qualitative research focus

Chapter 12. Focus Groups

Introduction.

Focus groups are a particular and special form of interviewing in which the interview asks focused questions of a group of persons, optimally between five and eight. This group can be close friends, family members, or complete strangers. They can have a lot in common or nothing in common. Unlike one-on-one interviews, which can probe deeply, focus group questions are narrowly tailored (“focused”) to a particular topic and issue and, with notable exceptions, operate at the shallow end of inquiry. For example, market researchers use focus groups to find out why groups of people choose one brand of product over another. Because focus groups are often used for commercial purposes, they sometimes have a bit of a stigma among researchers. This is unfortunate, as the focus group is a helpful addition to the qualitative researcher’s toolkit. Focus groups explicitly use group interaction to assist in the data collection. They are particularly useful as supplements to one-on-one interviews or in data triangulation. They are sometimes used to initiate areas of inquiry for later data collection methods. This chapter describes the main forms of focus groups, lays out some key differences among those forms, and provides guidance on how to manage focus group interviews.

Focus Groups: What Are They and When to Use Them

As interviews, focus groups can be helpfully distinguished from one-on-one interviews. The purpose of conducting a focus group is not to expand the number of people one interviews: the focus group is a different entity entirely. The focus is on the group and its interactions and evaluations rather than on the individuals in that group. If you want to know how individuals understand their lives and their individual experiences, it is best to ask them individually. If you want to find out how a group forms a collective opinion about something (whether a product or an event or an experience), then conducting a focus group is preferable. The power of focus groups resides in their being both focused and oriented to the group . They are best used when you are interested in the shared meanings of a group or how people discuss a topic publicly or when you want to observe the social formation of evaluations. The interaction of the group members is an asset in this method of data collection. If your questions would not benefit from group interaction, this is a good indicator that you should probably use individual interviews (chapter 11). Avoid using focus groups when you are interested in personal information or strive to uncover deeply buried beliefs or personal narratives. In general, you want to avoid using focus groups when the subject matter is polarizing, as people are less likely to be honest in a group setting. There are a few exceptions, such as when you are conducting focus groups with people who are not strangers and/or you are attempting to probe deeply into group beliefs and evaluations. But caution is warranted in these cases. [1]

As with interviewing in general, there are many forms of focus groups. Focus groups are widely used by nonresearchers, so it is important to distinguish these uses from the research focus group. Businesses routinely employ marketing focus groups to test out products or campaigns. Jury consultants employ “mock” jury focus groups, testing out legal case strategies in advance of actual trials. Organizations of various kinds use focus group interviews for program evaluation (e.g., to gauge the effectiveness of a diversity training workshop). The research focus group has many similarities with all these uses but is specifically tailored to a research (rather than applied) interest. The line between application and research use can be blurry, however. To take the case of evaluating the effectiveness of a diversity training workshop, the same interviewer may be conducting focus group interviews both to provide specific actionable feedback for the workshop leaders (this is the application aspect) and to learn more about how people respond to diversity training (an interesting research question with theoretically generalizable results).

When forming a focus group, there are two different strategies for inclusion. Diversity focus groups include people with diverse perspectives and experiences. This helps the researcher identify commonalities across this diversity and/or note interactions across differences. What kind of diversity to capture depends on the research question, but care should be taken to ensure that those participating are not set up for attack from other participants. This is why many warn against diversity focus groups, especially around politically sensitive topics. The other strategy is to build a convergence focus group , which includes people with similar perspectives and experiences. These are particularly helpful for identifying shared patterns and group consensus. The important thing is to closely consider who will be invited to participate and what the composition of the group will be in advance. Some review of sampling techniques (see chapter 5) may be helpful here.

Moderating a focus group can be a challenge (more on this below). For this reason, confining your group to no more than eight participants is recommended. You probably want at least four persons to capture group interaction. Fewer than four participants can also make it more difficult for participants to remain (relatively) anonymous—there is less of a group in which to hide. There are exceptions to these recommendations. You might want to conduct a focus group with a naturally occurring group, as in the case of a family of three, a social club of ten, or a program of fifteen. When the persons know one another, the problems of too few for anonymity don’t apply, and although ten to fifteen can be unwieldy to manage, there are strategies to make this possible. If you really are interested in this group’s dynamic (not just a set of random strangers’ dynamic), then you will want to include all its members or as many as are willing and able to participate.

There are many benefits to conducting focus groups, the first of which is their interactivity. Participants can make comparisons, can elaborate on what has been voiced by another, and can even check one another, leading to real-time reevaluations. This last benefit is one reason they are sometimes employed specifically for consciousness raising or building group cohesion. This form of data collection has an activist application when done carefully and appropriately. It can be fun, especially for the participants. Additionally, what does not come up in a focus group, especially when expected by the researcher, can be very illuminating.

Many of these benefits do incur costs, however. The multiplicity of voices in a good focus group interview can be overwhelming both to moderate and later to transcribe. Because of the focused nature, deep probing is not possible (or desirable). You might only get superficial thinking or what people are willing to put out there publicly. If that is what you are interested in, good. If you want deeper insight, you probably will not get that here. Relatedly, extreme views are often suppressed, and marginal viewpoints are unspoken or, if spoken, derided. You will get the majority group consensus and very little of minority viewpoints. Because people will be engaged with one another, there is the possibility of cut-off sentences, making it even more likely to hear broad brush themes and not detailed specifics. There really is very little opportunity for specific follow-up questions to individuals. Reading over a transcript, you may be frustrated by avenues of inquiry that were foreclosed early.

Some people expect that conducting focus groups is an efficient form of data collection. After all, you get to hear from eight people instead of just one in the same amount of time! But this is a serious misunderstanding. What you hear in a focus group is one single group interview or discussion. It is not the same thing at all as conducting eight single one-hour interviews. Each focus group counts as “one.” Most likely, you will need to conduct several focus groups, and you can design these as comparisons to one another. For example, the American Sociological Association (ASA) Task Force on First-Generation and Working-Class Persons in Sociology began its study of the impact of class in sociology by conducting five separate focus groups with different groups of sociologists: graduate students, faculty (in general), community college faculty, faculty of color, and a racially diverse group of students and faculty. Even though the total number of participants was close to forty, the “number” of cases was five. It is highly recommended that when employing focus groups, you plan on composing more than one and at least three. This allows you to take note of and potentially discount findings from a group with idiosyncratic dynamics, such as where a particularly dominant personality silences all other voices. In other words, putting all your eggs into a single focus group basket is not a good idea.

How to Conduct a Focus Group Interview/Discussion

Advance preparations.

Once you have selected your focus groups and set a date and time, there are a few things you will want to plan out before meeting.

As with interviews, you begin by creating an interview (or discussion) guide. Where a good one-on-one interview guide should include ten to twelve main topics with possible prompts and follow-ups (see the example provided in chapter 11), the focus group guide should be more narrowly tailored to a single focus or topic area. For example, a focus might be “How students coped with online learning during the pandemic,” and a series of possible questions would be drafted that would help prod participants to think about and discuss this topic. These questions or discussion prompts can be creative and may include stimulus materials (watching a video or hearing a story) or posing hypotheticals. For example, Cech ( 2021 ) has a great hypothetical, asking what a fictional character should do: keep his boring job in computers or follow his passion and open a restaurant. You can ask a focus group this question and see what results—how the group comes to define a “good job,” what questions they ask about the hypothetical (How boring is his job really? Does he hate getting up in the morning, or is it more of an everyday tedium? What kind of financial support will he have if he quits? Does he even know how to run a restaurant?), and how they reach a consensus or create clear patterns of disagreement are all interesting findings that can be generated through this technique.

As with the above example (“What should Joe do?”), it is best to keep the questions you ask simple and easily understood by everyone. Thinking about the sequence of the questions/prompts is important, just as it is in conducting any interviews.

Avoid embarrassing questions. Always leave an out for the “I have a friend who X” response rather than pushing people to divulge personal information. Asking “How do you think students coped?” is better than “How did you cope?” Chances are, some participants will begin talking about themselves without you directly asking them to do so, but allowing impersonal responses here is good. The group itself will determine how deep and how personal it wants to go. This is not the time or place to push anyone out of their comfort zone!

Of course, people have different levels of comfort talking publicly about certain topics. You will have provided detailed information to your focus group participants beforehand and secured consent. But even so, the conversation may take a turn that makes someone uncomfortable. Be on the lookout for this, and remind everyone of their ability to opt out—to stay silent or to leave if necessary. Rather than call attention to anyone in this way, you also want to let everyone know they are free to walk around—to get up and get coffee (more on this below) or use the restroom or just step out of the room to take a call. Of course, you don’t really want anyone to do any of these things, and chances are everyone will stay seated during the hour, but you should leave this “out” for those who need it.

Have copies of consent forms and any supplemental questionnaire (e.g., demographic information) you are using prepared in advance. Ask a friend or colleague to assist you on the day of the focus group. They can be responsible for making sure the recording equipment is functioning and may even take some notes on body language while you are moderating the discussion. Order food (coffee or snacks) for the group. This is important! Having refreshments will be appreciated by your participants and really damps down the anxiety level. Bring name tags and pens. Find a quiet welcoming space to convene. Often this is a classroom where you move chairs into a circle, but public libraries often have meeting rooms that are ideal places for community members to meet. Be sure that the space allows for food.

Researcher Note

When I was designing my research plan for studying activist groups, I consulted one of the best qualitative researchers I knew, my late friend Raphael Ezekiel, author of The Racist Mind . He looked at my plan to hand people demographic surveys at the end of the meetings I planned to observe and said, “This methodology is missing one crucial thing.” “What?” I asked breathlessly, anticipating some technical insider tip. “Chocolate!” he answered. “They’ll be tired, ready to leave when you ask them to fill something out. Offer an incentive, and they will stick around.” It worked! As the meetings began to wind down, I would whip some bags of chocolate candies out of my bag. Everyone would stare, and I’d say they were my thank-you gift to anyone who filled out my survey. Once I learned to include some sugar-free candies for diabetics, my typical response rate was 100 percent. (And it gave me an additional class-culture data point by noticing who chose which brand; sure enough, Lindt balls went faster at majority professional-middle-class groups, and Hershey’s minibars went faster at majority working-class groups.)

—Betsy Leondar-Wright, author of Missing Class , coauthor of The Color of Wealth , associate professor of sociology at Lasell University, and coordinator of staffing at the Mission Project for Class Action

During the Focus Group

As people arrive, greet them warmly, and make sure you get a signed consent form (if not in advance). If you are using name tags, ask them to fill one out and wear it. Let them get food and find a seat and do a little chatting, as they might wish. Once seated, many focus group moderators begin with a relevant icebreaker. This could be simple introductions that have some meaning or connection to the focus. In the case of the ASA task force focus groups discussed above, we asked people to introduce themselves and where they were working/studying (“Hi, I’m Allison, and I am a professor at Oregon State University”). You will also want to introduce yourself and the study in simple terms. They’ve already read the consent form, but you would be surprised at how many people ignore the details there or don’t remember them. Briefly talking about the study and then letting people ask any follow-up questions lays a good foundation for a successful discussion, as it reminds everyone what the point of the event is.

Focus groups should convene for between forty-five and ninety minutes. Of course, you must tell the participants the time you have chosen in advance, and you must promptly end at the time allotted. Do not make anyone nervous by extending the time. Let them know at the outset that you will adhere to this timeline. This should reduce the nervous checking of phones and watches and wall clocks as the end time draws near.

Set ground rules and expectations for the group discussion. My preference is to begin with a general question and let whoever wants to answer it do so, but other moderators expect each person to answer most questions. Explain how much cross-talk you will permit (or encourage). Again, my preference is to allow the group to pick up the ball and run with it, so I will sometimes keep my head purposefully down so that they engage with one another rather than me, but I have seen other moderators take a much more engaged position. Just be clear at the outset about what your expectations are. You may or may not want to explain how the group should deal with those who would dominate the conversation. Sometimes, simply stating at the outset that all voices should be heard is enough to create a more egalitarian discourse. Other times, you will have to actively step in to manage (moderate) the exchange to allow more voices to be heard. Finally, let people know they are free to get up to get more coffee or leave the room as they need (if you are OK with this). You may ask people to refrain from using their phones during the duration of the discussion. That is up to you too.

Either before or after the introductions (your call), begin recording the discussion with their collective permission and knowledge . If you have brought a friend or colleague to assist you (as you should), have them attend to the recording. Explain the role of your colleague to the group (e.g., they will monitor the recording and will take short notes throughout to help you when you read the transcript later; they will be a silent observer).

Once the focus group gets going, it may be difficult to keep up. You will need to make a lot of quick decisions during the discussion about whether to intervene or let it go unguided. Only you really care about the research question or topic, so only you will really know when the discussion is truly off topic. However you handle this, keep your “participation” to a minimum. According to Lune and Berg ( 2018:95 ), the moderator’s voice should show up in the transcript no more than 10 percent of the time. By the way, you should also ask your research assistant to take special note of the “intensity” of the conversation, as this may be lost in a transcript. If there are people looking overly excited or tapping their feet with impatience or nodding their heads in unison, you want some record of this for future analysis.

I’m not sure why this stuck with me, but I thought it would be interesting to share. When I was reviewing my plan for conducting focus groups with one of my committee members, he suggested that I give the participants their gift cards first. The incentive for participating in the study was a gift card of their choice, and typical processes dictate that participants must complete the study in order to receive their gift card. However, my committee member (who is Native himself) suggested I give it at the beginning. As a qualitative researcher, you build trust with the people you engage with. You are asking them to share their stories with you, their intimate moments, their vulnerabilities, their time. Not to mention that Native people are familiar with being academia’s subjects of interest with little to no benefit to be returned to them. To show my appreciation, one of the things I could do was to give their gifts at the beginning, regardless of whether or not they completed participating.

—Susanna Y. Park, PhD, mixed-methods researcher in public health and author of “How Native Women Seek Support as Survivors of Intimate Partner Violence: A Mixed-Methods Study”

After the Focus Group

Your “data” will be either fieldnotes taken during the focus group or, more desirably, transcripts of the recorded exchange. If you do not have permission to record the focus group discussion, make sure you take very clear notes during the exchange and then spend a few hours afterward filling them in as much as possible, creating a rich memo to yourself about what you saw and heard and experienced, including any notes about body language and interactions. Ideally, however, you will have recorded the discussion. It is still a good idea to spend some time immediately after the conclusion of the discussion to write a memo to yourself with all the things that may not make it into the written record (e.g., body language and interactions). This is also a good time to journal about or create a memo with your initial researcher reactions to what you saw, noting anything of particular interest that you want to come back to later on (e.g., “It was interesting that no one thought Joe should quit his job, but in the other focus group, half of the group did. I wonder if this has something to do with the fact that all the participants were first-generation college students. I should pay attention to class background here.”).

Please thank each of your participants in a follow-up email or text. Let them know you appreciated their time and invite follow-up questions or comments.

One of the difficult things about focus group transcripts is keeping speakers distinct. Eventually, you are going to be using pseudonyms for any publication, but for now, you probably want to know who said what. You can assign speaker numbers (“Speaker 1,” “Speaker 2”) and connect those identifications with particular demographic information in a separate document. Remember to clearly separate actual identifications (as with consent forms) to prevent breaches of anonymity. If you cannot identify a speaker when transcribing, you can write, “Unidentified Speaker.” Once you have your transcript(s) and memos and fieldnotes, you can begin analyzing the data (chapters 18 and 19).

Advanced: Focus Groups on Sensitive Topics

Throughout this chapter, I have recommended against raising sensitive topics in focus group discussions. As an introvert myself, I find the idea of discussing personal topics in a group disturbing, and I tend to avoid conducting these kinds of focus groups. And yet I have actually participated in focus groups that do discuss personal information and consequently have been of great value to me as a participant (and researcher) because of this. There are even some researchers who believe this is the best use of focus groups ( de Oliveira 2011 ). For example, Jordan et al. ( 2007 ) argue that focus groups should be considered most useful for illuminating locally sanctioned ways of talking about sensitive issues. So although I do not recommend the beginning qualitative researcher dive into deep waters before they can swim, this section will provide some guidelines for conducting focus groups on sensitive topics. To my mind, these are a minimum set of guidelines to follow when dealing with sensitive topics.

First, be transparent about the place of sensitive topics in your focus group. If the whole point of your focus group is to discuss something sensitive, such as how women gain support after traumatic sexual assault events, make this abundantly clear in your consent form and recruiting materials. It is never appropriate to blindside participants with sensitive or threatening topics .

Second, create a confidentiality form (figure 12.2) for each participant to sign. These forms carry no legal weight, but they do create an expectation of confidentiality for group members.

In order to respect the privacy of all participants in [insert name of study here], all parties are asked to read and sign the statement below. If you have any reason not to sign, please discuss this with [insert your name], the researcher of this study, I, ________________________, agree to maintain the confidentiality of the information discussed by all participants and researchers during the focus group discussion.

Signature: _____________________________ Date: _____________________

Researcher’s Signature:___________________ Date:______________________

Figure 12.2 Confidentiality Agreement of Focus Group Participants

Third, provide abundant space for opting out of the discussion. Participants are, of course, always permitted to refrain from answering a question or to ask for the recording to be stopped. It is important that focus group members know they have these rights during the group discussion as well. And if you see a person who is looking uncomfortable or like they want to hide, you need to step in affirmatively and remind everyone of these rights.

Finally, if things go “off the rails,” permit yourself the ability to end the focus group. Debrief with each member as necessary.

Further Readings

Barbour, Rosaline. 2018. Doing Focus Groups . 2nd ed. Thousand Oaks, CA: SAGE. Written by a medical sociologist based in the UK, this is a good how-to guide for conducting focus groups.

Gibson, Faith. 2007. “Conducting Focus Groups with Children and Young People: Strategies for Success.” Journal of Research in Nursing 12(5):473–483. As the title suggests, this article discusses both methodological and practical concerns when conducting focus groups with children and young people and offers some tips and strategies for doing so effectively.

Hopkins, Peter E. 2007. “Thinking Critically and Creatively about Focus Groups.” Area 39(4):528–535. Written from the perspective of critical/human geography, Hopkins draws on examples from his own work conducting focus groups with Muslim men. Useful for thinking about positionality.

Jordan, Joanne, Una Lynch, Marianne Moutray, Marie-Therese O’Hagan, Jean Orr, Sandra Peake, and John Power. 2007. “Using Focus Groups to Research Sensitive Issues: Insights from Group Interviews on Nursing in the Northern Ireland ‘Troubles.’” International Journal of Qualitative Methods 6(4), 1–19. A great example of using focus groups productively around emotional or sensitive topics. The authors suggest that focus groups should be considered most useful for illuminating locally sanctioned ways of talking about sensitive issues.

Merton, Robert K., Marjorie Fiske, and Patricia L. Kendall. 1956. The Focused Interview: A Manual of Problems and Procedures . New York: Free Press. This is one of the first classic texts on conducting interviews, including an entire chapter devoted to the “group interview” (chapter 6).

Morgan, David L. 1986. “Focus Groups.” Annual Review of Sociology 22:129–152. An excellent sociological review of the use of focus groups, comparing and contrasting to both surveys and interviews, with some suggestions for improving their use and developing greater rigor when utilizing them.

de Oliveira, Dorca Lucia. 2011. “The Use of Focus Groups to Investigate Sensitive Topics: An Example Taken from Research on Adolescent Girls’ Perceptions about Sexual Risks.” Cien Saude Colet 16(7):3093–3102. Another example of discussing sensitive topics in focus groups. Here, the author explores using focus groups with teenage girls to discuss AIDS, risk, and sexuality as a matter of public health interest.

Peek, Lori, and Alice Fothergill. 2009. “Using Focus Groups: Lessons from Studying Daycare Centers, 9/11, and Hurricane Katrina.” Qualitative Research 9(1):31–59. An examination of the efficacy and value of focus groups by comparing three separate projects: a study of teachers, parents, and children at two urban daycare centers; a study of the responses of second-generation Muslim Americans to the events of September 11; and a collaborative project on the experiences of children and youth following Hurricane Katrina. Throughout, the authors stress the strength of focus groups with marginalized, stigmatized, or vulnerable individuals.

Wilson, Valerie. 1997. “Focus Groups: A Useful Qualitative Method for Educational Research?” British Educational Research Journal 23(2):209–224. A basic description of how focus groups work using an example from a study intended to inform initiatives in health education and promotion in Scotland.

• Note that I have included a few examples of conducting focus groups with sensitive issues in the “ Further Readings ” section and have included an “ Advanced: Focus Groups on Sensitive Topics ” section on this area. ↵

A focus group interview is an interview with a small group of people on a specific topic.  “The power of focus groups resides in their being focused” (Patton 2002:388).  These are sometimes framed as “discussions” rather than interviews, with a discussion “moderator.”  Alternatively, the focus group is “a form of data collection whereby the researcher convenes a small group of people having similar attributes, experiences, or ‘focus’ and leads the group in a nondirective manner.  The objective is to surface the perspectives of the people in the group with as minimal influence by the researcher as possible” (Yin 2016:336).  See also diversity focus group and convergence focus group.

A form of focus group construction in which people with diverse perspectives and experiences are chosen for inclusion.  This helps the researcher identify commonalities across this diversity and/or note interactions across differences.  Contrast with a convergence focus group

A form of focus group construction in which people with similar perspectives and experiences are included.  These are particularly helpful for identifying shared patterns and group consensus.  Contrast with a diversity focus group .

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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Methodology

• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on September 5, 2024.

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.

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

• Unreliability

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

• Subjectivity

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

• Limited generalizability

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

• Labor-intensive

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

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

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

Research bias

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

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

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

There are five common approaches to qualitative research :

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

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

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

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

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

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Qualitative Research: Introducing focus groups

• Related content
• Peer review
• Jenny Kitzinger , research fellow a
• a Glasgow University Media Group, Department of Sociology, University of Glasgow, Glasgow G12 8LF

This paper introduces focus group methodology, gives advice on group composition, running the groups, and analysing the results. Focus groups have advantages for researchers in the field of health and medicine: they do not discriminate against people who cannot read or write and they can encourage participation from people reluctant to be interviewed on their own or who feel they have nothing to say.

This is the fifth in a series of seven articles describing non-quantitative techniques and showing their value in health research

**FIGURE OMITTED**

Rationale and uses of focus groups

Focus groups are a form of group interview that capitalises on communication between research participants in order to generate data. Although group interviews are often used simply as a quick and convenient way to collect data from several people simultaneously, focus groups explicitly use group interaction as part of the method. This means that instead of the researcher asking each person to respond to a question in turn, people are encouraged to talk to one another: asking questions, exchanging anecdotes and commenting on each other's experiences and points of view. 1 The method is particularly useful for exploring people's knowledge and experiences and can be used to examine not only what people think but how they think and why they think that way.

Focus groups were originally used within communication studies to explore the effects of films and television programmes, 2 and are a popular method for assessing health education messages and examining public understandings of illness and of health behaviours. 3 4 5 6 7 They are widely used to examine people's experiences of disease and of health services. 8 9 and are an effective technique for exploring the attitudes and needs of staff. 10 11

The idea behind the focus group method is that group processes can help people to explore and …

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Chapter 14: Focus groups

Tess Tsindos

Learning Outcomes

Upon completion of this chapter, you should be able to:

• Assess when to use focus groups in qualitative research.
• Develop questions for a focus group guide.
• Understand how to conduct a focus group.

What are focus groups?

Focus groups are convened to discuss an issue of mutual concern. The purpose of a focus group is to explore the experiences, understandings, opinions or motivations of research participants. 1 While individual interviews explore the experiences of (usually) one participant (see Chapter 13 ), focus groups are conducted with three or more people who share an experience or concern. The conversation between participants in a focus group is mediated and facilitated by the researcher. Focus groups can be used when little is known about the participants or a topic (an exploratory process), when testing new ideas (e.g. acceptability of a program or intervention) or when undertaking an evaluation of a service or product.

The focus of the discussion is on the interaction between participants in the group; some participants may have similar experiences or views, while others have different experiences. The group dynamic is important and therefore it is important that participants lead the discussion and are encouraged to talk through their similarities and differences, so that the researcher might gain a well-rounded perspective and account of the topic. A group might be homogeneous, get along well and share similar experiences. Or the group might be heterogeneous and have differing opinions and experiences. Participants might know each other because they have been recruited from the same program or community, or they could be total strangers. All these elements contribute to the focus of discussion, and to the group dynamic; that is, the interactivity of the focus group.

How many focus group members should there be?

Ideally, a focus group should include 6–10 participants 2 and the conversation should be moderated by the researcher, using a focus group discussion guide. However, the number of participants may vary according to the topic and the number of participants able to be recruited. The data collected from focus groups tends to differ from interview data because people respond and compare their own experiences with those of others in the group. Therefore, the number and composition of group members influence the data gathered.

Having too many people in a group means that discussion can become chaotic and it is unlikely that everyone in the group will have a say. Having too few people means that there may not be sufficient interaction to enable to capture a group perspective. Focus groups have been conducted with as few as two people: in a focus group conducted by one of the authors of this chapter, several participants had been invited, but only two attended. Since participants were difficult to recruit from the target population, it was not feasible to cancel the focus group. The topic was recovery after percutaneous coronary intervention (a cardiac procedure). The focus group discussion developed into an intimate conversation between two older men about their challenges in physical recovery and the psychological effects of not being able to fulfil a traditional male role. The small group size was serendipitous, in that the researcher may not have been able to collect such rich data had the group been larger. 3

The researcher (s)

It is common to have two researchers present in a focus group. One facilitates the group, while the other observes and records the session, and takes notes about who said what, body language and other observable information that contributes to the context of the data being collected. The observer should be as unobtrusive as possible and not participate in the group discussion. Similar to interviews, focus groups are audio-recorded so the conversation can be transcribed for analysis.  The researcher is encouraged to build rapport with focus group participants, which is aided by having a friendly and approachable manner. The focus group method enables the facilitator to probe ideas as they arise and to check their understanding of participants’ responses. This active facilitation enhances the robustness of the data collected. The quality of the data collected will depend greatly on how effective the researcher is at facilitating the group, and thus good interpersonal skills are essential. Conducting effective focus group discussions comes with practice and experience.

How long should a focus group be?

There are no strict rules about how long a focus group should be. Different groups will likely run for different amounts of time because this depends on the research question/s and the types of group members. For example, a group of people who know each other and have a common experience may need no longer than 45 minutes, whereas a group of strangers with different experiences may need up to 2 hours. Additionally, the number of people in the focus group will affect the amount of time needed. A focus group discussion with 6 participants may likely be shorter than a focus group with 12 participants.

Designing the focus group guide

Before the commencement of a focus group, the researchers need to develop a focus group discussion guide, which is similar to an interview guide. Both aim to explore the experiences, understandings, opinions and motivations of participants. If the study’s research methods include interviews and focus groups, the questions will be very similar. T he difference is that the focus group discussion guide do es not typically ask questions to elicit individual storytelling, but rather to ask questions to invite discussion of shared experiences , in which participants confirm or contrast each others ’ views . If focus groups are the sole data collection method, the researcher may consult existing literature, speak to experts, including people with lived experience about the focus of the research, and draw on their knowledge so that the topics and questions can be mapped to the research question/s.

The focus group guide should be developed well in advance of commencing data collection. This provides time for the facilitator and the observer to explore together the language and clarity of questions, the order and flow of the guide, and whether the instructions for participants are clear and comprehensive. To facilitate free-flowing responses, it is important to use open-ended questions that encourage participants to be expansive in their responses. Examples of open-ended question formats include those that start with ‘who’, ‘how’ ‘tell me more about’ and ‘where’.

Pilot interview/s enable the researchers to test the interview guide. However, they are often not conducted because it can be difficult to recruit enough relevant participants. Instead, focus group questions might be reviewed by other members of the research team for clarity and comprehensiveness. The study design will determine the number of questions asked and the extent of the focus group guide. The target population may also determine the extent of the focus group guide; for example, clinicians who are time-poor may need shorter focus groups while patient populations may be interested in exploring their experiences in detail and at length.

Following is a template that can be adapted for the introduction of a focus group. Table 14.1 offers example questions for a focus group discussion guide.

Focus group introduction

‘Hi everyone. My name is [insert name] and I’m from [insert organisation]. I am conducting [describe study]. Thank you for agreeing to be part of this focus group today. You were invited to participate in this focus group because [include reason]. Today we would like to discuss [outline topics]. We anticipate that the session will go for approximately [insert expected time]. Before we get started, I’d like to explain how we would like to structure the discussion. 1. We would like to hear from everyone present. This may mean that I will call on you by name to respond to a question. I may also indicate to you when it’s time to wrap up your thoughts so we can move on to another person or topic. 2. Feel free to respond directly to each other. I’m here to facilitate the discussion, but you are encouraged to respond to the other participants in this group. 3. We are recording the session today. This will ensure that we capture everything discussed. Your names will not be used in the reporting of this data and we will be using pseudonyms or codes instead when writing up results. 4. Please be respectful of what other participants share. Due to the nature of focus groups, we cannot ensure confidentiality, but we do ask that you do not repeat what is discussed in this group to people who were not present. You should feel free to not answer a question if you don’t feel comfortable answering. Do you have any questions before we begin?”

Table 14.1. Focus group guide: Example questions for a descriptive study

An earlier variation of this table has appeared in the Supplementary material for the article Why do students plagiarise? Informing higher education teaching and learning policy and practice . 4

Setting up the f ocus group

In the past, most focus groups were conducted in person. Emerging technologies have enabled the conduct of focus groups online, using teleconferencing and videoconferencing platforms. While it is more challenging to conduct a focus group online – primarily because participants’ body language is often not seen – it can be a very useful method of collecting data. The benefits include low cost, greater access to participants in different locations and time efficiencies. 5 Participants who are less inclined to participate verbally are able to use ‘chat’ functions to contribute their comments. Whether the focus group is face-to-face or online, the facilitator will need to help participants feel as comfortable as possible and encourage discussion.

Focus group activities

Focus groups may incorporate activities in addition to, or to aid discussion; for example, sorting and ranking activities to prioritise topics for discussion in the focus group; or a River of Life 6 activity (see Chapter 18 ).

C onsiderations for the conduct of focus groups

C onfidentiality should be addressed explicitly; for example, using the Chatham House rule, which sets out expectations about repeating what is said in a meeting without revealing the identities of who said it or other participants. 7  It is advisable to provide each participant with an explanatory statement to read, which states that confidentiality is essential to the focus group discussions.

Expectations need to be communicated in advance. Many of the tips for interviews in Chapter 13 apply also to focus groups, but it is important to communicate the researchers’ and the group’s expectations upfront. Some, but not all, of the expectations of focus groups are included in Table 14.2. The facilitator should explain these expectations before the focus group starts. Table 14.3 provides examples of studies using focus groups for data collection.

Table 14.2. Dos and don’ts of conducting focus groups

Power imbalances. When setting up a focus group, the facilitator should pay strict attention to how homogenous the group needs to be concerning the topic, and how possible power imbalances might affect the data collection. For example, if the research question seeks to understand why drug administration errors occur in hospitals, it would not be a good idea to have doctors, nurses and pharmacists in the same group. Why? Because they might not feel comfortable expressing views in front of the very people they have seen make errors. Instead, you could run three separate groups: one with doctors, one with nurses and another with pharmacists. Conducting separate group discussions helps to avoid the chance that a powerful group might dominate the discussion and enables each group member to express their views openly.

Participant identity. The facilitator should invite participants to introduce themselves to other group members, to encourage familiarity; name tags can help participants remember each other’s names. The researchers will need to maintain a list of participants and any necessary demographic details.

Risk. The possibility of distress or harm occurring must always be considered in a focus group. Participants may become distressed because sensitive topics are being discussed, and there is always a risk that some participants might overshare their experiences. The facilitator will need to judge when to stop the discussion if it becomes clear that one or more participants are distressed. 8 Researchers should have a clear protocol developed that provides advice about how to handle distress.

After the f ocus g roup

Once the discussion is concluded, participants should be thanked for their time and contributions. Explain how participants might contact the researcher if they have any questions or would like to provide the facilitator with follow-up information. If the focus group has covered sensitive topics or any participants have become distressed during the discussion, make sure that you spend some time privately with the participant to provide appropriate referrals and follow-up (see Section 6 ). Referrals and follow-up are usually described in the protocol addressing distress.

Data analysis is discussed in Section 4 , but it is important to know what to do immediately after each focus group is completed. Download (or upload) the recording from the audio-recording device to ensure it is saved in a secure location that can only be accessed by people on the research team (see Chapter 34). The recording should be transcribed; that is, reproduced verbatim, for data coding and analysis. The transcription of data is an important step in the analysis process, and it is important to note that this is a highly time-consuming task. Transcribing a 60-minute focus group discussion can take up to 10 hours.

Table 14.3. Examples of focus groups

Focus groups and (individual interviews) are the most common data collection techniques in qualitative research. The success of a focus group depends on the group composition and the effectiveness of the facilitator. It is important to formulate open-ended focus group questions that are understandable and easy for participants to engage with. Setting up the focus group discussion guide, rules and other considerations will enhance the experience of the focus group for the participant and the researchers, as well as the quality of the data collected.

• Gill P, Stewart K, Treasure E et al . Methods of data collection in qualitative research: interviews and focus groups. Br Dent J . 2008;204(6):291-295. doi:10.1038/bdj.2008.192
• Gill, P, Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J . 2018;225:668-672. doi:10.1038/sj.bdj.2018.815
• Soh S-E, Barker AL, Ayton DR et al. What matters most to patients following percutaneous coronary interventions? A new patient-reported outcome measure developed using Rasch analysis. PLoS ONE . 2019;14(9):e0222185. doi.org/10.1371/journal.pone.0222185
• Ayton D, Hillman C, Hatzikiriakidis K, et al. Why do students plagiarise? Informing higher education teaching and learning policy and practice. Stud High Educ . Sep 2 2022;47(9):1921-1934. doi:10.1080/03075079.2021.1985103
• Abrams K, Gaiser T. Online focus groups. In: Field N, Lee R, Blank G, eds. The Sage Handbook of Online Research Methods . Sage Publications, 2016;435–450.
• Moussa Z. Rivers of life. Participatory Learning and Action. Community-based adaptation to climate change, 2009. The International Institute for Environment and Development. Accessed March 24, 2023. https://www.iied.org/g02828
• The Chatham House rule. Chatham House, The Royal Institute of International Affairs, 2023. Accessed March 24, 2023. https://www.chathamhouse.org/about-us/chatham-house-rule#:~:text=The%20Rule%20reads%20as%20follows,other%20participant%2C%20may%20be%20revealed .
• Sim J, Waterfield J. Focus group methodology: some ethical challenges. Qual Quant. 2019;53:3003-3022. doi/10.1007/s11135-019-00914-5
• van der Spek N, Vos J, van Uden-Kraan CF et al. Meaning making in cancer survivors: a focus group study. P LoS ONE . 2013;8(9):e76089. doi.org/10.1371/journal.pone.0076089
• Visser E, Den Oudsten BL, Traa MJ et al . Patients’ experiences and wellbeing after injury: a focus group study. PLoS ONE . 2021;1 6(1):e0245198. doi.org/10.1371/journal.pone.0245198
• Moynihan R, Sims R, Hersch J et al . Communicating about overdiagnosis: learning from community focus groups on osteoporosis. PLoS ONE . 2017;12(2):e0170142. doi.org/10.1371/journal.pone.0170142
• Sabet Sarvestani A, Bufumbo L, Geiger JD et al. . Traditional male circumcision in Uganda: a qualitative focus group discussion analysis. PLoS ONE . 2012;7(10):e45316. doi.org/10.1371/journal.pone.0045316

Qualitative Research – a practical guide for health and social care researchers and practitioners Copyright © 2023 by Tess Tsindos is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Qualitative Research: Focus Groups

• Getting Started

Focus Groups

• Observation
• Case Studies
• Data Collection
• Cleaning Text
• Analysis Tools
• Institutional Review

Photo: http://bit.ly/2tqEBFw

What is a focus group?

• Consists of a small group usually made up of six to twelve people
• Gathers opinions, beliefs, and attitudes about issues of interest
• Group is led through an open discussion by a skilled moderator
• Allows testing of assumptions
• Encourages discussion about a particular topic

Tips for Effective Moderating

• Keep track of which questions have and have not been asked and answered
• Know how to phrase questions that encourage participants to provide elaborate, detailed (rather than brief) responses
• Ask questions that elicit participant’s own views and experiences as opposed to reflecting the convictions of the moderator
• Ask one question at a time, verifying unclear responses,
• Use follow-ups and probes
• Remain neutral by asking open-ended questions and avoiding leading questions

Adapted from Qualitative Research Methods: A Data Collector's Field Guide

Suggested Readings

• U.S. Dept. of Commerce. (2009). Introduction to conducting focus groups (Open Access)
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29 Conceptualization in qualitative research

Chapter outline

• 15.1 Alternative paradigms: Interpretivism, critical paradigm, and pragmatism

15.2 Multiparadigmatic research: An example

15.3 idiographic causal relationships, 15.4 qualitative research questions.

Now let’s change things up! In the previous chapters, we explored steps to create and carry out a quantitative research study. Quantitative studies are great when we want to summarize or test relationships between ideas using numbers and the power of statistics. However, qualitative research offers us a different and equally important tool. Sometimes the aim of research projects is to explore meaning and lived experience. Instead of trying to arrive at generalizable conclusions for all people, some research projects establish a deep, authentic description of a specific time, place, and group of people.

Qualitative research relies on the power of human expression through words, pictures, movies, performance and other artifacts that represent these things. All of these tell stories about the human experience and we want to learn from them and have them be represented in our research. Generally speaking, qualitative research is about the gathering up of these stories, breaking them into pieces so we can examine the ideas that make them up, and putting them back together in a way that allows us to tell a common or shared story that responds to our research question. To do that, we need to discuss the assumptions underlying social science.

17.1 Alternative paradigms: Interpretivism, critical, and pragmatism

Learning objectives.

Students will be able to…

• Distinguish between the assumptions of positivism, interpretivism, critical, and pragmatist research paradigms.
• Use paradigm to describe how scientific thought changes over time.

In Chapter 10, we reviewed the assumptions that underly post-positivism (abbreviated hereafter as positivism for brevity). Quantitative methods are most often the choice for positivist research questions because they conform to these assumptions. Qualitative methods  can conform to these assumptions; however, they are limited in their generalizability.

Kivunja & Kuyini (2017) [1] describe the essential features of positivism as:

• A belief that theory is universal and law-like generalizations can be made across contexts
• The assumption that context is not important
• The belief that truth or knowledge is ‘out there to be discovered’ by research
• The belief that cause and effect are distinguishable and analytically separable
• The belief that results of inquiry can be quantified
• The belief that theory can be used to predict and to control outcomes
• The belief that research should follow the scientific method of investigation
• Rests on formulation and testing of hypotheses
• Employs empirical or analytical approaches
• Pursues an objective search for facts
• Believes in ability to observe knowledge
• The researcher’s ultimate aim is to establish a comprehensive universal theory, to account for human and social behavior
• Application of the scientific method

Because positivism is the dominant social science research paradigm, it can be easy to ignore or be confused by research that does not use these assumptions. We covered in Chapter 10 the table reprinted below when discussing the assumptions underlying positivistic social science.

As you consider your research project, keep these philosophical assumptions in mind. They are useful shortcuts to understanding the deeper ideas and assumptions behind the construction of knowledge. The purpose of exploring these philosophical assumptions isn’t to find out which is true and which is false. Instead, the goal is to identify the assumptions that fit with how you think about your research question. Choosing a paradigm helps you make those assumptions explicit.

Before we explore alternative paradigms, it’s important for us to review what paradigms are.

How do scientific ideas change over time?

Much like your ideas develop over time as you learn more, so does the body of scientific knowledge. Kuhn’s (1962) [2] The Structure of Scientific Revolutions is one of the most influential works on the philosophy of science, and is credited with introducing the idea of competing paradigms (or “disciplinary matrices”) in research. Kuhn investigated the way that scientific practices evolve over time, arguing that we don’t have a simple progression from “less knowledge” to “more knowledge” because the way that we approach inquiry is changing over time. This can happen gradually, but the process results in moments of change where our understanding of a phenomenon changes more radically (such as in the transition from Newtonian to Einsteinian physics; or from Lamarckian to Darwinian theories of evolution). For a social work practice example, Fleuridas & Krafcik (2019) [3] trace the development of the “four forces” of psychotherapy , from psychodynamics to behaviorism to humanism as well as the competition among emerging perspectives to establish itself as the fourth force to guide psychotherapeutic practice. But how did the problems in one paradigm inspire new paradigms? Kuhn presents us with a way of understanding the history of scientific development across all topics and disciplines.

As you can see in this video from Matthew J. Brown (CC-BY), there are four stages in the cycle of science in Kuhn’s approach. Firstly, a pre-paradigmatic state where competing approaches share no consensus. Secondly, the “normal” state where there is wide acceptance of a particular set of methods and assumptions. Thirdly, a state of crisis where anomalies that cannot be solved within the existing paradigm emerge and competing theories to address them follow. Fourthly, a revolutionary phase where some new paradigmatic approach becomes dominant and supplants the old. Shnieder (2009) [4] suggests that the Kuhnian phases are characterized by different kinds of scientific activity.

Newer approaches often build upon rather than replace older ones, but they also overlap and can exist within a state of competition. Scientists working within a particular paradigm often share methods, assumptions and values. In addition to supporting specific methods, research paradigms also influence things like the ambition and nature of research, the researcher-participant relationship and how the role of the researcher is understood.

Paradigm vs. theory

The terms ‘ paradigm ‘ and ‘ theory ‘ are often used interchangeably in social science. There is not a consensus among social scientists as to whether these are identical or distinct concepts. With that said, in this text, we will make a clear distinction between the two ideas because thinking about each concept separately is more useful for our purposes.

We define paradigm a set of common philosophical (ontological, epistemological, and axiological) assumptions that inform research. The four paradigms we describe in this section refer to patterns in how groups of researchers resolve philosophical questions. Some assumptions naturally make sense together, and paradigms grow out of researchers with shared assumptions about what is important and how to study it. Paradigms are like “analytic lenses” and a provide framework on top of which we can build theoretical and empirical knowledge (Kuhn, 1962). [5] Consider this video of an interview with world-famous physicist Richard Feynman in which he explains why “when you explain a ‘why,’ you have to be in some framework that you allow something to be true. Otherwise, you are perpetually asking why.” In order to answer basic physics question like “what is happening when two magnets attract?” or a social work research question like “what is the impact of this therapeutic intervention on depression,” you must understand the assumptions you are making about social science and the social world. Paradigmatic assumptions about objective and subjective truth support methodological choices like whether to conduct interviews or send out surveys, for example.

While paradigms are broad philosophical assumptions, theory is more specific, and refers to a set of concepts and relationships scientists use to explain the social world. Theories are more concrete, while paradigms are more abstract. Look back to Figure 7.1 at the beginning of this chapter. Theory helps you identify the concepts and relationships that align with your paradigmatic understanding of the problem. Moreover, theory informs how you will measure the concepts in your research question and the design of your project.

For both theories and paradigms, Kuhn’s observation of scientific paradigms, crises, and revolutions is instructive for understanding the history of science. Researchers inherit institutions, norms, and ideas that are marked by the battlegrounds of theoretical and paradigmatic debates that stretch back hundreds of years. We have necessarily simplified this history into four paradigms: positivism, interpretivism, critical, and pragmatism. Our framework and explanation are inspired by the framework of Guba and Lincoln (1990) [6] and Burrell and Morgan (1979). [7] while also incorporating pragmatism as a way of resolving paradigmatic questions. Most of social work research and theory can be classified as belonging to one of these four paradigms, though this classification system represents only one of many useful approaches to analyzing social science research paradigms.

Building on our discussion in section 7.1 on objective vs. subjective epistemologies and ontologies, we will start with the difference between positivism and interpretivism. Afterward, we will link our discussion of axiology in section 7.2 with the critical paradigm. Finally, we will situate pragmatism as a way to resolve paradigmatic questions strategically. The difference between positivism and interpretivism is a good place to start, since the critical paradigm and pragmatism build on their philosophical insights.

It’s important to think of paradigms less as distinct categories and more as a spectrum along which projects might fall. For example, some projects may be somewhat positivist, somewhat interpretivist, and a little critical. No project fits perfectly into one paradigm. Additionally, there is no paradigm that is more correct than the other. Each paradigm uses assumptions that are logically consistent, and when combined, are a useful approach to understanding the social world using science. The purpose of this section is to acquaint you with what research projects in each paradigm look like and how they are grounded in philosophical assumptions about social science.

You should read this section to situate yourself in terms of what paradigm feels most “at home” to both you as a person and to your project. You may find, as I have, that your research projects are more conventional and less radical than what feels most like home to you, personally. In a research project, however, students should start with their working question rather than their heart. Use the paradigm that fits with your question the best, rather than which paradigm you think fits you the best.

Interpretivism: Researcher as “empathizer”

Positivism is focused on generalizable truth. Interpretivism , by contrast, develops from the idea that we want to understand the truths of individuals, how they interpret and experience the world, their thought processes, and the social structures that emerge from sharing those interpretations through language and behavior. The process of interpretation (or social construction) is guided by the empathy of the researcher to understand the meaning behind what other people say.

Historically, interpretivism grew out of a specific critique of positivism: that knowledge in the human and social sciences cannot conform to the model of natural science because there are features of human experience that cannot objectively be “known”. The tools we use to understand objects that have no self-awareness may not be well-attuned to subjective experiences like emotions, understandings, values, feelings, socio-cultural factors, historical influences, and other meaningful aspects of social life. Instead of finding a single generalizable “truth,” the interpretivist researcher aims to generate understanding and often adopts a relativist position.

While positivists seek “the truth,” the social constructionist framework argues that “truth” varies. Truth differs based on who you ask, and people change what they believe is true based on social interactions. These subjective truths also exist within social and historical contexts, and our understanding of truth varies across communities and time periods. This is because we, according to this paradigm, create reality ourselves through our social interactions and our interpretations of those interactions. Key to the interpretivist perspective is the idea that social context and interaction frame our realities.

Researchers operating within this framework take keen interest in how people come to socially agree, or disagree, about what is real and true. Consider how people, depending on their social and geographical context, ascribe different meanings to certain hand gestures. When a person raises their middle finger, those of us in Western cultures will probably think that this person isn’t very happy (not to mention the person at whom the middle finger is being directed!). In other societies around the world, a thumbs-up gesture, rather than a middle finger, signifies discontent (Wong, 2007). [8] The fact that these hand gestures have different meanings across cultures aptly demonstrates that those meanings are socially and collectively constructed. What, then, is the “truth” of the middle finger or thumbs up? As we’ve seen in this section, the truth depends on the intention of the person making the gesture, the interpretation of the person receiving it, and the social context in which the action occurred.

Qualitative methods are preferred as ways to investigate these phenomena. Data collected might be unstructured (or “messy”) and correspondingly a range of techniques for approaching data collection have been developed. Interpretivism acknowledges that it is impossible to remove cultural and individual influence from research, often instead making a virtue of the positionality of the researcher and the socio-cultural context of a study.

One common objection positivists levy against interpretivists is that interpretivism tends to emphasize the subjective over the objective. If the starting point for an investigation is that we can’t fully and objectively know the world, how can we do research into this without everything being a matter of opinion? For the positivist, this risk for confirmation bias as well as invalid and unreliable measures makes interpretivist research unscientific. Clearly, we disagree with this assessment, and you should, too. Positivism and interpretivism have different ontologies and epistemologies with contrasting notions of rigor and validity (for more information on assumptions about measurement, see Chapter 11 for quantitative validity and reliability and Chapter 20 for qualitative rigor). Nevertheless, both paradigms apply the values and concepts of the scientific method through systematic investigation of the social world, even if their assumptions lead them to do so in different ways. Interpretivist research often embraces a relativist epistemology, bringing together different perspectives in search of a trustworthy and authentic understanding or narrative.

Kivunja & Kuyini (2017) [9] describe the essential features of interpretivism as:

• The belief that truths are multiple and socially constructed
• The acceptance that there is inevitable interaction between the researcher and his or her research participants
• The acceptance that context is vital for knowledge and knowing
• The belief that knowledge can be value laden and the researcher’s values need to be made explicit
• The need to understand specific cases and contexts rather deriving universal laws that apply to everyone, everywhere.
• The belief that causes and effects are mutually interdependent, and that causality may be circular or contradictory
• The belief that contextual factors need to be taken into consideration in any systematic pursuit of understanding

One important clarification: it’s important to think of the interpretivist perspective as not just about individual interpretations but the social life of interpretations. While individuals may construct their own realities, groups—from a small one such as a married couple to large ones such as nations—often agree on notions of what is true and what “is” and what “is not.” In other words, the meanings that we construct have power beyond the individuals who create them. Therefore, the ways that people and communities act based on such meanings is of as much interest to interpretivists as how they were created in the first place. Theories like social constructionism, phenomenology, and symbolic interactionism are often used in concert with interpretivism.

Is interpretivism right for your project?

An interpretivist orientation to research is appropriate when your working question asks about subjective truths. The cause-and-effect relationships that interpretivist studies produce are specific to the time and place in which the study happened, rather than a generalizable objective truth. More pragmatically, if you picture yourself having a conversation with participants like an interview or focus group, then interpretivism is likely going to be a major influence for your study.

Positivists critique the interpretivist paradigm as non-scientific. They view the interpretivist focus on subjectivity and values as sources of bias. Positivists and interpretivists differ on the degree to which social phenomena are like natural phenomena. Positivists believe that the assumptions of the social sciences and natural sciences are the same, while interpretivists strongly believe that social sciences differ from the natural sciences because their subjects are social creatures.

Similarly, the critical paradigm finds fault with the interpretivist focus on the status quo rather than social change. Although interpretivists often proceed from a feminist or other standpoint theory, the focus is less on liberation than on understanding the present from multiple perspectives. Other critical theorists may object to the consensus orientation of interpretivist research. By searching for commonalities between people’s stories, they may erase the uniqueness of each individual’s story. For example, while interpretivists may arrive at a consensus definition of what the experience of “coming out” is like for people who identify as lesbian, gay, bisexual, transgender, or queer, it cannot represent the diversity of each person’s unique “coming out” experience and what it meant to them. For example, see Rosario and colleagues’ (2009) [10] critique the literature on lesbians “coming out” because previous studies did not addressing how appearing, behaving, or identifying as a butch or femme impacted the experience of “coming out” for lesbians.

• From your literature search, identify an empirical article that uses qualitative methods to answer a research question similar to your working question or about your research topic.
• Review the assumptions of the interpretivist research paradigm.
• Discuss in a few sentences how the author’s conclusions are based on some of these paradigmatic assumptions. How might a researcher operating from a different paradigm (like positivism or the critical paradigm) critique the conclusions of this study?

Critical paradigm: Researcher as “activist”

As we’ve discussed a bit in the preceding sections, the critical paradigm focuses on power, inequality, and social change. Although some rather diverse perspectives are included here, the critical paradigm, in general, includes ideas developed by early social theorists, such as Max Horkheimer (Calhoun et al., 2007), [11] and later works developed by feminist scholars, such as Nancy Fraser (1989). [12] Unlike the positivist paradigm, the critical paradigm assumes that social science can never be truly objective or value-free. Furthermore, this paradigm operates from the perspective that scientific investigation should be conducted with the express goal of social change. Researchers in the critical paradigm foreground axiology, positionality and values . In contrast with the detached, “objective” observations associated with the positivist researcher, critical approaches make explicit the intention for research to act as a transformative or emancipatory force within and beyond the study.

Researchers in the critical paradigm might start with the knowledge that systems are biased against certain groups, such as women or ethnic minorities, building upon previous theory and empirical data. Moreover, their research projects are designed not only to collect data, but to impact the participants as well as the systems being studied. The critical paradigm applies its study of power and inequality to change those power imbalances as part of the research process itself. If this sounds familiar to you, you may remember hearing similar ideas when discussing social conflict theory in your human behavior in the social environment (HBSE) class. [13] Because of this focus on social change, the critical paradigm is a natural home for social work research. However, we fall far short of adopting this approach widely in our profession’s research efforts.

Is the critical paradigm right for your project?

Every social work research project impacts social justice in some way. What distinguishes critical research is how it integrates an analysis of power into the research process itself. Critical research is appropriate for projects that are activist in orientation. For example, critical research projects should have working questions that explicitly seek to raise the consciousness of an oppressed group or collaborate equitably with community members and clients to addresses issues of concern. Because of their transformative potential, critical research projects can be incredibly rewarding to complete. However, partnerships take a long time to develop and social change can evolve slowly on an issue, making critical research projects a more challenging fit for student research projects which must be completed under a tight deadline with few resources.

Positivists critique the critical paradigm on multiple fronts. First and foremost, the focus on oppression and values as part of the research process is seen as likely to bias the research process, most problematically, towards confirmation bias. If you start out with the assumption that oppression exists and must be dealt with, then you are likely to find that regardless of whether it is truly there or not. Similarly, positivists may fault critical researchers for focusing on how the world should be, rather than how it truly is . In this, they may focus too much on theoretical and abstract inquiry and less on traditional experimentation and empirical inquiry. Finally, the goal of social transformation is seen as inherently unscientific, as science is not a political practice.

Interpretivists often find common cause with critical researchers. Feminist studies, for example, may explore the perspectives of women while centering gender-based oppression as part of the research process. In interpretivist research, the focus is less on radical change as part of the research process and more on small, incremental changes based on the results and conclusions drawn from the research project. Additionally, some critical researchers’ focus on individuality of experience is in stark contrast to the consensus-orientation of interpretivists. Interpretivists seek to understand people’s true selves. Some critical theorists argue that people have multiple selves or no self at all.

• From your literature search, identify an article relevant to your working question or broad research topic that uses a critical perspective. You should look for articles where the authors are clear that they are applying a critical approach to research like feminism, anti-racism, Marxism and critical theory, decolonization, anti-oppressive practice, or other social justice-focused theoretical perspectives. To target your search further, include keywords in your queries to research methods commonly used in the critical paradigm like participatory action research and community-based participatory research. If you have trouble identifying an article for this exercise, consult your professor for some help. These articles may be more challenging to find, but reviewing one is necessary to get a feel for what research in this paradigm is like.
• Review the assumptions of the critical research paradigm.
• Discuss in a few sentences how the author’s conclusions are based on some of these paradigmatic assumptions. How might a researcher operating from different assumptions (like values-neutrality or researcher as neutral and unbiased) critique the conclusions of this study?

Pragmatism: Researcher as “strategist”

“Essentially, all models are wrong but some are useful.” (Box, 1976) [14]

Pragmatism is a research paradigm that suspends questions of philosophical ‘truth’ and focuses more on how different philosophies, theories, and methods can be used strategically to provide a multidimensional view of a topic. Researchers employing pragmatism will mix elements of positivist, interpretivist, and critical research depending on the purpose of a particular project and the practical constraints faced by the researcher and their research context. We favor this approach for student projects because it avoids getting bogged down in choosing the “right” paradigm and instead focuses on the assumptions that help you answer your question, given the limitations of your research context. Student research projects are completed quickly and moving in the direction of pragmatism can be a route to successfully completing a project. Your project is a representation of what you think is feasible, ethical, and important enough for you to study.

The crucial consideration for the pragmatist is whether the outcomes of research have any real-world application, rather than whether they are “true.” The methods, theories, and philosophies chosen by pragmatic researchers are guided by their working question. There are no distinctively pragmatic research methods since this approach is about making judicious use whichever methods fit best with the problem under investigation. Pragmatic approaches may be less likely to prioritize ontological, epistemological or axiological consistency when combining different research methods. Instead, the emphasis is on solving a pressing problem and adapting to the limitations and opportunities in the researchers’ context.

Adopt a multi-paradigmatic perspective

Believe it or not, there is a long literature of acrimonious conflict between scientists from positivist, interpretivist, and critical camps (see Heineman-Pieper et al., 2002 [15] for a longer discussion). Pragmatism is an old idea, but it is appealing precisely because it attempts to resolve the problem of multiple incompatible philosophical assumptions in social science. To a pragmatist, there is no “correct” paradigm. All paradigms rely on assumptions about the social world that are the subject of philosophical debate. Each paradigm is an incomplete understanding of the world, and it requires a scientific community using all of them to gain a comprehensive view of the social world. This multi-paradigmatic perspective is a unique gift of social work research, as our emphasis on empathy and social change makes us more critical of positivism, the dominant paradigm in social science.

We offered the metaphors of expert, empathizer, activist, and strategist for each paradigm. It’s important not to take these labels too seriously. For example, some may view that scientists should be experts or that activists are biased and unscientific. Nevertheless, we hope that these metaphors give you a sense of what it feels like to conduct research within each paradigm.

One of the unique aspects of paradigmatic thinking is that often where you think you are most at home may actually be the opposite of where your research project is. For example, in my graduate and doctoral education, I thought I was a critical researcher. In fact, I thought I was a radical researcher focused on social change and transformation. Yet, often times when I sit down to conceptualize and start a research project, I find myself squarely in the positivist paradigm, thinking through neat cause-and-effect relationships that can be mathematically measured. There is nothing wrong with that! Your task for your research project is to find the paradigm that best matches your research question. Think through what you really want to study and how you think about the topic, then use assumptions of that paradigm to guide your inquiry.

Another important lesson is that no research project fits perfectly in one paradigm or another. Instead, there is a spectrum along which studies are, to varying degrees, interpretivist, positivist, and critical. For example, all social work research is a bit activist in that our research projects are designed to inform action for change on behalf of clients and systems. However, some projects will focus on the conclusions and implications of projects informing social change (i.e., positivist and interpretivist projects) while others will partner with community members and design research projects collaboratively in a way that leads to social change (i.e. critical projects). In section 7.5, we will describe a pragmatic approach to research design guided by your paradigmatic and theoretical framework.

Key Takeaways

• Social work research falls, to some degree, in each of the four paradigms: positivism, interpretivism, critical, and pragmatist.
• Adopting a pragmatic, multi-paradigmatic approach to research makes sense for student researchers, as it directs students to use the philosophical assumptions and methodological approaches that best match their research question and research context.
• Research in all paradigms is necessary to come to a comprehensive understanding of a topic, and social workers must be able to understand and apply knowledge from each research paradigm.
• Describe which paradigm best fits your perspective on the world and which best fits with your project.
• Identify any similarities and differences in your personal assumptions and the assumption your research project relies upon. For example, are you a more critical and radical thinker but have chosen a more “expert” role for yourself in your research project?

Learners will be able to…

• Apply the assumptions of each paradigm to your project
• Summarize what aspects of your project stem from positivist, interpretivist, or critical assumptions

In the previous sections, we reviewed the major paradigms and theories in social work research. In this section, we will provide an example of how to apply theory and paradigm in research. This process is depicted in Figure 7.2 below with some quick summary questions for each stage. Some questions in the figure below have example answers like designs (i.e., experimental, survey) and data analysis approaches (i.e., discourse analysis). These examples are arbitrary. There are a lot of options that are not listed. So, don’t feel like you have to memorize them or use them in your study.

This diagram (taken from an archived Open University (UK) course entitled E89 ​- Educational Inquiry ) ​ shows one way to visualize the research design process. While research is far from linear, in general, this is how research projects progress sequentially. Researchers begin with a working question, and through engaging with the literature, develop and refine those questions into research questions (a process we will finalize in Chapter 9 ). But in order to get to the part where you gather your sample, measure your participants, and analyze your data, you need to start with paradigm. Based on your work in section 7.3, you should have a sense of which paradigm or paradigms are best suited to answering your question. The approach taken will often reflect the nature of the research question; the kind of data it is possible to collect; and work previously done in the area under consideration. When evaluating paradigm and theory, it is important to look at what other authors have done previously and the framework used by studies that are similar to the one you are thinking of conducting.

Once you situate your project in a research paradigm, it becomes possible to start making concrete choices about methods. Depending on the project, this will involve choices about things like:

• What is my final research question?
• What are the key variables and concepts under investigation, and how will I measure them?
• How do I find a representative sample of people who experience the topic I’m studying?
• What design is most appropriate for my research question?
• How will I collect and analyze data?
• How do I determine whether my results describe real patterns in the world or are the result of bias or error?

The data collection phase can begin once these decisions are made. It can be very tempting to start collecting data as soon as possible in the research process as this gives a sense of progress. However, it is usually worth getting things exactly right before collecting data as an error found in your approach further down the line can be harder to correct or recalibrate around.

Designing a study using paradigm and theory: An example

Paradigm and theory have the potential to turn some people off since there is a lot of abstract terminology and thinking about real-world social work practice contexts. In this section, I’ll use an example from my own research, and I hope it will illustrate a few things. First, it will show that paradigms are really just philosophical statements about things you already understand and think about normally. It will also show that no project neatly sits in one paradigm and that a social work researcher should use whichever paradigm or combination of paradigms suit their question the best. Finally, I hope it is one example of how to be a pragmatist and strategically use the strengths of different theories and paradigms to answering a research question. We will pick up the discussion of mixed methods in the next chapter.

Thinking as an expert: Positivism

In my undergraduate research methods class, I used an open textbook much like this one and wanted to study whether it improved student learning. You can read a copy of the article we wrote on based on our study . We’ll learn more about the specifics of experiments and evaluation research in Chapter 13 , but you know enough to understand what evaluating an intervention might look like. My first thought was to conduct an experiment, which placed me firmly within the positivist or “expert” paradigm.

Experiments focus on isolating the relationship between cause and effect. For my study, this meant studying an open textbook (the cause, or intervention) and final grades (the effect, or outcome). Notice that my position as “expert” lets me assume many things in this process. First, it assumes that I can distill the many dimensions of student learning into one number—the final grade. Second, as the “expert,” I’ve determined what the intervention is: indeed, I created the book I was studying, and applied a theory from experts in the field that explains how and why it should impact student learning.

Theory is part of applying all paradigms, but I’ll discuss its impact within positivism first. Theories grounded in positivism help explain why one thing causes another. More specifically, these theories isolate a causal relationship between two (or more) concepts while holding constant the effects of other variables that might confound the relationship between the key variables. That is why experimental design is so common in positivist research. The researcher isolates the environment from anything that might impact or bias the cause and effect relationship they want to investigate.

But in order for one thing to lead to change in something else, there must be some logical, rational reason why it would do so. In open education, there are a few hypotheses (though no full-fledged theories) on why students might perform better using open textbooks. The most common is the access hypothesis , which states that students who cannot afford expensive textbooks or wouldn’t buy them anyway can access open textbooks because they are free, which will improve their grades. It’s important to note that I held this theory prior to starting the experiment, as in positivist research you spell out your hypotheses in advance and design an experiment to support or refute that hypothesis.

Notice that the hypothesis here applies not only to the people in my experiment, but to any student in higher education. Positivism seeks generalizable truth, or what is true for everyone. The results of my study should provide evidence that  anyone  who uses an open textbook would achieve similar outcomes. Of course, there were a number of limitations as it was difficult to tightly control the study. I could not randomly assign students or prevent them from sharing resources with one another, for example. So, while this study had many positivist elements, it was far from a perfect positivist study because I was forced to adapt to the pragmatic limitations of my research context (e.g., I cannot randomly assign students to classes) that made it difficult to establish an objective, generalizable truth.

Thinking like an empathizer: Interpretivism

One of the things that did not sit right with me about the study was the reliance on final grades to signify everything that was going on with students. I added another quantitative measure that measured research knowledge, but this was still too simplistic. I wanted to understand how students used the book and what they thought about it. I could create survey questions that ask about these things, but to get at the subjective truths here, I thought it best to use focus groups in which students would talk to one another with a researcher moderating the discussion and guiding it using predetermined questions. You will learn more about focus groups in Chapter 18 .

Researchers spoke with small groups of students during the last class of the semester. They prompted people to talk about aspects of the textbook they liked and didn’t like, compare it to textbooks from other classes, describe how they used it, and so forth. It was this focus on  understanding and subjective experience that brought us into the interpretivist paradigm. Alongside other researchers, I created the focus group questions but encouraged researchers who moderated the focus groups to allow the conversation to flow organically.

We originally started out with the assumption, for which there is support in the literature, that students would be angry with the high-cost textbook that we used prior to the free one, and this cost shock might play a role in students’ negative attitudes about research. But unlike the hypotheses in positivism, these are merely a place to start and are open to revision throughout the research process. This is because the researchers are not the experts, the participants are! Just like your clients are the experts on their lives, so were the students in my study. Our job as researchers was to create a group in which they would reveal their informed thoughts about the issue, coming to consensus around a few key themes.

When we initially analyzed the focus groups, we uncovered themes that seemed to fit the data. But the overall picture was murky. How were themes related to each other? And how could we distill these themes and relationships into something meaningful? We went back to the data again. We could do this because there isn’t one truth, as in positivism, but multiple truths and multiple ways of interpreting the data. When we looked again, we focused on some of the effects of having a textbook customized to the course. It was that customization process that helped make the language more approachable, engaging, and relevant to social work practice.

Ultimately, our data revealed differences in how students perceived a free textbook versus a free textbook that is customized to the class. When we went to interpret this finding, the remix  hypothesis of open textbook was helpful in understanding that relationship. It states that the more faculty incorporate editing and creating into the course, the better student learning will be. Our study helped flesh out that theory by discussing the customization process and how students made sense of a customized resource.

In this way, theoretical analysis operates differently in interpretivist research. While positivist research tests existing theories, interpretivist research creates theories based on the stories of research participants. However, it is difficult to say if this theory was totally emergent in the dataset or if my prior knowledge of the remix hypothesis influenced my thinking about the data. Interpretivist researchers are encouraged to put a box around their prior experiences and beliefs, acknowledging them, but trying to approach the data with fresh eyes. Interpretivists know that this is never perfectly possible, though, as we are always influenced by our previous experiences when interpreting data and conducting scientific research projects.

Thinking like an activist: Critical

Although adding focus groups helped ease my concern about reducing student learning down to just final grades by providing a more rich set of conversations to analyze. However, my role as researcher and “expert” was still an important part of the analysis. As someone who has been out of school for a while, and indeed has taught this course for years, I have lost touch with what it is like to be a student taking research methods for the first time. How could I accurately interpret or understand what students were saying? Perhaps I would overlook things that reflected poorly on my teaching or my book. I brought other faculty researchers on board to help me analyze the data, but this still didn’t feel like enough.

By luck, an undergraduate student approached me about wanting to work together on a research project. I asked her if she would like to collaborate on evaluating the textbook with me. Over the next year, she assisted me with conceptualizing the project, creating research questions, as well as conducting and analyzing the focus groups. Not only would she provide an “insider” perspective on coding the data, steeped in her lived experience as a student, but she would serve as a check on my power through the process.

Including people from the group you are measuring as part of your research team is a common component of critical research. Ultimately, critical theorists would find my study to be inadequate in many ways. I still developed the research question, created the intervention, and wrote up the results for publication, which privileges my voice and role as “expert.” Instead, critical theorists would emphasize the role of students (community members) in identifying research questions, choosing the best intervention to used, and so forth. But collaborating with students as part of a research team did address some of the power imbalances in the research process.

Critical research projects also aim to have an impact on the people and systems involved in research. No students or researchers had profound personal realizations as a result of my study, nor did it lessen the impact of oppressive structures in society. I can claim some small victory that my department switched to using my textbook after the study was complete (changing a system), though this was likely the result of factors other than the study (my advocacy for open textbooks).

Social work research is almost always designed to create change for people or systems. To that end, every social work project is at least somewhat critical. However, the additional steps of conducting research with people rather than on people reveal a depth to the critical paradigm. By bringing students on board the research team, study had student perspectives represented in conceptualization, data collection, and analysis. That said, there was much to critique about this study from a critical perspective. I retained a lot of the power in the research process, and students did not have the ability to determine the research question or purpose of the project. For example, students might likely have said that textbook costs and the quality of their research methods textbook were less important than student debt, racism, or other potential issues experienced by students in my class. Instead of a ground-up research process based in community engagement, my research included some important participation by students on project created and led by faculty.

Conceptualization is an iterative process

I hope this conversation was useful in applying paradigms to a research project. While my example discusses education research, the same would apply for social work research about social welfare programs, clinical interventions, or other topics. Paradigm and theory are covered at the beginning of the conceptualization of your project because these assumptions will structure the rest of your project. Each of the research steps that occur after this chapter (e.g., forming a question, choosing a design) rely upon philosophical and theoretical assumptions. As you continue conceptualizing your project over the next few weeks, you may find yourself shifting between paradigms. That is normal, as conceptualization is not a linear process. As you move through the next steps of conceptualizing and designing a project, you’ll find philosophies and theories that best match how you want to study your topic.

Viewing theoretical and empirical arguments through this lens is one of the true gifts of the social work approach to research. The multi-paradigmatic perspective is a hallmark of social work research and one that helps us contribute something unique on research teams and in practice.

• Multi-paradigmatic research is a distinguishing hallmark of social work research. Understanding the limitations and strengths of each paradigm will help you justify your research approach and strategically choose elements from one or more paradigms to answer your question.
• Paradigmatic assumptions help you understand the “blind spots” in your research project and how to adjust and address these areas. Keep in mind, it is not necessary to address all of your blind spots, as all projects have limitations.
• Sketch out which paradigm applies best to your project. Second, building on your answer to the exercise in section 7.3, identify how the theory you chose and the paradigm in which you find yourself are consistent or are in conflict with one another. For example, if you are using systems theory in a positivist framework, you might talk about how they both rely on a deterministic approach to human behavior with a focus on the status-quo and social order.
• Define and provide an example of an idiographic causal explanation
• Differentiate between idiographic and nomothetic causal relationships
• Link idiographic and nomothetic causal relationships with the process of theory building and theory testing
• Describe how idiographic and nomothetic causal explanations can be complementary

As we transition away from positivism, it is important to highlight the assumptions it makes about the scientific process–the hypothetico-deductive method, sometimes referred to as the research circle.

The hypothetico-deductive method

The primary way that researchers in the positivist paradigm use theories is sometimes called the hypothetico-deductive method (although this term is much more likely to be used by philosophers of science than by scientists themselves). Researchers choose an existing theory. Then, they make a prediction about some new phenomenon that should be observed if the theory is correct. Again, this prediction is called a hypothesis. The researchers then conduct an empirical study to test the hypothesis. Finally, they reevaluate the theory in light of the new results and revise it if necessary.

This process is usually conceptualized as a cycle because the researchers can then derive a new hypothesis from the revised theory, conduct a new empirical study to test the hypothesis, and so on. As Figure 8.8 shows, this approach meshes nicely with the process of conducting a research project—creating a more detailed model of “theoretically motivated” or “theory-driven” research. Together, they form a model of theoretically motivated research. 

Keep in mind the hypothetico-deductive method is only one way of using social theory to inform social science research. It starts with describing one or more existing theories, deriving a hypothesis from one of those theories, testing your hypothesis in a new study, and finally reevaluating the theory based on the results data analyses. This format works well when there is an existing theory that addresses the research question—especially if the resulting hypothesis is surprising or conflicts with a hypothesis derived from a different theory.

But what if your research question is more interpretive? What if it is less about theory-testing and more about theory-building? This is what our next chapter covers: the process of inductively deriving theory from people’s stories and experiences. This process looks different than that depicted in Figure 8.8. It still starts with your research question and answering that question by conducting a research study. But instead of testing a hypothesis you created based on a theory, you will create a theory of your own that explain the data you collected. This format works well for qualitative research questions and for research questions that existing theories do not address.

Inductive reasoning is most commonly found in studies using qualitative methods, such as focus groups and interviews. Because inductive reasoning involves the creation of a new theory, researchers need very nuanced data on how the key concepts in their working question operate in the real world. Qualitative data is often drawn from lengthy interactions and observations with the individuals and phenomena under examination. For this reason, inductive reasoning is most often associated with qualitative methods, though it is used in both quantitative and qualitative research.

Whose truth does science establish?

Social work is concerned with the “isms” of oppression (ableism, ageism, cissexism, classism, heterosexism, racism, sexism, etc.), and so our approach to science must reconcile its history as both a tool of oppression and its exclusion of oppressed groups. Science grew out of the Enlightenment, a philosophical movement which applied reason and empirical analysis to understanding the world. While the Enlightenment brought forth tremendous achievements, the critiques of Marxian, feminist, and other critical theorists complicated the Enlightenment understanding of science. For this section, I will focus on feminist critiques of science, building upon an entry in the Stanford Encyclopedia of Philosophy (Crasnow, 2020). [16]

In its original formulation, science was an individualistic endeavor. As we learned in Chapter 1 , a basic statement of the scientific method is that a researcher studies existing theories on a topic, formulates a hypothesis about what might be true, and either confirms or disconfirms their hypothesis through experiment and rigorous observation. Over time, our theories become more accurate in their predictions and more comprehensive in their conclusions. Scientists put aside their preconceptions, look at the data, and build their theories based on objective rationality.

Yet, this cannot be perfectly true. Scientists are human, after all. As a profession historically dominated by white men, scientists have dismissed women and other minorities as being psychologically unfit for the scientific profession. While attitudes have improved, science, technology, engineering, mathematics (STEM) and related fields remain dominated by white men (Grogan, 2019). [17] Biases can persist in social work theory and research when social scientists do not have similar experiences to the populations they study.

Gender bias can influence the research questions scientists choose to answer. Feminist critiques of medical science drew attention to women’s health issues, spurring research and changing standards of care. The focus on domestic violence in the empirical literature can also be seen as a result of feminist critique. Thus, critical theory helps us critique what is on the agenda for science. If science is to answer important questions, it must speak to the concerns of all people. Through the democratization in access to scientific knowledge and the means to produce it, science becomes a sister process of social development and social justice.

The goal of a diverse and participatory scientific community lies in contrast to much of what we understand to be “proper” scientific knowledge. Many of the older, classic social science theories were developed based on research which observed males or from university students in the United States or other Western nations. How these observations were made, what questions were asked, and how the data were interpreted were shaped by the same oppressive forces that existed in broader society, a process that continues into the present. In psychology, the concept of hysteria or hysterical women was believed to be caused by a wandering womb (Tasca et al., 2012). [18] Even today, there are gender biases in diagnoses of histrionic personality disorder and racial biases in psychotic disorders (Klonsky et al., 2002) [19] because the theories underlying them were created in a sexist and racist culture. In these ways, science can reinforce the truth of the white Western male perspective.

Finally, it is important to note that social science research is often conducted on populations rather than with populations. Historically, this has often meant Western men traveling to other countries and seeking to understand other cultures through a Western lens. Lacking cultural humility and failing to engage stakeholders, ethnocentric research of this sort has led to the view of non-Western cultures as inferior. Moreover, the use of these populations as research subjects rather than co-equal participants in the research process privileges the researcher’s knowledge over that from other groups or cultures. Researchers working with indigenous cultures, in particular, had a destructive habit of conducting research for a short time and then leaving, without regard for the impact their study had on the population. These critiques of Western science aim to decolonize social science and dismantle the racist ideas the oppress indigenous and non-Western peoples through research (Smith, 2013). [20]

The central concept in feminist, anti-racist, and decolonization critiques (among other critical frames) is epistemic injustice. Epistemic injustice happens when someone is treated unfairly in their capacity to know something or describe their experience of the world. As described by Fricker (2011), [21] the injustice emerges from the dismissal of knowledge from oppressed groups, discrimination against oppressed groups in scientific communities, and the resulting gap between what scientists can make sense of from their experience and the experiences of people with less power who have lived experience of the topic. We recommend this video from Edinburgh Law School which applies epistemic injustice to studying public health emergencies, disabilities, and refugee services .

Positivism relies on nomothetic causality, or the idea that “one event, behavior, or belief will result in the occurrence of another, subsequent event, behavior, or belief.” Then, we described one kind of causality: a simple cause-and-effect relationship supported by existing theory and research on the topic, also known as a nomothetic causal relationship. But what if there is not a lot of literature on your topic? What if your question is more exploratory than explanatory? Then, you need a different kind of causal explanation, one that accounts for the complexity of human interactions.

How can we build causal relationships if we are just describing or exploring a topic? Recall the definitions of exploratory research , descriptive research , and explanatory research from Chapter 2. Wouldn’t we need to do explanatory research to build any kind of causal explanation? Explanatory research attempts to establish nomothetic causal relationships: an independent variable is demonstrated to cause change in a dependent variable. Exploratory and descriptive qualitative research contains some causal relationships, but they are actually descriptions of the causal relationships established by the study participants.

What do idiographic causal explanations look like?

An idiographic causal relationship   tries to identify the many, interrelated causes that account for the phenomenon the researcher is investigating. So, if idiographic causal explanations do not look like Figure 8.5, 8.6, or 8.7 what do they look like? Instead of saying “x causes y,” your participants will describe their experiences with “x,” which they will tell you was caused and influenced by a variety of other factors, as interpreted through their unique perspective, time, and environment. As we stated before, idiographic causal explanations are messy. Your job as a social science researcher is to accurately describe the patterns in what your participants tell you.

Let’s think about this using an example. If I asked you why you decided to become a social worker, what might you say? For me, I would say that I wanted to be a mental health clinician since I was in high school. I was interested in how people thought, and I was privileged enough to have psychology courses at my local high school. I thought I wanted to be a psychologist, but at my second internship in my undergraduate program, my supervisors advised me to become a social worker because the license provided greater authority for independent practice and flexibility for career change. Once I found out social workers were like psychologists who also raised trouble about social justice, I was hooked.

That’s not a simple explanation at all! But it’s definitely a causal explanation. It is my individual, subjective truth of a complex process. If we were to ask multiple social workers the same question, we might find out that many social workers begin their careers based on factors like personal experience with a disability or social injustice, positive experiences with social workers, or a desire to help others. No one factor is the “most important factor,” like with nomothetic causal relationships. Instead, a complex web of factors, contingent on context, emerge when you interpret what people tell you about their lives.

Understanding “why?”

In creating an idiographic explanation, you are still asking “why?” But the answer is going to be more complex. Those complexities are described in Table 8.1 as well as this short video comparing nomothetic and idiographic relationships .

Remember our question from the last section, “Are you trying to generalize or nah?” If you answered nah (or no, like a normal person), you are trying to establish an idiographic causal explanation. The purpose of that explanation isn’t to predict the future or generalize to larger populations, but to describe the here-and-now as it is experienced by individuals within small groups and communities. Idiographic explanations are focused less on what is generally experienced by all people but more on the particularities of what specific individuals in a unique time and place experience.

Researchers seeking idiographic causal relationships are not trying to generalize or predict, so they have no need to reduce phenomena to mathematics. In fact, only examining things that can be counted can rob a causal relationship of its meaning and context. Instead, the goal of idiographic causal relationships is understanding, rather than prediction. Idiographic causal relationships are formed by interpreting people’s stories and experiences. Usually, these are expressed through words. Not all qualitative studies use word data, as some can use interpretations of visual or performance art. However, the vast majority of qualitative studies do use word data, like the transcripts from interviews and focus groups or documents like journal entries or meeting notes. Your participants are the experts on their lives—much like in social work practice—and as in practice, people’s experiences are embedded in their cultural, historical, and environmental context.

Idiographic causal explanations are powerful because they can describe the complicated and interconnected nature of human life. Nomothetic causal explanations, by comparison, are simplistic. Think about if someone asked you why you wanted to be a social worker. Your story might include a couple of vignettes from your education and early employment. It might include personal experience with the social welfare system or family traditions. Maybe you decided on a whim to enroll in a social work course during your graduate program. The impact of each of these events on your career is unique to you.

Idiographic causal explanations are concerned with individual stories, their idiosyncrasies, and the patterns that emerge when you collect and analyze multiple people’s stories. This is the inductive reasoning we discussed at the beginning of this chapter. Often, idiographic causal explanations begin by collecting a lot of qualitative data, whether though interviews, focus groups, or looking at available documents or cultural artifacts. Next, the researcher looks for patterns in the data and arrives at a tentative theory for how the key ideas in people’s stories are causally related.

Unlike nomothetic causal relationships, there are no formal criteria (e.g., covariation) for establishing causality in idiographic causal relationships. In fact, some criteria like temporality and nonspuriousness may be violated. For example, if an adolescent client says, “It’s hard for me to tell whether my depression began before my drinking, but both got worse when I was expelled from my first high school,” they are recognizing that it may not so simple that one thing causes another. Sometimes, there is a reciprocal relationship where one variable (depression) impacts another (alcohol abuse), which then feeds back into the first variable (depression) and into other variables as well (school). Other criteria, such as covariation and plausibility, still make sense, as the relationships you highlight as part of your idiographic causal explanation should still be plausible and its elements should vary together.

Theory building and theory testing

As we learned in the previous section, nomothetic causal explanations are created by researchers applying deductive reasoning to their topic and creating hypotheses using social science theories. Much of what we think of as social science is based on this hypothetico-deductive method, but this leaves out the other half of the equation. Where do theories come from? Are they all just revisions of one another? How do any new ideas enter social science?

Through inductive reasoning and idiographic causal explanations!

Let’s consider a social work example. If you plan to study domestic and sexual violence, you will likely encounter the Power and Control Wheel, also known as the Duluth Model (Figure 8.9). The wheel is a model designed to depict the process of domestic violence. The wheel was developed based on qualitative focus groups conducted by sexual and domestic violence advocates in Duluth, MN. This video explains more about the Duluth Model of domestic abuse.

The Power and Control Wheel is an example of what an idiographic causal relationship looks like. By contrast, look back at the previous section’s Figure 8.5, 8.6, and 8.7 on nomothetic causal relationships between independent and dependent variables. See how much more complex idiographic causal explanations are?! They are complex, but not difficult to understand. At the center of domestic abuse is power and control, and while not every abuser would say that is what they were doing, that is the understanding of the survivors who informed this theoretical model. Their power and control is maintained through a variety of abusive tactics from social isolation to use of privilege to avoid consequences.

What about the role of hypotheses in idiographic causal explanations? In nomothetic causal explanations, researchers create hypotheses using existing theory and then test them for accuracy. Hypotheses in idiographic causality are much more tentative, and are probably best considered as “hunches” about what they think might be true. Importantly, they might indicate the researcher’s prior knowledge and biases before the project begins, but the goal of idiographic research is to let your participants guide you rather than existing social work knowledge. Continuing with our Duluth Model example, advocates likely had some tentative hypotheses about what was important in a relationship with domestic violence. After all, they worked with this population for years prior to the creation of the model. However, it was the stories of the participants in these focus groups that led the Power and Control Wheel explanation for domestic abuse.

As qualitative inquiry unfolds, hypotheses and hunches are likely to emerge and shift as researchers learn from what their participants share. Because the participants are the experts in idiographic causal relationships, a researcher should be open to emerging topics and shift their research questions and hypotheses accordingly. This is in contrast to hypotheses in quantitative research, which remain constant throughout the study and are shown to be true or false.

Over time, as more qualitative studies are done and patterns emerge across different studies and locations, more sophisticated theories emerge that explain phenomena across multiple contexts. Once a theory is developed from qualitative studies, a quantitative researcher can seek to test that theory. For example, a quantitative researcher may hypothesize that men who hold traditional gender roles are more likely to engage in domestic violence. That would make sense based on the Power and Control Wheel model, as the category of “using male privilege” speaks to this relationship. In this way, qualitatively-derived theory can inspire a hypothesis for a quantitative research project, as we will explore in the next section.

Complementary approaches

If idiographic and nomothetic still seem like obscure philosophy terms, let’s consider another example. Imagine you are working for a community-based non-profit agency serving people with disabilities. You are putting together a report to lobby the state government for additional funding for community support programs. As part of that lobbying, you are likely to rely on both nomothetic and idiographic causal relationships.

If you looked at nomothetic causal relationships, you might learn how previous studies have shown that, in general, community-based programs like yours are linked with better health and employment outcomes for people with disabilities. Nomothetic causal explanations seek to establish that community-based programs are better for everyone with disabilities, including people in your community.

If you looked at idiographic causal explanations, you would use stories and experiences of people in community-based programs. These individual stories are full of detail about the lived experience of being in a community-based program. You might use one story from a client in your lobbying campaign, so policymakers can understand the lived experience of what it’s like to be a person with a disability in this program. For example, a client who said “I feel at home when I’m at this agency because they treat me like a family member,” or “this is the agency that helped me get my first paycheck,” can communicate richer, more complex causal relationships.

Neither kind of causal explanation is better than the other. A decision to seek idiographic causal explanations means that you will attempt to explain or describe your phenomenon exhaustively, attending to cultural context and subjective interpretations. A decision to seek nomothetic causal explanations, on the other hand, means that you will try to explain what is true for everyone and predict what will be true in the future. In short, idiographic explanations have greater depth, and nomothetic explanations have greater breadth.

Most importantly, social workers understand the value of both approaches to understanding the social world. A social worker helping a client with substance abuse issues seeks idiographic explanations when they ask about that client’s life story, investigate their unique physical environment, or probe how their family relationships. At the same time, a social worker also uses nomothetic explanations to guide their interventions. Nomothetic explanations may help guide them to minimize risk factors and maximize protective factors or use an evidence-based therapy, relying on knowledge about what in general  helps people with substance abuse issues.

So, which approach speaks to you? Are you interested in learning about (a) a few people’s experiences in a great deal of depth, or (b) a lot of people’s experiences more superficially, while also hoping your findings can be generalized to a greater number of people? The answer to this question will drive your research question and project. These approaches provide different types of information and both types are valuable.

• Idiographic causal explanations focus on subjectivity, context, and meaning.
• Idiographic causal explanations are best suited to exploratory research questions and qualitative methods.
• Idiographic causal explanations are used to create new theories in social science.
• Explore the literature on the theory you identified in section 8.1.
• Read about the origins of your theory. Who developed it and from what data?
• See if you can find a figure like Figure 8.9 in an article or book chapter that depicts the key concepts in your theory and how those concepts are related to one another causally. Write out a short statement on the causal relationships contained in the figure.
• List the key terms associated with qualitative research questions
• Distinguish between qualitative and quantitative research questions

Qualitative research questions differ from quantitative research questions. Because qualitative research questions seek to explore or describe phenomena, not provide a neat nomothetic explanation, they are often more general and openly worded. They may include only one concept, though many include more than one. Instead of asking how one variable causes changes in another, we are instead trying to understand the experiences ,  understandings , and  meanings that people have about the concepts in our research question. These keywords often make an appearance in qualitative research questions.

Let’s work through an example from our last section. In Table 9.1, a student asked, “What is the relationship between sexual orientation or gender identity and homelessness for late adolescents in foster care?” In this question, it is pretty clear that the student believes that adolescents in foster care who identify as LGBTQ+ may be at greater risk for homelessness. This is a nomothetic causal relationship—LGBTQ+ status causes changes in homelessness.

However, what if the student were less interested in  predicting  homelessness based on LGBTQ+ status and more interested in  understanding  the stories of foster care youth who identify as LGBTQ+ and may be at risk for homelessness? In that case, the researcher would be building an idiographic causal explanation . The youths whom the researcher interviews may share stories of how their foster families, caseworkers, and others treated them. They may share stories about how they thought of their own sexuality or gender identity and how it changed over time. They may have different ideas about what it means to transition out of foster care.

Because qualitative questions usually center on idiographic causal relationships, they look different than quantitative questions. Table 9.3 below takes the final research questions from Table 9.1 and adapts them for qualitative research. The guidelines for research questions previously described in this chapter still apply, but there are some new elements to qualitative research questions that are not present in quantitative questions.

• Qualitative research questions often ask about lived experience, personal experience, understanding, meaning, and stories.
• Qualitative research questions may be more general and less specific.
• Qualitative research questions may also contain only one variable, rather than asking about relationships between multiple variables.

Qualitative research questions have one final feature that distinguishes them from quantitative research questions: they can change over the course of a study. Qualitative research is a reflexive process, one in which the researcher adapts their approach based on what participants say and do. The researcher must constantly evaluate whether their question is important and relevant to the participants. As the researcher gains information from participants, it is normal for the focus of the inquiry to shift.

For example, a qualitative researcher may want to study how a new truancy rule impacts youth at risk of expulsion. However, after interviewing some of the youth in their community, a researcher might find that the rule is actually irrelevant to their behavior and thoughts. Instead, their participants will direct the discussion to their frustration with the school administrators or the lack of job opportunities in the area. This is a natural part of qualitative research, and it is normal for research questions and hypothesis to evolve based on information gleaned from participants.

However, this reflexivity and openness unacceptable in quantitative research for good reasons. Researchers using quantitative methods are testing a hypothesis, and if they could revise that hypothesis to match what they found, they could never be wrong! Indeed, an important component of open science and reproducability is the preregistration of a researcher’s hypotheses and data analysis plan in a central repository that can be verified and replicated by reviewers and other researchers. This interactive graphic from 538 shows how an unscrupulous research could come up with a hypothesis and theoretical explanation  after collecting data by hunting for a combination of factors that results in a statistically significant relationship. This is an excellent example of how the positivist assumptions behind quantitative research and intepretivist assumptions behind qualitative research result in different approaches to social science.

• Qualitative research questions often contain words or phrases like “lived experience,” “personal experience,” “understanding,” “meaning,” and “stories.”
• Qualitative research questions can change and evolve over the course of the study.
• Using the guidance in this chapter, write a qualitative research question. You may want to use some of the keywords mentioned above.
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• Fleuridas, C., & Krafcik, D. (2019). Beyond four forces: The evolution of psychotherapy. Sage Open ,  9 (1), 2158244018824492. ↵
• Shneider, A. M. (2009). Four stages of a scientific discipline; four types of scientist. Trends in Biochemical Sciences 34 (5), 217-233. https://doi.org/10.1016/j.tibs.2009.02.00 ↵
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• Routledge. Guba, E. (ed.) (1990). The paradigm dialog . SAGE. ↵
• Burrell, G. & Morgan, G. (1979). Sociological paradigms and organizational analysis . Here is a summary of Burrell & Morgan from Babson College , and our classification collapses radical humanism and radical structuralism into the critical paradigm, following Guba and Lincoln's three-paradigm framework. We feel this approach is more parsimonious and easier for students to understand on an introductory level. ↵
• For more about how the meanings of hand gestures vary by region, you might read the following blog entry: Wong, W. (2007). The top 10 hand gestures you’d better get right . Retrieved from: http://www.languagetrainers.co.uk/blog/2007/09/24/top-10-hand-gestures ↵
• Rosario, M., Schrimshaw, E. W., Hunter, J., & Levy-Warren, A. (2009). The coming-out process of young lesbian and bisexual women: Are there butch/femme differences in sexual identity development?. Archives of sexual behavior ,  38 (1), 34-49. ↵
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• Fraser, N. (1989).  Unruly practices: Power, discourse, and gender in contemporary social theory . Minneapolis, MN: University of Minnesota Press. ↵
• Here are links to two HBSE open textbooks, if you are unfamiliar with social work theories and would like more background. https://uark.pressbooks.pub/hbse1/ and https://uark.pressbooks.pub/humanbehaviorandthesocialenvironment2/ ↵
• Box, G. E. P.. (1976). Science and statistics. Journal of the American Statistical Association, 71 (356), 791. ↵
• Heineman-Pieper, J., Tyson, K., & Pieper, M. H. (2002). Doing good science without sacrificing good values: Why the heuristic paradigm is the best choice for social work.  Families in Society ,  83 (1), 15-28. ↵
• Crasnow, S. (2020). Feminist perspectives on science. In E. N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Winter 2020 Edition). Retrieved from: https://plato.stanford.edu/entries/feminist-science/ ↵
• Grogan, K.E. (2019) How the entire scientific community can confront gender bias in the workplace. Nature Ecology & Evolution, 3 ,  3–6. doi:10.1038/s41559-018-0747-4 ↵
• Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women and hysteria in the history of mental health. Clinical practice and epidemiology in mental health: Clinical practice & epidemiology in mental health ,  8 , 110-119. ↵
• Klonsky, E. D., Jane, J. S., Turkheimer, E., & Oltmanns, T. F. (2002). Gender role and personality disorders.  Journal of personality disorders ,  16 (5), 464-476. ↵
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The highest level of measurement. Denoted by mutually exclusive categories, a hierarchy (order), values can be added, subtracted, multiplied, and divided, and the presence of an absolute zero.

a paradigm based on the idea that social context and interaction frame our realities

a paradigm in social science research focused on power, inequality, and social change

a research paradigm that suspends questions of philosophical ‘truth’ and focuses more on how different philosophies, theories, and methods can be used strategically to resolve a problem or question within the researcher's unique context

A cyclical process of theory development, starting with an observed phenomenon, then developing or using a theory to make a specific prediction of what should happen if that theory is correct, testing that prediction, refining the theory in light of the findings, and using that refined theory to develop new hypotheses, and so on.

when someone is treated unfairly in their capacity to know something or describe their experience of the world

conducted during the early stages of a project, usually when a researcher wants to test the feasibility of conducting a more extensive study or if the topic has not been studied in the past

research that describes or defines a particular phenomenon

explains why particular phenomena work in the way that they do; answers “why” questions

attempts to explain or describe your phenomenon exhaustively, based on the subjective understandings of your participants

"Assuming that the null hypothesis is true and the study is repeated an infinite number times by drawing random samples from the same populations(s), less than 5% of these results will be more extreme than the current result" (Cassidy et al., 2019, p. 233).

Scientific Inquiry in Social Work (2nd Edition) Copyright © 2020 by Matthew DeCarlo, Cory Cummings, and Kate Agnelli is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Qualitative Research: Characteristics, Design, Methods & Examples

Lauren McCall

MSc Health Psychology Graduate

MSc, Health Psychology, University of Nottingham

Lauren obtained an MSc in Health Psychology from The University of Nottingham with a distinction classification.

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Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

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Qualitative research is a type of research methodology that focuses on gathering and analyzing non-numerical data to gain a deeper understanding of human behavior, experiences, and perspectives.

It aims to explore the “why” and “how” of a phenomenon rather than the “what,” “where,” and “when” typically addressed by quantitative research.

Unlike quantitative research, which focuses on gathering and analyzing numerical data for statistical analysis, qualitative research involves researchers interpreting data to identify themes, patterns, and meanings.

Qualitative research can be used to:

• Gain deep contextual understandings of the subjective social reality of individuals
• To answer questions about experience and meaning from the participant’s perspective
• To design hypotheses, theory must be researched using qualitative methods to determine what is important before research can begin. 

Examples of qualitative research questions include: 

• How does stress influence young adults’ behavior?
• What factors influence students’ school attendance rates in developed countries?
• How do adults interpret binge drinking in the UK?
• What are the psychological impacts of cervical cancer screening in women?
• How can mental health lessons be integrated into the school curriculum? 

Characteristics 

Naturalistic setting.

Individuals are studied in their natural setting to gain a deeper understanding of how people experience the world. This enables the researcher to understand a phenomenon close to how participants experience it. 

Naturalistic settings provide valuable contextual information to help researchers better understand and interpret the data they collect.

The environment, social interactions, and cultural factors can all influence behavior and experiences, and these elements are more easily observed in real-world settings.

Reality is socially constructed

Qualitative research aims to understand how participants make meaning of their experiences – individually or in social contexts. It assumes there is no objective reality and that the social world is interpreted (Yilmaz, 2013). 

The primacy of subject matter 

The primary aim of qualitative research is to understand the perspectives, experiences, and beliefs of individuals who have experienced the phenomenon selected for research rather than the average experiences of groups of people (Minichiello, 1990).

An in-depth understanding is attained since qualitative techniques allow participants to freely disclose their experiences, thoughts, and feelings without constraint (Tenny et al., 2022). 

Variables are complex, interwoven, and difficult to measure

Factors such as experiences, behaviors, and attitudes are complex and interwoven, so they cannot be reduced to isolated variables , making them difficult to measure quantitatively.

However, a qualitative approach enables participants to describe what, why, or how they were thinking/ feeling during a phenomenon being studied (Yilmaz, 2013). 

Emic (insider’s point of view)

The phenomenon being studied is centered on the participants’ point of view (Minichiello, 1990).

Emic is used to describe how participants interact, communicate, and behave in the research setting (Scarduzio, 2017).

Interpretive analysis

In qualitative research, interpretive analysis is crucial in making sense of the collected data.

This process involves examining the raw data, such as interview transcripts, field notes, or documents, and identifying the underlying themes, patterns, and meanings that emerge from the participants’ experiences and perspectives.

Collecting Qualitative Data

There are four main research design methods used to collect qualitative data: observations, interviews,  focus groups, and ethnography.

Observations

This method involves watching and recording phenomena as they occur in nature. Observation can be divided into two types: participant and non-participant observation.

In participant observation, the researcher actively participates in the situation/events being observed.

In non-participant observation, the researcher is not an active part of the observation and tries not to influence the behaviors they are observing (Busetto et al., 2020). 

Observations can be covert (participants are unaware that a researcher is observing them) or overt (participants are aware of the researcher’s presence and know they are being observed).

However, awareness of an observer’s presence may influence participants’ behavior. 

Interviews give researchers a window into the world of a participant by seeking their account of an event, situation, or phenomenon. They are usually conducted on a one-to-one basis and can be distinguished according to the level at which they are structured (Punch, 2013). 

Structured interviews involve predetermined questions and sequences to ensure replicability and comparability. However, they are unable to explore emerging issues.

Informal interviews consist of spontaneous, casual conversations which are closer to the truth of a phenomenon. However, information is gathered using quick notes made by the researcher and is therefore subject to recall bias. 

Semi-structured interviews have a flexible structure, phrasing, and placement so emerging issues can be explored (Denny & Weckesser, 2022).

The use of probing questions and clarification can lead to a detailed understanding, but semi-structured interviews can be time-consuming and subject to interviewer bias. 

Focus groups 

Similar to interviews, focus groups elicit a rich and detailed account of an experience. However, focus groups are more dynamic since participants with shared characteristics construct this account together (Denny & Weckesser, 2022).

A shared narrative is built between participants to capture a group experience shaped by a shared context. 

The researcher takes on the role of a moderator, who will establish ground rules and guide the discussion by following a topic guide to focus the group discussions.

Typically, focus groups have 4-10 participants as a discussion can be difficult to facilitate with more than this, and this number allows everyone the time to speak.

Ethnography

Ethnography is a methodology used to study a group of people’s behaviors and social interactions in their environment (Reeves et al., 2008).

Data are collected using methods such as observations, field notes, or structured/ unstructured interviews.

The aim of ethnography is to provide detailed, holistic insights into people’s behavior and perspectives within their natural setting. In order to achieve this, researchers immerse themselves in a community or organization. 

Due to the flexibility and real-world focus of ethnography, researchers are able to gather an in-depth, nuanced understanding of people’s experiences, knowledge and perspectives that are influenced by culture and society.

In order to develop a representative picture of a particular culture/ context, researchers must conduct extensive field work. 

This can be time-consuming as researchers may need to immerse themselves into a community/ culture for a few days, or possibly a few years.

Qualitative Data Analysis Methods

Different methods can be used for analyzing qualitative data. The researcher chooses based on the objectives of their study. 

The researcher plays a key role in the interpretation of data, making decisions about the coding, theming, decontextualizing, and recontextualizing of data (Starks & Trinidad, 2007). 

Grounded theory

Grounded theory is a qualitative method specifically designed to inductively generate theory from data. It was developed by Glaser and Strauss in 1967 (Glaser & Strauss, 2017).

This methodology aims to develop theories (rather than test hypotheses) that explain a social process, action, or interaction (Petty et al., 2012). To inform the developing theory, data collection and analysis run simultaneously. 

There are three key types of coding used in grounded theory: initial (open), intermediate (axial), and advanced (selective) coding. 

Throughout the analysis, memos should be created to document methodological and theoretical ideas about the data. Data should be collected and analyzed until data saturation is reached and a theory is developed. 

Content analysis

Content analysis was first used in the early twentieth century to analyze textual materials such as newspapers and political speeches.

Content analysis is a research method used to identify and analyze the presence and patterns of themes, concepts, or words in data (Vaismoradi et al., 2013). 

This research method can be used to analyze data in different formats, which can be written, oral, or visual. 

The goal of content analysis is to develop themes that capture the underlying meanings of data (Schreier, 2012). 

Qualitative content analysis can be used to validate existing theories, support the development of new models and theories, and provide in-depth descriptions of particular settings or experiences.

The following six steps provide a guideline for how to conduct qualitative content analysis.

• Define a Research Question : To start content analysis, a clear research question should be developed.
• Identify and Collect Data : Establish the inclusion criteria for your data. Find the relevant sources to analyze.
• Define the Unit or Theme of Analysis : Categorize the content into themes. Themes can be a word, phrase, or sentence.
• Develop Rules for Coding your Data : Define a set of coding rules to ensure that all data are coded consistently.
• Code the Data : Follow the coding rules to categorize data into themes.
• Analyze the Results and Draw Conclusions : Examine the data to identify patterns and draw conclusions in relation to your research question.

Discourse analysis

Discourse analysis is a research method used to study written/ spoken language in relation to its social context (Wood & Kroger, 2000).

In discourse analysis, the researcher interprets details of language materials and the context in which it is situated.

Discourse analysis aims to understand the functions of language (how language is used in real life) and how meaning is conveyed by language in different contexts. Researchers use discourse analysis to investigate social groups and how language is used to achieve specific communication goals.

Different methods of discourse analysis can be used depending on the aims and objectives of a study. However, the following steps provide a guideline on how to conduct discourse analysis.

• Define the Research Question : Develop a relevant research question to frame the analysis.
• Gather Data and Establish the Context : Collect research materials (e.g., interview transcripts, documents). Gather factual details and review the literature to construct a theory about the social and historical context of your study.
• Analyze the Content : Closely examine various components of the text, such as the vocabulary, sentences, paragraphs, and structure of the text. Identify patterns relevant to the research question to create codes, then group these into themes.
• Review the Results : Reflect on the findings to examine the function of the language, and the meaning and context of the discourse. 

Thematic analysis

Thematic analysis is a method used to identify, interpret, and report patterns in data, such as commonalities or contrasts. 

Although the origin of thematic analysis can be traced back to the early twentieth century, understanding and clarity of thematic analysis is attributed to Braun and Clarke (2006).

Thematic analysis aims to develop themes (patterns of meaning) across a dataset to address a research question. 

In thematic analysis, qualitative data is gathered using techniques such as interviews, focus groups, and questionnaires. Audio recordings are transcribed. The dataset is then explored and interpreted by a researcher to identify patterns. 

This occurs through the rigorous process of data familiarisation, coding, theme development, and revision. These identified patterns provide a summary of the dataset and can be used to address a research question.

Themes are developed by exploring the implicit and explicit meanings within the data. Two different approaches are used to generate themes: inductive and deductive. 

An inductive approach allows themes to emerge from the data. In contrast, a deductive approach uses existing theories or knowledge to apply preconceived ideas to the data.

Phases of Thematic Analysis

Braun and Clarke (2006) provide a guide of the six phases of thematic analysis. These phases can be applied flexibly to fit research questions and data. 

Template analysis

Template analysis refers to a specific method of thematic analysis which uses hierarchical coding (Brooks et al., 2014).

Template analysis is used to analyze textual data, for example, interview transcripts or open-ended responses on a written questionnaire.

To conduct template analysis, a coding template must be developed (usually from a subset of the data) and subsequently revised and refined. This template represents the themes identified by researchers as important in the dataset. 

Codes are ordered hierarchically within the template, with the highest-level codes demonstrating overarching themes in the data and lower-level codes representing constituent themes with a narrower focus.

A guideline for the main procedural steps for conducting template analysis is outlined below.

• Familiarization with the Data : Read (and reread) the dataset in full. Engage, reflect, and take notes on data that may be relevant to the research question.
• Preliminary Coding : Identify initial codes using guidance from the a priori codes, identified before the analysis as likely to be beneficial and relevant to the analysis.
• Organize Themes : Organize themes into meaningful clusters. Consider the relationships between the themes both within and between clusters.
• Produce an Initial Template : Develop an initial template. This may be based on a subset of the data.
• Apply and Develop the Template : Apply the initial template to further data and make any necessary modifications. Refinements of the template may include adding themes, removing themes, or changing the scope/title of themes. 
• Finalize Template : Finalize the template, then apply it to the entire dataset. 

Frame analysis

Frame analysis is a comparative form of thematic analysis which systematically analyzes data using a matrix output.

Ritchie and Spencer (1994) developed this set of techniques to analyze qualitative data in applied policy research. Frame analysis aims to generate theory from data.

Frame analysis encourages researchers to organize and manage their data using summarization.

This results in a flexible and unique matrix output, in which individual participants (or cases) are represented by rows and themes are represented by columns. 

Each intersecting cell is used to summarize findings relating to the corresponding participant and theme.

Frame analysis has five distinct phases which are interrelated, forming a methodical and rigorous framework.

• Familiarization with the Data : Familiarize yourself with all the transcripts. Immerse yourself in the details of each transcript and start to note recurring themes.
• Develop a Theoretical Framework : Identify recurrent/ important themes and add them to a chart. Provide a framework/ structure for the analysis.
• Indexing : Apply the framework systematically to the entire study data.
• Summarize Data in Analytical Framework : Reduce the data into brief summaries of participants’ accounts.
• Mapping and Interpretation : Compare themes and subthemes and check against the original transcripts. Group the data into categories and provide an explanation for them.

Preventing Bias in Qualitative Research

To evaluate qualitative studies, the CASP (Critical Appraisal Skills Programme) checklist for qualitative studies can be used to ensure all aspects of a study have been considered (CASP, 2018).

The quality of research can be enhanced and assessed using criteria such as checklists, reflexivity, co-coding, and member-checking. 

Co-coding 

Relying on only one researcher to interpret rich and complex data may risk key insights and alternative viewpoints being missed. Therefore, coding is often performed by multiple researchers.

A common strategy must be defined at the beginning of the coding process  (Busetto et al., 2020). This includes establishing a useful coding list and finding a common definition of individual codes.

Transcripts are initially coded independently by researchers and then compared and consolidated to minimize error or bias and to bring confirmation of findings. 

Member checking

Member checking (or respondent validation) involves checking back with participants to see if the research resonates with their experiences (Russell & Gregory, 2003).

Data can be returned to participants after data collection or when results are first available. For example, participants may be provided with their interview transcript and asked to verify whether this is a complete and accurate representation of their views.

Participants may then clarify or elaborate on their responses to ensure they align with their views (Shenton, 2004).

This feedback becomes part of data collection and ensures accurate descriptions/ interpretations of phenomena (Mays & Pope, 2000). 

Reflexivity in qualitative research

Reflexivity typically involves examining your own judgments, practices, and belief systems during data collection and analysis. It aims to identify any personal beliefs which may affect the research. 

Reflexivity is essential in qualitative research to ensure methodological transparency and complete reporting. This enables readers to understand how the interaction between the researcher and participant shapes the data.

Depending on the research question and population being researched, factors that need to be considered include the experience of the researcher, how the contact was established and maintained, age, gender, and ethnicity.

These details are important because, in qualitative research, the researcher is a dynamic part of the research process and actively influences the outcome of the research (Boeije, 2014). 

Reflexivity Example

Who you are and your characteristics influence how you collect and analyze data. Here is an example of a reflexivity statement for research on smoking. I am a 30-year-old white female from a middle-class background. I live in the southwest of England and have been educated to master’s level. I have been involved in two research projects on oral health. I have never smoked, but I have witnessed how smoking can cause ill health from my volunteering in a smoking cessation clinic. My research aspirations are to help to develop interventions to help smokers quit.

Establishing Trustworthiness in Qualitative Research

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability.

1. Credibility in Qualitative Research

Credibility refers to how accurately the results represent the reality and viewpoints of the participants.

To establish credibility in research, participants’ views and the researcher’s representation of their views need to align (Tobin & Begley, 2004).

To increase the credibility of findings, researchers may use data source triangulation, investigator triangulation, peer debriefing, or member checking (Lincoln & Guba, 1985). 

2. Transferability in Qualitative Research

Transferability refers to how generalizable the findings are: whether the findings may be applied to another context, setting, or group (Tobin & Begley, 2004).

Transferability can be enhanced by giving thorough and in-depth descriptions of the research setting, sample, and methods (Nowell et al., 2017). 

3. Dependability in Qualitative Research

Dependability is the extent to which the study could be replicated under similar conditions and the findings would be consistent.

Researchers can establish dependability using methods such as audit trails so readers can see the research process is logical and traceable (Koch, 1994).

4. Confirmability in Qualitative Research

Confirmability is concerned with establishing that there is a clear link between the researcher’s interpretations/ findings and the data.

Researchers can achieve confirmability by demonstrating how conclusions and interpretations were arrived at (Nowell et al., 2017).

This enables readers to understand the reasoning behind the decisions made. 

Audit Trails in Qualitative Research

An audit trail provides evidence of the decisions made by the researcher regarding theory, research design, and data collection, as well as the steps they have chosen to manage, analyze, and report data. 

The researcher must provide a clear rationale to demonstrate how conclusions were reached in their study.

A clear description of the research path must be provided to enable readers to trace through the researcher’s logic (Halpren, 1983).

Researchers should maintain records of the raw data, field notes, transcripts, and a reflective journal in order to provide a clear audit trail. 

Discovery of unexpected data

Open-ended questions in qualitative research mean the researcher can probe an interview topic and enable the participant to elaborate on responses in an unrestricted manner.

This allows unexpected data to emerge, which can lead to further research into that topic. 

The exploratory nature of qualitative research helps generate hypotheses that can be tested quantitatively (Busetto et al., 2020).

Flexibility

Data collection and analysis can be modified and adapted to take the research in a different direction if new ideas or patterns emerge in the data.

This enables researchers to investigate new opportunities while firmly maintaining their research goals. 

Naturalistic settings

The behaviors of participants are recorded in real-world settings. Studies that use real-world settings have high ecological validity since participants behave more authentically. 

Limitations

Time-consuming .

Qualitative research results in large amounts of data which often need to be transcribed and analyzed manually.

Even when software is used, transcription can be inaccurate, and using software for analysis can result in many codes which need to be condensed into themes. 

Subjectivity 

The researcher has an integral role in collecting and interpreting qualitative data. Therefore, the conclusions reached are from their perspective and experience.

Consequently, interpretations of data from another researcher may vary greatly. 

Limited generalizability

The aim of qualitative research is to provide a detailed, contextualized understanding of an aspect of the human experience from a relatively small sample size.

Despite rigorous analysis procedures, conclusions drawn cannot be generalized to the wider population since data may be biased or unrepresentative.

Therefore, results are only applicable to a small group of the population. 

While individual qualitative studies are often limited in their generalizability due to factors such as sample size and context, metasynthesis enables researchers to synthesize findings from multiple studies, potentially leading to more generalizable conclusions.

By integrating findings from studies conducted in diverse settings and with different populations, metasynthesis can provide broader insights into the phenomenon of interest.

Extraneous variables

Qualitative research is often conducted in real-world settings. This may cause results to be unreliable since extraneous variables may affect the data, for example:

• Situational variables : different environmental conditions may influence participants’ behavior in a study. The random variation in factors (such as noise or lighting) may be difficult to control in real-world settings.
• Participant characteristics : this includes any characteristics that may influence how a participant answers/ behaves in a study. This may include a participant’s mood, gender, age, ethnicity, sexual identity, IQ, etc.
• Experimenter effect : experimenter effect refers to how a researcher’s unintentional influence can change the outcome of a study. This occurs when (i) their interactions with participants unintentionally change participants’ behaviors or (ii) due to errors in observation, interpretation, or analysis. 

What sample size should qualitative research be?

The sample size for qualitative studies has been recommended to include a minimum of 12 participants to reach data saturation (Braun, 2013).

Are surveys qualitative or quantitative?

Surveys can be used to gather information from a sample qualitatively or quantitatively. Qualitative surveys use open-ended questions to gather detailed information from a large sample using free text responses.

The use of open-ended questions allows for unrestricted responses where participants use their own words, enabling the collection of more in-depth information than closed-ended questions.

In contrast, quantitative surveys consist of closed-ended questions with multiple-choice answer options. Quantitative surveys are ideal to gather a statistical representation of a population.

What are the ethical considerations of qualitative research?

Before conducting a study, you must think about any risks that could occur and take steps to prevent them. Participant Protection : Researchers must protect participants from physical and mental harm. This means you must not embarrass, frighten, offend, or harm participants. Transparency : Researchers are obligated to clearly communicate how they will collect, store, analyze, use, and share the data. Confidentiality : You need to consider how to maintain the confidentiality and anonymity of participants’ data.

What is triangulation in qualitative research?

Triangulation refers to the use of several approaches in a study to comprehensively understand phenomena. This method helps to increase the validity and credibility of research findings. 

Types of triangulation include method triangulation (using multiple methods to gather data); investigator triangulation (multiple researchers for collecting/ analyzing data), theory triangulation (comparing several theoretical perspectives to explain a phenomenon), and data source triangulation (using data from various times, locations, and people; Carter et al., 2014).

Why is qualitative research important?

Qualitative research allows researchers to describe and explain the social world. The exploratory nature of qualitative research helps to generate hypotheses that can then be tested quantitatively.

In qualitative research, participants are able to express their thoughts, experiences, and feelings without constraint.

Additionally, researchers are able to follow up on participants’ answers in real-time, generating valuable discussion around a topic. This enables researchers to gain a nuanced understanding of phenomena which is difficult to attain using quantitative methods.

What is coding data in qualitative research?

Coding data is a qualitative data analysis strategy in which a section of text is assigned with a label that describes its content.

These labels may be words or phrases which represent important (and recurring) patterns in the data.

This process enables researchers to identify related content across the dataset. Codes can then be used to group similar types of data to generate themes.

What is the difference between qualitative and quantitative research?

Qualitative research involves the collection and analysis of non-numerical data in order to understand experiences and meanings from the participant’s perspective.

This can provide rich, in-depth insights on complicated phenomena. Qualitative data may be collected using interviews, focus groups, or observations.

In contrast, quantitative research involves the collection and analysis of numerical data to measure the frequency, magnitude, or relationships of variables. This can provide objective and reliable evidence that can be generalized to the wider population.

Quantitative data may be collected using closed-ended questionnaires or experiments.

What is trustworthiness in qualitative research?

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability. 

Credibility refers to how accurately the results represent the reality and viewpoints of the participants. Transferability refers to whether the findings may be applied to another context, setting, or group.

Dependability is the extent to which the findings are consistent and reliable. Confirmability refers to the objectivity of findings (not influenced by the bias or assumptions of researchers).

What is data saturation in qualitative research?

Data saturation is a methodological principle used to guide the sample size of a qualitative research study.

Data saturation is proposed as a necessary methodological component in qualitative research (Saunders et al., 2018) as it is a vital criterion for discontinuing data collection and/or analysis. 

The intention of data saturation is to find “no new data, no new themes, no new coding, and ability to replicate the study” (Guest et al., 2006). Therefore, enough data has been gathered to make conclusions.

Why is sampling in qualitative research important?

In quantitative research, large sample sizes are used to provide statistically significant quantitative estimates.

This is because quantitative research aims to provide generalizable conclusions that represent populations.

However, the aim of sampling in qualitative research is to gather data that will help the researcher understand the depth, complexity, variation, or context of a phenomenon. The small sample sizes in qualitative studies support the depth of case-oriented analysis.

What is narrative analysis?

Narrative analysis is a qualitative research method used to understand how individuals create stories from their personal experiences.

There is an emphasis on understanding the context in which a narrative is constructed, recognizing the influence of historical, cultural, and social factors on storytelling.

Researchers can use different methods together to explore a research question.

Some narrative researchers focus on the content of what is said, using thematic narrative analysis, while others focus on the structure, such as holistic-form or categorical-form structural narrative analysis. Others focus on how the narrative is produced and performed.

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Schreier, M. (2012). Qualitative content analysis in practice / Margrit Schreier.

Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22 , 63–75.

Starks, H., & Trinidad, S. B. (2007). Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qualitative health research , 17 (10), 1372–1380. https://doi.org/10.1177/1049732307307031

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Qualitative Research Definition

Qualitative research methods and examples, advantages and disadvantages of qualitative approaches, qualitative vs. quantitative research, showing qualitative research skills on resumes, what is qualitative research methods and examples.

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Table of Contents

Qualitative research seeks to understand people’s experiences and perspectives by studying social organizations and human behavior. Data in qualitative studies focuses on people’s beliefs and emotional responses. Qualitative data is especially helpful when a company wants to know how customers feel about a product or service, such as in user experience (UX) design or marketing . 

Researchers use qualitative approaches to “determine answers to research questions on human behavior and the cultural values that drive our thinking and behavior,” says Margaret J. King, director at The Center for Cultural Studies & Analysis in Philadelphia.

Data in qualitative research typically can’t be assessed mathematically — the data is not sets of numbers or quantifiable information. Rather, it’s collections of images, words, notes on behaviors, descriptions of emotions, and historical context. Data is collected through observations, interviews, surveys, focus groups, and secondary research. 

However, a qualitative study needs a “clear research question at its base,” notes King, and the research needs to be “observed, categorized, compared, and evaluated (along a scale or by a typology chart) by reference to a baseline in order to determine an outcome with value as new and reliable information.”

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Who Uses Qualitative Research?

Researchers in social sciences and humanities often use qualitative research methods, especially in specific areas of study like anthropology, history, education, and sociology. 

Qualitative methods are also applicable in business, technology , and marketing spaces. For example, product managers use qualitative research to understand how target audiences respond to their products. They may use focus groups to gain insights from potential customers on product prototypes and improvements or surveys from existing customers to understand what changes users want to see. 

Other careers that may involve qualitative research include: 

• Marketing analyst
• UX and UI analyst
• Market researcher
• Statistician
• Business analyst
• Data analyst
• Research assistant
• Claims investigator

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Good research begins with a question, and this question informs the approach used by qualitative researchers. 

Grounded Theory

Grounded theory is an inductive approach to theory development. In many forms of research, you begin with a hypothesis and then test it to see if you’re correct. In grounded theory, though, you go in without any assumptions and rely on the data you collect to form theories. You start with an open question about a phenomenon you are studying and collect and analyze data until you can form a fully-fledged theory from the information. 

Example: A company wants to improve its brand and marketing strategies. The company performs a grounded theory approach to solving this problem by conducting interviews and surveys with past, current, and prospective customers. The information gathered from these methods helps the company understand what type of branding and marketing their customer-base likes and dislikes, allowing the team to inductively craft a new brand and marketing strategy from the data. 

Action Research

Action research is one part study and one part problem-solving . Through action research, analysts investigate a problem or weakness and develop practical solutions. The process of action research is cyclical —- researchers assess solutions for efficiency and effectiveness, and create further solutions to correct any issues found. 

Example: A manager notices her employees struggle to cooperate on group projects. She carefully reviews how team members interact with each other and asks them all to respond to a survey about communication. Through the survey and study, she finds that guidelines for group projects are unclear. After changing the guidelines, she reviews her team again to see if there are any changes to their behavior.  

>>MORE: Explore how action research helps consultants serve clients with Accenture’s Client Research and Problem Identification job simulation .

Phenomenological Research

Phenomenological research investigates a phenomenon in depth, looking at people’s experiences and understanding of the situation. This sort of study is primarily descriptive and seeks to broaden understanding around a specific incident and the people involved. Researchers in phenomenological studies must be careful to set aside any biases or assumptions because the information used should be entirely from the subjects themselves. 

Example : A researcher wants to better understand the lived experience of college students with jobs. The purpose of this research is to gain insights into the pressures of college students who balance studying and working at the same time. The researcher conducts a series of interviews with several college students, learning about their past and current situations. Through the first few interviews, the researcher builds a relationship with the students. Later discussions are more targeted, with questions prompting the students to discuss their emotions surrounding both work and school and the difficulties and benefits arising from their situation. The researcher then analyzes these interviews, and identifies shared themes to contextualize the experiences of the students.

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Ethnography

Ethnography is an immersive study of a particular culture or community. Through ethnographic research, analysts aim to learn about a group’s conventions, social dynamics, and cultural norms. Some researchers use active observation methods, finding ways to integrate themselves into the culture as much as possible. Others use passive observation, watching closely from the outside but not fully immersing themselves. 

Example: A company hires an external researcher to learn what their company’s culture is actually like. The researcher studies the social dynamics of the employees and may even look at how these employees interact with clients and with each other outside of the office. The goal is to deliver a comprehensive report of the company’s culture and the social dynamics of its employees.

Case Studies

A case study is a type of in-depth analysis of a situation. Case studies can focus on an organization, belief system, event, person, or action. The goal of a case study is to understand the phenomenon and put it in a real-world context. Case studies are also commonly used in marketing and sales to highlight the benefits of a company’s products or services. 

Example: A business performs a case study of its competitors’ strategies. This case study aims to show why the company should adopt a specific business strategy. The study looks at each competitor’s business structure, marketing campaigns, product offerings, and historical growth trends. Then, using this data on other businesses, the researcher can theorize how that strategy would benefit their company.

>>MORE: Learn how companies use case study interviews to assess candidates’ research and problem-solving skills. 

Qualitative research methods are great for generating new ideas. The exploratory nature of qualitative research means uncovering unexpected information, which often leads to new theories and further research topics. Additionally, qualitative findings feel meaningful. These studies focus on people, emotions, and societies and may feel closer to their communities than quantitative research that relies on more mathematical and logical data. 

However, qualitative research can be unreliable at times. It’s difficult to replicate qualitative studies since people’s opinions and emotions can change quickly. For example, a focus group has a lot of variables that can affect the outcome, and that same group, asked the same questions a year later, may have entirely different responses. The data collection can also be difficult and time-consuming with qualitative research. Ultimately, interviewing people, reviewing surveys, and understanding and explaining human emotions can be incredibly complex.

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While qualitative research deals with data that isn’t easily manipulated by mathematics, quantitative research almost exclusively involves numbers and numerical data. Quantitative studies aim to find concrete details, like units of time, percentages, or statistics. 

Besides the types of data used, a core difference between quantitative and qualitative research is the idea of control and replication. 

“Qualitative is less subject to control (as in lab studies) and, therefore, less statistically measurable than quantitative approaches,” says King.

One person’s interview about a specific topic can have completely different responses than every other person’s interview since there are so many variables in qualitative research. On the other hand, quantitative studies can often be replicated. For instance, when testing the effects of a new medication, quantifiable data, like blood test results, can be repeated. Qualitative data, though, like how people feel about the medication, may differ from person to person and from moment to moment.

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You can show your experience with qualitative research on your resume in your skills or work experience sections and your cover letter . 

• In your skills section , you can list types of qualitative research you are skilled at, like conducting interviews, performing grounded theory research, or crafting case studies. 
• In your work or internship experience descriptions , you can highlight specific examples, like talking about a time you used action research to solve a complex issue at your last job. 
• In your cover letter , you can discuss in-depth qualitative research projects you’ve completed. For instance, say you spent a summer conducting ethnographic research or a whole semester running focus groups to get feedback on a product. You can talk about these experiences in your cover letter and note how these skills make you a great fit for the job. 

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How to code focus group data for qualitative research.

Home » How to Code Focus Group Data for Qualitative Research

Focus Group Coding serves as a vital process in qualitative research, enabling researchers to analyze and interpret rich discussions from focus groups. By systematically organizing responses, researchers can identify key themes, recurring patterns, and nuanced insights that arise during group interactions. This foundational step enhances the overall validity and depth of the research findings.

Understanding the intricacies of Focus Group Coding is essential for accurately interpreting qualitative data. Effective coding requires a careful balance between categorizing data and maintaining the nuances of participants' voices. This section will explore various coding techniques, the importance of coding rigor, and strategies to ensure that insights derived from focus group data are meaningful and actionable.

The Importance of Focus Group Coding in Qualitative Research

Focus group coding is essential in qualitative research as it helps to systematically interpret and analyze diverse participant perspectives. This process transforms raw data into meaningful insights, allowing researchers to identify patterns and themes that reflect consumer sentiments. By categorizing the data collected during focus group discussions, researchers can link various ideas and sentiments to enhance their understanding of complex social phenomena.

Moreover, effective coding facilitates meaningful comparisons across different groups and sessions. It enables researchers to address specific research questions by highlighting key issues shared among participants. This not only enriches the qualitative analysis but also ensures that the findings are more reliable and actionable. Consequently, focus group coding becomes an integral part of designing effective qualitative research that can lead to better decision-making and strategies in various fields, such as marketing or product development.

Why Coding Matters

Coding focus group data is essential for distilling meaningful insights from qualitative research. It transforms raw, complex discussions into organized themes, facilitating easier analysis and interpretation. By applying systematic coding techniques, researchers can identify patterns and trends that reveal participants' perceptions, experiences, and emotions. This process enhances understanding of the underlying narratives that might otherwise be overlooked.

Moreover, effective coding contributes to improved communication among team members and stakeholders. It enables clear documentation of findings, ensuring that insights are accessible for decision-making. Consistent focus group coding fosters a collaborative environment, where research outcomes can be shared and discussed comprehensively. In essence, coding serves as the backbone of qualitative research, illuminating the voices of participants and guiding actionable strategies based on their shared experiences. Thus, asserting the importance of meticulous coding cannot be overstated in achieving reliable qualitative data analysis.

Benefits of Accurate Coding

Accurate coding of focus group data plays a crucial role in the success of qualitative research. It provides clarity and context to the insights gathered, ensuring that the narrative being constructed accurately reflects participant perspectives. By employing precise coding techniques, researchers can derive meaningful themes from discussion data, making it easier to identify trends and insights that can drive strategic decisions.

Furthermore, accurate coding enhances the reliability and validity of the research findings. It minimizes misinterpretation of data, enabling researchers to present results that stakeholders can trust. This level of confidence fosters stronger relationships between researchers and participants, as individuals feel their viewpoints are respected and accurately represented. Ultimately, effective focus group coding not only enriches the research process but also ensures actionable insights, which can lead to transformative outcomes for organizations.

Steps to Effectively Code Focus Group Data

To effectively code focus group data, begin by familiarizing yourself with the transcripts of the discussions. Review these transcripts thoroughly, identifying recurring themes and key concepts that emerge from the participants' responses. Next, develop a coding framework based on these observations; this framework will help categorize and group similar ideas. Coding can be done manually or through qualitative data analysis software, depending on the volume of data and your preferences.

Once you have established your coding framework, apply the codes consistently across the data set. This involves labeling segments of text with appropriate codes, ensuring that every relevant response is captured. After the initial coding, revisit your framework to refine and adjust the codes as needed. This iterative process enhances the accuracy of your focus group coding, providing clearer insights into participant opinions and behaviors. Finally, synthesize the coded data to identify broader trends and narratives that can inform your qualitative research findings.

Preparing Your Data for Coding

Preparing your data for coding involves crucial steps that ensure accurate focus group coding for qualitative research. Begin by transcribing any recorded discussions, as transcripts will serve as the foundation for your analysis. Once you have the transcripts, it is essential to upload them junto with any criteria or benchmark documents that outline your research objectives. This combination allows for a streamlined coding process, setting clear guidelines for analysis.

Next, develop a coding framework that categorizes the data based on key themes or questions derived from the focus group discussions. Assign specific codes to different responses, creating a structured approach to data interpretation. This method will not only enhance your coding efficiency but also ensure that you capture the nuances of participant insights accurately. In sum, preparing your data methodically will pave the way for insightful analysis and meaningful conclusions in your qualitative research.

The Coding Process: A Step-by-Step Guide

The coding process begins with organizing and preparing your focus group data. After collecting the transcripts, create a clear project structure that allows for easy access and analysis. Review each session individually, paying attention to key themes and notable remarks. As you navigate through the data, consider using tools and matrices that can help identify recurring patterns and insights.

Next, develop a systematic approach to categorize the data. This involves assigning codes to specific topics or sentiments, helping to streamline analysis. Assigning these codes can range from general to specific, allowing for a nuanced understanding of the data. Once coded, it’s essential to continually revisit and refine your categories, as new insights may emerge during the analysis. This iterative process of coding ensures that all significant themes are captured, ultimately enhancing your qualitative research findings.

Conclusion: Mastering Focus Group Coding for Better Insights

Mastering focus group coding is essential for extracting meaningful insights from qualitative data. This process enables researchers to identify recurring themes, patterns, and sentiments among participants. By systematically analyzing focus group discussions, you can uncover valuable information that highlights consumer needs, preferences, and emotions.

The journey doesn't end with data collection; coding plays a vital role in transforming raw discussions into actionable insights. Implementing robust coding techniques allows for a clearer analysis of key takeaways. As a result, organizations can make informed decisions that align with the desires of their target audience, ultimately enhancing product development and marketing strategies.

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Qualitative data analysis methods should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these). Some established methods include Content Analysis, Critical Analysis, Discourse Analysis, Gestalt Analysis, Grounded Theory Analysis, Interpretive Analysis, Narrative Analysis, Normative Analysis, Phenomenological Analysis, Rhetorical Analysis, and Semiotic Analysis, among others. The following resources should help you navigate your methodological options and put into practice methods for coding, themeing, interpreting, and presenting your data.

• Users can browse content by topic, discipline, or format type (reference works, book chapters, definitions, etc.). SRM offers several research tools as well: a methods map, user-created reading lists, a project planner, and advice on choosing statistical tests.  
• Abductive Coding: Theory Building and Qualitative (Re)Analysis by Vila-Henninger, et al.  The authors recommend an abductive approach to guide qualitative researchers who are oriented towards theory-building. They outline a set of tactics for abductive analysis, including the generation of an abductive codebook, abductive data reduction through code equations, and in-depth abductive qualitative analysis.  
• Analyzing and Interpreting Qualitative Research: After the Interview by Charles F. Vanover, Paul A. Mihas, and Johnny Saldana (Editors)   Providing insight into the wide range of approaches available to the qualitative researcher and covering all steps in the research process, the authors utilize a consistent chapter structure that provides novice and seasoned researchers with pragmatic, "how-to" strategies. Each chapter author introduces the method, uses one of their own research projects as a case study of the method described, shows how the specific analytic method can be used in other types of studies, and concludes with three questions/activities to prompt class discussion or personal study.   
• "Analyzing Qualitative Data." Theory Into Practice 39, no. 3 (2000): 146-54 by Margaret D. LeCompte   This article walks readers though rules for unbiased data analysis and provides guidance for getting organized, finding items, creating stable sets of items, creating patterns, assembling structures, and conducting data validity checks.  
• "Coding is Not a Dirty Word" in Chapter 1 (pp. 1–30) of Enhancing Qualitative and Mixed Methods Research with Technology by Shalin Hai-Jew (Editor)   Current discourses in qualitative research, especially those situated in postmodernism, represent coding and the technology that assists with coding as reductive, lacking complexity, and detached from theory. In this chapter, the author presents a counter-narrative to this dominant discourse in qualitative research. The author argues that coding is not necessarily devoid of theory, nor does the use of software for data management and analysis automatically render scholarship theoretically lightweight or barren. A lack of deep analytical insight is a consequence not of software but of epistemology. Using examples informed by interpretive and critical approaches, the author demonstrates how NVivo can provide an effective tool for data management and analysis. The author also highlights ideas for critical and deconstructive approaches in qualitative inquiry while using NVivo. By troubling the positivist discourse of coding, the author seeks to create dialogic spaces that integrate theory with technology-driven data management and analysis, while maintaining the depth and rigor of qualitative research.   
• The Coding Manual for Qualitative Researchers by Johnny Saldana   An in-depth guide to the multiple approaches available for coding qualitative data. Clear, practical and authoritative, the book profiles 32 coding methods that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldaña discusses the methods, origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. Essential reading across the social sciences.  
• Flexible Coding of In-depth Interviews: A Twenty-first-century Approach by Nicole M. Deterding and Mary C. Waters The authors suggest steps in data organization and analysis to better utilize qualitative data analysis technologies and support rigorous, transparent, and flexible analysis of in-depth interview data.  
• From the Editors: What Grounded Theory is Not by Roy Suddaby Walks readers through common misconceptions that hinder grounded theory studies, reinforcing the two key concepts of the grounded theory approach: (1) constant comparison of data gathered throughout the data collection process and (2) the determination of which kinds of data to sample in succession based on emergent themes (i.e., "theoretical sampling").  
• “Good enough” methods for life-story analysis, by Wendy Luttrell. In Quinn N. (Ed.), Finding culture in talk (pp. 243–268). Demonstrates for researchers of culture and consciousness who use narrative how to concretely document reflexive processes in terms of where, how and why particular decisions are made at particular stages of the research process.   
• The Ethnographic Interview by James P. Spradley  “Spradley wrote this book for the professional and student who have never done ethnographic fieldwork (p. 231) and for the professional ethnographer who is interested in adapting the author’s procedures (p. iv) ... Steps 6 and 8 explain lucidly how to construct a domain and a taxonomic analysis” (excerpted from book review by James D. Sexton, 1980). See also:  Presentation slides on coding and themeing your data, derived from Saldana, Spradley, and LeCompte Click to request access.  
• Qualitative Data Analysis by Matthew B. Miles; A. Michael Huberman   A practical sourcebook for researchers who make use of qualitative data, presenting the current state of the craft in the design, testing, and use of qualitative analysis methods. Strong emphasis is placed on data displays matrices and networks that go beyond ordinary narrative text. Each method of data display and analysis is described and illustrated.  
• "A Survey of Qualitative Data Analytic Methods" in Chapter 4 (pp. 89–138) of Fundamentals of Qualitative Research by Johnny Saldana   Provides an in-depth introduction to coding as a heuristic, particularly focusing on process coding, in vivo coding, descriptive coding, values coding, dramaturgical coding, and versus coding. Includes advice on writing analytic memos, developing categories, and themeing data.   
• "Thematic Networks: An Analytic Tool for Qualitative Research." Qualitative Research : QR, 1(3), 385–405 by Jennifer Attride-Stirling Details a technique for conducting thematic analysis of qualitative material, presenting a step-by-step guide of the analytic process, with the aid of an empirical example. The analytic method presented employs established, well-known techniques; the article proposes that thematic analyses can be usefully aided by and presented as thematic networks.  
• Using Thematic Analysis in Psychology by Virginia Braun and Victoria Clark Walks readers through the process of reflexive thematic analysis, step by step. The method may be adapted in fields outside of psychology as relevant. Pair this with One Size Fits All? What Counts as Quality Practice in Reflexive Thematic Analysis? by Virginia Braun and Victoria Clark

Data visualization can be employed formatively, to aid your data analysis, or summatively, to present your findings. Many qualitative data analysis (QDA) software platforms, such as NVivo , feature search functionality and data visualization options within them to aid data analysis during the formative stages of your project.

For expert assistance creating data visualizations to present your research, Harvard Library offers Visualization Support . Get help and training with data visualization design and tools—such as Tableau—for the Harvard community. Workshops and one-on-one consultations are also available.

The quality of your data analysis depends on how you situate what you learn within a wider body of knowledge. Consider the following advice:

A good literature review has many obvious virtues. It enables the investigator to define problems and assess data. It provides the concepts on which percepts depend. But the literature review has a special importance for the qualitative researcher. This consists of its ability to sharpen his or her capacity for surprise (Lazarsfeld, 1972b). The investigator who is well versed in the literature now has a set of expectations the data can defy. Counterexpectational data are conspicuous, readable, and highly provocative data. They signal the existence of unfulfilled theoretical assumptions, and these are, as Kuhn (1962) has noted, the very origins of intellectual innovation. A thorough review of the literature is, to this extent, a way to manufacture distance. It is a way to let the data of one's research project take issue with the theory of one's field.

- McCracken, G. (1988), The Long Interview, Sage: Newbury Park, CA, p. 31

Once you have coalesced around a theory, realize that a theory should  reveal  rather than  color  your discoveries. Allow your data to guide you to what's most suitable. Grounded theory  researchers may develop their own theory where current theories fail to provide insight.  This guide on Theoretical Models  from Alfaisal University Library provides a helpful overview on using theory.

If you'd like to supplement what you learned about relevant theories through your coursework and literature review, try these sources:

• Annual Reviews   Review articles sum up the latest research in many fields, including social sciences, biomedicine, life sciences, and physical sciences. These are timely collections of critical reviews written by leading scientists.  
• HOLLIS - search for resources on theories in your field   Modify this example search by entering the name of your field in place of "your discipline," then hit search.  
• Oxford Bibliographies   Written and reviewed by academic experts, every article in this database is an authoritative guide to the current scholarship in a variety of fields, containing original commentary and annotations.  
• ProQuest Dissertations & Theses (PQDT)   Indexes dissertations and masters' theses from most North American graduate schools as well as some European universities. Provides full text for most indexed dissertations from 1990-present.  
• Very Short Introductions   Launched by Oxford University Press in 1995, Very Short Introductions offer concise introductions to a diverse range of subjects from Climate to Consciousness, Game Theory to Ancient Warfare, Privacy to Islamic History, Economics to Literary Theory.
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Concentrations

Qualitative methods concentration (qual).

The Qualitative Methods Concentration focuses on qualitative research design, methods, and data analysis. It provides methodological training for students and researchers through formal coursework, qualitative data analysis software workshops (ATLAS.ti) and speaker events.

Please contact [email protected]  if you have any questions.

Concentration Requirements

• Minimum 10 credits from Methods courses
• Minimum 5 credits from Theory or Gateway courses
• Complete at least 2 Atlas.ti Data Analysis workshops.
• Attend a minimum of 2 Speaker Series events.

How to Apply

Step 1: Students must declare their intention to complete the QUAL Concentration by filling out the planning form and submitting it to [email protected] . All forms must be approved by academic advisors at the undergraduate level and faculty advisors or committee chairs at the graduate level.

Step 2: The Steering Committee will review and approve all planning forms during the second week of each academic quarter. We will then confirm with students that their form has been approved. Students should then start completing the requirements .

Step 3: Once the student has completed all requirements, the student should complete the checklist for completion   and submit it to [email protected] along with a copy of their unofficial transcripts. The Committee will review the checklist and unofficial transcript before granting the QUAL concentration.

The course list below is inexhaustive and many courses change year to year. If you believe a course you have taken or plan to take should qualify for the QUAL concentration, you can petition the steering committee. Send an email to [email protected] and include the course name, description and syllabus.

*Some exceptions for extraordinary circumstances can be made to the requirements on a case-by-case basis.

Questions about the forms or processes should be directed to [email protected] .

Methods Courses

Methods courses delve deeply into and equip students to employ specific qualitative methods or techniques.

Minimum 10 credits.

• ANTH 519 / GH 538 – Advanced Qualitative Research Methods in Anthropology and Public Health (5)
• ANTH 549 / DANCE 550 – Dance Ethnography (3)
• ANTH 550 – Ethnographic Field Techniques (5)
• COM 513 – Fieldwork Research Methods (5)
• COM 514 – Critical Discourse Analysis (5)
• COM 525 – Community Based Research Methods (5)
• GEOG 525 – Advanced Qualitative Methods in Geography (5)
• GH 531 – Practical Research & Evaluation Methods for Global Health (3)
• GH 538 – Advanced Qualitative Research Design and Methods in Global Health (3)
• GH 539 – Analyzing Qualitative Data (3)
• JSIS 512 – Qualitative Data Analysis (5)
• JSIS 595 – Research Tutorial: Qualitative Research (5)
• NMETH 583 – Advanced Qualitative Research Methods (4)
• NURS 576 – Assessment & Collaboration with Communities, Populations, and Systems (3)
• POL S 504 – Multi-Method Field Research (5)
• POL S 559 – Qualitative and Mixed Methods (5)
• PUBPOL 525 – Qualitative Case-Based Research Methods (4)

Gateway Courses

Gateway courses are broad umbrella courses that introduce a variety of qualitative methods and foreground research design principles.

Minimum 5 credits from Theory or Gateway courses.

• AIS 501 / GWSS 510 – Documentary Research Methods for the Social Sciences and Humanities (5)
• BIO A 525 – Research Methods & Study Design in Biocultural Anthropology (5)
• COM 527 – Global Communication Research Methods (5)
• EDPSY 586 – Qualitative Methods of Educational Research I (4)
• EDPSY 587 – Qualitative Methods of Educational Research II (4)
• FRENCH 590 – Qualitative Research Methods (5)
• HSERV 538-9 – Evaluation and Community Organizing (6)
• JSIS 595 – Research Tutorial: Research Methods & Design (5)
• NMETH 582 – Qualitative Research Inquiry and Methods (4)
• PHI 513 – Analytic Skills for Public Health II (3)
• SOC 582 – Doing Qualitative Research (3)
• SOCWL 581 – Qualitative Research: Methods and Designs (3)
• SOCWL 585 – Qualitative Methods in Social Work Research I (3)

Theory Courses

Theory courses focus on paradigms, epistemologies, and implications of research design and qualitative methods.

• B H 552 – Advanced Qualitative Methods (4)
• COM 597 – Special Topics: Comparative Social Research (5)
• GWSS 503 – Feminist Research and Methods of Inquiry (5)
• NMETH 588 – Mixed Methods Research for Health Sciences (4)
• SOCWL 586 – Qualitative Methods in Social Work Research II (3)

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• Published: 11 September 2024

A qualitative study of healthy ageing and co-production

• Anne Seneca Terkelsen 1 ,
• Gabriel Gulis 1 , 2 ,
• Jørgen Jespersen 1 &
• Pernille Tanggaard Andersen 1  

Scientific Reports volume  14 , Article number:  21239 ( 2024 ) Cite this article

Metrics details

• Health policy
• Health services
• Public health
• Quality of life

Europe’s ageing population increases the demand for housing solutions targeting older citizens’ needs and preferences. Establishing age-friendly communities fostering social participation is essential for healthy ageing and various housing options with shared facilities prioritizing social contact have emerged. While involving older people in public service delivery is emphasized, studies on co-production with older people in building age-friendly communities remain limited. This study explores a co-production initiative between older citizens, a municipality and a real estate company in a newly established senior village focusing on organizational settings and physical facilities. A qualitative study inspired by the BIKVA methodology was conducted using focus group interviews with citizens, frontline staff, and management. Through reflexive thematic analysis, the physical environment, organizational setting and other factors influencing the co-production process were analysed. Citizens expressed satisfaction with the unique physical environment, the different activities and being involved in the co-production process on development and building up the senior village. However, the co-production initiative was influenced by the lack of frontline staff involvement, how the physical facilities were organized for building inclusive communities as well as the level of information provided to align expectations among stakeholders. Involving older citizens in the co-production of age-friendly community initiatives has the potential to take the identified challenges into account. To understand what constitutes an optimal environment for healthy ageing further research in collaboration with older citizens is needed.

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Introduction.

Europe has an ageing population. Over the last ten years, there has been an increase in citizens aged 65 years and over from 16 to 21% and the share of citizens aged 80 years and over has doubled 1 . This demographic transition increases the demand for healthcare and other housing alternatives for the elderly population that prefer to live on their own. Other approaches for promoting healthy ageing must be considered in order to fulfil the needs of this generation. Within our study we understand healthy ageing 2 defined as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’ 3 .

One way to support healthy ageing is through the creation of age-friendly communities 4 in which municipal/government policies, services and structures related to the physical and social environment are designed to support and enable older citizens to “age actively”, that is, to live in security, enjoy good health and continue to participate fully in society 5 .

Several countries and cities around the world are engaged in the Global Network for Age-Friendly Cities and Communities (AFCC) which builds on the idea that both the physical and social environment affect physical and mental health and well-being and thus quality of life 6 , 7 .

In recent years there has been rising demand for in-between solutions to meet the needs of citizens entering older adulthood. Senior co-housing communities 8 , 9 , 10 , 11 , which are a mixture of individual housing units with shared facilities, striking a balance between privacy and shared spaces 12 , multigenerational housing forms where different generations live together within a larger-scale intergenerational co-housing 13 , 14 , 15 , 16 , and accommodation with technology and opportunities for daily assistance and care 17 , 18 , 19 , 20 are being implemented. Common to all housing forms are the support and comfort offered through social contacts with partners, family, friends and neighbours or professional careers.

Social contacts seem to enrich life and become more important as citizens get older 21 , 22 , and the availability of social contacts and one’s ability to participate in social interactions are regarded as important to maintain healthy ageing and mitigate loneliness 23 , 24 . It is well-known that the health status among older citizens is strengthened by networks and social relations because of increased terms of belonging, independence and safety 25 . Social participation, according to the World Health Organization (WHO), involves empowering people, communities, and civil society by including them in decision-making processes that impact health at all levels of the system and through the policy cycle 26 . According to Arnstein´s Ladder of Citizen Participation, participation exists in various forms, categorized into eight levels that represent different degrees of citizen power. These levels fall under three overarching categories: nonparticipation, tokenism and citizen power 27 and can be used to determine the level of participation of older citizens 28 .

Professional social networks in the communities, especially senior housing and nursing homes, are in Denmark often driven by the municipality with some support from voluntary and community organizations 2 . However, policy initiatives are increasingly focused on involving older citizens in the delivery of public services, aiming to reduce healthcare costs, provide high-quality service, and increase citizen satisfaction with the services delivered 29 , 30 . There has been a rising interest on advancement of collaborative and co-productive approaches in local health policies 31 , 32 , 33 and the concepts of co-creation and co-production have gained attention as potential solutions to welfare challenges 34 , 35 . Co-creation emerged from private sector commercial business 36 , while co-production stems from the public sector, in which Elinor Ostrom observed and documented the positive effect of active involvement of users on the quality and effect of public services in the 1970s 37 , 38 . Brandsen and Honingh argue that co-creation and co-production are two different concepts, in which co-creation deals with involving citizens in the design and planning phase and co-production involves citizens in the implementation of services 36 . In literature the two terms are often used as synonyms 30 but in relation to involvement of users in the public sector it is suggested to phase out the term, co-creation, to be able to create coherence between the how, when and why users are involved in co-production 39 . The fundamental element of co-production is the equitable distribution of power so that recipients of public services have real control over their desires, needs, and expectations 35 . Users will become members of the public organization and are expected to take an active part in it, changing the roles that users and the public play. This shift in the balance of power places demands on the organization as well as the users, since it must guarantee that users, front-line staff, management, and politicians work together to build and produce welfare 39 . As we concentrate on co-production about public services and outcomes and an equal distribution of power between citizens and the public, we lean on the definition by Loeffler and Bovaird, 2013: “Professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improved efficiency” 35 .

The involvement of older citizens has primarily been in the healthcare sector where there is an increased recognition of the benefits of involving patients and their relatives to optimize service delivery and patient outcomes 40 , 41 . In addition, the involvement of older citizens as co-researchers has grown in the past 20 years 42 .

Studies on the involvement of older citizens in the planning and development of age-friendly communities are on the rise, in particular various ways to engage older citizens in the development of new housing initiatives 28 . However, concrete examples of the involvement of older citizens often evolve around the conceptual development and design phases of housing solutions of homes and buildings 43 or transformations of existing housing units for older citizens 44 . To contribute to the field of age-friendly community building, we believe it is crucial to explore a co-production initiative within a recently established senior village. This exploration will enable us to provide recommendations on creating optimal environments for healthy ageing.

Aim of the study

To increase our understanding of the involvement of older citizens in the planning and development of an age-friendly community initiative and to identify barriers and potentials for refinement of co-production with older citizens, this qualitative study aims to investigate a co-production initiative between older citizens, a municipality, and a real estate company in a newly established senior village. The primary research questions are:

How does the organizational setting and physical environment influence the co-production process?

What other factors influence citizens´ engagement and perceptions of the co-production process?

The study was conducted in a senior village in a municipality on the west coast of Denmark developed in line with the aim the vision of the municipality ‘to create a framework for seniors to live a good and dignified senior life, where they have control over their existence and ample opportunities to live a physically and mentally healthy life with strong social relationships’ 45 .

Shown in Fig.  1 , the senior village consists of a public nursing home (centrally situated), two senior housing blocks with atrium courtyards (each side of the nursing home) administered by a private real-estate company, medical facilities (far right corner), and a variety of shared facilities to offer their seniors a safe environment with opportunities to stay social and active 46 . The municipality engaged in the project has been a part of the AFCC since 2018 and is thus obligated to have an age-friendly vision and strategies by offering facilities, services and activities that support healthy ageing 47 .

The senior village with nursing home, senior housing, and medical facilities. Obtained from https://danskboligbyg.dk/c/aktuelt/krebsehusene-rejsegilde-paa-fremtidens-seniorby . Picture taken by the turnkey contractor, Dansk Boligbyg ( https://danskboligbyg.dk/ ) and owned by entrepreneur, Claus Sørensen Ejendomme A/S ( https://www.csgruppen.dk/en/ejendomme/ ).

Study design

We conducted an explorative qualitative study in the senior village from March to August 2023. To guide the evaluation of the co-production initiative in the senior village, we introduced the user-oriented Danish BIKVA model (“Brugerinddragelse i kvalitetsvurdering”) which in English is “service user involvement in quality development” 48 , 49 .

The BIKVA model consists of four steps (Fig.  2 ). The first step is a group interview with users in which they present their view of the service provided; positive as well as negative. Secondly, their subjective experiences and statements are then thematically systemized and presented to front-line staff (employees in direct contact with users). In a group interview with front-line staff, the statements from the users are discussed and their practice is reflected on. In step three, statements from users and front-line staff are presented to managers for them to discuss and reflect on. Ideally, politicians are involved as the fourth and last step of the evaluation, who, based on a summary of the statements from the users, front-line personnel and management, must assess the causes of problems and decide how to develop the practice 48 , 50 . The fourth step was, however not included in the evaluation of the co-production process in the senior village as politicians were not involved in the process.

Modified BIKVA flow chart 39 illustrating the interview process. Generated by first author using draw.oi (version 1, https://www.drawio.com ).

Study population, sampling, and data collection

For the first step of the evaluation process, we recruited older citizens 60+ years of age to take part in an activity that had been co-produced via purposeful sampling, while an additional group were recruited via snowball sampling. The aim was to include a diverse sample of older citizens with regards to age (60 ± years of age), gender, educational level, and residence (nursing home, senior housing, and neighbouring area). Participants for the first step of the evaluation process were purposefully sampled via an employee from the municipality and via other older citizens in the senior village.

For the second and third steps of the evaluation process frontline staff in the senior village and management respectively were recruited via purposeful sampling by email. We wanted to include frontline staff who were often in direct contact with the older people in the senior village and management responsible for the co-production. Frontline staff were one facilitator/coordinator of the co-production of activities in the shared facilities, two nurses from the nursing home, one nurse from the in-house nurse clinic, one physiotherapist from the fitness centre, one kitchen leader and one kitchen staff from the café. Managers from the municipality, responsible for the co-production initiative, were one manager of the health department, one leader responsible for activity centres in the municipality, and one coordinator of activities, while the interviewees from the real estate company were one manager and one person responsible for the real estate facilities in the senior village.

All interviews followed an interview guide consisting of questions related to the older citizens’ experience of moving to or using the shared facilities in a newly established senior village, their view of the physical facilities and surroundings in the senior village, their perception of being involved in co-production of arrangement and activities in the shared facilities, and questions related to their expectations to the senior village. As guided by the second step in the model, the subjective experiences and statements of the older citizens were transcribed, thematized and presented to seven front-line staff members. For the last step of the BIKVA-model evaluation, the summary of the statements from the older citizens and front-line staff formed the basis for the last interview guide for a focus group interview with the municipality and the real-estate company management. The participants in the final focus group discussed and evaluated the statements and came up with ideas as to how to solve potential problems.

For the focus group interviews at steps 2 and 3 with front-line staff and managers respectively, a student assistant from the university, observed the interviews looking for non-verbal cues such as body language and significant interactions or group dynamics, and provided feedback to the researcher after the interview.

Data analysis

All interviews were audio-recorded and automatically transcribed using the transcript software Good Tape 51 . To assure reliability, the automatic transcriptions were subsequently reviewed by the researcher and compared with the audio recordings.

Data transcripts were exported to NVivo version 12.0 52 and inductively analysed using reflexive thematic analysis by Braun and Clarke 53 .

To help guide the analysis a six-phase process was followed iteratively. As an initial step, the researcher got familiar with the data by listening to the audio recordings and taking notes. Secondly, data were systematically coded in NVivo, and initial themes were generated. The themes were then reviewed and further developed by re-exploring the data and the final themes were defined and named.

Characteristics of study participants

The demographic characteristics of the participants of the BIKVA evaluation are summarized in Table 1 .

Just over half of the older citizens were women (56%). The median age of all participants was 75 years of age with a range of 60–90 years. Most participants lived in the senior housing (67%) or the neighbouring area (31%), while one participant was from the nursing home. Almost all participated in an activity (92%), while 19% had been involved in the co-production process.

In the focus group with front-line staff (step 2), most participants were female (86%) all employed by the municipality in various positions in the senior village. Half of the staff (43%) had been involved in the co-production process.

The third and last step of the evaluation process included five participants at the management level (4 men and 1 woman). Three participants represented the municipality while two participants came from the real-estate company.

Overall, six themes emerged from the thematic analysis as summarized in Fig.  3 . All themes were divided into three broader categories organizational, environmental, and other challenges affecting co-production and unfolded below by statements from interviewees.

Categories and themes of the thematic analysis. Generated by first author using draw.oi (version 1, https://www.drawio.com ).

Impact of the organizational setting on co-production

The municipal organization shows up as one of the most important themes therefore, to understand how the co-production process was organized in the senior village, an organizational chart of stakeholders is presented in Fig.  4 .

Stakeholders in the co-production process. Generated by first author using draw.oi (version 1, https://www.drawio.com ).

The municipal management initiated the co-production process and informed frontline staff and citizens about the initiative through a written invitation to a joined information meeting and workshop before establishing the senior village. The purpose of the meeting was to inform about the reasons for establishing the senior village, information about facilities and the citizens´ possibility to co-produce arrangements of rooms and activities. As part of the co-production initiative and aim to build communities, the municipality left the 2200 m 2 ground floor of the nursing home open for citizens from the nursing home, the senior housing, and the neighbouring area to arrange rooms and create activities. Also, the two atrium courtyards at the senior housing blocks were kept open by the real estate company for citizens to enjoy. Three separate information meetings and workshops were carried out, each with 50 citizens from the senior housing, nursing home or neighbouring area respectively. Citizens interested in contributing ideas for arrangements and activities in the shared facilities continued the work in a joint workshop. All workshops were facilitated by staff from the municipality. According to both the management in the municipality and the real estate company, the ambition of the senior village was to create a framework for the municipality’s older citizens that enhances their quality of life through easy access to healthcare services and communities with co-produced activities.

Municipal organization—bridging the gap with frontline staff

Creating a senior village with communities across nursing homes and senior housing proved more difficult than expected as mentioned by the municipal management. In their effort to include citizens as much as possible in the co-production of arrangements of rooms and activities frontline staff were not included in the decisions around the organization of rooms at the ground floor or included in the co-production of activities together with citizens. Frontline staff were primarily informed about the concept of co-production as being a process with citizens initiating activities and organizing rooms, leaving frontline staff no influence on matters as expressed by nursing home staff:

But we were informed, but it was more of an information. This is the vision, and this is how it will be. And sometimes you can still feel a bit like we don’t have a say, even though we can see something that could be done differently, but it gets shut down. (Frontline staff, nursing home)

Not involving frontline staff in the entire co-production process has resulted in a lack of relations with senior housing residents and a greater division of units, which may hinder future collaboration and communication between municipal frontline staff and senior housing residents. The nursing home staff said:

The relationship we currently have with the seniors (senior housing residents) ... Of course, we have some couples where one spouse lives over there (in the senior housing) ... that’s where we build these relationships, but otherwise, we don’t have any relationship with them because we’re not involved in that. So, we almost become guests in our own house, and then it becomes ‘us and them.’ Because we’re not part of each other, and I think that’s a shame. (Frontline staff, nursing home)

To solve this issue, frontline staff believed that greater involvement of frontline staff in decisions together with citizens and management would optimize the co-production process and increase their interest and ownership as expressed by staff from the kitchen:

And that’s what I understand by co-production, that we want to be involved. We just need to be listened to and involved, because otherwise, you don’t have ownership over it. (Frontline staff, kitchen)

Frontline staff and municipal management did however not agree on the level of involvement. The municipal management believed that frontline staff had been involved in steering group meetings before the co-production process with citizens and did not want further involvement from the frontline after the establishment of the senior village. When presented with statements from frontline staff regarding the matter, municipal management believed that frontline staff were stuck in old roles and that a cultural change was needed in the organization to address the resistance to the type of co-production that the municipality’s management had envisioned.

To create the best conditions for future collaboration on co-production within the organization, bridging the gap between frontline staff and municipal management perspectives on the degree of involvement in the co-production process is essential.

Impact of the physical environment on co-production

Organization of facilities.

The organization of the physical facilities in the senior village was regarded positively when it came to access to healthcare and the availability of activities on the ground floor of the nursing home. Residents considered having the doctor and nurse nearby gave them a sense of security not having to travel long distances to see a doctor.

In the shared facilities on the ground floor of the nursing home, the area around the kitchen created a lot of debate among citizens, frontline staff, and municipal leaders. Citizens expected a cafeteria in the shared facilities which would act as a place to gather around meals and events in a cozy environment. However, the kitchen is run by municipal staff, primarily catering to the nursing home with the option for senior housing residents and neighbouring citizens to pre-order meals. According to residents, having to pre-order meals limited the number of residents and neighbouring citizens visiting the kitchen. The area around the kitchen thus became more of a passage for entering activity groups instead of a shared environment with a nice atmosphere. Frontline staff believed that the missing atmosphere was due to citizens not coming to the area even though frontline staff at the kitchen made several attempts to attract customers. Besides they experienced the area becoming more of an information centre for visitors to the nursing home and drop off for postal service, which did not leave frontline staff much time to create a nice atmosphere and attract customers. Municipal leaders, however, believed that bringing life to the area and initiating common meals and events was still to come from citizens being true to the concept of co-production with citizens as initiators of ideas and activities. The different opinions of who would initiate activities and create an atmosphere in the area created tension among citizens, frontline staff and municipal leaders.

According to a senior housing resident, they regarded the atrium courtyards private as they pay a monthly rent whereas the shared facilities on the municipality’s premises were public:

It’s once again the misunderstanding that was created when they made this project. Because you’re creating a private development with locked doors, and of course, we consider that ours because it’s part of our rent that we pay to have those facilities. And that’s the whole difference, it’s private, whereas the other is public. So, you can’t compare them in the same way. (Senior housing resident)

Frontline staff the other hand were convinced that there was a mutual sharing of facilities as access to atrium courtyards would be beneficial for nursing home residents:

That’s also what was implied... that we all gave a little, and then everyone gave a little, and then the atrium courtyards are completely closed off to us (the nursing home). In the beginning, they were open, so our residents could go in there, and it gave them some peace. We don’t want a constant stream of citizens coming over here. That’s not what we want, but just a walk around, that’s something we would like. (Frontline staff, nursing home)

Building inclusive communities

One of the goals of building a nursing home and senior housing close together was to create synergy between the two units and offer residents inclusive communities in the common areas on the ground floor and in the atriums connected to the senior housing.

Participating in the co-produced activities provided senior housing-, nursing home residents and neighbouring citizens an opportunity to build communities. They expressed great satisfaction in being a part of an inclusive community. A close neighbouring citizen was welcomed by a senior housing resident in the billiard community and enjoyed spending time together with other men in a community including everyone despite personal limitations:

So, I’ve come this far since I met X (senior housing resident) and then we’ve started this up more or less together, and we simply find it so cosy. It’s something we all can do. I mean, our rules and our laws, everything is such that everyone can participate. You can see, even someone like Y (nursing home resident) can participate (Neighbouring citizen)

Despite good intentions, creating a senior village as one entity where residents collectively build activities and more resourceful citizens assist weaker citizens has not been successful according to the municipal management:

There isn’t the connection we thought we could achieve, and that’s probably because the residents over there (senior housing) are too frail to engage in activities. So, they can’t muster the energy to support those who are even weaker. We haven’t achieved that synergy effect (Municipal management)

The communities that have emerged around the co-produced activities in the shared facilities on the municipality’s premises were characterized by the fact that it was primarily residents from the senior housing who initiated and participated in activities. Nursing home residents did not participate in the co-produced activities but attended events organized by the nursing home itself. According to frontline staff, these siloed communities could be attributed to several factors. First and foremost, they believed that the lack of participation was due to residents being both physically and mentally limited and that there was also not enough staff to accompany residents to activities. Frontline staff also believed that residents of the senior housing did not have the resources or sufficient knowledge to take care of nursing home residents during activities. They missed volunteers who could bring nursing home and senior housing residents together in activities. However, the physical planning of the senior village, with a nursing home on five floors and secured to prevent residents with dementia from leaving the building unattended, did not invite spontaneous access and visits by volunteers.

Other challenges affecting co-production

Information gaps.

Despite the municipality informing citizens about facilities and their intention to co-production arrangements of rooms and activities at information meetings and workshops, several citizens were not aware of the possibility of engaging in the co-production process. Only residents already assigned to the senior housing and nursing home as well as a limited number of neighbouring citizens received an invitation and were able to join the information meeting and workshops. For that reason, newcomers to the nursing home and senior housing did not know of the facilities and the municipality’s intentions of co-producing arrangements of rooms and activities. A relative from the nursing home got the impression that the co-production process was solely for residents in senior housing. She said:

It just seemed like it was mostly for those who lived in the senior housing. And we don’t live there. The municipality clearly stated that 3 million kroner were allocated for arrangement here. And it was the users who were supposed to arrange it. It is not my impression that anyone from the nursing home has been involved in the arrangement. That, I think, is a deficiency. (Relative, nursing home)

Information on the availability of activities in the senior village was lacking according to citizens from the neighbouring area. Some were surprised by the number of activities offered and the possibility of making use of the activities together with senior housing and nursing home residents:

I have a father who is on the fourth floor here at the nursing home. And it’s because of that, I look at the bulletin board. If it hadn’t been for that, I would never have received information that there was an offer here about various leisure activities. And I have also talked to some people around here over Easter, who live in the area. Well, they don’t know anything about it. (Neighbouring citizen and relative, nursing home)

In line with this, frontline staff missed information from the management as well and experienced uncertainty about the framework for participation in the senior village and to which extent neighbouring citizens could make use of the shared facilities:

But it (the information) is generally word of mouth. Suddenly, I can have someone call the fitness centre who wants this free offer because they heard it from someone else. And I’ve often been faced with, what is the neighbouring area? It’s quite complex to answer because I don’t have a framework for it. (Physiotherapist, shared facilities)

Not only frontline staff miss a framework. Citizens engaged in the co-production of arrangements of rooms and activities missed information about the financial ceiling for purchasing equipment for the shared facilities and how to organize rooms to meet everyone’s needs. A woman in the creative workshop said:

We have received everything we have come up with to use, and it’s fantastic, but then the problem, the way I see it, was that they could have made some frames so we knew something about, well, how much should it cost? How many should share a space? Or what’s the idea behind it? And we couldn’t get any information about it at all. (Senior housing resident)

Navigating expectations

Despite varying degrees of information about the new senior village and its activities, most informants believed that the senior village had met their expectations overall. Several respondents expressed great satisfaction, especially with the communities formed across activities and around the senior housing:

For my part, I would say that what reality is today, has far exceeded the expectations I had. Of course, there have been some things that haven´t been good enough. But my expectations have certainly been more than met. Especially with the social aspect, the companionship, and so on. I think it´s great. (Senior housing resident)

At some points, the information provided by the municipality and real-estate company was not clear as to which facilities were available and to whom. As mentioned earlier, citizens expected a cafeteria in the shared facilities which would act as a place to gather around meals and events in a cozy environment and a place for overnight guests. Citizens’ expectations were thus not met generating a negative mood among citizens and creating a distrust in the municipality and real-estate company. On behalf of the focus group informants, a senior housing resident expressed the following:

Well, the whole setup, also in the public space where they (the municipality and the real-estate company) describe this project with the senior village, it was kind of implied that it included both a cafeteria and the possibility of having guests overnight, which then turns out not to be the case because these things are only related to the nursing home. They (the municipality and the real-estate company) haven’t been good enough at distinguishing between the two (nursing home and senior housing). (Senior housing resident)

Harmonizing roles

As communicated at information meetings and workshops, the municipality expected citizens to initiate and run activities in line with the concept of co-production. In addition, the municipality aimed for residents at the senior housing to act as volunteers and include nursing home residents in activities. However, the expectations from the municipality exceeded citizens’ experienced resources leading to role strains with citizens having difficulties fulfilling the expectations. Some citizens believed that not being able to initiate and run activities or take care of nursing home residents was due to the old age of senior housing residents, being higher than expected, while others suggested that lack of personal resources was the main cause as expressed by one senior housing resident:

I feel that they (the municipality) have some expectations of us that I find unreasonable. We have people who are sick, we have people with spouses at the nursing home whom they must take care of, and we have people with all sorts of difficulties and problems. And if they (the municipality) think that we should include others who may have some problems... I don’t think we have the capacity for that. (Senior housing resident)

During interviews and observations in the senior village, it became clear that only a few residents from the senior housing were initiators of activities. Besides old age and lack of personal resources, some residents expressed that moving to the senior village was their time to enjoy their retirement and not be responsible for activities as described by a resident from the senior housing:

We’re all seniors, and we’ve been active our whole lives, both as chairpersons and in many other roles in associations. Now, it’s as if we should also start enjoying things. (Senior housing resident)

That citizens did not assume the roles that the municipality had hoped for means that there is a need for a new distribution of roles to create new activities for and with the citizens. On several occasions frontline staff had come up with ideas for new activities but experienced a need for additional support to help get the citizens started:

I experience that the motivation and drive for those who should be the driving force, it’s not there. I think that if someone else started it, maybe others would join in…. (Coordinator of activities, shared facilities)

His assumption was supported by the real estate company, which regularly holds meetings with the residents of the senior housing. They believed that residents were requesting assistance in initiating and running activities. To support the co-production of activities in the senior village it became clear during the interviews that the level of information from the municipality and real-estate company plays a crucial role in the collaboration with citizens. To support the co-production of activities timely communication and clarity of expectations and roles between stakeholders seems essential.

In this study we explored a co-production initiative between older citizens a municipality, and a real-estate company in a Danish senior village (1) to identify how the physical environment and the organizational setting influenced the co-production process and (2) to describe other factors influencing citizens’ engagement and perceptions of the co-production process.

We identified that the municipal management and real-estate company initially managed to involve citizens in the co-production process. However, there were difficulties in properly informing citizens and frontline staff about the framework of the project and their roles as co-producers. The lack of information and involvement of frontline staff in the decision-making process may have affected the internal collaboration in the municipality as well as the relationships between citizens from the different units. We also found that residents were in general satisfied with the unique physical environment and the activities co-produced, but tension arose due to different opinions regarding the use of shared facilities and the development of sub-communities. In addition, the physical planning of the senior village may have affected the formation of siloed communities. Information gaps and sparse communication may have contributed to citizens’ expectations for the senior village, their role as co-producers and their willingness to participate, which addressed the need for clarity and support from stakeholders to facilitate the co-production process. In the following, the main findings will be discussed.

What to be aware of when building communities

The senior village, a unique collaboration between a public and private organization, aims to create an environment promoting healthy ageing. Our study found that creating a framework for the municipality’s older citizens has largely succeeded in building communities. In other studies, we found that social participation in activities and communities increased citizens’ sense of belonging, reduced loneliness, and fostered feelings of safety 25 , 54 , 55 . In addition, social relationships are found to be favourable for both the mental and physical health of older citizens, reduce mortality rates and increase overall quality of life 56 , 57 . However, challenges arose in creating a senior village with inclusive communities across nursing homes and senior housing.

The communities that emerged were divided, with limited interaction among residents from different units. While some co-produced activities involved participants from both senior housing, nursing homes, and the neighbouring area, most communities formed within the senior housing remained exclusive to their residents. The absence of nursing home residents in these shared facilities caused concern among relatives and frontline staff, who believed that community-building should extend beyond the municipality’s premises to the property company’s domain.

As suggested by frontline staff the physical planning may have contributed to the fragmentation of units but may also be due to resource constraints at both the personal and organizational level. That is; residents at the nursing home were mentally unable to participate fully in the co-production of activities and needed assistance from either relatives, volunteers, or nursing home staff, who on the other hand were limited by staff resources. Residents from the senior housing unit were not able to or interested in acting as volunteers and taking care of nursing home residents but wanted to enjoy the communities as they were with other senior housing residents. This finding is supported by a systematic review that identified barriers to social participation in older adults stating that individual factors such as health and motivation affected older citizens´ inclination to act as volunteers 58 .

The degree of stakeholder involvement in the co-production process may also have affected the communities built and the collaboration between the nursing home -and senior housing units as stated by frontline staff. Not only do citizens and management possess skills, knowledge and expertise, but so do frontline staff as service professionals 59 . Involving all stakeholders in the co-production process, could enhance the number of resources available and enable the management to make use of a diverse set of resources to assist their capabilities 60 , ideally with equal involvement and influence 61 . As stated by Loeffler and Bovaird, in their definition of co-production: “Professionals and citizens making better use of each other’s assets, resources and contributions to achieve better outcomes or improved efficiency” 35 , not involving frontline staff in the entire co-production process may have limited the overall collaboration between units.

The fragmented nature of the communities at the senior housing units and in the shared facilities on the municipality’s premises may impact the co-production of activities. Limited interaction between residents from senior housing and nursing homes, and differing perceptions of shared facilities pose challenges to collaboration. Additionally, the physical planning and factors such as physical and mental limitations among nursing home residents, and insufficient staffing may further hinder residents’ ability to participate in co-produced activities.

Information is key to matching expectations and distributing roles

Our study found that citizens generally had a positive attitude toward participating in co-production. Engaging in the process empowered them and increased their ownership of the activities co-produced as supported by other studies 62 , 63 . Active participation in the co-production process also enhanced greater satisfaction with the activities. This finding is in line with other research stating that citizen satisfaction is not only a motivation for engagement in co-production but also related to the concrete outcome co-produced 64 . Factors such as transparency and trustworthiness may however impact the degree of satisfaction and perceived quality of the public service co-produced 65 , 66 . As described in our findings, not all citizens’ expectations of the shared facilities were met. The degree of transparency from the municipality and real-estate company side may explain the dissatisfaction among citizens as enhanced transparency may elevate expectations, which in turn might mitigate the positive impacts of service quality and perceived citizen satisfaction 67 . We found that not meeting citizens´ expectations created distrust towards the municipality and the real-estate company. Trustworthiness is indeed a concept closely linked to the principles of co-production 30 , 68 and is important as distrust may be a barrier to co-production 69 . The presence of clear incentives is another important factor for successful co-production 30 . Our findings suggest that the level of information from the municipality and real-estate company was not adequate, as citizens expressed concerns about inadequate details related to finances, organization of facilities and follow-up procedures. Additionally, expectations regarding citizens’ roles as co-producers remained unclear.” As stressed in other studies, informing participants about the incentive and aim of the co-production initiative and matching expectations for outcome and roles, appropriate information and follow-up is crucial to guide participants in the process and to gain a successful outcome of the co-production process 70 , 71 .

While the intentions behind establishing an age-friendly senior village are positive, addressing these issues is crucial for future collaboration and optimization.”

Methodological considerations

As recruitment for the study was based on purposeful sampling to include citizens informed and involved in the co-production process, the focus groups mainly consisted of senior housing residents from activity groups, potentially leading to selection bias as nursing home residents and neighbouring citizens were underrepresented. Attempts to include more diverse participants through flyers yielded minimal participation. The study used focus group interviews to explore perceptions of the co-production initiative among citizens, frontline staff, and management. However, power dynamics during management interviews may have influenced responses suggesting individual interviews with management could mitigate this issue. Reflexive thematic analysis 53 was used for data analysis, leveraging the first author’s preexisting knowledge of the co-production process and participant views. However, there is a risk that these preconceptions may have impacted the analysis ‘objectivity. Going forward it is important to continue evaluating housing options for older citizens to create the best conditions for this generation in terms of health and well-being. In practice, exploring how public and private organizations may involve older citizens in the development of new housing forms is crucial, keeping in mind that older citizens are willing to engage under the right conditions. To investigate this, an exploration of their preferences for housing forms is necessary considering diversity and inequality within the target group, as one size does not fit all.

In conclusion, our study demonstrates that creating a healthy ageing environment through co-production is feasible. Citizens generally exhibit a positive attitude towards participating in co-production, which empowers them at different levels and enhances their ownership and satisfaction with the activities and the community in general. However, building healthy ageing environments through co-production is complex. Many interests are at stake, and it is challenging to meet everyone’s needs and expectations. The success of the co-production process is highly influenced by the organizational structure such as the level of involvement of stakeholders. The lack of frontline staff involvement in the decision-making affect internal municipal collaboration and the relationship between nursing home and senior housing units negatively affecting the overall result of co-production. Engaging all stakeholders, each possessing valuable knowledge and expertise, is vital for a fruitful process and outcome. In addition, the physical separation of nursing homes and senior housing units as well as different perceptions of shared facilities can lead to more isolated sub-communities hindering collaboration among all residents. Assuring adequate information during the entire co-production process to all stakeholders may improve communication to align expectations, increase the level of involvement at different levels and optimize outcomes. The findings of this paper contributes to the understanding of challenges associated with building healthy aging communities through co-production and highlights concerns that should be taken into consideration in future co-production relationships between the public and older citizens. To refine co-production practices and create healthier environments, future research on co-production with older citizens should explore how to properly engage multiple stakeholders in the process being aware of the impact of the physical planning on collaboration and community building as well as identifying optimal communication channels to assure adequate information throughout the process.

Data availability

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

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Acknowledgements

The authors would like to thank the older citizens in the senior village, frontline staff and management from the municipality and real-estate company for their genuine interest and participation in the study. Thanks to the student assistant from the University of Southern Denmark for doing observations during focus group interviews. Thanks to the University of Southern Denmark, Esbjerg municipality, Denmark, and the Alice and Tage Soerensen Foundation, Denmark for funding the study.

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Anne Seneca Terkelsen, Gabriel Gulis, Jørgen Jespersen & Pernille Tanggaard Andersen

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AST conducted the interviews and drafted the manuscript. GG, JJ, and PTA conceived and supervised the project. GG, JJ, and PTA helped in analysis and manuscript review. All authors read and approved the final manuscript.

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The study was conducted by the ethical principles for medical research presented in the Helsinki Declaration and the study protocol was approved by the legal department of the University of Southern Denmark. Participants were orally and written informed about the study’s objectives, data collection methods, and ethics. Informed consent was obtained from participants opting in agreeing to study terms and the option to withdraw at any time during the study period.

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Seneca Terkelsen, A., Gulis, G., Jespersen, J. et al. A qualitative study of healthy ageing and co-production. Sci Rep 14 , 21239 (2024). https://doi.org/10.1038/s41598-024-71787-4

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Qualitative Research: Getting Started

Introduction.

As scientifically trained clinicians, pharmacists may be more familiar and comfortable with the concept of quantitative rather than qualitative research. Quantitative research can be defined as “the means for testing objective theories by examining the relationship among variables which in turn can be measured so that numbered data can be analyzed using statistical procedures”. 1 Pharmacists may have used such methods to carry out audits or surveys within their own practice settings; if so, they may have had a sense of “something missing” from their data. What is missing from quantitative research methods is the voice of the participant. In a quantitative study, large amounts of data can be collected about the number of people who hold certain attitudes toward their health and health care, but what qualitative study tells us is why people have thoughts and feelings that might affect the way they respond to that care and how it is given (in this way, qualitative and quantitative data are frequently complementary). Possibly the most important point about qualitative research is that its practitioners do not seek to generalize their findings to a wider population. Rather, they attempt to find examples of behaviour, to clarify the thoughts and feelings of study participants, and to interpret participants’ experiences of the phenomena of interest, in order to find explanations for human behaviour in a given context.

WHAT IS QUALITATIVE RESEARCH?

Much of the work of clinicians (including pharmacists) takes place within a social, clinical, or interpersonal context where statistical procedures and numeric data may be insufficient to capture how patients and health care professionals feel about patients’ care. Qualitative research involves asking participants about their experiences of things that happen in their lives. It enables researchers to obtain insights into what it feels like to be another person and to understand the world as another experiences it.

Qualitative research was historically employed in fields such as sociology, history, and anthropology. 2 Miles and Huberman 2 said that qualitative data “are a source of well-grounded, rich descriptions and explanations of processes in identifiable local contexts. With qualitative data one can preserve chronological flow, see precisely which events lead to which consequences, and derive fruitful explanations.” Qualitative methods are concerned with how human behaviour can be explained, within the framework of the social structures in which that behaviour takes place. 3 So, in the context of health care, and hospital pharmacy in particular, researchers can, for example, explore how patients feel about their care, about their medicines, or indeed about “being a patient”.

THE IMPORTANCE OF METHODOLOGY

Smith 4 has described methodology as the “explanation of the approach, methods and procedures with some justification for their selection.” It is essential that researchers have robust theories that underpin the way they conduct their research—this is called “methodology”. It is also important for researchers to have a thorough understanding of various methodologies, to ensure alignment between their own positionality (i.e., bias or stance), research questions, and objectives. Clinicians may express reservations about the value or impact of qualitative research, given their perceptions that it is inherently subjective or biased, that it does not seek to be reproducible across different contexts, and that it does not produce generalizable findings. Other clinicians may express nervousness or hesitation about using qualitative methods, claiming that their previous “scientific” training and experience have not prepared them for the ambiguity and interpretative nature of qualitative data analysis. In both cases, these clinicians are depriving themselves of opportunities to understand complex or ambiguous situations, phenomena, or processes in a different way.

Qualitative researchers generally begin their work by recognizing that the position (or world view) of the researcher exerts an enormous influence on the entire research enterprise. Whether explicitly understood and acknowledged or not, this world view shapes the way in which research questions are raised and framed, methods selected, data collected and analyzed, and results reported. 5 A broad range of different methods and methodologies are available within the qualitative tradition, and no single review paper can adequately capture the depth and nuance of these diverse options. Here, given space constraints, we highlight certain options for illustrative purposes only, emphasizing that they are only a sample of what may be available to you as a prospective qualitative researcher. We encourage you to continue your own study of this area to identify methods and methodologies suitable to your questions and needs, beyond those highlighted here.

The following are some of the methodologies commonly used in qualitative research:

• Ethnography generally involves researchers directly observing participants in their natural environments over time. A key feature of ethnography is the fact that natural settings, unadapted for the researchers’ interests, are used. In ethnography, the natural setting or environment is as important as the participants, and such methods have the advantage of explicitly acknowledging that, in the real world, environmental constraints and context influence behaviours and outcomes. 6 An example of ethnographic research in pharmacy might involve observations to determine how pharmacists integrate into family health teams. Such a study would also include collection of documents about participants’ lives from the participants themselves and field notes from the researcher. 7
• Grounded theory, first described by Glaser and Strauss in 1967, 8 is a framework for qualitative research that suggests that theory must derive from data, unlike other forms of research, which suggest that data should be used to test theory. Grounded theory may be particularly valuable when little or nothing is known or understood about a problem, situation, or context, and any attempt to start with a hypothesis or theory would be conjecture at best. 9 An example of the use of grounded theory in hospital pharmacy might be to determine potential roles for pharmacists in a new or underserviced clinical area. As with other qualitative methodologies, grounded theory provides researchers with a process that can be followed to facilitate the conduct of such research. As an example, Thurston and others 10 used constructivist grounded theory to explore the availability of arthritis care among indigenous people of Canada and were able to identify a number of influences on health care for this population.
• Phenomenology attempts to understand problems, ideas, and situations from the perspective of common understanding and experience rather than differences. 10 Phenomenology is about understanding how human beings experience their world. It gives researchers a powerful tool with which to understand subjective experience. In other words, 2 people may have the same diagnosis, with the same treatment prescribed, but the ways in which they experience that diagnosis and treatment will be different, even though they may have some experiences in common. Phenomenology helps researchers to explore those experiences, thoughts, and feelings and helps to elicit the meaning underlying how people behave. As an example, Hancock and others 11 used a phenomenological approach to explore health care professionals’ views of the diagnosis and management of heart failure since publication of an earlier study in 2003. Their findings revealed that barriers to effective treatment for heart failure had not changed in 10 years and provided a new understanding of why this was the case.

ROLE OF THE RESEARCHER

For any researcher, the starting point for research must be articulation of his or her research world view. This core feature of qualitative work is increasingly seen in quantitative research too: the explicit acknowledgement of one’s position, biases, and assumptions, so that readers can better understand the particular researcher. Reflexivity describes the processes whereby the act of engaging in research actually affects the process being studied, calling into question the notion of “detached objectivity”. Here, the researcher’s own subjectivity is as critical to the research process and output as any other variable. Applications of reflexivity may include participant-observer research, where the researcher is actually one of the participants in the process or situation being researched and must then examine it from these divergent perspectives. 12 Some researchers believe that objectivity is a myth and that attempts at impartiality will fail because human beings who happen to be researchers cannot isolate their own backgrounds and interests from the conduct of a study. 5 Rather than aspire to an unachievable goal of “objectivity”, it is better to simply be honest and transparent about one’s own subjectivities, allowing readers to draw their own conclusions about the interpretations that are presented through the research itself. For new (and experienced) qualitative researchers, an important first step is to step back and articulate your own underlying biases and assumptions. The following questions can help to begin this reflection process:

• Why am I interested in this topic? To answer this question, try to identify what is driving your enthusiasm, energy, and interest in researching this subject.
• What do I really think the answer is? Asking this question helps to identify any biases you may have through honest reflection on what you expect to find. You can then “bracket” those assumptions to enable the participants’ voices to be heard.
• What am I getting out of this? In many cases, pressures to publish or “do” research make research nothing more than an employment requirement. How does this affect your interest in the question or its outcomes, or the depth to which you are willing to go to find information?
• What do others in my professional community think of this work—and of me? As a researcher, you will not be operating in a vacuum; you will be part of a complex social and interpersonal world. These external influences will shape your views and expectations of yourself and your work. Acknowledging this influence and its potential effects on personal behaviour will facilitate greater self-scrutiny throughout the research process.

FROM FRAMEWORKS TO METHODS

Qualitative research methodology is not a single method, but instead offers a variety of different choices to researchers, according to specific parameters of topic, research question, participants, and settings. The method is the way you carry out your research within the paradigm of quantitative or qualitative research.

Qualitative research is concerned with participants’ own experiences of a life event, and the aim is to interpret what participants have said in order to explain why they have said it. Thus, methods should be chosen that enable participants to express themselves openly and without constraint. The framework selected by the researcher to conduct the research may direct the project toward specific methods. From among the numerous methods used by qualitative researchers, we outline below the three most frequently encountered.

DATA COLLECTION

Patton 12 has described an interview as “open-ended questions and probes yielding in-depth responses about people’s experiences, perceptions, opinions, feelings, and knowledge. Data consists of verbatim quotations and sufficient content/context to be interpretable”. Researchers may use a structured or unstructured interview approach. Structured interviews rely upon a predetermined list of questions framed algorithmically to guide the interviewer. This approach resists improvisation and following up on hunches, but has the advantage of facilitating consistency between participants. In contrast, unstructured or semistructured interviews may begin with some defined questions, but the interviewer has considerable latitude to adapt questions to the specific direction of responses, in an effort to allow for more intuitive and natural conversations between researchers and participants. Generally, you should continue to interview additional participants until you have saturated your field of interest, i.e., until you are not hearing anything new. The number of participants is therefore dependent on the richness of the data, though Miles and Huberman 2 suggested that more than 15 cases can make analysis complicated and “unwieldy”.

Focus Groups

Patton 12 has described the focus group as a primary means of collecting qualitative data. In essence, focus groups are unstructured interviews with multiple participants, which allow participants and a facilitator to interact freely with one another and to build on ideas and conversation. This method allows for the collection of group-generated data, which can be a challenging experience.

Observations

Patton 12 described observation as a useful tool in both quantitative and qualitative research: “[it involves] descriptions of activities, behaviours, actions, conversations, interpersonal interactions, organization or community processes or any other aspect of observable human experience”. Observation is critical in both interviews and focus groups, as nonalignment between verbal and nonverbal data frequently can be the result of sarcasm, irony, or other conversational techniques that may be confusing or open to interpretation. Observation can also be used as a stand-alone tool for exploring participants’ experiences, whether or not the researcher is a participant in the process.

Selecting the most appropriate and practical method is an important decision and must be taken carefully. Those unfamiliar with qualitative research may assume that “anyone” can interview, observe, or facilitate a focus group; however, it is important to recognize that the quality of data collected through qualitative methods is a direct reflection of the skills and competencies of the researcher. 13 The hardest thing to do during an interview is to sit back and listen to participants. They should be doing most of the talking—it is their perception of their own life-world that the researcher is trying to understand. Sophisticated interpersonal skills are required, in particular the ability to accurately interpret and respond to the nuanced behaviour of participants in various settings. More information about the collection of qualitative data may be found in the “Further Reading” section of this paper.

It is essential that data gathered during interviews, focus groups, and observation sessions are stored in a retrievable format. The most accurate way to do this is by audio-recording (with the participants’ permission). Video-recording may be a useful tool for focus groups, because the body language of group members and how they interact can be missed with audio-recording alone. Recordings should be transcribed verbatim and checked for accuracy against the audio- or video-recording, and all personally identifiable information should be removed from the transcript. You are then ready to start your analysis.

DATA ANALYSIS

Regardless of the research method used, the researcher must try to analyze or make sense of the participants’ narratives. This analysis can be done by coding sections of text, by writing down your thoughts in the margins of transcripts, or by making separate notes about the data collection. Coding is the process by which raw data (e.g., transcripts from interviews and focus groups or field notes from observations) are gradually converted into usable data through the identification of themes, concepts, or ideas that have some connection with each other. It may be that certain words or phrases are used by different participants, and these can be drawn together to allow the researcher an opportunity to focus findings in a more meaningful manner. The researcher will then give the words, phrases, or pieces of text meaningful names that exemplify what the participants are saying. This process is referred to as “theming”. Generating themes in an orderly fashion out of the chaos of transcripts or field notes can be a daunting task, particularly since it may involve many pages of raw data. Fortunately, sophisticated software programs such as NVivo (QSR International Pty Ltd) now exist to support researchers in converting data into themes; familiarization with such software supports is of considerable benefit to researchers and is strongly recommended. Manual coding is possible with small and straightforward data sets, but the management of qualitative data is a complexity unto itself, one that is best addressed through technological and software support.

There is both an art and a science to coding, and the second checking of themes from data is well advised (where feasible) to enhance the face validity of the work and to demonstrate reliability. Further reliability-enhancing mechanisms include “member checking”, where participants are given an opportunity to actually learn about and respond to the researchers’ preliminary analysis and coding of data. Careful documentation of various iterations of “coding trees” is important. These structures allow readers to understand how and why raw data were converted into a theme and what rules the researcher is using to govern inclusion or exclusion of specific data within or from a theme. Coding trees may be produced iteratively: after each interview, the researcher may immediately code and categorize data into themes to facilitate subsequent interviews and allow for probing with subsequent participants as necessary. At the end of the theming process, you will be in a position to tell the participants’ stories illustrated by quotations from your transcripts. For more information on different ways to manage qualitative data, see the “Further Reading” section at the end of this paper.

ETHICAL ISSUES

In most circumstances, qualitative research involves human beings or the things that human beings produce (documents, notes, etc.). As a result, it is essential that such research be undertaken in a manner that places the safety, security, and needs of participants at the forefront. Although interviews, focus groups, and questionnaires may seem innocuous and “less dangerous” than taking blood samples, it is important to recognize that the way participants are represented in research can be significantly damaging. Try to put yourself in the shoes of the potential participants when designing your research and ask yourself these questions:

• Are the requests you are making of potential participants reasonable?
• Are you putting them at unnecessary risk or inconvenience?
• Have you identified and addressed the specific needs of particular groups?

Where possible, attempting anonymization of data is strongly recommended, bearing in mind that true anonymization may be difficult, as participants can sometimes be recognized from their stories. Balancing the responsibility to report findings accurately and honestly with the potential harm to the participants involved can be challenging. Advice on the ethical considerations of research is generally available from research ethics boards and should be actively sought in these challenging situations.

GETTING STARTED

Pharmacists may be hesitant to embark on research involving qualitative methods because of a perceived lack of skills or confidence. Overcoming this barrier is the most important first step, as pharmacists can benefit from inclusion of qualitative methods in their research repertoire. Partnering with others who are more experienced and who can provide mentorship can be a valuable strategy. Reading reports of research studies that have utilized qualitative methods can provide insights and ideas for personal use; such papers are routinely included in traditional databases accessed by pharmacists. Engaging in dialogue with members of a research ethics board who have qualitative expertise can also provide useful assistance, as well as saving time during the ethics review process itself. The references at the end of this paper may provide some additional support to allow you to begin incorporating qualitative methods into your research.

CONCLUSIONS

Qualitative research offers unique opportunities for understanding complex, nuanced situations where interpersonal ambiguity and multiple interpretations exist. Qualitative research may not provide definitive answers to such complex questions, but it can yield a better understanding and a springboard for further focused work. There are multiple frameworks, methods, and considerations involved in shaping effective qualitative research. In most cases, these begin with self-reflection and articulation of positionality by the researcher. For some, qualitative research may appear commonsensical and easy; for others, it may appear daunting, given its high reliance on direct participant– researcher interactions. For yet others, qualitative research may appear subjective, unscientific, and consequently unreliable. All these perspectives reflect a lack of understanding of how effective qualitative research actually occurs. When undertaken in a rigorous manner, qualitative research provides unique opportunities for expanding our understanding of the social and clinical world that we inhabit.

Further Reading

• Breakwell GM, Hammond S, Fife-Schaw C, editors. Research methods in psychology. Thousand Oaks (CA): Sage Publications Ltd; 1995. [ Google Scholar ]
• Strauss A, Corbin J. Basics of qualitative research. Thousand Oaks (CA): Sage Publications Ltd; 1998. [ Google Scholar ]
• Willig C. Introducing qualitative research in psychology. Buckingham (UK): Open University Press; 2001. [ Google Scholar ]
• Guest G, Namey EE, Mitchel ML. Collecting qualitative data: a field manual for applied research. Thousand Oaks (CA): Sage Publications Ltd; 2013. [ Google Scholar ]
• Ogden R. Bias. In: Given LM, editor. The Sage encyclopedia of qualitative research methods. Thousand Oaks (CA): Sage Publications Inc; 2008. pp. 61–2. [ Google Scholar ]

This article is the seventh in the CJHP Research Primer Series, an initiative of the CJHP Editorial Board and the CSHP Research Committee. The planned 2-year series is intended to appeal to relatively inexperienced researchers, with the goal of building research capacity among practising pharmacists. The articles, presenting simple but rigorous guidance to encourage and support novice researchers, are being solicited from authors with appropriate expertise.

Previous article in this series:

Bond CM. The research jigsaw: how to get started. Can J Hosp Pharm . 2014;67(1):28–30.

Tully MP. Research: articulating questions, generating hypotheses, and choosing study designs. Can J Hosp Pharm . 2014;67(1):31–4.

Loewen P. Ethical issues in pharmacy practice research: an introductory guide. Can J Hosp Pharm. 2014;67(2):133–7.

Tsuyuki RT. Designing pharmacy practice research trials. Can J Hosp Pharm . 2014;67(3):226–9.

Bresee LC. An introduction to developing surveys for pharmacy practice research. Can J Hosp Pharm . 2014;67(4):286–91.

Gamble JM. An introduction to the fundamentals of cohort and case–control studies. Can J Hosp Pharm . 2014;67(5):366–72.

Competing interests: None declared.

• Open access
• Published: 11 September 2024

What does ‘safe care’ mean in the context of community-based mental health services? A qualitative exploration of the perspectives of service users, carers, and healthcare providers in England

• Phoebe Averill 1 ,
• Bryher Bowness 1 ,
• Claire Henderson 1   na1 &
• Nick Sevdalis 2   na1  

BMC Health Services Research volume  24 , Article number:  1053 ( 2024 ) Cite this article

Metrics details

Having traditionally received limited attention in empirical research and safety improvement agendas, issues of patient safety in mental healthcare increasingly feature in healthcare quality improvement discourses. Dominant approaches to safety stem from narrow clinical risk management perspectives, yet existing evidence points to the limitations of this characterisation. Although mental healthcare is increasingly delivered in community-based settings, narratives of safety pertain primarily to hospital-based mental healthcare. Therefore, through exploratory qualitative interviews and one focus group, we aimed to examine how service users, carers, and healthcare providers conceptualise ‘patient safety’ in community-based mental healthcare.

Semi-structured interviews and a single focus group were conducted with users of UK community-based mental healthcare provision for adults ( n  = 13), their carers ( n  = 12), and providers ( n  = 18), who were diverse in characteristics and experiences. Study data were analysed in accordance with a reflexive approach to thematic analysis.

Four key themes were developed, reflecting contrasting conceptualisations of safety in this care context, where participant thinking evolved throughout discussions. ‘ Systemic inertia: threats to safety ’ characterises the entrenched, systemic challenges which rendered participants powerless to advocate for or deliver safe care. ‘ Managing the risks service users present ’ equates ‘safe care’ to the mitigation of risks service users may pose to themselves or others when unwell, or risks from those around them. ‘ More than responding to risks: everyone plays a role in creating safety ’ recognises providers’ agency in causing or proactively preventing patient harm. Finally, ‘ The goals of ‘safety’: our destination is not yet in sight ’ positions safety as a work in progress, calling for ambitious safety agendas, giving primacy to goals which meaningfully improve service users’ lives.

Conclusions

Our findings have implications for the understanding and improvement of patient safety in community-based mental healthcare settings, where improvement objectives should transcend beyond management of risks and preventing deterioration to address patient and carer-centred concerns, including practices that make people feel unsafe.

Peer Review reports

Improving healthcare safety and reducing avoidable harm are global imperatives [ 1 ]. Until recently, safety optimisation efforts have centred primarily on physical healthcare settings, including acute care hospitals [ 2 , 3 , 4 ]. Nevertheless, emerging research has begun to illuminate the nature and causation of safety problems within mental healthcare [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. These works advance insights into inpatient safety, or that of various mental health settings more broadly. Safety challenges specific to community-based mental health services, where most mental healthcare is delivered, warrant focused scientific enquiry.

Although the field lacks coherent definitions and models of patient safety in mental healthcare, recognised safety concerns in mental healthcare include generic incidents, such as medication errors [ 12 ], and specialty-specific issues, such as self-harm or use of restrictive interventions [ 13 , 14 , 15 ]. Care in community-based mental health services may present distinct safety considerations. Lengthy waiting times; infrequent care encounters; and insufficient involvement of family carers in risk assessment, constitute particular concerns [ 5 , 7 , 16 , 17 ].

Historically, ‘patient safety’ has been appraised through a narrow clinical risk management lens [ 18 ]. This is pertinent in mental healthcare, where management of risks to self and others are key aspects of clinical practice [ 19 , 20 ]. That iatrogenic risks appear less widely considered, perhaps marks a distinction between mental healthcare and other health specialties [ 20 , 21 ]. Nevertheless, existing research demonstrates that service users can play a valuable role in safety improvement [ 22 ], and may conceptualise safety differently to healthcare providers [ 23 , 24 , 25 ]. Alongside providers, it is vital that service users and carers are involved both in defining ‘safety’ and in shaping meaningful improvement agendas [ 26 ]. Accordingly, the present study aimed to examine service user, carer, and healthcare providers’ subjective experiences and conceptualisations of ‘patient safety’ in community-based mental healthcare. Specifically, we sought to understand what ‘safe’ and, conversely, ‘unsafe care’ meant to these participant groups.

An exploratory design was adopted, involving semi-structured qualitative interviews and a single focus group with service users, carers, and healthcare providers. Participants took part in their choice of an individual interview or a focus group with others from the same respondent group. Compared to individual interviews, focus groups may yield additional layers of insight as a product of interaction between participants. Nonetheless, it is plausible that deeper understanding of individual participants’ subjective experiences may be achieved through individual interviews [ 27 ]. We expected that participants may describe distressing personal or professional experiences on the topic of patient safety problems in community-based mental health services. Therefore, presenting participants with the choice of an individual interview or a group discussion constituted an important ethical decision, allowing participants to take part in a format in which they felt most comfortable and able to speak with candour. Study methods were approved by a Welsh National Health Service (NHS) research ethics committee (IRAS ID: 279409) and prospectively registered (identifier: NCT04866693). Research reporting corresponds to the Standards for Reporting Qualitative Research [ 28 ].

Patient and public involvement

Through group workshops and individual consultations, seven service users and carers with lived experience of mental health services provided guidance on participant selection considerations, interview questioning, topic guide piloting, and refinement of participant-facing materials. A healthcare provider topic guide was also piloted and modified according to feedback from two clinicians. Based upon contributor feedback, we focused on both specialist and non-specialist mental healthcare provision, as general practitioner (GP) support represented the only care available for many people with mental health problems.

Participants and setting

Eligible participants had current or past year experience of contact with or employment within community-based mental health services for working-age adults within England, including primary care (e.g. GP support with psychotropic medication management) or specialist mental healthcare provision (e.g. community mental health team; CMHT input). Participants were required to be 18 years old or over and able to speak sufficient English to provide informed consent and to take part in an interview, owing to lack of resource for translation costs. Informed by comparable existing literature, where people from minority ethnic groups; male participants; and those with experience of severe mental illness (e.g. schizophrenia, bipolar disorder), have typically been underrepresented [ 5 , 6 , 7 , 29 ], targeted efforts were made to ensure that a diversity of voices were heard. Accordingly, we selected participants purposively according to gender, ethnicity, age, mental health diagnosis (if applicable), and service(s) experienced. All individuals who were screened for eligibility were informed of the possibility that they may not be recruited to the study, where we had already heard from multiple participants sharing similar characteristics. We notified those we were unable to recruit within two months of screening and ascertained their interest in being contacted should future involvement opportunities arise.

The decision to stop sampling was guided by ‘information power’ principles, an indicator of internal validity based on the notion that the greater the ‘information power’ a sample provides, fewer participants are needed for adequate analysis [ 30 ]. Adequacy of our sample was appraised according to multiple interrelated facets of ‘information power’, such as the breadth of our study aims, sample diversity, and data quality. The achieved sample was diverse in terms of participant characteristics and perspectives.

Data collection

Recruitment and data collection were conducted by one researcher (PA) over a nine-month period (May 2021—February 2022). Advertisement flyers were distributed within a local English NHS mental health trust. An open recruitment call saw flyers shared online, through newsletters, and via pre-established service user and carer engagement groups. Participants contacted the research team directly to express interest in participating in their choice of an individual interview or focus group discussion.

Consenting participants primarily took part virtually via videoconferencing software, although two interviewees opted to participate in person. Except for one focus group comprising seven healthcare providers, all other participants expressed a preference to take part in individual interviews ( n  = 36), lasting between 26 and 89 ( M  = 47) minutes. Separate topic guides for service users, carers, and providers were developed for this study and used flexibly to guide discussions (Supplementary Materials 1 , 2 , 3 ). Participants were first asked contextual questions, and then to define patient safety in their own language, reflecting approaches used in prior research [ 7 , 23 ]. Service users and carers were offered a £15.00 voucher for their contributions; and all participants were thanked and provided information about available sources of support, should they wish to seek support after taking part. Audio-recordings from interviews and the single focus group were transcribed verbatim and anonymised.

Methodological perspectives and reflexivity

Underpinned by critical realism, the ontological notion that reality exists, but that it is independent of human observation and cannot be accessed directly [ 31 , 32 ], participants’ narratives were examined as representations of reality shaped by subjective experiences. To generate knowledge on the topic under investigation, it follows that participants’ subjective representations of phenomena must be interpreted [ 33 ]. Within reflexive thematic analysis, the analytical approach adopted, researcher subjectivity is acknowledged as the primary tool for generating findings [ 34 ]. Analysis was undertaken primarily by one researcher (PA, White British female), with multiple coding on several transcripts conducted by a second researcher (BB, White British female). We recognise that our own experiences, along with the social, economic, and political context contemporaneous to this study will have shaped our analysis. The lead author (PA) is currently an outsider to all groups at the centre of this research, though has prior experience of working in unqualified positions within various inpatient mental health services, including settings which at times felt unsafe for service users and staff alike. The second author (BB), a qualified mental health nurse, has lived experience of using services and of working within community-based mental healthcare settings. These experiences undoubtedly shaped our interpretations of meaning within the present study. Likewise, we were conscious of additional barriers to delivering safe care that providers faced during the COVID-19 pandemic.

To examine patterns of meaning across the qualitative dataset, reflexive thematic analysis was conducted by the first author (PA) using methods outlined by Braun and Clarke [ 34 , 35 ]. Braun and Clarke’s approach to reflexive thematic analysis has been widely used within the psychological sciences and across a range of research disciplines; it emphasises the active and iterative role of the researcher in generating meaning through analysis [ 34 , 35 ]. The analysis was inductive and data-driven, comprising six phases (Table  1 ; phases 3–5 were performed recursively rather than linearly). First, audio-recordings, deidentified transcripts, and researcher notes were iteratively reviewed to gain familiarity with the dataset. Using NVivo software, transcripts were then systematically coded at semantic and latent levels, capturing both explicit and conceptual meanings (Supplementary Material 4 ). Multiple coding was conducted on three transcripts by a second researcher (BB) to explore alternative data interpretations, which were then discussed between both coders (PA, BB). Codes were further refined throughout the analysis and initial themes were generated through grouping of codes representing similar concepts or shared meanings. Theme fidelity was appraised against coded data extracts, resulting in reorganisation. Analytical progress was discussed regularly amongst all authors, and four themes were retained, defined, and labelled.

Participant characteristics

Of 97 expressions of interest received, 43 participants were recruited, comprised of 13 service users, 12 carers, and 18 healthcare providers. Participant characteristics are presented in Table  2 . A further fifty-four people who expressed interest in taking part were not recruited for the following reasons: omission to provide information required for eligibility screening ( n  = 27); not meeting study eligibility criteria, e.g. experience of services involved mental healthcare provision for children and adolescents ( n = 13 ); unable to schedule interview ( n = 2 ). According to our purposive recruitment strategy, an additional 12 people were not recruited where they shared characteristics with multiple other participants who had already taken part (e.g. female gender, White ethnicity).

Overview of findings

Four interpretative themes and several subthemes were developed, representing contrasting conceptualisations of patient safety in community-based mental health services (Table  3 ). Our thematic structure elucidates the ways in which notions of safety problems, their origins, and approaches to resolution were positioned within participant narratives. Each theme depicts a contrasting discourse as to whether safety risks are: (1) driven by systemic challenges; (2) by service users; (3) by responsible care teams; or (4) surmountable with an ambitious safety agenda, centred on outcomes of importance to service users and carers. These ideas are not mutually exclusive: participants typically espoused views aligning with several themes as their conceptualisations of ‘safe care’ evolved throughout discussions.

Theme 1: systemic inertia: threats to safety

The first theme sets out the position that complex, systemic issues make community-based mental healthcare less safe. Accordingly, ‘unsafe care’ is presented as the product of these ingrained challenges. Healthcare providers appeared to situate systems-level challenges as beyond their own locus of control, at times apportioning responsibility to other care teams. However, whilst recognising entrenched safety threats within ‘the system’, service users and carers did not view individual providers and care teams as entirely blameless or external to their causation. All participant groups nevertheless faced the same experiential outcome: a shared sense of powerlessness.

Timely access was central to conceptualisations of safe care:

It’s not about panic buttons and CCTV. How about making mental healthcare available to people when they need it?’ (Carer, CMHT, individual interview)

Negotiating service access, from GP consultations through to crisis care, was likened to ‘moving mountains’ (Carer, Crisis team, individual interview). Access appeared contingent upon the advocacy of carers, who acquired expertise in the language of service navigation:

You have to say the words that get people moving: ‘risk’, ‘harm’, ‘complaint’, ‘crisis’…words you have to know to get something done. (Carer, Crisis team, individual interview)

Delayed, mismanaged, and inappropriately rejected referrals to specialist community-based mental health services constituted a particular obstacle to safe care, seemingly contributing to deterioration, hopelessness, and self-harm. For apparent mood disorders, GPs were obliged to evidence trialling several unsuccessful prior treatments for referral acceptance. For one individual, accurate diagnosis (bipolar disorder) and appropriate treatment were delayed, owing to late entry into specialist services:

It took years of fiddling with medications [in primary care] before I got to see a psychiatrist and in that time this life that I’d been trying to hold onto imploded. (Service user, CMHT, individual interview)

Once the case for referral was established, lengthy waits for assessment and initial outpatient consultations introduced further risks. These waiting periods were a collective concern. However, providers were thought not to appreciate the gravity of such delays:

Time is the enemy here…I don’t think they understand how each setback and every single delay, it just makes it more likely that my partner’s going to die. (Carer, CMHT, individual interview)

Access challenges were not resolved upon entering specialist mental health services. Waits spanning months to several years for autism assessments, or specialist psychological therapies, further obstructed safety. Moral injury—distress or internal conflict triggered by situations which contravene a provider’s personal or professional principles—was apparent where service users needed urgent input, yet providers perceived limited capacity to alleviate delays:

It feels like you are condemning someone to deteriorate because you’re putting them on such a long waiting list and contributing to their hopelessness…I think it does raise people’s risk of self-harm, of deterioration. Puts people in harm’s way really. (Clinical psychologist, Crisis team, individual interview)

Moreover, participant narratives suggested that care intensity was inadequate for maintaining safety and preventing harm. Staffing time limits, alongside closures of voluntary sector resources and day centres, meant that providers struggled to offer suitable support. Consequently, patient safety and public safety incidents were foreseeable:

I just don’t feel like we’re meeting his needs…a bit more input and attention might have avoided these situations blowing up. (Nurse, CMHT, focus group)

Service users and carers often communicated notions of ‘patient safety’ through the lens of feeling safe or unsafe within interactions with providers, or the community-based mental healthcare system as a whole. System-driven shortfalls in care provision seemed to threaten service users’ psychological sense of safety. This was particularly pertinent in conversations about crisis care:

I worry it will become so out of control because I didn’t get help soon enough…they won’t do anything and won’t notice, and I’ll just be gone in my mind (Service user, CMHT, individual interview)

Imbalances between demands for care and service offer were especially apparent in emergency situations. Crisis care, including out-of-hours provision, was characterised as inaccessible or insufficient to avert immediate safety risks. Challenges in reaching the crisis team via telephone, or refusals to conduct home visits, meant service users and carers felt unsafe. Even where daily care was provided, participants regarded crisis team care as an ineffective alternative to hospitalisation:

If they’re only there for one hour of one day…they can’t physically prevent you from killing yourself. (Carer, Crisis team, individual interview)

‘Falling through the gaps’ could be regarded as a further system-driven safety threat. ‘Gaps’ ranged from concrete and tangible, including a lack of services to meet service users’ needs, through to the relational, reflecting communication divides between care teams. ‘Gaps’ also manifested conceptually, characterising subjective experiences of powerlessness in the face of service exclusion.

Communication breakdowns were intimately linked to patient safety, emerging in verbal handovers; through documentation errors; or stemming from the design of formal information-sharing channels (e.g. lack of shared electronic patient records). For those under multiple services, communication challenges operated at organisational interfaces between primary care, specialist mental health services, and social care, contributing to care delays, omitted medications, and mistrust of services. To improve safety, there were calls to strengthen interprofessional relationships between services:

It is dialogue between primary and secondary [specialist] mental health services that should improve because we hardly have interactions with them apart from referrals. We don’t get to know them. (GP, Primary care, individual interview)

‘Falling through the gaps’ also arose from service organisation and patient flow. Gaps in commissioned care pathways resulted in service exclusion, including for individuals whose problems appeared too complex for primary care input, yet not severe enough to warrant specialist care. Poor cooperation between services was a product of workload pressures, manifesting in excessive gatekeeping, with some patients receiving no care at all:

Tying care together is much more challenging, because everyone is pressurised, every service tends to ringfence what they’re prepared to provide…The number of service users who are unable to access any care at all, it’s really difficult. (Nurse, CMHT, individual interview)

Impacts of service divisions were evident. It seemed that providers avoided delivering interventions requiring between-service multidisciplinary collaboration, including physical healthcare provision for people with severe mental illness. There was a tendency for siloed working, meaning that service users’ care was not cohesive:

90% of the people in my clinic will be on dreadful polypharmacy…the burden of side effects is horrendous, the interactions are dreadful, and the problem is, nobody will take responsibility and technically it’s not my job either. (Pharmacist, Specialist medication clinic, individual interview)

Care transitions were viewed as equally fraught; premature or poorly coordinated discharges jeopardised service user progress. Nevertheless, responding to pressure from service managers, providers recognised their own role in discharging patients before they were ready:

Loved ones start calling and say, ‘What are you people doing?…I don’t want to discharge, I am wanting to continue. (Nurse, CMHT, individual interview)

Service users’ sociodemographic and clinical characteristics appeared interrelated to their service navigation experiences. Care quality corresponded to social class; those regarded as articulate or well-presented reportedly received better standards of care. Care journeys for Black service users were characterised more-so by police involvement and restrictive practices, relative to White patients:

There are also the different pathways to care, how our ethnic communities perceive our systems, the fear of the psychiatric system…If you’re a Black family, you’re far more likely to have longer duration of untreated psychosis for your loved one…then you’re far more likely to call the police. (Clinical psychologist, CMHT, focus group)

Ethnicity-based preconceptions also appeared to shape the care offered to Asian patients:

Asian women, I don’t think we’re perceived as a danger to society…And of course, to get treatment, you have to be a danger to yourself or someone else. (Carer, Crisis team, individual interview)

Similarly, personality disorder diagnoses underpinned stigmatisation and service exclusion, with recurrent risks unaddressed:

They’ve said they’ll never take me back with the same presentation, which is self-harm. I’m not going to morph into someone with psychosis, so whatever risk I present, they’re not going to respond. (Service user, Primary care, individual interview)

Additional system-drivers of harm included chronic workforce underinvestment. Staffing shortages seemingly arose from long-term disinvestment from community teams, causing unmanageable workloads, which damaged recruitment and retention efforts. Whilst inpatient services are limited by bed availability, community-based providers experienced uncapped caseloads, exceeding safe limits:

These wonderful people trying to do their best with limited resources…when I have been let down, it’s not them…it’s the institution letting me down. (Service user, CMHT, individual interview)

Workforce underinvestment explained inadequacies in staff training and skills mix. Knowledge about psychotropic medications amongst care teams was thought inadequate. Risk assessment and management expertise were also considered lacking. Experience and seniority levels within community teams were understood to have declined over time, with inexperienced staff increasingly delivering care in high-risk situations.

Participant accounts suggested that policies and procedures resulted in further safety vulnerabilities. Administrative tasks aimed at monitoring safety, including incident reporting, equipment audits, and extensive paperwork, were thought to detract from time to deliver safe care:

Our performance is measured upon our completion of forms, rather than the risks that we’ve managed over the month… (Occupational therapist, CMHT, focus group)

Moreover, workarounds to staff safety protocols were necessary, including disregarding lone working protocols to ensure that service users were actually seen. Compromising one’s own safety appeared unavoidable in the face of unmanageable caseloads.

Another perceived mismatch between healthcare policy and achieving safety related to the UK Mental Health Act. Beyond challenges in securing police attendance at assessments and hospital bed availability, there were tensions between upholding human rights whilst preventing patient harm. Providers must wait for those declining treatment to become unwell enough to warrant detention and hospitalisation. Within this period, harmful outcomes included patient arrests, or involvement in an assault, possibly preventable with earlier hospitalisation. Legislation reforms worried carers, who feared increased thresholds for involuntary treatment:

Being sectioned, it’s not the most fun experience, but it does mean you get treated. But they’re bringing in the new White Paper. It’s going to be even harder to get her sectioned, so she might be facing a lifetime of illness. (Carer, Crisis team, individual interview)

Participant accounts suggest that efforts to deliver ‘safe care’ within community-based mental health services were rendered untenable owing to seemingly insurmountable systems-level issues. Local and distal challenges including insufficient resources, staffing shortfalls, and poorly joined-up services, constrained service users’ prospects of accessing timely, appropriate, safe care. Patient safety appeared to be compromised actively, through necessitating violations of unworkable policies, but also in more subtle ways, through communication disconnects; inequities in service access for specific patient groups; and erosion of workforce morale and resilience.

Theme 2: managing the risks service users present

Aside from systems-generated safety risks, ‘patient safety’ in community-based mental healthcare was equated to the management of risks originating from service users. Indeed, a second theme ‘Managing the risks service users present’ , characterises a seemingly dominant perception that ‘safe care’ provision in this context is that which mitigates the risks of harm service users may pose to themselves or others when unwell. Risk of harm to self was a recurrent topic, including self-neglect, self-harm, and suicide. Although infrequent, risks to others of rare acts of violence were also raised. It appears that staff had limited tools for community prevention of violence, yet these incidents were contextualised in terms of care that is ‘unsafe’:

Unsafe mental healthcare could come from different means. Either the client is not engaging, or the risk associated with clients…did anyone call that the client is shouting along the road or tried to attack somebody? (Nurse, CMHT, individual interview)

Risks to service users from those around them were also described, including physical, sexual, and financial abuse. Family members who discouraged medication adherence presented further threats to safety. Oversight of such risks was considered a key function of safe mental healthcare:

In the thick of it in the community, you are in this incredibly vulnerable spot and that’s why we have things like care coordinators, so that they can keep an eye on you. (Service user, CMHT, individual interview)

Whilst ‘patient safety’ was framed predominantly as the inverse of ‘risk’, staff sometimes drew subtle distinctions between the two. Whether suicide constituted a safety incident was debated, in scenarios where providers deemed it beyond service prevention. Nuances were evident in sense-making about patient safety in this care context:

When you mention ‘patient safety’ within mental healthcare, my mind thinks about what is their risk of harm to themselves or others? Whereas ‘safe mental healthcare’ is where we are looking at providing appropriate or effective mental healthcare for their needs. It’s got two connotations in how it can be measured. (GP, Primary care, individual interview)

Likewise, ‘holding’ risk dominated conversations about community safety. Carers’ accounts suggested that they were insufficiently supported to maintain patient safety at home, holding risks such as self-neglect, or active suicidal intent. Although often excluded from formal safety planning, it appears that carers were positioned as part of the service user’s care team, relied upon to fill gaps within the care system and to navigate risk:

No one gave me any training, ’If she refuses her meds, if she doesn’t want to eat, this is the best way to approach it’…I didn’t have a clue. (Carer, CMHT, individual interview)

Beyond carers, providers were similarly apprehensive about assuming responsibility for risks. Community staff perceived greater individual accountability for risk relative to inpatient care teams. The burdens of clinical decision-making in high-risk situations were evident:

You hold those risks of patients going into crisis, harming themselves, harming other people…you hold that risk almost on your own…it’s only your clinical judgement keeping that person safe. (Nurse, CMHT, focus group)

Throughout participant accounts, it appeared that service users were positioned as inherently ‘unsafe’. It can be contended that risks were deemed to arise from service users, rather than the processes of healthcare itself. Key tensions can be discerned within this discourse: the extent to which risks could feasibly be averted within the structures of community care was unclear. Nevertheless, participant narratives suggest that the prevention of such harms by services should be considered a fundamental tenet of ‘safe care’.

Theme 3: more than responding to risks: everyone plays a role in creating safety

Beyond safety problems stemming from the system itself, or risks presented by users within it, a third theme recognises providers’ agency in contributing to safety. Within this theme, the creation of ‘safety’ can be regarded as a dynamic process, where it is acknowledged that ‘everyone’ (individual providers, care teams, and wider services) has the potential to cause or mitigate harm, but also to proactively influence the delivery of safe care.

It’s easy to say, ‘I didn’t cause someone harm’, but there needs to be more reflection on ‘Well what more could you have done to prevent that? (Carer, Crisis team, individual interview)

That contact with services could inadvertently cause harm appeared an accepted truth. Overt harm precursors included errors (e.g. incorrect medication), and protocol breaches, such as a failure to follow-up patients newly prescribed with antidepressants:

A regular number of people are taking their own lives, who have been recently prescribed an antidepressant and they’ve not had follow-up monitoring as per NICE guidance…those deaths are completely avoidable. (Pharmacist, Specialist medication clinic, individual interview)

Iatrogenic consequences of psychotropic medication, including weight gain-induced complications, sleep disturbances, and elevated blood pressure, were prominent concerns. In several cases, medications caused new physical health conditions (e.g. quetiapine-induced diabetes). There was a sense that prescriber opinions were privileged over service users’ lived experience:

Each time I see the psychiatrist, he will prescribe more drugs, he fails to listen to you first…about your side effects, about internal experiences that are horrible…he brings your medication, injects it into you, then he goes. (Service user, Community outreach and rehabilitation service, individual interview)

Failure to respond to patient deterioration, including reactive responses to accumulating safety risks, were described recurrently. Service users and carers were seemingly powerless to ensure their concerns were addressed:

He [psychiatrist] didn’t seem to appreciate the severity of my dad’s symptoms…it is so challenging to advocate for yourself because there’s such a power imbalance (Carer, Crisis team, individual interview)

Subtle manifestations of harm appeared widespread, including providers’ failures to meet commitments. This included appointment non-attendance or cancellation, or simply ceasing contact with service users without explanation. The latter occurred during long-term staff sickness absence, where there were no safeguards to ensure caseload reassignment. Equally, experiences of psychological harm were common. The potential for each care encounter to have therapeutic value was recognised by all participant groups and thought vital to maintaining safety:

What you want is staff who have good, positive relationships with patients. That is what keeps people safe. (Social worker, CMHT, individual interview)

Negative patient-provider interactions led to patients losing trust in services, non-disclosure of care-relevant information, or service avoidance. Service withdrawal following a harmful encounter occurred for varying reasons, including fears of involuntary treatment:

I don’t want her to be sectioned again, I don’t want them to decide she’s better off in the unit because she prefers to be at home, it’s safer for her… (Carer, CMHT, individual interview)

Also within this theme was the position that safer care can be achieved through proactive approaches to care delivery, emphasising harm prevention through planning, team working, and collaboration with service users and carers:

That time for safety, you just don’t find it. If you think about the time that you spend doing incident reports or, reading complaints…so yeah, I would have those safety mechanisms early on. (Psychiatrist, CMHT, individual interview)

Aspirations to mitigate harm were evident. One preventative strategy involved allocating more time resource at the outset (e.g. investing time into clinical formulation, learning from prior treatment history), rather than in response to something going wrong. Other examples of frontloading care included proactive medication monitoring, averting safety problems before they arose. In the case of lithium treatment, toxicity was prevented through reviewing longitudinal lithium level trends, instead of individual results in isolation. Service users were also educated on toxicity signs, encouraging timely support-seeking.

Communication systems appeared vital to planning for safety. Electronic patient record systems were paramount to effective information sharing, despite challenges in navigating large volumes of information recorded in different locations. The importance of documenting safety information so that it is meaningful to all providers, was explored:

When I’m documenting risks, that person might turn up to A&E [Accident and Emergency department], might be an inpatient, or might go to the home treatment team…I need to do it in a way that conveys easily that information, so you get a narrative of the patient, rather than a shopping list. (Psychiatrist, CMHT, individual interview)

Related to communication were the merits of team working for strengthening safety. ‘Zoning meetings’, where service users are classified according to risk and care needs, helped to prioritise interventions at team-level, supporting staff in caring for service users presenting with complex needs. Likewise, safety huddles were used proactively within primary care practices.

Service user’ and carer’ narratives suggested a similar endorsement of a proactive safety outlook. Harmful outcomes of deterioration, such as involuntary hospitalisation, breakdown of family relationships, or loss of dignity, were deemed avoidable with timely service intervention. Indeed, safety planning was thought most effective when designed whilst an individual was relatively well, rather than in crisis. It appeared that active involvement of service users and carers in crisis mitigation restored confidence and indicated mutual respect:

I have to give credit to the new psychiatrist my brother has been seeing…he decided to take the risk and he asked me, ‘Do you think it’s better just to be sent straight away to the hospital, or maybe just give him a chance?’…I said, ‘Okay, I’ll be home with him, let’s not lose what we actually achieved over these months. (Carer, CMHT, individual interview)

The above outlined theme, representing a third conceptual component of ‘safe care’, presents clear points of distinction from the preceding themes. Indeed, beyond apparent latent risks to safety which providers inherit from the systems they are required to operate within, or risks which surround service users, the agentic role of providers in ensuring that care is safe is clearly acknowledged. These findings highlight the propensity of providers, teams, and services to impact patient safety, both positively and negatively.

Theme 4: the goals of ‘safety’: our destination is not yet in sight

Marking a fourth element of participant characterisations of ‘patient safety’ in community-based mental health services, a final theme sets out a position that the pursuit of ‘safe care’ is a work in progress. Indeed, according to participant narratives, this theme depicts the breadth of change required to reach a point of safety: ‘our destination is not yet in sight’. Beyond managing risks and preventing deterioration, this theme presents the ideological stance that ‘safe’ mental healthcare provision is that which strives towards goals which meaningfully improve service users’ lives.

I don’t for one minute think that those people are causing him direct harm. But by indirect behaviour they are causing him harm…that harm is he’s not progressing, he’s not developing. (Carer, Dual diagnosis supported accommodation services, individual interview)

It appeared that safety was compromised by a preoccupation with managing incident outcomes, rather than addressing their causation. Basic wound care or liver function assessment sometimes constituted the only follow-up interventions provided after self-harm or suicide attempts, at the expense of compassionately exploring underlying distress. Services were seemingly oriented towards managing risks, lacking focus on promoting service user resilience and long-term care goals. Instead, respondent accounts are indicative that patient stabilisation was regarded as the treatment endpoint:

No one said ‘What do you want to achieve? How can we help you? (Carer, Crisis team, individual interview)

Beyond calls to re-examine the objectives of ‘safety’ in community mental healthcare, safety improvement priorities were widely explored. Enhancing care access could be regarded as a unanimous goal. Faster, streamlined routes into specialist services were deemed vital for promoting recovery. Accordingly, ineffective triage processes, crisis care, and out-of-hours care, were regarded as vital system-wide foci for safety improvement.

Further safety improvement priorities concerned care transitions and joint working between services. A higher intensity of support was considered essential for safer transitions across the inpatient-to-community interface, and from specialist community services into primary care. Proactive service follow-up was considered a vehicle for safer transitions, allowing timely monitoring for relapse signs:

Even if it’s like in a month or two…If you have that follow-up…you will be able to pick things up before it gets bad. (Service user, Specialist psychological therapy service, individual interview)

Where multiple teams were involved in a person’s care, participant accounts suggest that strengthening provider-collaboration was a safety priority. Relationships between staff in primary care and specialist services were strained by perceived reluctance on part of the other service to accept referrals or discharges. The need for improved cooperation was voiced:

We really do need to bring primary and secondary [specialist] care services closer together, to be working more with each other rather than this ‘us and them’ scenario. (Specialist pharmacist, Primary care, individual interview)

Improved joint working was also raised in relation to people at risk of service exclusion. These individuals often had multiple complex needs (e.g. severe mental illness and co-morbid substance use problems). There were calls for practical, cooperative, patient-centred approaches to planning care:

People might fall in theory into two or three services or none…It might be a negotiation, ‘Okay, this time I take this person, next time you take the case. (Psychiatrist, CMHT, individual interview)

Service user and carer support resembled a further safety improvement priority. It was proposed that service users could better maintain their own safety with individualised, co-produced, up-to-date safety plans, incorporating advanced planning for relapses. Carers similarly needed guidance for keeping service users safe (e.g. in lethal means restriction for suicidal individuals), but discerned a lack of provider willingness to offer such support:

Someone should come up with a plan to make sure carers have proper training…They need certain skills and they’re not given skills, and no-one wants to listen to them or encourage them. (Carer, CMHT, individual interview)

Medication safety represented a final safety priority. It was apparent that education on antidepressant use and prescription marked a key concern for respondents. Prescribers identified medication counselling needs on the risks of premature discontinuation of antidepressants upon perceiving no therapeutic benefit. Similarly, carers considered antidepressants to be prescribed too readily, without educating people about potential negative side-effects (e.g. suicidal thoughts) upon initial treatment:

They hand out antidepressants, whenever they feel like it. Without any recourse to ‘Is this person going to be susceptible to problems with these drugs? (Carer, Assessment and treatment team, individual interview)

Medication non-adherence could be regarded as an important early indicator of risks to safety. Given the narrow therapeutic range of many psychotropic medications, where dosage and timeliness are essential, the absence of mechanisms to detect when medications were not ordered or collected concerned participants. Where GP practices had in-house pharmacies, alerting systems were proposed to mitigate risks of delayed or omitted medications.

Moreover, medication interaction burden was another area warranting closer attention. Improved prescriber awareness of the potential for harm was considered an important prerequisite to reducing risk. Accordingly, a participant discussed developing a bespoke form within the electronic health record system, prompting clinicians to reflect on risks introduced by their prescribing, inviting consideration of alternative treatment approaches:

Once you’ve listed your drugs, then you have to list the potential interactions, and a suggestion of how you might want to manage that (Pharmacist, Specialist medication clinic, individual interview)

Although service users, carers, and providers alike indicated support for patient-centred care planning and delivery, there were seemingly differences between participant groups in views on how this is achieved in practice. It can be contended that patient safety is compromised owing to an apparent lack of ambition on part of providers to strive towards meaningful, recovery-oriented goals, which support service users to approach their own vision of ‘getting better’. Beyond the treatment of clinical symptoms alone, recovery approaches to mental illness are concerned with “the processes by which people experiencing mental illness can develop a purposeful and meaningful life” [ 36 ]. Recovery can be considered a deeply individual journey, characterised by connectedness; hope and optimism about the future; a positive sense of identity; meaning in life; and empowerment [ 37 ]. Indeed, service user’ and carer’ accounts implied that ‘safe care’ could not be realised where the objectives of community-based mental healthcare were limited to achieving stabilisation and preventing deterioration alone. Tangible avenues for improving patient safety within this care context are evident within participant narratives.

This study articulates the multifaceted ways in which service users, carers, and providers conceptualise ‘safe care’ and, conversely, ‘unsafe care’ in community-based mental health services in England. Upon incorporating wider stakeholder perspectives, our findings suggest that the remit of patient safety and objectives for its improvement expand beyond mere efforts to manage risks. Indeed, aligned with mental health services research conducted primarily within inpatient contexts [ 9 , 38 ], or mixed settings [ 7 ], service users often framed safety subjectively in terms of feeling safe. Although the management of risks to self, to others, and from others, when unwell is recognised as a core component of patient safety (Theme 2), we posit that this dominant perspective alone is incomplete. Threats to ‘safe care’ were apparent first and foremost at mental healthcare systems-level (Theme 1). Whether care is ‘safe’ is also contingent upon the actions, or inaction, of providers (Theme 3). Moreover, we hold that ambitious safety agendas, giving primacy to goals which meaningfully improve service users’ lives, are required for the achievement of ‘safe care’ (Theme 4).

Consistent with findings from non-psychiatric hospital-based settings [ 23 ], participants were unaccustomed to considering the meaning and connotations of ‘patient safety’ in the present service context. Surprisingly, this was true of all participant groups, including providers, perhaps reflecting the dominance of inpatient settings in current discourses and initiatives aimed at improving safety in mental healthcare [ 39 ]. Well-evidenced iatrogenic harms within these settings (e.g. physical restraint, seclusion) [ 10 ], are possibly particularly salient to service users, carers, and staff alike. Nevertheless, from a point of uncertainty, participants refined their conceptualisations of safety throughout the interviews.

Theme one findings illustrated that systemic conditions result in care which departs from safe practice. Mirroring conclusions of the annual NHS community mental health survey [ 40 ], service access was a prominent concern, where care delays risked potentially severe consequences for deteriorating patients. Apparent inequities in care access, corresponding to sociodemographic and clinical characteristics, contributed to a sense of ‘falling through the gaps’. That participants deliberated on disparities in care for service users from Black backgrounds was perhaps unsurprising, given evidenced inequities in experiences of mental health services. Indeed, delayed access to specialist services and higher rates of compulsory treatment, are salient examples of adverse experiences faced by Black communities [ 41 , 42 , 43 , 44 ]. In contrast, intersections between ethnicity and access for Asian women, as voiced by participants, are less well-documented amongst the literature and warrant exploration in further research. Issues in recruiting and retaining staff further undermined patient safety, culminating in a less experienced and insufficiently supervised workforce, as described in existing research [ 45 ]. Finally, key healthcare policies, including the UK Mental Health Act, presented challenges for providers in the balance between upholding human rights and preventing harm to patients.

A second position characterised ‘safe care’ as the management of risks originating from service users. Prior research indicates that risk and safety are treated as equivalent concepts by mental health services staff [ 19 , 46 ]. Risks of harm from others in the community (e.g. physical, sexual, financial abuse) indicate setting-specific safety challenges within mental healthcare. Moreover, although carers felt left to hold risks, they were seldom involved in proactive safety planning; essential for improving safety in community-based care [ 16 , 47 ].

Provider agency in harm causation or mitigation was recognised in a third theme. Overt unsafe practices (e.g. protocol breaches) were less widespread than other less measurable harms (e.g. psychological harm). Finally, a fourth theme set out visions for the future of patient safety within community-based mental healthcare, contending that supporting service users to live fulfilling lives must be considered within the remit of ‘safe’ care, consistent with research capturing nursing perspectives [ 17 ]. This finding provides backing to calls for patient-directed safety targets [ 47 ], and resonates with recovery principles [ 37 ]. Indeed, in the context of the ongoing transformation of community-based mental healthcare in England in efforts to deliver integrated place-based care [ 48 ], patient safety considerations within voluntary sector and social care services will become increasingly important, warranting attention in future research.

Strengths and limitations

We detail novel insights into how ‘safety’ is conceptualised by those who use or deliver care within community-based mental health services, illuminating plausible safety improvement foci. Key strengths lie in our study sample, diverse in participant characteristics including ethnicity, diagnosis, and service experience, where sampling was guided by information power principles [ 30 ]. Moreover, we hold that the reflexive approach to data analysis adopted, positioned in relation to our own experiences, constitutes an additional strength of this work. However, although our findings are not limited to a single region or NHS trust, almost two-thirds of participants were London-based. Accordingly, we may not have adequately captured geographical disparities in safety experiences, including the concerns of rural communities. Overall, we noted a preference amongst participants to take part in an individual interview. As such, whilst our findings present a rich picture of individuals’ subjective experiences, it is possible that further insights yielded from interaction between participants may have been gained had we have been able to conduct focus groups with service users and carers. Although we believe that service user and carer involvement in shaping the research methods and focus resembles a strength of this study, we recognise that a more extensive approach to patient and public involvement throughout the research cycle may have improved this work [ 49 ]. In future research examining the safety of mental healthcare, training of lived experience co-researchers in qualitative interviewing, analysis, and interpretation may introduce valuable new perspectives on this topic. Such methods were beyond the limits of available resource for the present study, which formed part of a PhD project. Taking the findings of this study as a starting point, we believe that equitable co-production partnerships with service users and carers will be particularly important in any follow-on research aiming to develop interventions to improve patient safety in this context [ 50 ].

Implications

This study supplements recently emerging literature exploring the specifics of patient safety in community-based mental health services [ 16 , 17 ], expanding upon existing research by integrating service user, carer, and provider perspectives. Our findings offer a reimagining of ‘safe care’ in this service context, transcending narrow safety definitions and risk management agendas, which have dominated patient safety discourse [ 25 , 26 ]. Safety improvement priorities, as identified by participants, warrant examination in future research, to move the field towards effective safety interventions.

There was striking overlap between the safety shortfalls participants recounted and recommendations from a suicide reduction toolkit for primary care and specialist mental health services providers [ 51 ]. For example, timely post-discharge follow-up; 24-hour crisis care access; and carer involvement, constituted key recommendations. Beyond associations with lower suicide rates [ 52 , 53 ], full implementation of these recommendations may plausibly help to drive wider improvements in service safety.

In illustrating safety problems alongside examples of system resilience where safe care is successfully delivered, our findings correspond to both Safety-I and Safety-II paradigms [ 54 ]. Participants identified opportunities for optimising practice to improve service resilience, yet service pressures and efforts to manage the consequences of things going wrong (Safety-I), impacted provider capacity to engage in proactive planning for safety (Safety-II). Taken together, this underlines the importance of continued efforts to improve staffing and skills development, which will afford healthcare providers the time and expertise to deliver safer care.

The present research provides nuanced insights into the ways in which service users, carers, and healthcare providers conceptualise ‘patient safety’ within community-based mental healthcare, where extant research has primarily explored safety within inpatient mental healthcare settings only. Our findings indicate that participants conceived of ‘safe care’ in multiple contrasting, yet not mutually exclusive, ways. Dominant risk management narratives, which focus on those risks emanating from service users themselves when unwell, characterised one aspect of patient safety only. Indeed, systemic conditions were thought to culminate in mental healthcare provision which diverges from safe, effective clinical practice. Beyond these entrenched, systems-level challenges, participants nevertheless recognised the propensity of healthcare providers to cause or circumvent harm. Finally, this research highlights a vital need to pursue goals which are meaningful to service users in the shaping of safety improvement agendas within mental healthcare, indicating a range of potential foci for future interventional research.

Data availability

The dataset generated and analysed within the current study is not available for sharing and is not publicly available. Consent for data sharing was not sought from research participants and was not agreed as part of the research ethics committee approval obtained for this research. Queries about these data may be directed to the corresponding author.

Abbreviations

Accident and Emergency department

Community Mental Health Team

General Practitioner

National Health Service

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Acknowledgements

We would like to thank the service users and carers who provided valuable guidance in a patient and public involvement capacity, which helped to shape this research. Likewise, we acknowledge the support of the Maudsley Biomedical Research Centre’s Feasibility and Acceptability Support Team for Researchers (FAST-R). Finally, we would like to express our sincere thanks to the participants in this study, who so generously gave up their time in helping us to understand their experiences.

This project is supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute (THIS Institute), grant number PHD-2018‐01‐026. The views expressed in this publication are those of the authors, and not necessarily those of the Health Foundation or THIS Institute.

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Claire Henderson and Nick Sevdalis are joint senior authors of this study.

Authors and Affiliations

Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, UK

Phoebe Averill, Bryher Bowness & Claire Henderson

Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Nick Sevdalis

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Contributions

PA: Conceptualisation; Formal analysis, Investigation; Methodology; Project administration; Writing – Original Draft Preparation; Writing – Review & Editing. BB: Formal analysis; Writing – Review & Editing. CH: Conceptualisation; Funding acquisition; Methodology; Supervision; Writing – Review & Editing. NS: Conceptualisation; Funding acquisition; Methodology; Supervision; Writing – Review & Editing.

Corresponding author

Correspondence to Phoebe Averill .

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Ethics approval and consent to participate.

This research was approved by a Welsh National Health Service (NHS) research ethics committee (IRAS ID: 279409). Participants were aware of the aims of the research and the voluntary nature of taking part. Informed consent was documented prior to participation.

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Not applicable.

Competing interests

NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors report no competing interests.

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Averill, P., Bowness, B., Henderson, C. et al. What does ‘safe care’ mean in the context of community-based mental health services? A qualitative exploration of the perspectives of service users, carers, and healthcare providers in England. BMC Health Serv Res 24 , 1053 (2024). https://doi.org/10.1186/s12913-024-11473-3

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Received : 09 January 2024

Accepted : 21 August 2024

Published : 11 September 2024

DOI : https://doi.org/10.1186/s12913-024-11473-3

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