conclusion of your research in large bold print at the top of your poster, on brightly colored (contrasting) paper, and paste in a QR code that links to your full paper online ( Calarco 2020:280 ). Use the rest of the poster board to provide a couple of highlights and details of the study. For an interview-based study, for example, you will want to put in some details about your sample (including number of interviews) and setting and then perhaps one or two key quotes, also distinguished by contrasting color background.

Incorporating Visual Design in Your Presentations

In addition to ensuring that your presentation is accessible to as large an audience as possible, you also want to think about how to display your data in general, particularly how to use charts and graphs and figures. [6] The first piece of advice is, use them! As the saying goes, a picture is worth a thousand words. If you can cut to the chase with a visually stunning display, do so. But there are visual displays that are stunning, and then there are the tired, hard-to-see visual displays that predominate at conferences. You can do better than most presenters by simply paying attention here and committing yourself to a good design. As with model section passages, keep a file of visual displays that work as models for your own presentations. Find a good guidebook to presenting data effectively (Evergreen 2018 , 2019 ; Schwabisch 2021) , and refer to it often.

Let me make a few suggestions here to get you started. First, test every visual display on a friend or colleague to find out how quickly they can understand the point you are trying to convey. As with reading passages aloud to ensure that your writing works, showing someone your display is the quickest way to find out if it works. Second, put the point in the title of the display! When writing for an academic journal, there will be specific conventions of what to include in the title (full description including methods of analysis, sample, dates), but in a public presentation, there are no limiting rules. So you are free to write as your title “Working-Class College Students Are Three Times as Likely as Their Peers to Drop Out of College,” if that is the point of the graphic display. It certainly helps the communicative aspect. Third, use the themes available to you in Excel for creating graphic displays, but alter them to better fit your needs . Consider adding dark borders to bars and columns, for example, so that they appear crisper for your audience. Include data callouts and labels, and enlarge them so they are clearly visible. When duplicative or otherwise unnecessary, drop distracting gridlines and labels on the y-axis (the vertical one). Don’t go crazy adding different fonts, however—keep things simple and clear. Sans serif fonts (those without the little hooks on the ends of letters) read better from a distance. Try to use the same color scheme throughout, even if this means manually changing the colors of bars and columns. For example, when reporting on working-class college students, I use blue bars, while I reserve green bars for wealthy students and yellow bars for students in the middle. I repeat these colors throughout my presentations and incorporate different colors when talking about other items or factors. You can also try using simple grayscale throughout, with pops of color to indicate a bar or column or line that is of the most interest. These are just some suggestions. The point is to take presentation seriously and to pay attention to visual displays you are using to ensure they effectively communicate what you want them to communicate. I’ve included a data visualization checklist from Evergreen ( 2018 ) here.

Ethics of Presentation and Reliability

Until now, all the data you have collected have been yours alone. Once you present the data, however, you are sharing sometimes very intimate information about people with a broader public. You will find yourself balancing between protecting the privacy of those you’ve interviewed and observed and needing to demonstrate the reliability of the study. The more information you provide to your audience, the more they can understand and appreciate what you have found, but this also may pose risks to your participants. There is no one correct way to go about finding the right balance. As always, you have a duty to consider what you are doing and must make some hard decisions.

The most obvious place we see this paradox emerge is when you mask your data to protect the privacy of your participants. It is standard practice to provide pseudonyms, for example. It is such standard practice that you should always assume you are being given a pseudonym when reading a book or article based on qualitative research. When I was a graduate student, I tried to find information on how best to construct pseudonyms but found little guidance. There are some ethical issues here, I think. [7] Do you create a name that has the same kind of resonance as the original name? If the person goes by a nickname, should you use a nickname as a pseudonym? What about names that are ethnically marked (as in, almost all of them)? Is there something unethical about reracializing a person? (Yes!) In her study of adolescent subcultures, Wilkins ( 2008 ) noted, “Because many of the goths used creative, alternative names rather than their given names, I did my best to reproduce the spirit of their chosen names” ( 24 ).

Your reader or audience will want to know all the details about your participants so that they can gauge both your credibility and the reliability of your findings. But how many details are too many? What if you change the name but otherwise retain all the personal pieces of information about where they grew up, and how old they were when they got married, and how many children they have, and whether they made a splash in the news cycle that time they were stalked by their ex-boyfriend? At some point, those details are going to tip over into the zone of potential unmasking. When you are doing research at one particular field site that may be easily ascertained (as when you interview college students, probably at the institution at which you are a student yourself), it is even more important to be wary of providing too many details. You also need to think that your participants might read what you have written, know things about the site or the population from which you drew your interviews, and figure out whom you are talking about. This can all get very messy if you don’t do more than simply pseudonymize the people you interviewed or observed.

There are some ways to do this. One, you can design a study with all of these risks in mind. That might mean choosing to conduct interviews or observations at multiple sites so that no one person can be easily identified. Another is to alter some basic details about your participants to protect their identity or to refuse to provide all the information when selecting quotes . Let’s say you have an interviewee named “Anna” (a pseudonym), and she is a twenty-four-year-old Latina studying to be an engineer. You want to use a quote from Anna about racial discrimination in her graduate program. Instead of attributing the quote to Anna (whom your reader knows, because you’ve already told them, is a twenty-four-year-old Latina studying engineering), you might simply attribute the quote to “Latina student in STEM.” Taking this a step further, you might leave the quote unattributed, providing a list of quotes about racial discrimination by “various students.”

The problem with masking all the identifiers, of course, is that you lose some of the analytical heft of those attributes. If it mattered that Anna was twenty-four (not thirty-four) and that she was a Latina and that she was studying engineering, taking out any of those aspects of her identity might weaken your analysis. This is one of those “hard choices” you will be called on to make! A rather radical and controversial solution to this dilemma is to create composite characters , characters based on the reality of the interviews but fully masked because they are not identifiable with any one person. My students are often very queasy about this when I explain it to them. The more positivistic your approach and the more you see individuals rather than social relationships/structure as the “object” of your study, the more employing composites will seem like a really bad idea. But composites “allow researchers to present complex, situated accounts from individuals” without disclosing personal identities ( Willis 2019 ), and they can be effective ways of presenting theory narratively ( Hurst 2019 ). Ironically, composites permit you more latitude when including “dirty laundry” or stories that could harm individuals if their identities became known. Rather than squeezing out details that could identify a participant, the identities are permanently removed from the details. Great difficulty remains, however, in clearly explaining the theoretical use of composites to your audience and providing sufficient information on the reliability of the underlying data.

There are a host of other ethical issues that emerge as you write and present your data. This is where being reflective throughout the process will help. How and what you share of what you have learned will depend on the social relationships you have built, the audiences you are writing or speaking to, and the underlying animating goals of your study. Be conscious about all of your decisions, and then be able to explain them fully, both to yourself and to those who ask.

Our research is often close to us. As a Black woman who is a first-generation college student and a professional with a poverty/working-class origin, each of these pieces of my identity creates nuances in how I engage in my research, including how I share it out. Because of this, it’s important for us to have people in our lives who we trust who can help us, particularly, when we are trying to share our findings. As researchers, we have been steeped in our work, so we know all the details and nuances. Sometimes we take this for granted, and we might not have shared those nuances in conversation or writing or taken some of this information for granted. As I share my research with trusted friends and colleagues, I pay attention to the questions they ask me or the feedback they give when we talk or when they read drafts.

—Kim McAloney, PhD, College Student Services Administration Ecampus coordinator and instructor

Final Comments: Preparing for Being Challenged

Once you put your work out there, you must be ready to be challenged. Science is a collective enterprise and depends on a healthy give and take among researchers. This can be both novel and difficult as you get started, but the more you understand the importance of these challenges, the easier it will be to develop the kind of thick skin necessary for success in academia. Scientists’ authority rests on both the inherent strength of their findings and their ability to convince other scientists of the reliability and validity and value of those findings. So be prepared to be challenged, and recognize this as simply another important aspect of conducting research!

Considering what challenges might be made as you design and conduct your study will help you when you get to the writing and presentation stage. Address probable challenges in your final article, and have a planned response to probable questions in a conference presentation or job talk. The following is a list of common challenges of qualitative research and how you might best address them:

• Questions about generalizability . Although qualitative research is not statistically generalizable (and be prepared to explain why), qualitative research is theoretically generalizable. Discuss why your findings here might tell us something about related phenomena or contexts.
• Questions about reliability . You probably took steps to ensure the reliability of your findings. Discuss them! This includes explaining the use and value of multiple data sources and defending your sampling and case selections. It also means being transparent about your own position as researcher and explaining steps you took to ensure that what you were seeing was really there.
• Questions about replicability. Although qualitative research cannot strictly be replicated because the circumstances and contexts will necessarily be different (if only because the point in time is different), you should be able to provide as much detail as possible about how the study was conducted so that another researcher could attempt to confirm or disconfirm your findings. Also, be very clear about the limitations of your study, as this allows other researchers insight into what future research might be warranted.

None of this is easy, of course. Writing beautifully and presenting clearly and cogently require skill and practice. If you take anything from this chapter, it is to remember that presentation is an important and essential part of the research process and to allocate time for this as you plan your research.

Data Visualization Checklist for Slideshow (PPT) Presentations

Adapted from Evergreen ( 2018 )

Text checklist

• Short catchy, descriptive titles (e.g., “Working-class students are three times as likely to drop out of college”) summarize the point of the visual display
• Subtitled and annotations provide additional information (e.g., “note: male students also more likely to drop out”)
• Text size is hierarchical and readable (titles are largest; axes labels smallest, which should be at least 20points)
• Text is horizontal. Audience members cannot read vertical text!
• All data labeled directly and clearly: get rid of those “legends” and embed the data in your graphic display
• Labels are used sparingly; avoid redundancy (e.g., do not include both a number axis and a number label)

Arrangement checklist

• Proportions are accurate; bar charts should always start at zero; don’t mislead the audience!
• Data are intentionally ordered (e.g., by frequency counts). Do not leave ragged alphabetized bar graphs!
• Axis intervals are equidistant: spaces between axis intervals should be the same unit
• Graph is two-dimensional. Three-dimensional and “bevelled” displays are confusing
• There is no unwanted decoration (especially the kind that comes automatically through the PPT “theme”). This wastes your space and confuses.

Color checklist

• There is an intentional color scheme (do not use default theme)
• Color is used to identify key patterns (e.g., highlight one bar in red against six others in greyscale if this is the bar you want the audience to notice)
• Color is still legible when printed in black and white
• Color is legible for people with color blindness (do not use red/green or yellow/blue combinations)
• There is sufficient contrast between text and background (black text on white background works best; be careful of white on dark!)

Lines checklist

• Be wary of using gridlines; if you do, mute them (grey, not black)
• Allow graph to bleed into surroundings (don’t use border lines)
• Remove axis lines unless absolutely necessary (better to label directly)

Overall design checklist

• The display highlights a significant finding or conclusion that your audience can ‘”see” relatively quickly
• The type of graph (e.g., bar chart, pie chart, line graph) is appropriate for the data. Avoid pie charts with more than three slices!
• Graph has appropriate level of precision; if you don’t need decimal places
• All the chart elements work together to reinforce the main message

Universal Design Checklist for Slideshow (PPT) Presentations

• Include both verbal and written descriptions (e.g., captions on slides); consider providing a hand-out to accompany the presentation
• Microphone available (ask audience in back if they can clearly hear)
• Face audience; allow people to read your lips
• Turn on captions when presenting audio or video clips
• Adjust light settings for visibility
• Speak slowly and clearly; practice articulation; don’t mutter or speak under your breath (even if you have something humorous to say – say it loud!)
• Use Black/White contrasts for easy visibility; or use color contrasts that are real contrasts (do not rely on people being able to differentiate red from green, for example)
• Use easy to read font styles and avoid too small font sizes: think about what an audience member in the back row will be able to see and read.
• Keep your slides simple: do not overclutter them; if you are including quotes from your interviews, take short evocative snippets only, and bold key words and passages. You should also read aloud each passage, preferably with feeling!

Supplement: Models of Written Sections for Future Reference

Data collection section example.

Interviews were semi structured, lasted between one and three hours, and took place at a location chosen by the interviewee. Discussions centered on four general topics: (1) knowledge of their parent’s immigration experiences; (2) relationship with their parents; (3) understanding of family labor, including language-brokering experiences; and (4) experiences with school and peers, including any future life plans. While conducting interviews, I paid close attention to respondents’ nonverbal cues, as well as their use of metaphors and jokes. I conducted interviews until I reached a point of saturation, as indicated by encountering repeated themes in new interviews (Glaser and Strauss 1967). Interviews were audio recorded, transcribed with each interviewee’s permission, and conducted in accordance with IRB protocols. Minors received permission from their parents before participation in the interview. ( Kwon 2022:1832 )

Justification of Case Selection / Sample Description Section Example

Looking at one profession within one organization and in one geographic area does impose limitations on the generalizability of our findings. However, it also has advantages. We eliminate the problem of interorganizational heterogeneity. If multiple organizations are studied simultaneously, it can make it difficult to discern the mechanisms that contribute to racial inequalities. Even with a single occupation there is considerable heterogeneity, which may make understanding how organizational structure impacts worker outcomes difficult. By using the case of one group of professionals in one religious denomination in one geographic region of the United States, we clarify how individuals’ perceptions and experiences of occupational inequality unfold in relation to a variety of observed and unobserved occupational and contextual factors that might be obscured in a larger-scale study. Focusing on a specific group of professionals allows us to explore and identify ways that formal organizational rules combine with informal processes to contribute to the persistence of racial inequality. ( Eagle and Mueller 2022:1510–1511 )

Ethics Section Example

I asked everyone who was willing to sit for a formal interview to speak only for themselves and offered each of them a prepaid Visa Card worth $25–40. I also offered everyone the opportunity to keep the card and erase the tape completely at any time they were dissatisfied with the interview in any way. No one asked for the tape to be erased; rather, people remarked on the interview being a really good experience because they felt heard. Each interview was professionally transcribed and for the most part the excerpts are literal transcriptions. In a few places, the excerpts have been edited to reduce colloquial features of speech (e.g., you know, like, um) and some recursive elements common to spoken language. A few excerpts were placed into standard English for clarity. I made this choice for the benefit of readers who might otherwise find the insights and ideas harder to parse in the original. However, I have to acknowledge this as an act of class-based violence. I tried to keep the original phrasing whenever possible. ( Pascale 2021:235 )

Further Readings

Calarco, Jessica McCrory. 2020. A Field Guide to Grad School: Uncovering the Hidden Curriculum . Princeton, NJ: Princeton University Press. Don’t let the unassuming title mislead you—there is a wealth of helpful information on writing and presenting data included here in a highly accessible manner. Every graduate student should have a copy of this book.

Edwards, Mark. 2012. Writing in Sociology . Thousand Oaks, CA: SAGE. An excellent guide to writing and presenting sociological research by an Oregon State University professor. Geared toward undergraduates and useful for writing about either quantitative or qualitative research or both.

Evergreen, Stephanie D. H. 2018. Presenting Data Effectively: Communicating Your Findings for Maximum Impact . Thousand Oaks, CA: SAGE. This is one of my very favorite books, and I recommend it highly for everyone who wants their presentations and publications to communicate more effectively than the boring black-and-white, ragged-edge tables and figures academics are used to seeing.

Evergreen, Stephanie D. H. 2019. Effective Data Visualization 2 . Thousand Oaks, CA: SAGE. This is an advanced primer for presenting clean and clear data using graphs, tables, color, font, and so on. Start with Evergreen (2018), and if you graduate from that text, move on to this one.

Schwabisch, Jonathan. 2021. Better Data Visualizations: A Guide for Scholars, Researchers, and Wonks . New York: Columbia University Press. Where Evergreen’s (2018, 2019) focus is on how to make the best visual displays possible for effective communication, this book is specifically geared toward visual displays of academic data, both quantitative and qualitative. If you want to know when it is appropriate to use a pie chart instead of a stacked bar chart, this is the reference to use.

• Some examples: Qualitative Inquiry , Qualitative Research , American Journal of Qualitative Research , Ethnography , Journal of Ethnographic and Qualitative Research , Qualitative Report , Qualitative Sociology , and Qualitative Studies . ↵
• This is something I do with every article I write: using Excel, I write each element of the expected article in a separate row, with one column for “expected word count” and another column for “actual word count.” I fill in the actual word count as I write. I add a third column for “comments to myself”—how things are progressing, what I still need to do, and so on. I then use the “sum” function below each of the first two columns to keep a running count of my progress relative to the final word count. ↵
• And this is true, I would argue, even when your primary goal is to leave space for the voices of those who don’t usually get a chance to be part of the conversation. You will still want to put those voices in some kind of choir, with a clear direction (song) to be sung. The worst thing you can do is overwhelm your audience with random quotes or long passages with no key to understanding them. Yes, a lot of metaphors—qualitative researchers love metaphors! ↵
• To take Calarco’s recipe analogy further, do not write like those food bloggers who spend more time discussing the color of their kitchen or the experiences they had at the market than they do the actual cooking; similarly, do not write recipes that omit crucial details like the amount of flour or the size of the baking pan used or the temperature of the oven. ↵
• The exception is the “compare and contrast” of two or more quotes, but use caution here. None of the quotes should be very long at all (a sentence or two each). ↵
• Although this section is geared toward presentations, many of the suggestions could also be useful when writing about your data. Don’t be afraid to use charts and graphs and figures when writing your proposal, article, thesis, or dissertation. At the very least, you should incorporate a tabular display of the participants, sites, or documents used. ↵
• I was so puzzled by these kinds of questions that I wrote one of my very first articles on it ( Hurst 2008 ). ↵

The visual presentation of data or information through graphics such as charts, graphs, plots, infographics, maps, and animation.  Recall the best documentary you ever viewed, and there were probably excellent examples of good data visualization there (for me, this was An Inconvenient Truth , Al Gore’s film about climate change).  Good data visualization allows more effective communication of findings of research, particularly in public presentations (e.g., slideshows).

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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Open Access

Peer-reviewed

Research Article

Women’s techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18–93

Roles Formal analysis, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America, Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana, United States of America, OMGYES Research Group, For Goodness Sake LLC, Berkeley, California, United States of America

Roles Writing – original draft, Writing – review & editing

Affiliation OMGYES Research Group, For Goodness Sake LLC, Berkeley, California, United States of America

Roles Conceptualization, Project administration, Writing – original draft, Writing – review & editing

Roles Conceptualization, Funding acquisition, Methodology, Project administration, Writing – original draft, Writing – review & editing

• Devon J. Hensel, 
• Christiana D. von Hippel, 
• Charles C. Lapage, 
• Robert H. Perkins

• Published: June 29, 2022
• https://doi.org/10.1371/journal.pone.0268785
• Reader Comments

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel ® . Data suggest that 40% of women find ‘Anal Surfacing’ pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using ‘Anal Shallowing’: penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using ‘Anal Pairing’: touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Citation: Hensel DJ, von Hippel CD, Lapage CC, Perkins RH (2022) Women’s techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18–93. PLoS ONE 17(6): e0268785. https://doi.org/10.1371/journal.pone.0268785

Editor: Andrew R. Dalby, University of Westminster, UNITED KINGDOM

Received: November 16, 2021; Accepted: May 4, 2022; Published: June 29, 2022

Copyright: © 2022 Hensel 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 raw data files used in this study are available from the Inter-university Consortium for Political and Social Research (ICPSR) open data sharing consortium (“Second OMGYES Pleasure Report – Anal Touch Items”: https://doi.org/10.3886/E136982V1 ).

Funding: CDvH, CCL, and RHP received funding in the form of salary from Goodness Sake, LLC. DJH received funding as a paid consultant for Goodness Sake LLC. RHP received funding in the form of salary from Geno LLC. The funders had a role in study design, data collection and analysis, decision to publish, or and preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.

Competing interests: CDvH, CCL, and RHP were salaried employees of Goodness Sake LLC during the course of the study. DJH was a paid consultant of Goodness Sake LLC during the course of the study. RHP was also a salaried employee of Geno LLC during the course of the study. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Introduction

The purpose of this study is to use nationally representative data to describe the ways in which adult women use different anal touch and stimulation techniques–defined for the purposes of this paper as penetration or internal/external stimulation of the anus with a penis, finger(s), lips/tongue, sex toy, or other object [ 1 ]–as a means of achieving sexual pleasure. The geography of the anus makes it a highly pleasurable sex organ: it contains a dense network of sensory nerves that participate with the genitals in the engorgement, muscular tension and contractions of sexual arousal and orgasm [ 2 , 3 ].

Despite this anatomic pleasure potential [ 4 ], much of the existing published scientific research on anal sexuality narrowly focuses on what body part–typically a penis, and less often a mouth/tongue or finger–is stimulating or penetrating the anus, rather than thinking more broadly about how women and their partners may individuate stimulation and penetration techniques. For example, existing studies most commonly operationalize “anal sex” for women in terms of penetration of their anus with a male partner’s penis. The prevalence of women’s participation in anal sex varies depending both upon the behavior as well as the timeframe of reference. Different nationally representative studies from the past decade suggest that about a third of women have lifetime experience with penile-anal sex [ 5 – 10 ]. Between 11.8% and 13.2% have engaged in penile-anal sex in the past year [ 5 , 6 ] and about 10% have done so in the past 90 days [ 11 ]. Less than five percent of women report engaging in anal sex during their most recent sexual experience [ 12 ]. A less developed body of literature using nationally representative data from the United States and from Australia suggests that women have also participated in other anal stimulation and penetration techniques, such as digital-penetration, manual stimulation, and/or oral-anal contact. This work suggests that between five percent and 43% of women have participated in oral-anal contact [ 1 , 13 , 14 ], between 15% and 20% have had a partner digitally stimulate and/or penetrate their anus [ 1 , 15 ] and very few have ever had a partner insert a fist into their anus [ 14 ]. None of this literature assessed the specific touch techniques that were used by women and their partners to stimulate the anus internally or externally, or to what extent they were pleasurable.

A lack of detailed scientific studies on women’s anal pleasure techniques means that women and their partners likely receive more information from adverse-outcome focused peer-reviewed literature or from print/electronic/film media, about what women’s anal sex lives “look” like and/or how they “should” feel about engaging specific practices. In public health literature, for example, anal sex–especially when defined as women’s receipt of penile penetration of their anus–typically broadly quantifies frequency and with whom anal sex practices occur, often framing the outcomes in terms of potential “risks” (e.g. sexually transmitted infections, pain, bodily injury) [ 16 ], rather than emphasizing how women and partners work to choose specific stimulation and penetration techniques that are associated with positive outcomes like pleasure. Peer-reviewed scientific studies do examine women’s experiences with receptive penile-anal sex, and while some do document pleasure as a motivator [ 17 , 18 ], far more emphasize adverse aspects, such as the cultural stigma associated with anal sex, or how women do not enjoy or are coerced into participating in anal sex [ 19 ]. Next to nothing is known about either the ways in which women actively choose different techniques that are not penile-anal penetration or about how pleasure levels may vary across these techniques [ 20 ]. Popular print and electronic media interest in anal sex has increased in the past decade, with common emphasis on the “right way” or “how to”–often using slang or ambiguous terms (e.g. “butt sex”)–to both prepare for and to engage in penile-anal sex [ 21 , 22 ]. These sources rarely acknowledge a wider repertoire of anal stimulation and stimulation methods that women can and do choose [ 23 ].

In the current paper, we use data from the second OMGYES Pleasure Report to address both a measurement and a sampling gap in the literature about women’s experiences with anal stimulation and penetration. The second OMGYES Pleasure Report is a nationally representative study designed to investigate women’s preferences for genital touch/stimulation and penetration, including those involving the anus. From a measurement perspective, it is important for sexual pleasure research to assess a range of ways that women use for anal touch that are not currently explored in existing studies, as it elicits the information needed to both validate what women are doing, and also to provide the techniques names that are accessible and non-ambiguous. Usable terminology scaffolds a woman’s ability to communicate with partners, as well her ability to learn new techniques and/or to tinker with existing techniques she is already using [ 24 ]. We have used this level of specificity in detail and naming in a prior nationally representative study, the first OMGYES pleasure report , which explored women’s experiences with external vulvar and clitoral touch techniques [ 25 ] as well as a previous paper using data from the second OMGYES Pleasure Report describing women’s preferences for internal vaginal touch techniques [ 24 ]. In both these previous studies, rather than asking participants whether they liked to be touched externally or inside their vagina, the data demonstrated that women use different ways of touching–different locations, pressure, shapes, and patterns–as a means of increasing their sexual enjoyment. From a sampling perspective, although existing nationally representative studies in the United States assess women’s participation in penile-anal sex [ 5 – 12 ], the lack of other anal stimulation and penetration techniques means that their prevalence and patterns at the population level are unknown [ 24 ]. Such data are important to be able to reflect the experiences of all women in the United States.

Accordingly, the purpose of the current study was to use nationally representative probability data from the second OMGYES Pleasure Report to investigate women’s experiences and preferences for anal stimulation and penetration.

Materials and methods

Data collection.

Data for the current study were drawn from the second OMGYES Pleasure Report —a cross-sectional, online, nationally representative survey of sexual behaviors, sexual attitudes, relationships, sexual satisfaction, and experiences with genital touching among women aged 18 and over in the United States. The study was conducted in July 2018 by Ipsos Research using their KnowledgePanel ® (Menlo Park, California) to recruit a probability-based web panel designed to be representative–including an oversample of lesbian and bisexual women–of all noninstitutionalized U.S. women. The 90-item online survey took a median of 29 minutes to complete, was available in English, and was open for participation from July 12-July 31, 2018. Questions assessed participation in demographics, sexual behavior background, as well as lifetime participation in different types of Anal Surfacing, Anal Shallowing, and Anal Pairing . All sexual touch technique items are original to this study and have not been yet examined in the peer-reviewed literature. Definitions and sexually explicit line drawing illustrations of these four techniques are provided in an online S1 Table . Images contained in this table are visually graphic.

Of those who opened the study link, 88.8% (3017/3398) completed the survey (49.7% [3017/6123] of the initial sampling frame) and represent the analytical sample in this study. This completion rate is similar to other Ipsos-conducted nationally representative studies of sexuality and sexual behavior (44%–51%) [ 5 , 26 – 28 ]. Post-stratification, study-specific weights adjusted for over- or under-sampling as well as non-response. Participants provided electronic informed consent. All study procedures were approved by the institutional review board at Indiana University School of Medicine (IRB # 1801846511). Additional methodological details–for both this survey as well as the development of this survey–are available in Hensel et al. [ 24 ] All data used in this study are available through the ICPSR open data sharing consortium [ 29 ].

Participants were asked about their experiences with three domains of anal touch and stimulation techniques, including Anal Surfacing, Anal Shallowing , and Anal Pairing . These domains were originally identified as part of qualitative work conducted prior to the larger study (additional detail on this work is available in Hensel et al., 2021: [ 24 ]). Anal Surfacing emerged through a theme of many women’s discovery that anal touch could be pleasurable when the anus was reconceptualized as a flat erogenous zone, which could be stimulated with touch on the surface, as opposed to solely as an opening for penetration. Anal Shallowing emerged from the qualitative analysis through a theme that demonstrated many women had discovered anal pleasure with shallow penetrative touch just inside the anal opening, in contrast to the deeper penetration commonly associated with the concept of anal sex. Anal Pairing emerged from the theme of women’s insight that when anal touch occurs simultaneously with other forms of sexual touch (e.g., vaginal penetration, clitoral touching), it can make the sexual experience more pleasurable. This is consistent with findings from our previous research on techniques women use for pleasure during vaginal penetration where Pairing, in this case of clitoral stimulation with vaginal stimulation, helped 69.7% of women orgasm more often or make vaginal penetration more pleasurable [ 24 ]. Definitions and sexually explicit line art illustrations of all three anal touch techniques are provided in the S1 Table .

Questions about anal touch were prefaced in the survey with a statement that said: “One area of sexuality that’s rarely talked about is anal touch/stimulation, even though nearly half of Americans have tried anal play. We are not talking just about anal penetration or what’s commonly called ‘anal sex.’ Rather, we are talking about any kind of touch of the outside or inside of the anus or butthole with a fingertip, toy, penis or anything else.”

Anal surfacing.

Participants were first asked the extent to which they had ever found different methods of “touch on the outside of your anus/butthole” pleasurable when used either during sex with a partner or alone during masturbation (all: four-point Likert scale: 1. not pleasurable to 4. very pleasurable; or “don’t know or never tried”). The four items related to specific sub-forms of Anal Surfacing were: “with your own finger,” “with your partner’s finger,” “with a sex toy,” and “with a penis.” All items were dichotomized as pleasurable (a little/somewhat/very pleasurable) vs. not (not at all pleasurable/don’t know or never tried) for analysis. A response of a little/somewhat/very pleasurable to at least one anal surfacing item indicated a woman had found any form of anal surfacing pleasurable.

Anal penetration and shallowing.

Participants were asked the extent to which they had ever found different methods of “penetration inside of your anus/butthole (either shallow or deeper)” pleasurable when used either during sex with a partner or alone during masturbation (all: four-point Likert scale: 1. not pleasurable to 4. very pleasurable; or “don’t know or never tried”). The four items related to specific sub-forms of Anal Penetration were: “with your own finger,” “with your partner’s finger,” “with a sex toy,” and “with a penis.” All items were dichotomized as pleasurable (a little/somewhat/very pleasurable) vs. not (not at all pleasurable/don’t know or never tried) for analysis. A response of a little/somewhat/very pleasurable to at least one anal penetration item indicated a woman had found any form of anal penetration pleasurable.

Women who found any form of anal penetration pleasurable were then asked the multiple response item “You mentioned you found penetration inside your anus pleasurable. At what depth have you found anal stimulation most pleasurable?” Participants selected the depth that applied from the following list: “just barely inside of anus/butthole (such as the very tip of a finger);” “about 1-knuckle inside;” “2-knuckles deep or as deep as an entire finger can go;” “deeper inside than an entire finger can usually reach;” or they selected “I don’t know.” A selection of either the “just barely inside of anus/butthole (such as the very tip of a finger)” or the “about 1-knuckle inside” depth response option indicated a woman had found any form of Anal Shallowing pleasurable. A selection of any of the greater depths of penetration as most pleasurable indicated a woman enjoyed deeper anal penetration.

Prior experience and pleasure from any form of anal touch.

A response of a little/somewhat/very pleasurable to at least one Likert scaled anal surfacing or anal penetration (shallow or deeper) item indicated a woman had experienced pleasure with any form of anal touch. Conversely, a response of “I don’t know or never tried” to every Likert scaled anal surfacing and anal penetration (shallow or deeper) item indicated a woman had no prior experience with or knowledge of pleasure from any form of anal touch. Subsequent measures described below were asked only of the subgroup of women with prior experience of pleasure from any form of anal touch. These measures were used to evaluate patterns observed in the qualitative research phase relating to women’s experiences of discovering anal touch could be pleasurable and specific ways in which it was pleasurable for them.

Assessment of anal pleasure discovery patterns.

To discern whether women’s enjoyment of anal touch was immediate or gradual, women who indicated that they found any form of external anal touch pleasurable were asked which statement best described their experience with touch outside their anus: either, “You found it pleasurable from the first time you tried it;” or, “You didn’t find it pleasurable at first, but learned to enjoy it over time.” In the same fashion, women who indicated they found any form of anal penetration pleasurable were asked which of the same two statements as above best described their experience with anal penetration.

Additionally, women who previously indicated they enjoyed any form of anal touch were asked to enter into number boxes the approximate ages in years at which they discovered that touch on the outside of the anus could be pleasurable and/or discovered that touch inside the anus could be pleasurable. If they did not recall their age, women entered “99;” all responses of “99” and women missing responses were excluded from the analyses of age at discovery. Additionally, age 14 years at discovery was used as the lower bound for analysis since this is a typical age at which young people in U.S. states can consent to sexual, reproductive health services without parental permission [ 30 ].

Factors contributing to women’s discovery of pleasure with any form of anal touch were assessed with a multiple response item: “Over time, which of the following do you think made you realize anal stimulation could be pleasurable for you?” Response options were “during self-exploration/masturbation, I found a way of anal stimulation that I liked;” “a partner approached anal sex in a way that worked for me;” “trying anal touch or anal sex on my own terms (e.g., communicating about the way I wanted to do it and having that respected);” “once I/we used enough lubricant;” “I had enough "warm up time" beforehand;” “trying it with someone I loved or deeply cared for;” “a partner just barely touched or brushed by my anus/butthole and I enjoyed it;” “I felt an increased desire for anal sex during or since pregnancy;” “I felt an increased desire for anal sex during or after menopause;” “other.”

Anal pairing and types of pleasure experienced from anal touch.

A single multiple response item asked women about the ways in which anal touch is pleasurable for them: “Other women have suggested the following reasons why anal stimulation is pleasurable. What do you think it is about anal stimulation that makes it pleasurable for you?” Respondents could select one or more of the following response options to describe their experience: “I can have orgasms just from anal touch/stimulation;” “it can make my orgasms feel more intense;” “it can make it easier for me to have an orgasm during other kinds of touch;” “when it happens at the same time as other kinds of touch (like vaginal sex or clitoral touching), it can make the experience more pleasurable;” “It has its own unique sensation that I find pleasurable;” “I get a thrill from the feeling that anal play is taboo;” “it feels profoundly intimate and emotional;” the pleasure feels fuller or ‘bigger’ than other kinds of sexual pleasure;” “other.” The selection of one or both of the two response options relating to pleasure from anal stimulation as an enhancement of their pleasure when done simultaneously with other touch indicated a woman found Anal Pairing pleasurable.

Statistical procedure

Weighted frequencies were calculated to assess the prevalence of women who have used Angling, Rocking, Shallowing, Pairing, and their sub-forms to make vaginal stimulation and penetration more pleasurable. We excluded from analysis of each item any participant whose response to that item was missing. IBM SPSS Statistics software was used for all analyses.

Respondent characteristics

Weighted respondent demographic characteristics—including age, gender, race/ethnicity, education, household income, and geographic region of residence in the US, sexual orientation and relationship status—are presented in Table 1 . Women ranged in age from 18 to 93 with a median age of 48 years. The majority of women self-described their sexual orientation as heterosexual (91.2%). Most women were in a married, committed, or dating relationship, with only 21.6% describing their relationship status as single and not dating at the time of the survey.

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https://doi.org/10.1371/journal.pone.0268785.t001

Prevalence of pleasure from anal touch

Approximately four out of ten women (43.5%, n = 1,283) reported experiencing pleasure with some form of anal touch (internal or external). One quarter (25.8%) of women had never tried any form of anal touch assessed. More specifically, 27.6% of respondents reported no prior experience with external anal touch, or “not knowing” how pleasurable that type of touch might be for them; 32.5% had never tried any penetrative/internal anal touch techniques or did not know how pleasurable they might be.

Prevalence of pleasure during anal surfacing

As shown in Table 2 , 40.3% of U.S. women have used and found pleasurable Anal Surfacing, or touch on the outside of the anus. One-third (34.0%) of women have found anal surfacing using a partner’s finger pleasurable whereas about one-fifth (20.3%) have found using their own finger pleasurable. Anal surfacing using a partner’s penis was reported as pleasurable by about one-third of women (31.4%) and about one-fifth (19.4%) reported using a sex toy for this kind of touch as pleasurable. About a quarter of participants noted they did not enjoy any form of anal surfacing (22.3%) and one-third of women reported they found no pleasure in each specific anal surfacing technique (31.6%–38.5%).

https://doi.org/10.1371/journal.pone.0268785.t002

Prevalence of pleasure during anal penetration and, specifically, anal shallowing

As shown in Table 3 , 34.6% of U.S. women have used and found pleasurable touch inside of the anus. Anal penetration using a partner’s finger was the most prevalent internal touch technique, found pleasurable by about over one-quarter (28.3%) of women. Half that number of women have found using their own finger pleasurable (15.4%). Anal penetration with a partner’s penis was reported as pleasurable by nearly the same proportion (25.7%) of women who enjoyed touch by a partner’s finger. Approximately one-sixth of women (17.4%) reported using a sex toy for this kind of touch as pleasurable. About a quarter of participants noted they did not enjoy any form of touch inside the anus (23.6%) and one-third of women reported they found no pleasure in each specific touch technique (30.9%–36.0%).

https://doi.org/10.1371/journal.pone.0268785.t003

Table 4 demonstrates that 38.2% of women who had experienced pleasure from any form of anal penetration found shallower depths of Anal Shallowing pleasurable, whereas 41.6% found deeper penetration pleasurable. Out of possible penetration depths, Anal Shallowing just barely inside of the anus such as with a fingertip was reported as pleasurable by the second greatest proportion of women; one-quarter (24.7%) of those who had experienced pleasure from any form of anal penetration enjoyed this shallow depth of penetration. The slightly deeper (‘about one knuckle inside’) sub-form of Anal Shallowing we assessed was found pleasurable by 13.5% of women who had experienced pleasure from any form of anal penetration. About a quarter found a finger’s depth pleasurable and 12.9% enjoyed depths more than a finger can typically reach.

https://doi.org/10.1371/journal.pone.0268785.t004

Anal pairing and types of pleasure experienced from anal touch

Women (N = 1,283) who reported pleasure with anal surfacing and/or anal penetration (shallow or deeper) were subsequently asked about the ways in which anal touch was pleasurable for them, as summarized in Table 5 . Over one-quarter of women (27.6%) enjoy anal touch because it makes their orgasms feel more intense. The most prevalent way in which anal touch was reported as pleasurable was as a complement to other forms of touch (e.g. clitoral touch and vaginal penetration) when done simultaneously; we refer to this technique as Anal Pairing. Four out of ten (39.9%) women endorsing pleasure from any form of anal touch reported that anal touch makes other sexual touch more pleasurable for them and one-sixth (16.7%) of women specifically noted it makes reaching orgasm easier during other kinds of sexual touch.

https://doi.org/10.1371/journal.pone.0268785.t005

Prevalent ways in which women discover anal touch is pleasurable for them

For many women who currently enjoy anal touch, finding pleasure with it was a gradual process. Indeed, 56.1% of women did not find Anal Surfacing to be pleasurable the first time they tried it, but rather enjoyed it more over time. Similarly, 67.7% of women who now enjoy penetrative anal touch did not find it pleasurable at first, but rather came to enjoy it over time. As shown in Table 6 , we assessed seven patterns through which women make the initial, often gradual, discovery that anal touch is pleasurable for them. The most prevalent discovery patterns involved women’s partners. For almost half of women (44.6%), their first experience of pleasure from anal touch came as a result of a partner approaching it in a way that worked for them. Four out of ten (39.4%) women noted the importance of the emotional connection they felt with the partner with whom they were trying anal touch as a critical factor in their discovery of anal pleasure. One-quarter of women suggested that physical factors such as having enough time to become aroused beforehand (24.7%) or simply using sufficient lubricant (amount self-determined; 22.7% of women) made the biggest difference in their discovery that anal touch could feel good. To a lesser extent, women (14.0%) noted that their own self-touch during masturbation was how they discovered anal touch could be pleasurable. There was a wide range of ages (14–72 years-old) at which women discovered anal touch was pleasurable for them. The mean age of discovery, however, was the same for both internal (n = 685) and external (n = 734) anal touch: 27 years-old.

https://doi.org/10.1371/journal.pone.0268785.t006

Despite the anatomic pleasure potential [ 4 ] of the anus to promote to maximize women’s sexual enjoyment [ 2 , 3 ], the specific ways in which women might engage the anus—by themselves or with partners—as a part of their sexual repertoire has remained largely unexamined in the current sexuality literature. To address this gap, we used data from the second OMGYES Pleasure Report to providing the first detailed, population level description of the of the distinct anal stimulation and penetration techniques women engage to enhance their sexual pleasure during both solo and partnered sex. Specifically, through inductive, qualitative research followed by this nationally representative survey, we identified and named three previously undefined anal touch techniques that are found pleasurable by large proportions of U.S. women: Anal Shallowing, Anal Surfacing, and Anal Pairing.

Describing the ways in which women engage the anus in personally enjoyable ways is an important expansion of the existing anus-focused literature in several ways. One important contribution of this work is our naming of touch and stimulation techniques in lay phrasing that is usable by women and their partners. As we have suggested in our work focused on vaginal stimulation and penetration [ 24 ], for women to be comfortable communicating what new techniques they want to try and/or what existing techniques they want to try differently, the words and descriptions they use to do so must be both straightforward and accessible to them. For the vast majority of anal sexual practices, however, with some exceptions around oral-anal sexual touch (specifically referred to as analingus , rimming , a rim job or tossing the salad) and deep anal penetration with a hand or arm (specifically referred to as anal fisting , handballing or brachioproctic eroticism ) [ 31 ], there has been a lack of standalone, clear terminology. For example, the term Anal Surfacing we developed refers to touch on the outside of the anus, which 4 out of 10 women have discovered is pleasurable. The technique we named Anal Shallowing refers to touch just inside the anal opening, no deeper than a fingertip/knuckle, which was found pleasurable by 38.2% of women who enjoy any form of anal penetration. This study also identified anal touch paired with simultaneous vaginal and/or clitoral touch—referred to as Anal Pairing —can work synergistically with other forms of sexual touch as an enhancement of women’s pleasure and orgasm. Language for knowing how and for what kinds of anal touch to ask a partner may be especially important since most prevalent forms of touch reported as pleasurable for women were done by a partner’s finger or penis. The wide range of ages at which women discovered that external and/or penetrative anal touch was pleasurable to them illustrates that new pleasurable touch techniques can be discovered at any age and may encourage women to continue exploring their pleasure throughout the lifespan. Thus, there is a wider anal sexual repertoire that women enjoy in everyday life than has been named in scientific literature or that is often discussed openly in society.

In addition, we also explored the dimensionality of these techniques, identifying what is being used for touch or stimulation (e.g., own or partner’s finger, penis, or sex toy), the manner in which it is being used (e.g., on the surface vs. inside, or just barely inside vs. one knuckle in vs. deeper than a finger’s length inside), why they find it pleasurable (e.g. increased orgasm intensity vs. thrill vs. intimacy) and how they discovered it (e.g. partner introduction vs. self-exploration). This granularity supports a women-centered models of anal sexuality in which women and/or their partners are empowered to choose anal touch and stimulation technique(s) that meets their own personal pleasure needs. As suggested earlier in this paper, most of what is “known”—either through scientifically literature or through popular culture—about using the anus during sex typically focuses on the anus being penetrated by another body part [ 1 , 5 – 15 ] or emphasizes the adverse outcomes (e.g. disease, pain or coercion) associated with anal sex for women [ 16 – 18 ]. Our detailed, nationally representative data on the prevalence of women’s participation in techniques and their variants, their technique discovery, and their motivation for techniques, is an important validation for women and/or their partners that individuals like themselves can and do actively choose anal touch and stimulation to meet their own personal pleasure needs. Information such as this is vital for women’s ability to “normalize” their participation in and motivations for a behavior that is often socially stigmatized [ 19 ].

Limitations and strengths

Several limitations associated with the current data should be considered. From a measurement perspective, some survey items assessed technique participation in general, whereas others assessed technique participation in association with sexual pleasure, which could challenge disentangling a participant’s reported use of technique from their motivation for choosing that technique, as well as disentangling their actual experience of pleasure or displeasure. For example, regarding pleasure from deep penetration preference depths, we asked participants “What depth have you found anal stimulation most pleasurable?” A participant’s selection of option (e.g., “one knuckle or less”) is comparative in nature and does not necessarily mean they do not enjoy another option (e.g., “two knuckles or more”). It is possible this approach could result in an underestimate of enjoyment in these approaches. Future measurement approaches to address this challenge could include both assessing lifetime participation in specific techniques, with linking questions regarding motivation or expected pleasure, as well as actual pleasure outcomes for those who affirmed participation.

In addition, participants only included female-identified individuals; we queried men neither about their experiences with any of the anal techniques assessed here nor about how such participation may have impacted their own or their partner’s sexual pleasure. It will be important for ongoing studies to understand how selection and enjoyment of specific anal techniques are linked to partnership factors like relationship satisfaction and happiness, communication, and sexual satisfaction.

Finally, we did not assess any oral-anal behaviors as part of the larger survey informing this paper. While such behaviors are part of a larger anal sexual behavior repertoire for women [ 1 , 13 , 14 ], survey lengths precluded their inclusion. It will be important in future work for these items to be added, particularly for understanding how participation and pleasure compare to the touch and penetration behaviors we assess here. These limitations are balanced with several methodological and substantive strengths of this study. From a methodological perspective, our use of a nationally representative probability sample permits generalization of findings to the broader population of women in the United States. Other sampling approaches common in sexual and reproductive health research, including convenience, clinical or community-based recruitment, do not allow this level of comparison. In addition, our use of Ipsos’ KnowledgePanel ® affords several data collection advantages, including access to already experienced survey participants, secure survey storage and sending of participation reminders to potential respondents. Ipsos also controls the number of surveys sent to each member, minimizing the unit- and item-level missingness on any given survey. Another methodological strength is online data collection, which facilitates survey completion in a setting of the participant’s choosing, thereby increasing data confidentiality and participant comfort with answering questions about potentially sensitive topics, like sexual behavior and sexual pleasure.

Data from this U.S. nationally representative survey provide descriptions of and prevalence estimates for three techniques women have discovered to make anal stimulation and penetration more pleasurable: Anal Surfacing, Anal Shallowing, and Anal Pairing. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover, engage in, and enjoy anal stimulation and penetration. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Supporting information

S1 table. definitions for and sexually explicit line drawing illustrations of anal surfacing, anal shallowing, and anal pairing techniques for experiencing sexual pleasure during anal touch..

https://doi.org/10.1371/journal.pone.0268785.s001

Acknowledgments

We would like to acknowledge Dr. Debby Herbenick for her contributions to the development of survey items for this study. We would like to thank Dr. Nicole S. Zelin for her participation in drafting and reviewing literature for the manuscript. We would also like to thank Dr. Jennifer Arter & Dr. Sybil Lockhart for their contributions to the pilot qualitative research phase, and preliminary qualitative analysis.

• View Article
• PubMed/NCBI
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• 15. Michael RT, Gagnon JH, Laumann EO, Kolata G. Sex in America: A definitive survey: Warner books New York; 1995.
• 29. Perkins RH. Second OMGYES Pleasure Report—Anal Touch Items. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor]; 2021.
• 30. Guttmacher Institute. An Overview of Consent to Reproductive Health Services by Young People. 2021.
• 31. Morin J. Anal Pleasure and Health: A Guide for Men and Women. Burlingame. CA: Down There Press; 1986.

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• Published: 11 June 2024

Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer

• Zhien Li 1 ,
• Maryam Asoodar 1 ,
• Nynke de Jong 2 ,
• Tom Keulers 3 ,
• Xian Liu 1 &
• Diana Dolmans 1  

BMC Medical Education volume  24 , Article number:  647 ( 2024 ) Cite this article

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Introduction

Virtual Patients (VPs) have been shown to improve various aspects of medical learning, however, research has scarcely delved into the specific factors that facilitate the knowledge gain and transfer of knowledge from the classroom to real-world applications. This exploratory study aims to understand the impact of integrating VPs into classroom learning on students’ perceptions of knowledge acquisition and transfer.

The study was integrated into an elective course on “Personalized Medicine in Cancer Treatment and Care,” employing a qualitative and quantitative approach. Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic analysis.

Quantitative data shows that students highly valued the role modeling introduction, scoring it 4.42 out of 5, and acknowledged the practice with VPs in enhancing their subject matter understanding, with an average score of 4.0 out of 5. However, students’ reflections on peer dialogue on feedback received mixed reviews, averaging a score of 3.24 out of 5. Qualitative analysis (of focus-group interviews) unearthed the following four themes: ‘Which steps to take in clinical reasoning’, ‘Challenging their reasoning to enhance deeper understanding’, ‘Transfer of knowledge ‘, and ' Enhance Reasoning through Reflections’. Quantitative and qualitative data are cohered.

The study demonstrates evidence for the improvement of learning by incorporating VPs with learning activities. This integration enhances students’ perceptions of knowledge acquisition and transfer, thereby potentially elevating students’ preparedness for real-world clinical settings. Key facets like expert role modeling and various authentic case exposures were valued for fostering a deeper understanding and active engagement, though with some mixed responses towards peer feedback discussions. While the preliminary findings are encouraging, the necessity for further research to refine feedback mechanisms and explore a broader spectrum of medical disciplines with larger sample sizes is underscored. This exploration lays a groundwork for future endeavors aimed at optimizing VP-based learning experiences in medical education.

Peer Review reports

In Medical Education, a persistent challenge lies in the bridge between acquiring theoretical knowledge and applying it in real-world clinical scenarios. Many medical students struggle with translating their classroom learning into practical settings. The primary challenge lies in effectively translating the concepts students have learned into authentic patient interactions. This gap is particularly concerning because it affects the quality of patient care, as medical students are not just learning to acquire knowledge but must be able to apply this knowledge in complex healthcare settings.

One approach to address this challenge is the use of Virtual Patients (VPs), a computer-based simulation of real-life clinical scenarios for students to train clinical skills [ 1 ]. Research has shown that using VPs in the classroom can effectively improve various aspects of learning, from core knowledge and clinical reasoning to decision-making skills and knowledge transfer [ 2 , 3 , 4 , 5 ]. The VPs provide students with the opportunity to practice skills in a safe and controlled simulation environment.

Recent studies have focused on optimizing the design and arrangement of VPs as part of learning activities to facilitate both knowledge acquisition and retention [ 6 , 7 , 8 ]. For instance, Verkuyl, Hughes [ 8 ] demonstrated that using VPs as gamification tools can improve students’ confidence, engagement, and satisfaction.

However, studies focusing on the specific factors that contribute to these improvements when integrating VPs into the classroom are limited, particularly in understanding how to use VPs in the classroom to facilitate the transfer of knowledge students’ gain from the class to the subsequent studying stage of their education and eventual practice.

Acquisition and transfer of knowledge are critical factors in medical education, as medical students must be able to apply their knowledge and skills to real-world clinical scenarios [ 9 ]. Research suggests that for the effective transfer of knowledge, students should be immersed in authentic environments, enabling the transition of learned competencies to advanced stages [ 10 , 11 , 12 , 13 ].

Despite the consensus on the efficacy of VPs as a tool, there is a gap in understanding how to integrate VPs in the classroom to optimize students’ learning, especially in facilitating learning transfer. The effectiveness of VPs is not just in their use but also in how they are used by students to enhance their understanding on how to reason and make decisions about medical treatments when dealing with clinical cases. Without a clear and deep understanding, we risk underutilizing their potential and losing opportunities for medical students to become well prepared for real-world clinical scenarios.

Certain elements, such as role modeling instruction [ 14 , 15 , 16 ], using various authentic cases [ 17 , 18 , 19 ], and engaging in peer discussions on feedback [ 20 , 21 , 22 ], emerge as potential key components that could be integrated to maximize the knowledge acquisition via VPs. For instance, Stalmeijer, Dolmans [ 23 ] show how an expert, serving as a role model, provides guidance that facilitates student learning by demonstrating clinical skills and reasoning out loud. While there is ample evidence supporting the advantages of inclusion of VPs in education, there is not enough research focusing on the detailed aspects of effective instructional design techniques. This paper delves into these components, seeking to understand how the VP integration influences students’ learning and knowledge transfer. Figure  1 shows the theoretical framework of how integrating VPs in class affects students’ learning and might impact the transfer of learning in a simulated VP environment to practice.

Relationship of implementing, impact factor, and transfer of training

This exploratory study aims to investigate how instructional design elements such as role modeling, various authentic cases, and peer dialogues on feedback within VP sessions affect students’ learning from the learner’s perceptions. The core research question in this study focuses on how the implementation of role modeling, various authentic cases, and peer dialogue on feedback in VPs, influences learners’ perception of knowledge gain and transfer in personalized medicine.

The study was conducted at Maastricht University in the elective course, “Personalized Medicine in Cancer Treatment and Care”. This course is open to second-year undergraduate medical students of Maastricht University.

Participants

Initially, 24 students enrolled in this course for the academic year of 2022–2023, and 22 students participated in the Virtual Patient session. In total, 19 students voluntarily completed the survey designed to evaluate their experiences and perceptions of the Virtual Patients session. Thereafter, 9 of the 19 survey respondents voluntarily agreed to participate in three focus group interviews, with 2–4 students in each focus group. Students were informed that participation in this research study had no impact on student’s academic performance or their continuation in their studies.

Intervention

The instructional approach for the VP cases was structured in a specific format for the students. Figure  2 shows the instructional design for VP integration. The first stage was a role-modeling phase, where an expert demonstrated the clinical reasoning process using VP Case A. This was followed by a practice session where students worked in pairs on two different VP cases (Case B and C). After that, students formed two larger groups each including 5 or 6 students, and discussed the system feedback that was provided by VP platform. Finally, the expert summarized the session and addressed students’ questions. The whole intervention lasted 120 min. Figure  1 gives an overview of the intervention steps.

The flow of integrated virtual patient session

1. Role modeling (30 min): The intervention started with an expert, a clinician with teaching experience, demonstrating a clinical case (Case A) and showing the clinical reasoning process by thinking aloud. The expert served as a role model in showcasing the approach toward clinical problem-solving, provided supportive information, and demonstrated how to proceed through the case. The aim of the role modeling session was to empower students to apply the insights and methodology gained from experts in case A to solve subsequent cases (case B and case C), Although these cases shared similarities in underlying principles, they diverged on patient characteristics such as age, complications, and smoking history that can influence patient treatment outcomes.

2 and 3. Two VP pair tasks (20 min each): In this segment, the 22 participating students were paired, resulting in 11 pairs. These pairs were then divided into two groups. Group 1 (6 pairs) and group 2 (5 pairs) alternated in going through Case B and Case C to account for the practice effect. These cases were variations of the clinical cases introduced during the role-modeling demonstration, differing in patient characteristics such as age, complications, and smoking history to challenge the students’ reasoning. Students were encouraged to work collaboratively.

4. Feedback discussion (30 min): Upon completion of the VP cases, an automated feedback is immediately provided about the reasoning analysis. Participants were instructed to save this feedback for later discussion. After that, Students were organized into groups of six, based on the sequence in which they engaged with the cases. For instance, those who first practiced with Case B and then proceeded to Case C formed Group (1) Conversely, students who started with case C and then moved on to case B were assembled into Group (2) To foster meaningful dialogue, students engaged in discussions focused on the feedback generated by the Virtual Patient system, guided by a printed discussion guide distributed to each group (see Appendix 2 ). The discussion aimed to deepen students’ understanding and enrich their conversations about the cases they had just completed.

5. Plenary (15 min): This part lasted 15 min. Hosted by the expert to summarize the session and address questions or doubts raised by students.

During the practice and discussion sessions, the expert circulated among the groups to offer additional guidance and support.

The virtual patient cases

Three Virtual Patient (VP) cases (Case A, B, and C) were created to enhance students’ comprehension of specific concepts, knowledge, and skills in clinical reasoning. The VP practice was developed on the P-Scribe ( www.pscribe.nl ) learning platform, a web-based e-learning system based in the Netherlands. The platform facilitates the design and implementation of text-based VP sessions (Appendix 4 ).

While these cases shared a foundation on authentic head and neck cancer treatment, they were characterized by varying patient characteristics in terms of age, gender, and medical history (anamnesis).

VP case flow chart

Within each VP case, students were presented with a scenario related to neck cancer. Figure  3 shows the chart of a VP case. Each case starts with an overview of the patient and their medical history which students had to use to make an initial assessment. After this, students encountered a mix of multiple-choice and open-ended practice questions. These questions guided students in planning diagnostics, formulating a diagnosis, and devising a treatment plan tailored to the patient’s specific needs. Immediate feedback was provided after students submitted each response, and comprehensive summative feedback was given at the conclusion of each case to foster understanding and learning from any potential misjudgments or oversights (See Appendix 4 ).

Measurement instruments

Learning-perception survey : The survey (Appendix 1 ) consisted of 20 items, structured into five primary sections: general experience, intended learning outcome, role modeling, practicing with various authentic cases, and reflection on peer dialogue around feedback. The first item asked about students’ general experience through the whole session. The second item focused on their perception of intended learning outcomes. Six items then focused on the students’ perceptions of learning through role modeling followed by 5 items addressing perceptions related to their learning on practicing with authentic cases. The final seven items explored students’ perception of learning from dialogue around feedback. Participants indicated their level of agreement for each statement using a 5-point Likert scale: 1 denoting “Strongly Disagree”, 2 for “Disagree”, 3 for “Neutral”, 4 for “Agree”, and 5 for “Strongly Agree”. For interpretation, average scores below 3 were considered as “in need for improvement”, those of 4 or higher as ‘good’, and those between 3 and 4 as ‘neutral’.

Focus group interviews : Three focus group interviews (Appendix 3 ) were conducted to dive deeper into students’ perceptions of their learning experience, knowledge gain, and knowledge transfer in real-world settings. The focus group took place after the survey and the survey data did not affect the development of the focus group questions. In focus group 1, two students, in focus group 2, two students and in focus group 3, five students participated. The interviews were structured around a series of questions that explored students’ perceptions of their learning across specifically designed sections. These sections included Role Modeling, Practice with Various Authentic Cases, and Dialogue around Feedback. The structure aimed to understand students’ perspectives on each key component of the learning sections.

The analysis of the survey data was conducted by calculating the mean, standard deviation, and the Alpha Coefficient for the responses pertaining to each of the five key dimensions of the survey. The mean score provided an indicator of the average student perception, while the standard deviation offered insights into the variability of the responses. The Alpha Coefficient, a measure of internal consistency, was computed to assess the reliability of the survey dimensions. Through these statistical measures, an overall understanding of the students’ perceptions regarding the various aspects of the Virtual Patients was attained, facilitating a robust analysis aligned with the research objectives.

The focus-group interview data were analyzed following the thematic analysis procedure set out by Braun and Clarke [ 24 ]: (1) familiarize yourself with your data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) define and name themes, and (6) produce the report. The interview was guided by pre-existing frameworks or theories in medical education. This ensured the capture of major aspects of the VP learning experience as underscored in the existing literature: role modeling, using various authentic cases, and peer dialogue around feedback [ 16 , 17 , 18 , 20 , 21 ]. The focus group interview was recorded, transcribed, and coded by three team members and ordered in initial themes (Z.L, M.A, and X.L). These themes were discussed with the larger team. We used a process of inductive and deductive analysis and used the three design principles of role modeling, practice with various authentic cases, and group discussion on feedback as sensitizing concepts to study the data [ 24 ]. Thereafter, quantitative and qualitative analyses were collectively appraised, compared, and checked for inconsistencies. In this triangulation, the themes identified in focus-group interviews were explanatory to the descriptive statistics of the survey.

Trustworthiness

Several measures were taken to enhance the study’s trustworthiness. First, triangulation was achieved by employing multiple data collection methods, including surveys and focus group interviews. The interview data collection continued until saturation was reached, ensuring a comprehensive understanding of the student’s experiences and perceptions. Secondly, the coding process followed an iterative approach. Team members initially coded transcripts independently, and then met to reach a consensus before moving on to code subsequent transcripts. Three researchers conducted the coding independently to minimize bias and enhance the validity of the findings. Finally, a member check among a sample of the focus group interviewees was conducted. In response to the question asking whether they agreed with summaries of preliminary results and would provide comments, confirmatory responses were received as well as some minor additional comments and clarifications. The latter were taken into account in the analysis and interpretation of the data.

Ethical approval

The Maastricht University Ethical Committee reviewed and approved this study. The approval number is FHML-REC/2023/021.

The findings from both the survey data and focus group interviews were presented to explore students’ perceptions of the effectiveness of the Virtual Patient (VP) Session in enhancing their clinical reasoning skills.

Survey data

The survey explored students’ perceptions across five key dimensions: General Experience, Intended Learning Outcome, Role Modeling, Practicing with Various Authentic Cases, and students’ reflection on Peer Dialogue around Feedback. The students scored the VP sessions on 20 items (Table  1 ). The scores varied between M = 2.95 to M = 4.58, on a scale of 1–5.

For the General Experience of Virtual Patient Session (Items Q1-Q2) the average score was M = 4.13 (SD = 0.70). Specifically, the overall experience was positively rated at M = 4.11. The component that assessed the improvement of clinical reasoning skills received an average score of M = 4.16.

Regarding the Students’ Perception of Learning from Role Modeling (Items Q3-Q8), the average score was M = 4.38 (SD = 0.61). Students agreed that the expert demonstration at the start of the session helped them understand the intended learning outcomes and was useful in guiding them through the Virtual Patient cases, with scores ranging from M = 4.26 to M = 4.58.

Students’ perception of learning from practicing with various authentic cases (Items Q9-Q13), received an average score of M = 4.00 (SD = 0.86). The scores measured the students’ perception of how well the provided Virtual Patient cases matched their current level of understanding, enhanced their comprehension of the subject matter, and helped them grasp the complexities inherent in real-world clinical scenarios.

For their perception of learning from Peer Dialogue around Feedback (Questions 14–20), the average score was M = 3.24 (SD = 1.05). These scores measure the students’ perception of the effectiveness of peer dialogue in enhancing understanding, generating strategies to address feedback, and prioritizing areas of improvement.

Focus group interview data

The interviews revealed five themes: ' Which steps to take in clinical reasoning’, ' Asking challenging questions to enhance deeper understanding of knowledge’, ‘The variety in cases helps to enhance transfer to the real world’, and ‘Deeper understanding of reasoning through reflections’.

Which steps to take in clinical reasoning

Students acknowledged the expert’s initial demonstration helped them to develop structured knowledge and gain understanding of the clinical reasoning process.

I think it (Role modeling) helps to find a pattern in clinical reasoning as well. At first, it (the expert) explained to us. For example, are there possible lymph nodes? Yes or no. Then you need to do this and this…Then you can make kind of…pattern that differs for the diagnosis and the prognosis. So you can make kind of a diagram in your head. Which you can use later on. And your knowledge becomes more structured. (Focus Group 2, Student B)

Students also perceived that the integrated practice with Virtual Patients helped them to anticipate the subsequent steps in clinical reasoning. They indicated the patterns learned through practicing with virtual Patients helped them understand the procedures they needed to follow to evaluate the patient.

I think now I know the steps which they (the procedural) followed to evaluate the patient, so first we can do this and then that. First, you determine the TNM (Tumour, Node, Metastasis) staging and do the endoscopy, then the TNM staging, and then you make the treatment plan. Now it’s more clear how they do those steps. (Focus Group 1, Student A)

Moreover, students thought the pair work and dialogue helped them think and clarify with each other what steps they needed to do in clinical reasoning when they had different opinions.

Yeah, that (pair working) was really nice because you can discuss, like I think do this and the other one says, you know, I think do that step, and then you’re already discussing the answers which is really nice to have. (The discussion) really make you think about the steps. (Focus Group 1, Student b)

Challenging their reasoning to enhance deeper understanding

Students reported how the course design differed from other blocks. According to the students, the VP practice was particularly beneficial in helping them integrate knowledge, and make the knowledge their own.

It (the VP practice) helps you to integrate knowledge because other blocks are really only lectures, they are all listening and listening. So the virtual patient was really nice to make this stuff our own. (Focus Group 2, Student A)

Students indicated the examples given by the expert helped them get a better understanding of the more detailed TNM (Tumor, Node, Metastasis) table, that are used in clinical reasoning.

Yeah, she (the expert) gave examples and guided the reading of the tables for TNM (Tumor, Node, Metastasis) staging, and those were also in the Virtual Patient cases, but because she already used them once and explained how we have to use them, it became more clear to us, what these tables are for and how they are used (Focus Group 1, Student B) .

The students noted that in VP practice sessions, compared with passive learning in traditional lectures, they were challenged to engage directly with the material by making clinical decisions, such as selecting appropriate tests to reach a diagnosis.

In lectures, we passively learn the trajectory from symptoms to diagnosis. During Virtual Patient practice, we actively process it. So you have to make decisions and select the test etc. (Focus Group 2, Student B)

Students indicated that practicing with the VP cases challenged them to look up information and reasoned by themselves. They gave an example of the imaging practice in which they were tasked with examining specific body parts in medical images on their own, they thought they were challenged to reason about what they saw instead of getting the information directly.

Yeah, also the (medical) imaging in the assignments where you need to look at a specific part of the body, normally you just see a picture and someone says, yeah, this is the stomach or this is the heart, whatever, and now you need to look it up yourself and think about it yourself, what you see, so that really helps. (Focus Group 1, Student B)

Furthermore, they emphasized the questions asked by experts challenged them to think, put the knowledge in their own words and apply the knowledge with their own reasoning.

The questions she (the expert) asked really make you think about the things she’s learning(teaching). So if she asks questions, you’re really thinking, and yeah, you’re challenged to put it in your own words. (Focus Group 1, Student B) For instance, she (the expert) asked questions that not from official guidelines, instead, it came from where widely doctor worked and her personal experiences. I applied what she said with my own reasoning behind it. (Focus Group 2, Student B)

Transfer of knowledge

Students perceived that practicing with VP cases in different situations offered them hands-on experience, where they actively engaged with various situations, which prepared them for future patient interactions.

Having cases that are closer to the real world, like the comorbidity we discussed, would make it more realistic. (For instance, ) What if he also has obesity or diabetes? Those are the patients that we are going to see in the future. So it helps out a lot to have those different conditions as well. (Focus Group 2, Student B)

Students also indicated their preference for the structured approach of the VP session, where an initial demonstration by an expert, sharing their clinical experience, followed by hands-on practice with VP cases was perceived to enhance transfer to practice. This method, as described by the student, bridged the gap between theoretical knowledge and practical application. They think this structure made the knowledge clear and further helped them to transfer their knowledge from theory to practice.

You (the Virtual Patient session that integrated with role modeling, authentic VP practice, and peer discussion around feedback) made it (the clinical reasoning) clear for me because of the first case we discussed with the teacher. Well, he discussed it and showed us how to think, and how to get things from certain perspectives with risk factors, age, et cetera. And then we do it ourselves. We had to find out what was wrong and go on. So I quite liked it. It gave me a deeper understanding. (Focus Group 3, Student A)

Students indicated the sense of practical immersion is amplified by the “side information that you don’t really need” (Focus Group 3, Student E) from the cases. They highlighted the side information represented the interaction with real patients and made them think of clinical situations in real-world settings.

(Side) information would be more realistic, also side information that you don’t really need because a patient also tells you a lot of things, and some of those things aren’t as important, but you still need to decide if they are important or not. What do you see, why do you see it, what’s different than normal. (Focus Group 3, Student E)

Moreover, several students indicated that the hypothetical “what-if” discussions during the role modeling session helped them with reasoning, prompting them to consider complications that might arise in real-life medical situations.

So for example, about age, it’s more difficult to do a treatment above 70. (What if that patient) has things like smoking history and that kind of stuff. I think it’s really valuable because you have already had an example about it (Demonstrating Case A). (Focus Group 1, Student A)

Students indicated that the diagnosis practice in VP led them to realize the difference in real-world scenarios. They said while in the simulated environment might seem easy to choose multiple diagnostic options, in the real world, medical professionals must make more selective decisions due to limitations. They think this experience taught them to think of prioritizing and decision-making in a realistic medical setting.

Yeah, maybe also there (in VP cases) were also a question about which imaging techniques you would use and then it was Echo or CT, MRI, there was also an option where you could listen to the lungs and some of the people also checked that one, but it isn’t really necessary, so you think it only takes one minute, so why not, but in the real world there isn’t always time to do everything, so it’s also good to think what is really necessary and what’s not. (Focus Group 1, Student A)

Enhance reasoning through reflections

During the VP session, students received feedback and conducted conversations around the feedback provided by the Virtual Patient system. Students thought the peer dialogues around feedback provided opportunities for collective reflection and insights, allowing them to pinpoint areas of improvement.

I thought that (the peer dialogue) was really useful, because sometimes one person, for example, when the teacher explains everything, you don’t pick up everything he says. She (your peer) might pick up a different thing, and I pick up a different thing, and we can ask each other, do you know how this works? So I thought that was really useful. (Focus Group 3, Student B)

The students emphasized the importance of expressing and discussing different opinions. They noted that such interactions could provide new insights and perspectives that they would not have considered independently, thereby enriching their understanding.

When you do have different opinions, I think they (your peers) can give you insight that you maybe didn’t have for yourself. So you can add to each other’s knowledge. If somebody has another view, then we can discuss it. It (the discussion) brightens my tunnel view. Also having to say it (the knowledge) out loud and explaining your thoughts to someone else can also help, I think. (Focus Group 2, Student A)

When talking about the peer dialogues around feedback during the VP session, Some students highlighted the benefits of immediate feedback, which provided them with clarity and instant validation. However, others saw value in delayed feedback, as it fostered discussion and multiple interpretations.

I liked that the Virtual Patient program, that it gave you immediate feedback. That was really handy. And I also liked the discussion afterward so we could speak about it a bit more (Focus Group 3, Student B) . There was immediate feedback on most questions, so you knew if you had been correct or wrong. But for the learning process it might be handy to have that after the group discussion, because now we all have the same answer. (Focus Group 2, Student B)

The study demonstrated the perception of students’ learning and knowledge transfer by integrating VP cases with role modeling introductions, and peer dialogue around feedback, specifically in the context of personalized medicine in cancer treatment and care. The survey reflected a positive learning experience and students reported they gained a better understanding of the clinical reasoning process as well as which steps to take when dealing with a clinical case through this specific course design with integration of VP cases. Qualitative data showed that the integration of VPs into the educational setting clearly shifted the students from being passive observers in a traditional lecture-based format to active participants in a simulated clinical environment. This shift is in line with previous research findings, which suggest that the use of VPs in clinical training actively engages learners and encourages the application of their knowledge [ 4 ].

The quantitative data revealed that students highly valued the role modeling session, as indicated by the high average scores. Qualitative data explained that the role modeling session enabled students to not only observe the clinical process being demonstrated but also to engage in active thinking by interacting with the expert. As discussed by Cruess, Cruess [ 15 ], role modeling not only consciously imparts knowledge but also unconsciously influences students’ attitudes and behaviors, making the learning experience more relatable to the clinical environment. In this study, by sharing clinical reasoning and personal anecdotes during the class, experts made the learning experience more relatable to the clinical environment that students would face in the future. This mirrored the role modeling research by Morgenroth, Ryan [ 25 ] which emphasizes the importance of role models in shaping the self-concept and motivation of individuals. Moreover, the qualitative data showed that the demonstration by the expert serves as a fundamental pre-knowledge for students to cover the knowledge gap and prepare them with the following practice. This finding aligns with van Merrienboer’s scaffolding concept emphasizing the importance of initial expert guidance in learning processes [ 16 ].

Followed by the role modeling demonstration, students practiced on two VP cases in pairs and perceived that the VP practice enhanced their clinical reasoning skills, and also helped them understand the real-world clinical setting. The result showed that the variety and real-life complexity of cases in the VP sessions were perceived to be essential for students’ knowledge gain and transfer. The positive perception of various authentic cases aligns with previous research highlighting the importance of exposure to diverse and authentic scenarios in medical training [ 17 , 18 ]. Moreover, the hypothetical “what-if” scenarios further enhanced students’ analytical abilities, preparing them for the multifaceted challenges they would encounter in real-world medical situations. Survey responses (Q10, mean = 4.37; Q13, mean = 4.05 in Table  1 ) indicated a consensus among students on the improvement with this practice in understanding and applying knowledge. Our findings corroborate with Jonassen and Hernandez-Serrano [ 26 ]’s study emphasis on the importance of authentic learning environments for effective knowledge transfer.

After the practice, students discussed the feedback provided by the VP system. Despite its mixed quantitative reception, the peer dialogue on feedback was qualitatively found to be a vital component for promoting critical thinking, discussion, and reflection. The Feedback from the VPs, both immediate and delayed, along with peer dialogue, emerged as crucial elements in students’ learning process. In this study, students showed different preferences for receiving feedback. Some students preferred immediate feedback, however, others preferred delayed feedback. How feedback was provided notably influenced peer interactions. Given that immediate feedback was dispensed upon submission of answers, the peer dialogues automatically started when students noticed disparities or encountered obstacles. Such dialogues not only served to resolve ambiguities but also fostered collective reflection, enhancing comprehension of the subject. By vocalizing their thoughts and engaging in active discussions, students were able to solidify their understanding and uncover nuances they might have missed otherwise. This aligns with the importance of engaging in peer discussions on feedback as outlined in the theoretical background [ 20 , 21 , 22 ].

When looking at the integration of VP cases with the particular course design, students perceived that the expert demonstration, followed by VP practice, and peer dialogue around feedback fostered a comprehensive understanding, allowing them to integrate diverse clinical knowledge, which in turn promoted understanding. The “Watch-think-do-reflect” structure not only ensured better knowledge retention but also enhanced students’ enthusiasm towards the subject. Observing model demonstrations enabled students to assimilate clinical nuances and contemplate real-world applications. Subsequent hands-on practice with VP cases fortified their cognitive structures, honing their clinical reasoning. Ultimately, students perceived that reflective peer discussions on feedback solidified their learnings, enhancing knowledge retention.

Limitations

This study employed a survey and focus group interviews that provided a comprehensive understanding of students’ perceptions of learning. However, there are several limitations. The study had a small sample size and was conducted in the context of an elective course, which may limit the generalizability of the findings. Furthermore, the study was exploratory in nature and did not measure actual learning outcomes or long-term retention, which are critical aspects of educational impact.

Implications for future research

Future research should investigate whether integrating Virtual Patients (VPs) into classroom activities enhance student learning outcomes by incorporating learning assessments and involving larger and more diverse participant groups to validate our findings. Additionally, a deeper analysis of students’ reasoning processes and interactions could provide insights into how and why knowledge gain and transfer are fostered or hindered. Furthermore, it is also important to understand the most beneficial moment for integrating VPs into educational settings to enhance transfer from a simulated to a real practice setting. This understanding could inform the development of more effective educational strategies and interventions.

The integration of Virtual Patients into classroom learning appears to offer a promising approach to enrich medical education. Key elements such as role modeling and various authentic cases contribute positively to students’ perception of learning, as well as peer dialogue on feedback. However, the approach to peer dialogue on feedback may need to be refined for more consistent benefits. Furthermore, studies with larger sample sizes and broader participant groups are essential to provide robust support for the efficacy of this educational approach and its components.

Data availability

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

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Acknowledgements

Thanks to all the participants and education workers who contributed to the study. ZL was supported by a scholarship granted by the China Scholarship Council. Thanks for the support of my family, and thanks Ang Li for joining our family.

ZL was supported by a scholarship granted by the China Scholarship Council (CSC, 202208440100).

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ZL, MA, DD, and NJ conceived of the presented idea. MA and DD verified the analytical methods. TK and ZL contribute to the creation of learning materials. ZL analyzed the data and drafted the manuscript under the supervision of MA and DD. All authors contributed to the article and approved the submitted version.

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Li, Z., Asoodar, M., de Jong, N. et al. Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer. BMC Med Educ 24 , 647 (2024). https://doi.org/10.1186/s12909-024-05624-7

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Received : 18 March 2024

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DOI : https://doi.org/10.1186/s12909-024-05624-7

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