What is qualitative research methods

This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ]. Because some research questions cannot be answered using only quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ].

A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors — but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed. While qualitative research is common in other fields, it is still relatively underrepresented in health services research.

The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs This focus on quantitative research and specifically randomised controlled trials RCT is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ].

Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand — "questions before methods" [ 2 , 7 , 8 , 9 ].

This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them.

Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention — essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ].

Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.

The process ends when saturation is achieved, i. For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented. While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research e. The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ]. The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study also called document analysis refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters. Observations are particularly useful to gain insights into a certain setting and actual behaviour — as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature.

In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. Observations can be planned e. During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups.

Written notes can be taken during or after the observations, depending on feasibility which is usually lower during participant observations and acceptability e.

Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions.

Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Interviews can be distinguished by the degree to which they are structured i. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different blocks of questions may differ and some questions may be skipped altogether e.

Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher.

This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ].

Focus groups are useful for bringing together homogeneous to a lesser extent heterogeneous groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ].

Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ].

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this — i.

It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results. As a first step, we could conduct a document study of the relevant standard operating procedures SOPs for this phase of care — are they up-to-date and in line with current guidelines?

Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs.

These results can and should be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation?

It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Another rationale for adding interviews is that some situations or all of their possible variations for different patient groups or the day, night or weekend shift cannot practically or ethically be observed.

In this case, it is possible to ask those involved to report on their actions — being aware that this is not the same as the actual observation. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT.

The discussion might reveal discrepancies between SOPs and actual care or between different physicians and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves.

For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by senior physicians only.

The resulting combination of data collection methods is shown in Fig. To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts see Fig.

Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour e. In the next step, the protocols and transcripts are coded , that is, marked or tagged, labelled with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources e.

SOPs, emergency room observations, staff and patient interview. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ].

It should be noted that these are data management tools which support the analysis performed by the researcher s [ 14 ]. Attributions for icons: see Fig. Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation.

The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ].

It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement e. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of unexpected results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 , 25 , 26 ].

The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig. In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results.

Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved.

In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed.

Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different types of hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups. A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ].

In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper. Standards for Reporting Qualitative Research SRQR to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research paper.

Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ]. While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research.

This includes what is called reflexivity, i. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ].

It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

An iterative sampling approach is advised, in which data collection e. This process continues until no new relevant information can be found and further sampling becomes redundant — which is called saturation [ 1 , 15 ].

In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. Other types of purposive sampling include but are not limited to maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ].

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ]. Good qualitative research is iterative in nature, i. Multiple sources of data. Qualitative researchers generally choose to collect the required data from various sources such as interviews, documentation, and observations, rather than relying only on one source data.

Inductive data analysis. Qualitative researchers build categories, patterns and themes from the ground up inductive or from separate data into a complete conclusion.

In the entire research process, the researcher must focus on studying the meaning obtained from the participants about the issue or research problem, not the meaning conveyed by other authors or researchers in certain literatures. Design that develops emergent design. Qualitative researchers argue that qualitative research is always evolving and dynamic.

This can mean that the initial plan is not a standard that must be adhered to, all stages of research may change after the researcher goes into the field and collects data.

Provided that these changes are still in line in achieving the research objectives, namely obtaining information about the problem or research issue. Theoretical perspective theoritical lens. Qualitative researchers often use certain perspectives in conducting research such as ethnography, cultural concepts, gender differences, race and others. Qualitative researchers make an interpretation of what they see, hear and what they understand. Usually there are differences in interpretation between researchers and readers and participants, so it appears that qualitative research offers different views on a content or problem.

A holistic account. Qualitative researchers usually try to make a complex picture of a research issue or problem. Researchers describe the perspectives and factors associated with the problem as a whole. The following are the strategies in qualitative research:. The following are strategies that need to be carried out in qualitative research:. Since psychologists study people, the traditional approach to science is not seen as an appropriate way of carrying out research, since it fails to capture the totality of human experience and the essence of what it is to be human.

Exploring the experience of participants is known as a phenomenological approach re: Humanism. The aim of qualitative research is to understand the social reality of individuals, groups and cultures as nearly as possible as its participants feel it or live it. Thus, people and groups, are studied in their natural setting. It can be used to generate hypotheses and theory from the data.

The results of qualitative methods provide a deep understandings of how people perceive their social realities, and in consequence, how they act within the social world. The researcher has several methods for collecting empirical materials, ranging from the interview to direct observation, to the analysis of artifacts, documents, and cultural records, to the use of visual materials or personal experience.

A good example of a qualitative research method would be unstructured interviews which generate qualitative data through the use of open questions. This allows the respondent to talk in some depth, choosing their own words. Notice that qualitative data could be much more than just words or text.

Photographs, videos, sound recordings and so on, can be considered qualitative data. Qualitative research is endlessly creative and interpretive. The researcher does not just leave the field with mountains of empirical data and then easily write up his or her findings.

Because of the time and costs involved, qualitative designs do not generally draw samples from large-scale data sets. The problem of adequate validity or reliability is a major criticism. Because of the subjective nature of qualitative data and its origin in single contexts, it is difficult to apply conventional standards of reliability and validity. For example, because of the central role played by the researcher in the generation of data, it is not possible to replicate qualitative studies.

Also, contexts, situations, events, conditions, and interactions cannot be replicated to any extent nor can generalizations be made to a wider context than the one studied with any confidence. The time required for data collection, analysis and interpretation are lengthy.

Analysis of qualitative data is difficult and expert knowledge of an area is necessary to try to interpret qualitative data, and great care must be taken when doing so, for example, if looking for symptoms of mental illness. Because of close researcher involvement, the researcher gains an insider's view of the field.

This allows the researcher to find issues that are often missed such as subtleties and complexities by the scientific, more positivistic inquiries. Qualitative descriptions can play the important role of suggesting possible relationships, causes, effects and dynamic processes.

Qualitative research uses a descriptive, narrative style; this research might be of particular benefit to the practitioner as she or he could turn to qualitative reports in order to examine forms of knowledge that might otherwise be unavailable, thereby gaining new insight. Quantitative research involves the process of objectively collecting and analyzing numerical data to describe, predict, or control variables of interest. Research is used to test a theory and ultimately support or reject it.

Experiments typically yield quantitative data, as they are concerned with measuring things. However, other research methods, such as controlled observations and questionnaires can produce both quantitative information.

For example, a rating scale or closed questions on a questionnaire would generate quantitative data as these produce either numerical data or data that can be put into categories e. Experimental methods limit the possible ways in which a research participant can react to and express appropriate social behavior.

Findings are therefore likely to be context-bound and simply a reflection of the assumptions which the researcher brings to the investigation.

Statistics help us turn quantitative data into useful information to help with decision making. We can use statistics to summarise our data, describing patterns, relationships, and connections.