reflexive journal qualitative research

Reflexive journals in qualitative research

Daniel Turner

It is common practice for researcher to keep a journal or diary during the research process, regardless of discipline or methodology. These are sometimes called reflexive diaries, self-reflexive journals, research journals or research diaries. They are all basically the same thing – a written (or verbal) record written by the researcher during the research process, detailing what they did and why.

Lincoln and Guba (1982) wrote a classic paper detailing reflexive journals as part of an auditing process for research projects, but with the very specific aim of improving the reliability of research and removing bias. Smith (1999) also describes research journals as an important part of ‘enhancing ethical and methodologic rigour’, but there much more to them than this, regardless of the rather positivistic terminology.

Qualitative research projects are complex to design, manage and analyse, and can take many years to complete. Keeping a personal record of the process, key decisions and feelings offers the researcher the opportunity to learn from the research process (Thorpe 2010) and better remember how things came to pass. When writing up, this log can become as a vital a source of data as a participant interview.

There are lots of papers and textbooks that give examples of what research journals look like (eg Silverman 2013 has several from former students), however few detail what they should contain, or how to keep them.

Lincoln and Guba (1982), offers one of the few good published guidelines for what should actually be in a reflexive journal. They define it as “analogous to the anthropologists field journals and is the major means for an inquirer to perform a running check on the biases, which he (sic) carried with him into the context”. The paper lists 4 major things to record in the diary:

1. A log of evolving perceptions

2. A log of day-to-day procedures

3. A log of methodological decision points

4. A log of day-to-day personal introspections

But as Janesick (1998) notes, another important role is to “refine the understanding of the responses of participants in the study, much like a physician or health care worker might do”. In other words, to also record the researchers own observations about the participants and their lives, when doing interviews, focus groups or ethnography, that will enrich and give context to other more ‘formal’ methods of data collection. She defines a different set of 4 roles for research journals which are more focused towards typical qualitative projects and philosophies:

1. Refine the understanding of the role of the researcher through reflection and writing, much like an artist might do;

2. Refine the understanding of the responses of participants in the study, much like a physician or health care worker might do;

3. Use a journal as an interactive tool of communication between the researcher and participants in the study, as a type of interdisciplinary triangulation of data;

4. View journal writing as a type of connoisseurship by which individuals become connoisseurs of their own thinking and reflection patterns, and indeed their own understanding of their work as qualitative researchers.

Reflexive diaries can also be used by those performing research that contains ethnographic methods, and diaries or journals are very commonly used in ethnography. See for example Barry and O’Callaghan (2009), using diaries to record the experiences of student therapists in a hospital setting. Reflexive journals can also be used in autoethnography, or other qualitative research that focuses on the researcher as the participant or main focus of the study or context.

But it’s important to not confuse these with diaries or journals which are given to participants as data collection of the lives and experiences of respondents. There is much more written in the literature on this topic, see our own post on participant diaries , and Janesick (1998) has written about distinguishing and triangulating these in her article.

So what does a reflective journal look like? Many people prefer to write a physical diary, in a paper journal or notebook (eg Nadin and Cassell 2006), or you can just use any standard word-processor like Word. There are advantages to having it digitally: it does make it easier to search, and easier to back up (by saving it in multiple places). Vicary, Young and Hicks (2016) recommend writing a research diary directly in qualitative data analysis software (CAQDAS), in their case using Nvivo 10, but any qualitative software has the same basic capability.

The latest version of Quirkos (2.3) contains a new feature which can help with a reflexive journal. For the live collaboration in Quirkos cloud, we added a chat feature so that people can communicate, either in real time, or when working sequentially on their project. But we also added this feature to the offline version as well, not just to keep feature parity, but to give a space to write project wide notes. While you can attach memos to sections of text, and use a source property to have notes attached to a section of text, there wasn’t an designated to write generally in the project file.

Banner - Qualitative analysis made simple with Quirkos

Previously we’ve suggested that people created a blank source and write in there, which gives the advantage that you can treat it like any other data source – coding it and including (or excluding) it from search and query results. However, the chat function works as a great journaling system Even though you are just ‘talking’ to yourself, each entry has a date and time stamp, and you can scroll up and down the list and remove specific entries if needs be. It’s also right there, in the same window you are using to analyse, which makes it very easy to keep quick comments as you work.

If you want to see how intuitive and simple Quirkos makes qualitative analysis, you can try either it with Cloud storage or offline storage for free, for Windows, Mac or Linux . You can also get a good idea of what it’s like to work with Quirkos by watching a short tutorial video right here:

Barry, P., O’Callaghan, 2009, Reflexive Journal Writing: A Tool for Music Therapy Student Clinical Practice Development, Nordic Journal of Music Therapy, 17(1) https://www.tandfonline.com/doi/abs/10.1080/08098130809478196

Janesick, V., 1998, Journal Writing as a Qualitative Research Technique: History, Issues, and Reflections, https://files.eric.ed.gov/fulltext/ED420702.pdf

Lincoln, Y., Guba, E., 1982, ESTABLISHING DEPENDABILITY AND CONFIRMABILITY IN NATURALISTIC INQUIRY THROUGH AN AUDIT, https://files.eric.ed.gov/fulltext/ED216019.pdf

Nadin, S., Cassell, C., 2006, The use of a research diary as a tool for reflexive practice: Some reflections from management research, Qualitative Research in Accounting & Management 3:208-217, https://www.researchgate.net/publication/227430125_The_use_of_a_research_diary_as_a_tool_for_reflexive_practice_Some_reflections_from_management_research

Silverman, D., 2013, Doing Qualitative Research, Sage, London

Smith, B., 1999, Ethical and methodologic benefits of using a reflexive journal in hermeneutic-phenomenologic research., Image Journal of Nursing Scholarship. 1999;31(4):359-63.

Thorpe, K. (2010) Reflective learning journals: From concept to practice Reflective Practice; International and multidisciplinary perspectives Vo 5 Issue 3 pp 327-343

Vicary, Young and Hicks, 2016, A reflective journal as learning process and contribution to quality and validity in Interpretative Phenomenological Analysis, Qualitative Social Work, 16(4), 550–565. https://www.research.manchester.ac.uk/portal/files/27234596/POST-PEER-REVIEW-NON-PUBLISHERS.PDF

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A practical guide to reflexivity in qualitative research: AMEE Guide No. 149

Affiliations.

1 Anesthesiology Department, Pontificia Universidad Javeriana, Bogotá, Colombia.
2 Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
3 Department of Medicine and Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
4 Division of Education and Innovation, Department of Medicine and Scientist, McMaster University, Hamilton, Canada.
PMID: 35389310
DOI: 10.1080/0142159X.2022.2057287

Qualitative research relies on nuanced judgements that require researcher reflexivity, yet reflexivity is often addressed superficially or overlooked completely during the research process. In this AMEE Guide, we define reflexivity as a set of continuous, collaborative, and multifaceted practices through which researchers self-consciously critique, appraise, and evaluate how their subjectivity and context influence the research processes. We frame reflexivity as a way to embrace and value researchers' subjectivity. We also describe the purposes that reflexivity can have depending on different paradigmatic choices. We then address how researchers can account for the significance of the intertwined personal, interpersonal, methodological, and contextual factors that bring research into being and offer specific strategies for communicating reflexivity in research dissemination. With the growth of qualitative research in health professions education, it is essential that qualitative researchers carefully consider their paradigmatic stance and use reflexive practices to align their decisions at all stages of their research. We hope this Guide will illuminate such a path, demonstrating how reflexivity can be used to develop and communicate rigorous qualitative research.

Keywords: Reflexivity; qualitative methods; qualitative research.

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Chapter 6. Reflexivity

Introduction.

Related to epistemological issues of how we know anything about the social world, qualitative researchers understand that we the researchers can never be truly neutral or outside the study we are conducting. As observers, we see things that make sense to us and may entirely miss what is either too obvious to note or too different to comprehend. As interviewers, as much as we would like to ask questions neutrally and remain in the background, interviews are a form of conversation, and the persons we interview are responding to us . Therefore, it is important to reflect upon our social positions and the knowledges and expectations we bring to our work and to work through any blind spots that we may have. This chapter discusses the concept of reflexivity and its importance for conducting reliable qualitative research.

Reflexivity: What It Is and Why It Is Important

Remember our discussion in epistemology ? Qualitative researchers tend to question assertions of absolute fact or reality, unmediated through subject positions and subject knowledge. There are limits to what we know because we are part of the social worlds we inhabit. To use the terminology of standpoint theorists, we have a standpoint from which we observe the world just as much as anyone else. In this, we too are the blind men, and the world is our elephant. None of us are omniscient or neutral observers. Because of this epistemological standpoint, qualitative researchers value the ability to reflect upon and think hard about our own effects on our research. We call this reflexivity. Reflexivity “generally involves the self-examination of how research findings were produced, and, particularly, the role of the researcher in their construction” ( Heaton 2004:104 ).

There are many aspects of being reflexive. First, there is the simple fact that we are human beings with the limitations that come with that condition. We have likes and dislikes, biases, blind spots, preferences, and so on. If we do not take these into account, they can prevent us from being the best researcher we can be. Being reflective means, first and foremost, trying as best as possible to bracket out elements of our own character and understanding that get in the way. It is important to note that bias (in this context, at least) is not inherently wrong. It just is. Unavoidable. But by noting it, we can minimize its impact or, in some cases, help explain more clearly what it is we see or why it is that we are asking the questions we are asking. For example, I might want to communicate to my audience that I grew up poor and that I have a lot of sympathy and concern for first-generation college students as a result. This “bias” of mine motivates me to do the work I do, even as I try to ensure that it does not blind me to things I find out in the course of my research. [1]

A second aspect of being reflexive is being aware that you yourself are part of the research when you are conducting qualitative research. This is particularly true when conducting interviews, observing interactions, or participating in activities. You have a body, and it will be “read” by those in the field. You will be perceived as an insider or an outsider, as a friend or foe, as empathetic or hostile. Some of this will be wrong. People will prejudge you based on the color of your skin, your presented gender, the accent of your language. People will classify you based on the clothes you wear, and they will be more open to you if you remind them of a friendly aunt or uncle and more reserved if you remind them of someone they don’t like. This is all natural and inevitable. Your research will suffer if you do not take this into account, if you do not reflect upon how you are being read and how this might be influencing what people tell you or what they are willing to do in front of you. The flip side of this problem is that your particular body and presence will open some doors barred to other researchers. Finding sites and contexts where your presented self is a benefit rather than a burden is an important part of your individual research career. Be honest with yourself about this, and you will be more successful as a qualitative researcher. Learn to leverage yourself in your research.

The third aspect of being reflexive is related to how we communicate our work to others. Being honest with our position, as I am about my own social background and its potential impact on what I study or about how I leveraged my own position to get people to open up to me, helps our audiences evaluate what we have found. Maybe I haven’t entirely eliminated my biases or weaknesses, but by telling my audience who I am and where I potentially stand, they can take account of those biases and weaknesses in their reading of my findings. Letting them know that I wore pink when talking with older men because that made them more likely to be kind to me (a strategy acknowledged by Posselt [ 2016 ]) helps them understand the interview context. In other words, my research becomes more reliable when my own social position and the strategies I used are communicated.

Some people think being reflective is just another form of narcissistic navel-gazing. “The study is not about you!” they might cry. True, to some degree—but that also misses the point. All studies on the social world are inevitably about us as well because we are part of that social world. It is actually more dangerous to pretend that we are neutral observers, outside what we are observing. Pierre Bourdieu makes this point several times, and I think it is worth quoting him here: “The idea of a neutral science is fiction, an interested fiction which enables its authors to present a version of the dominant representation of the social world, naturalized and euphemized into a particularly misrecognizable and symbolically, therefore, particularly effective form, and to call it scientific” (quoted in Lemert 1981:278 ).

Bourdieu ( 1984 ) argues that reflective analysis is “not an epistemological scruple” but rather “an indispensable pre-condition of scientific knowledge of the object” ( 92 ). It would be narcissistic to present findings without reflection, as that would give much more weight to any findings or insights that emerge than is due.

The critics are right about one thing, however. Putting oneself at the center of the research is also inappropriate. [2] The focus should be on what is being researched, and the reflexivity is there to advance the study, not to push it aside. This issue has emerged at times when researchers from dominant social positions reflect upon their social locations vis-à-vis study participants from marginalized locations. A researcher who studies how low-income women of color experience unemployment might need to address her White, upper-class, fully employed social location, but not at the cost of crowding out the stories, lived experiences, and understandings of the women she has interviewed. This can sometimes be a delicate balance, and not everyone will agree that a person has walked it correctly.

Examples of Reflexivity in Practice

Most qualitative researchers include a positionality statement in any “methods section” of their publications. This allows readers to understand the location of the researcher, which is often helpful for gauging reliability . Many journals now require brief positionality statements as well. Here are a few examples of such statements.

The first is from an ethnographic study of elite golfers. Ceron-Anaya ( 2017 ) writes about his class, race, and gender and how these aspects of his identity and social location affected his interactions with research participants:

My own class origins, situated near the intersection between the middle and the lower-middle class, hindered cooperation in some cases. For example, the amiable interaction with one club member changed toward the end of the interview when he realized that I commonly moved about in the city by public transportation (which is a strong class indicator). He was not rude but stopped elaborating on the answers as he had been doing up to that point.…Bodily confidence is a privilege of the privileged. My subordinate position, vis-à-vis golfers, was ameliorated by my possession of cultural capital, objectified in my status of researcher/student in a western university. However, my cultural capital dwindled in its value at the invisible but firm boundary between the upper-middle and the upper class. The few contacts I made with members of the upper class produced no connections with other members of the same group, illustrating how the research process is also inserted in the symbolic and material dynamics that shape the field. ( 288 )

What did you learn from Ceron-Anaya’s reflection? If he hadn’t told you about his background, would this have made a difference in reading about elite golfers? Would the findings be different had Ceron-Anaya driven up to the club in a limousine? Is it helpful to know he came by bus?

The second example is from a study on first-generation college students. Hinz ( 2016 ) discusses both differences and similarities between herself and those she interviewed and how both could have affected the study:

I endeavored to avoid researcher bias by allowing the data to speak for itself, but my own habitus as a White, female, middle-class second-generation college student with a few years of association with Selective State [elite university] may have influenced my interpretation. Being a Selective State student at the time of the interviews provided a familiarity with the environment in which the participants were living, and an ease of communication facilitated by a shared institutional culture. And yet, not being a first-gen myself, it seemed as if I were standing on the periphery of their experience, looking in. ( 289–290 )

Note that Hinz cannot change who she is, nor should she. Being aware (reflective) that she may “stand on the periphery” of the experience of those she interviews has probably helped her listen more closely rather than assume she understands what is really going on. Do you find her more reliable given this?

These statements can be quite long, especially when found in methodological appendixes in books rather than short statements in articles. This last lengthy example comes from my own work. I try to place myself, explaining the motivations for the research I conducted at small liberal arts colleges:

I began this project out of a deep curiosity about how college graduates today were faring in an increasingly debt-ridden and unequal labor market. I was working at a small liberal arts college when I began thinking about this project and was poised to take a job at another one. During my interview for the new job, I was told that I was a good fit, because I had attended Barnard College, so I knew what the point of a liberal arts college was. I did. A small liberal arts college was a magical place. You could study anything you wanted, for no reason at all, simply for the love of it. And people would like you for it. You were surrounded by readers, by people who liked to dress up in costume and recite Shakespeare, by people who would talk deep into the night about the meaning of life or whether “beauty” existed out there, in nature, or was simply a projection of our own circumstances. My own experience at Barnard had been somewhat like that. I studied Ancient Greek and Latin, wrote an undergraduate thesis on the legal standing of Vestal Virgins in Ancient Rome, and took frequent subway rides to the Cloisters, the medieval annex of the Metropolitan Museum of Art, where I sketched the courtyard and stared at unicorn tapestries. But I also worked full-time, as a waitress at a series of hectic and demanding restaurants around the city, as a security guard for the dorm, as a babysitter for some pretty privileged professors who lived in doorman buildings along Riverside Park, and at the library (the best job by far). I also constantly worried I would not be able to finish my degree, as every year I was unsure how I would come up with the money to pay for costs of college above and beyond the tuition (which, happily, was covered by the college given my family’s low income). Indeed, the primary reason I studied the Classics was because all the books were freely available in the library. There are no modern textbooks—you just find a copy of the Iliad. There are a lot of those in a city like New York. Due to my fears, I pushed to graduate one year early, taking a degree in “Ancient Studies” instead of “Classics,” which could have led on to graduate training. From there, I went to law school, which seemed like a safe choice. I do not remember ever having a conversation with anyone about how to find a job or what kinds of job one could do with a degree in Ancient Studies. I had little to no social networks, as I had spent my time studying and working. And I was very lucky, because I graduated with almost zero debt. For years, until that job interview, I hadn’t really thought my Barnard experience had been that great or unusual. But now it was directly helping me get a job, about fifteen years after graduation. And it probably had made me a better person, whatever that means. Had I graduated with debt, however, I am not so sure that it would have been worth it. Was it, on balance, a real opportunity and benefit for poor students like me? Even now? I had a hunch of what I might find if I looked: small liberal arts colleges were unique places of opportunity for low-income first-generation working-class students who somehow managed to find and get in to one of them (no easy task). I thought that, because of their ethos, their smallness, the fact that one could not hide from professors, these colleges would do a fair job equalizing opportunities and experiences for all their students. I wanted to tell this story. But that is not the story that I found, or not entirely. While everyone benefits from the kind of education a small liberal arts college can offer, because students begin and continue so differently burdened and privileged, the advantages of the already-advantaged are amplified, potentially increasing rather than decreasing initial inequalities. That is not really a surprising story, but it is an important one to tell and to remember. Education doesn’t reduce inequality. Going to a good college doesn’t level the playing field for low-income, first-generation, working-class students. But perhaps it can help them write a book about that. ( Hurst 2019:259–261 )

What do you think? Did you learn something about the author that would help you, as a reader, understand the reasons and context for the study? Would you trust the researcher? If you said yes, why?

How to Do It

How does one become a reflective researcher? Practice! Nearly every great qualitative researcher maintains a reflexive journal (there are exceptions that prove the rule), a type of diary where they record their thinking on the research process itself. This might include writing about the research design (chapter 2), plotting out strategies for sample selection (chapter 6), or talking through what one believes can be known (chapter 3). During analysis, this journal is a place to record ideas and insights and pose questions for further reflection or follow-up studies. This journal should be highly personal. It is a place to record fears, concerns, and hopes as well. Why are you studying what you are studying? What is really motivating you? Being clear with yourself and being able to put it down in words are invaluable to the research process.

Today, there are many blogs out there on writing reflective journals, with helpful suggestions and examples. Although you may want to take a look at some of these, the form of your own journal will probably be unique. This is you, the researcher, on the page. Each of us looks different. Use the journal to interrogate your decisions and clarify your intent. If you find something during the study of note, you might want to ask yourself what led you to note that. Why do you think this “thing” is a “thing”? What about your own position, background, or researcher status that makes you take note? And asking yourself this question might lead you to think about what you did not notice. Other questions to ask yourself include the following: How do I know “that thing” I noted? So what? What does it mean? What are the implications? Who cares about this and why? Remember that doing qualitative research well is recursive , meaning that we may begin with a research design, but the steps of doing the research often loop back to the beginning. By keeping a reflective journal, you allow yourself to circle back to the beginning, to make changes to the study to keep it in line with what you are really interested in knowing.

One might also consider designing research that includes multiple investigators, particularly those who may not share your preconceptions about the study. For example, if you are studying conservative students on campus, and you yourself thoroughly identify as liberal, you might want to pair up with a researcher interested in the topic who grew up in a conservative household. If you are studying racial regimes, consider creating a racially diverse team of researchers. Or you might include in your research design a component of participatory research wherein members of the community of interest become coresearchers. Even if you can’t form a research team, you can reach out to others for feedback as you move along. Doing research can be a lonely enterprise, so finding people who will listen to you and nudge you to clarify your thinking where necessary or move you to consider an aspect you have missed is invaluable.

Finally, make it a regular part of your practice to write a paragraph reporting your perspectives, positions, values, and beliefs and how these may have influenced the research. This paragraph may be included in publications upon request.

Internal Validity

Being reflexive can help ensure that our studies are internally valid. All research must be valid to be helpful. We say a study’s findings are externally valid when they are equally true of other times, places, people. Quantitative researchers often spend a lot of time grappling with external validity , as they are often trying to demonstrate that their sample is representative of a larger population. Although we do not do that in qualitative research, we do sometimes make claims that the processes and mechanisms we uncover here, in this particular setting, are likely to be equally active in that setting over there, although there may be (will be!) contextual differences as well. Internal validity is more peculiar to qualitative research. Is your finding an accurate representation of what you are studying? Are you describing the people you are observing or interviewing as they really are? This is internal validity , and you should be able to see how this connects with the requirement of reflexivity. To the extent that you leave unexamined your own biases or preconceptions, you will fail at accurately representing those people and processes you study. Remember that “bias” here is not a moral failing in the way we commonly use bias in the nonresearch world but an inevitable product of our being social beings who inhabit social worlds, with all the various complexities surrounding that. Because of things that have happened to you, certain things (concepts, quotes, activities) might jump out at you as being particularly important. Being reflexive allows you to take a step back and grapple with the larger picture, reflecting on why you might be seeing X (which is present) but also missing Y (which is also present). It also allows you to consider what effect/impact your presence has on what you are observing or being told and to make any adjustments necessary to minimize your impact or, at the very least, to be aware of these effects and talk about them in any descriptions or presentations you make. There are other ways of ensuring internal validity (e.g., member checking , triangulation ), but being reflective is an essential component.

Advanced: Bourdieu on Reflexivity

One researcher who really tackled the issue of reflexivity was Pierre Bourdieu. [3] Known in the US primarily as a theorist, Bourdieu was a very capable and thorough researcher, who employed a variety of methods in his wide-ranging studies. Originally trained as an anthropologist, he became uncomfortable with the unreflective “outsider perspective” he was taught to follow. How was he supposed to observe and write about the various customs and rules of the people he was studying if he did not take into account his own supposedly neutral position in the observations? And even more interestingly, how could he write about customs and rules as if they were lifted from but outside of the understandings and practice of the people following them? When you say “God bless you” to someone who sneezes, are you really following a social custom that requires the prevention of illness through some performative verbal ritual of protection, or are you saying words out of reflex and habit? Bourdieu wondered what it meant that anthropologists were so ready to attribute meaning to actions that, to those performing them, were probably unconsidered. This caused him to ponder those deep epistemological questions about the possibilities of knowledge, particularly what we can know and truly understand about others. Throughout the following decades, as he developed his theories about the social world out of the deep and various studies he engaged in, he thought about the relationship between the researcher and the researched. He came to several conclusions about this relationship.

First, he argued that researchers needed to be reflective about their position vis-à-vis the object of study. The very fact that there is a subject and an object needs to be accounted for. Too often, he argued, the researcher forgets that part of the relationship, bracketing out the researcher entirely, as if what is being observed or studied exists entirely independently of the study. This can lead to false reports, as in the case where a blind man grasps the trunk of the elephant and claims the elephant is cylindrical, not having recognized how his own limitations of sight reduced the elephant to only one of its parts.

As mentioned previously, Bourdieu ( 1984 ) argued that “reflective analysis of the tools of analysis is not an epistemological scruple but an indispensable precondition of scientific knowledge of the object” ( 92 ). It is not that researchers are inherently biased—they are—but rather that the relationship between researcher and researched is an unnatural one that needs to be accounted for in the analysis. True and total objectivity is impossible, as researchers are human subjects themselves, called to research what interests them (or what interests their supervisors) and also inhabiting the social world. The solution to this problem is to be reflective and to account for these aspects in the analysis itself. Here is how Bourdieu explains this charge:

To adopt the viewpoint of REFLEXIVITY is not to renounce objectivity but to question the privilege of the knowing subject, which the antigenetic vision arbitrarily frees, as purely noetic, from the labor of objectification. To adopt this viewpoint is to strive to account for the empirical “subject” in the very terms of the objectivity constructed by the scientific subject (notably by situating it in a determined place in social space-time) and thereby to give oneself awareness and (possible) mastery of the constraints which may be exercised on the scientific subject via all the ties which attach it to the empirical “subject,” to its interests, motives, assumptions, beliefs, its doxa, and which it must break in order to constitute itself . ( 1996:207 ; emphases added)

Reflexivity, for Bourdieu, was a trained state of mind for the researcher, essential for proper knowledge production. Let’s use a story from Hans Christian Andersen to illustrate this point. If you remember this story from your childhood, it goes something like this: Two con artists show up in a town in which its chief monarch spends a lot of money on expensive clothes and splashy displays. They sense an opportunity to make some money out of this situation and pretend they are talented weavers from afar. They tell the vain emperor that they can make the most magnificent clothes anyone has ever seen (or not seen, as the case may be!). Because what they really do is “pretend” to weave and sew and hand the emperor thin air, which they then help him to put on in an elaborate joke. They tell him that only the very stupid and lowborn will be unable to see the magnificent clothes. Embarrassed that he can’t see them either, he pretends he can. Everyone pretends they can see clothes, when really the emperor walks around in his bare nakedness. As he parades through town, people redden and bow their heads, but no one says a thing. That is, until one child looks at the naked emperor and starts to laugh. His laughter breaks the spell, and everyone realizes the “naked truth.”

Now let us add a new thread to this story. The boy did not laugh. Years go by, and the emperor continues to wear his new clothes. At the start of every day, his aides carefully drape the “new clothes” around his naked body. Decades go by, and this is all “normal.” People don’t even see a naked emperor but a fully robed leader of the free world. A researcher, raised in this milieu, visits the palace to observe court habits. She observes the aides draping the emperor. She describes the care they take in doing so. She nowhere reports that the clothes are nonexistent because she herself has been trained to see them . She thus misses a very important fact—that there are no clothes at all! Note that it is not her individual “biases” that are getting in the way but her unreflective acceptance of the reality she inhabits that binds her to report things less accurately than she might.

In his later years, Bourdieu turned his attention to science itself and argued that the promise of modern science required reflectivity among scientists. We need to develop our reflexivity as we develop other muscles, through constant practice. Bourdieu ( 2004 ) urged researchers “to convert reflexivity into a disposition, constitutive of their scientific habitus, a reflexivity reflex , capable of acting not ex poste , on the opus operatum , but a priori , on the modus operandi ” ( 89 ). In other words, we need to build into our research design an appreciation of the relationship between researcher and researched.

To do science properly is to be reflective, to be aware of the social waters in which one swims and to turn one’s researching gaze on oneself and one’s researcher position as well as on the object of the research. Above all, doing science properly requires one to acknowledge science as a social process. We are not omniscient gods, lurking above the humans we observe and talk to. We are human too.

Reflexivity and Positionality in Qualitative Research: On Being an Outsider in the Field

First Online: 29 November 2023

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Positionality matters in social scientific research. Qualitative scholars have long drawn attention to the impact of researchers’ multiple identities on research findings and knowledge production. They have also highlighted the intersectional, fluid, and context-dependent nature of positionality. In dialogue with this literature, this chapter acknowledges the ambivalence surrounding the insider/outsider dichotomy and focuses on being an “outsider”—as an ideal-typical category—when conducting ethnographic field research. Building on the author’s research experience among Kurdish religious elites in Southeastern Anatolia, where she was an outsider on many levels, it inquires about the challenges and advantages of the “outsider” position. Through vignettes and dialogues from the field it provides insight into how to navigate the fragile ground of such a position.

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Fieldwork and the Self: Perspectives and Debates

Power, Positionality, and the Ethic of Care in Qualitative Research

Restoring Context and Meaning in Social Inquiry: The Reach of Qualitative Methods

“Kurdish movement” includes the complex set of legal and illegal Kurdish organizations associated with the Kurdish struggle for greater political and cultural rights and political autonomy. It comprises the illegal PKK (Partiya Karkerên Kurdistan/Kürdistan İşçi Partisi/Kurdistan Workers’ Party), and TAK (Teyrêbazên Azadiya Kurdistan/Kurdistan Özgürlük Şahinleri/ Kurdistan Freedom Hawks), a PKK offshoot, and the legal HDP (Halkların Demokratik Partisi/Peoples’ Democratic Party), DBP (Demokratik Bölgeler Partisi/Democratic Regions Party), DTK (Demokratik Toplum Kongresi/Democratic Society Congress), and HDK (Halkların Demokratik Kongresi/Peoples’ Democratic Congress). The PKK is listed as a terrorist organization by the government of Turkey, the USA, EU and NATO.

My field research encompassed three cities in total: Diyarbakır, Batman, and İstanbul. However, for the purposes of this piece, I will be focusing only on my time and experiences in the former two (especially in Diyarbakır), as I did not occupy the same “outsider” position in İstanbul

Note, however, that there were also Kurdish revolts in the Ottoman Empire, which took place as early as the nineteenth century, mostly against the centralizing reforms of the empire at the time (see Chailand, 1993 ).

See details at: https://www.crisisgroup.org/content/turkeys-pkk-conflict-visualexplainer . Accessed January 10, 2020.

There is no official ban on Kurdish language in Turkey but Kurdish has been de facto criminalized since the very early days of the Republic. (The speaking of Kurdish in public was outlawed between 1983 and 1991.) The current constitution, penned in 1980, recognizes only Turkish as the country’s official language and article 42 of the constitution states that no language other than Turkish can be taught as a native tongue to Turkish citizens. Moreover, since the coup attempt in 2016, scores of Kurdish-language TVs, newspapers, and Kurdish-language courses have been closed down by emergency decrees.

While Kurds call Southeastern Anatolia “Northern Kurdistan” (Bakur), the Turkish media and politicians have, for a long time, called it “the region.”

Not connected to the Lebanese Hizbullah, the Kurdish Hizbullah was engaged in armed conflict with the PKK throughout the 1990s. In 2000, the leader of the organization, Hüseyin Velioğlu, was killed in a police raid in İstanbul and hundreds of Hizbullah members were detained. They have managed to survive as an underground organization and in 2013 founded an Islamist political party with the name of Hür Dava Partisi (Free Cause Party).

The Adıyaman-based Menzil has its roots in the Naqshbandi-Khalidi order and is currently one of the most influential religious orders in Turkish politics, with extensive networks all over the country.

Sohbet means conversation in Turkish. In this context, it refers to pious reading circles where informal conversations with religious overtones take place.

Established in the 1970s by Fethullah Gülen, a preacher in self-exile in the US since 1999 (due to charges of engaging in anti-secular activities), the Gülen movement used to be the largest religious network in Turkey. Called Hizmet (Service) by its followers, Cemaat (Jamaat) by some journalists and researchers, and Fethullah Terör Örgütü (Fethullah Terrorist Organization), FETÖ, by the government, the movement follows the teachings of Said-i Nursi, a Kurdish Sunni Muslim theologian who lived at the turn of the twentieth century. Between 2002 and 2012 they allied with the AKP to facilitate the latter’s takeover of key political institutions. At the time, the movement was accused of and criticized for using wiretapping, blackmail and fraud in eliminating rivals. The alliance started to crack in 2011 and reached a climax in 2016 when a clique in the Turkish Armed Forces attempted to undertake a coup to topple the government. Accusing Gülen for masterminding the coup the AKP has since started an all-out-war against Gülenists; thousands have been imprisoned and exiled, and the assets of Gülenist companies have been confiscated.

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Türkmen, G. (2023). Reflexivity and Positionality in Qualitative Research: On Being an Outsider in the Field. In: Şen, E., Sandal Önal, E., Sefa Uysal, M., Acar, Y.G. (eds) The Political Psychology of Kurds in Turkey. Palgrave Studies in Political Psychology. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-33291-3_8

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" (p. 484).

-- This can foster dialogue, lead to the development of complementary as well as divergent understandings of a study situation and provide a context in which researchers' - often hidden - beliefs, values, perspectives and assumptions can be revealed and contested.

(c.f. Lincoln and Guba). -- This is a type of diary where a researcher makes regular entries during the research process. In these entries, the researcher records methodological decisions and the reasons for them, the logistics of the study, and reflection upon what is happening in terms of one's own values and interests. Diary keeping of this type is often very private and cathartic.

. - - Many believe that it is valuable and essential to briefly report in manuscripts, as best as possible, how one's preconceptions, beliefs, values, assumptions and position may have come into play during the research process.

. 9(1), 26-44.

. 28(4), 882-890.

. Newbury Park, CA: Sage Publications.

. 358: pp. 483-488.


	© RWJF 2008 P.O. Box 2316 College Road East and Route 1 Princeton, NJ 08543	-->Citation: Cohen D, Crabtree B. "Qualitative Research Guidelines Project." July 2006.

Examining the world through qualitative inquiry

Reflective journals in qualitative inquiry

This week’s guest blogger is Kyu Ha Choi, who is a Ph.D. candidate in the Sport Management and Policy program in the Department of Kinesiology at the University of Georgia, Athens, GA, USA. His research focuses on sport event management with emphasis on the development of sport along with qualitative research methods.

Screencast on reflective journals in qualitative research

I initially had three questions that pertain to the concept of reflective journals in relation to qualitative research. Those three questions were: (1) what is the reflective journal in qualitative research? (2) why do we implement reflective journals in our research? and (3) what are the outcomes of employing reflective journals in research? In response to these questions, the objectives of this essay are to understand the concept of reflective journals within qualitative research and to understand why reflective journals are implemented in qualitative research. This essay has been written for any researcher, but especially novice researchers who are not very familiar with or have a limited knowledge of reflective journals in qualitative research and how they might incorporate them in their research. This essay will help researchers learn about the possible outcomes of employing reflective journals and outline some challenging issues of using reflective journals in research.

The reflective journal in qualitative research is a written record by the researchers themselves and is written throughout the research process. A reflective journal includes the details of what the researchers did, thought, and felt while analyzing the data. Then, the rationale behind those thoughts and percepts are recorded. According to Russell and Kelly (2002), keeping self-reflective journals during the analysis process is a strategy that facilitates reflexivity by using the researchers’ journals to examine “personal assumptions and goals” and to clarify “individual belief systems and subjectivities” (p. 2). By doing so, keeping reflective journals consciously acknowledges the values and experiences of the researchers rather than attempting to control their values through methods. In other words, the reflective practice encourages researchers to talk about the presuppositions, experiences, and actions and rationales behind them during the research process. In this regard, reflective journals are increasingly becoming visible within qualitative research.

As for the attributes of reflective writing, the fact that the reflective journal is written in the first-person point of view makes the writing fundamentally subjective. Through writing in the first-person point of view, the centrality of the researcher is acknowledged. Also, self-awareness and an internal dialogue that help in analyzing important issues in the research are supported. In this regard, Jasper (2005) noted that “the purpose of reflective writing is learning which will precipitate some form of action or change in behaviour… is to facilitate the researcher’s discovery and provide a verifiable audit-trail of the research process.” (p. 250) Reflective writing also develops critical thinking by enhancing higher-level conceptual skills. This development is supported because writing down ideas urges the author or researcher to develop and rationalize, which motivate the author to acquire new knowledge that is associated with the research. Finally, reflective writing, along with critical thinking, enables researchers to broaden their perspectives and discover new thoughts and research practices.

Reflective journals as data mainly fall into two categories. First, the products of reflective writing can be used as primary data. Autobiographies, journals, and logs are examples of the case in which reflective writing is employed as the primary data. Reflective writing as the primary data source is well-established in qualitative research, especially in the field of nursing and education. This essay focuses on reflective journals as the secondary data category, including field notes with reflection-on-action that includes insights and references to other data sources. Smith (1999) highlighted in his study that written reflections on one’s own feelings create an audit trail of one’s reasoning, thus contributing to the trustworthiness of the findings by supporting the researcher’s subjectivity.

One of the main reasons why the qualitative researcher maintains a reflective journal is to achieve a rigorous research process. Issues of rigor in qualitative research refer to the trustworthiness of the study (Guba & Lincoln, 1985), and some attributes of rigor include credibility, dependability, and transferability. According to Jasper (2005), reflective journal writing allows researchers to own centrality of their research process, which contributes to the legitimacy of the knowledge claims. Also, reflective journal writing provides an audit trail which clearly indicates the procedural steps that enhance the transparency of process. Moreover, a reflective journal is particularly useful when things did not happen as planned and as one’s thinking changes.

The primary purpose of using reflective journals is to enable researchers to explicitly map their role as researchers. By allowing the subjectivity of the researchers, reflective journals record one’s experiences, thoughts, opinions, and feelings and make them an acknowledged part within the data analysis and interpretation processes. By doing so, researchers can make a vague and unorganized research process more visible not only for themselves but also for their readers. Also, use of reflective journals affects the research process by changing the research design or approach if necessary. Last, but not least, as previously mentioned, use of reflective journals provides an audit trail of the research design, which enhances the transparency of the research process.

Despite the positive potential outcomes from using reflective journals, several challenging issues are associated with reflective journal writing. One potential issue is on ethical grounds in which confidentiality is hard to account for when reflective writing is practiced poorly. Another noticeable issue is hindsight bias. The practice of reflective journal writing may cause hindsight bias which happens when researchers know the outcome of their research in advance and consequently judge that outcome as more likely if they had not known that outcome knowledge (Rehm & Gadenne, 2013). As a result, researchers must overcome several issues in order to conduct a rigorous and reliable reflective journal writing that contributes positively to the research process.

Use of the reflective journal may seem a bit bothersome and time-consuming to some researchers. However, this practice certainly helps qualitative researchers to have a central role in a research process and enhances the transparency of the research process. I am certain that reflective journals are worthy of the required time, and we should make reflective journaling a priority in any type of research.

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Smith, B. A. (1999). Ethical and methodologic benefits of using a reflexive journal in hermeneutic‐phenomenologic research. Image: The Journal of Nursing Scholarship , 31 (4), 359-363.

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Kathy Roulston is a professor in the Qualitative Research program in the Department of Lifelong Education, Administration and Policy at the University of Georgia, Athens, GA, USA. She teaches qualitative research methods, and has written on qualitative interviewing. https://orcid.org/0000-0002-9429-2694 Kathryn J. Roulston on ResearchGate My books include: Interviewing: A guide to theory and practice, see: https://us.sagepub.com/en-us/nam/interviewing/book272521 Interactional studies of qualitative interviews. See: https://benjamins.com/catalog/z.220 View all posts by qualpage

Research Design Review

A discussion of qualitative & quantitative research design, reflections from the field: questions to stimulate reflexivity among qualitative researchers.

The outcomes from a qualitative study are only as good as the data the researcher returns from the field. And one of the biggest threats to the quality of the research data is the ever-present yet rarely examined assumptions and prejudices inadvertently contributed by the researcher.

This is why personal reflection is an important part of qualitative research design. To motivate and capture this reflection, the earlier RDR article discusses the use of a reflexive journal or diary by which the researcher provides a subjective account of each research event with details of the influences that may have affected results. The journal “sensitizes the [researcher] to his or her prejudices and subjectivities, while more fully informing the researcher on the impact of these influences on the credibility of the research outcomes.”

But what exactly are the particular questions the researcher should be addressing in this journal? That is, what exactly is the researcher reflecting on ? A reflexive exercise that is totally open and non-directional can be good, but it is also useful to consider particular questions that help stimulate reflective thoughts. Here are a few key questions for the researcher’s reflexive journal:

Broad Takeaways from the Research Event (e.g., the IDI, the focus group, the observation)

What do I think I “know” from this/these participants?
How do I think I “know” it?
Will this knowledge change the course of the research, in terms of objectives, methods, line of inquiry; and, if so, how?

Specific Reflections on the Experience

What assumptions did I make about the participant(s)?
What assumptions did I make about comments/responses to my questions?
How did these assumptions affect or shape: the questions I asked, the interjections I made, my listening skills, and/or my behavior?
How did my personal values, beliefs, life story, and/or social/economic status affect or shape: the questions I asked, the interjections I made, my listening skills, and/or my behavior?
To what degree did my emotions or feelings for the participant(s) affect or shape: the questions I asked, the interjections I made, my listening skills, and/or my behavior?
How will my emotions or feelings for the participant(s) affect the analytical process and my ability to draw valid interpretations from the data?
How did the physical setting/location of the research event alter how I related to the participant(s), and how the participant(s) related to me?
How did the physical setting/location impact data collection?
What were the logistical issues (e.g., in gaining access) that contributed to the “success” or weakness of the outcomes?

¹Compared to quantitative research.

Image captured from: http://photography.nationalgeographic.com/photography/photos/patterns-nature-reflections/#/sandhill-cranes-sartore_1516_600x450.jpg

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In school, I was trained to see reflexivity as an important part of the research process. Yet, as a researcher in business, it’s not something that we ever really have time for – I think because it’s not seen as directly useful for the bottom line or the design of products or experiences (even though such reflections can shape research design and analysis, and therefore results.)

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Reflexivity is definitely integral to community research, and inherent in approaches such as community based participatory research (CBPR). Interesting comment in above article about ’emotional connections’. Perhaps an unavoidable symptom of the blurred boundaries that emerge in this type of research. Is this an ethical issue? Read what some researchers have said about their experience of ethics in CBPR at http://cbprethics.wordpress.com .

Reblogged this on Qualitative PhD Research and commented: I wonder – how soon do Doctoral Researchers start practicing reflexivity? Is it something that your Supervisor flagged as important? Do researchers ‘dipping their toes’ in qualitative research take on reflexive practice?

Article Contents

Author contributions, acknowledgements, conflict of interest statement.

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Young people’s views and experience of diet-related inequalities in England (UK): a qualitative study

Article contents
Figures & tables
Supplementary Data

Vanessa Er, Mary Crowder, Eleanor Holding, Nicholas Woodrow, Naomi Griffin, Carolyn Summerbell, Matt Egan, Hannah Fairbrother, Young people’s views and experience of diet-related inequalities in England (UK): a qualitative study, Health Promotion International , Volume 39, Issue 4, August 2024, daae107, https://doi.org/10.1093/heapro/daae107

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Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP’s perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13–21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP’s diet. YP were aware of how inequalities in employment conditions impact their families’ income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns.

Our study recognizes that young people have an awareness and understanding of food as important in relation to health, and of diet-related inequalities.

Young people have a nuanced appreciation of bounded agency: that is, the way social, cultural and economic factors shape individual food choices and practices.

Young people are potential sources of support for health equity strategies that include social determinist approaches.

Further efforts are needed to shape and promote policies that resonate with young people and reflect and address both their health and wider social concerns.

Inequalities in diets contribute to overall inequalities in health ( The Parliamentary Office of Science and Technology, 2022 ). Improvements in diets can improve population-wide health and reduce wider health inequalities. Poor diet in childhood and adolescence tracks into adulthood ( Hovdenak et al. , 2019 ; Appannah et al. , 2021 ) and is associated with lower health-related quality of life ( Wu et al. , 2019 ) and higher risk of chronic diseases, such as cardiovascular disease ( Daniels et al. , 2011 ), diabetes ( Lascar et al. , 2018 ) and some cancers ( World Cancer Research Fund and American Institute for Cancer Research, 2018 ). According to the Global Burden of Disease dashboard, poor diet was the cause of 7.9 million deaths worldwide in 2019, accounting for 14% of all deaths ( Global Burden of Disease Collaborative Network, 2020 ).

One of the main drivers for poor dietary quality is economic inequality and the relatively high cost of eating a healthy diet. According to the Food and Agriculture Organization’s (FAO) report on ‘The State of Food Security and Nutrition in the World’, more than 3.1 billion people across the world could not afford a healthy diet in 2021 ( Food and Agriculture Organization et al. , 2023 ). In the UK, The Food Foundation reported an increase in the proportion of food insecure households with children, from 12.2% in 2022 to 24.4% in 2023 ( The Food Foundation, 2023 ). Additionally, healthy nutritious food was two times more expensive than unhealthy products. Young people (YP) from disadvantaged backgrounds are more likely to experience food insecurity ( O’Connell et al. , 2019 ), which has worsened since the COVID-19 pandemic and the cost-of-living crisis. Studies conducted in England have shown that YP from socioeconomically disadvantaged backgrounds are more likely to have poor diets ( Johnson et al. , 2018 ; Public Health England and Food Standards Agency, 2021 ). The 2020–21 UK National Diet and Nutrition Survey revealed higher consumption of sugar-sweetened beverages and energy-dense food, and lower consumption of fruits and vegetables among the most socioeconomically deprived YP ( Public Health England and Food Standards Agency, 2021 ). Furthermore, the latest statistics from the UK National Child Measurement Programme revealed that children aged 10–11 years living in the most deprived areas were more than twice as likely to be categorized as obese, based on body mass index, compared to those living in the least deprived areas (31.3% vs. 13.5%) ( Office for National Statistics, 2022 ).

Another driver of YP’s diet is the neighbourhood food environment. There is consistent evidence showing a high density of fast-food and takeaway outlets in socioeconomically deprived areas and areas with a high concentration of ethnic minority population ( Fleischhacker et al. , 2011 ; Molaodi et al. , 2012 ; Thornton et al. , 2016 ; Public Health England, 2018 ; Sanchez-Vaznaugh et al. , 2019 ). This means greater availability of, and access to unhealthy food, as these outlets tend to sell relatively cheap, energy-dense and nutrient-poor food ( Jaworowska et al. , 2014 ; Huang et al. , 2022 ; Rinaldi et al. , 2022 ). The inequalities also extend to unhealthy food advertising where YP from ethnic minority and socioeconomically disadvantaged backgrounds are disproportionately targeted where they live, as well as online ( Backholer et al. , 2021 ). In the UK, children living in low-income households are more likely to eat takeaway meals at home, and those who consume takeaways more frequently have poorer diets ( Adams et al. , 2015 ; Taher et al. , 2019 ). The density of takeaway outlets across England increases each year ( MRC Epidemiology Unit, University of Cambridge, 2019 ). A study of takeaway outlets in Norfolk, UK revealed that the density of takeaway outlets grew between 1990 and 2008, and the increase in the number of outlets was higher in the most deprived areas compared to the least deprived, with this widening over time (3.5 times higher in 2008 vs. 2.8 times higher in 1990) ( Maguire et al. , 2015 ). There is emerging evidence of socioeconomic patterning in online access to takeaway outlets too. A recent study by Keeble et al. (2021) found that the percentage of registered food outlets on an online food delivery service in the most deprived areas was approximately two times greater than in the least deprived areas in the UK.

Despite mounting evidence of the structural barriers to eating a healthy diet, such as economic inequalities and the food environment, less is known about how YP view and experience these inequalities where they live, or how to address them. There have been two previous systematic reviews and a scoping review of YP’s views on healthy eating, all focusing on body size (e.g. obesity, body shape and weight) rather than health or health inequalities per se . One review included 11- to 16-year-olds ( Shepherd et al. , 2006 ); another 12- to 18-year-olds ( Rees et al. , 2014 ) and the third 18- to 24-year-olds ( Munt et al. , 2017 ). None of these reviews presented detailed analysis focused on health inequalities, as the reviewers noted that included studies typically reported few details on equity dimensions. The reviews by Shepherd et al. (2006) and Rees et al. (2014) found that YP tended not to frame food as a health issue. Rather they tended to view food in terms of what they liked and disliked.

The case has been made that low agency population interventions, such as free school meals (FSMs), advertising restrictions of foods high in fat, salt and sugar (HFSS) and restrictions of takeaway outlets, are effective and equitable ways to reduce poor diet in the population ( Adams et al. , 2016 ). However, research literature is sparse on YP’s views of such interventions, or their views on alternative (high agency) education interventions or the relative merits of targeted and population-level approaches. In England, the FSM ( Department for Education, 2018 ) and holiday activities and food programmes ( Department for Education, 2022 ) provide healthy food to school-aged children from low-income backgrounds, but there is no provision for older YP (e.g. aged 18–24) from similar backgrounds. Currently, there is a restriction on broadcast advertising for HFSS foods, but only for those aimed at children ( UK Advertising Standards Authority, 2024 ). The existing planning policy only restricts the opening of new takeaway outlets ( Keeble et al. , 2019 ), which has been perceived as less useful in areas that already have a high density of takeaway outlets.

To address the gap in the literature, our study was guided by the following questions:

What is YP’s understanding and experience of diet-related health inequalities?

What are the drivers of diet-related health inequalities where YP live?

What are YP’s views on addressing diet-related health inequalities where they live?

The research in this article drew on data from a wider study exploring YP’s perceptions of what influences their opportunities to be healthy within their local area and their understanding of health inequalities ( Fairbrother et al. , 2022 ). The philosophical underpinning of our approach is critical realism. We view health inequalities as real (they exist independently of human practices and awareness) while acknowledging the role of human practices, perspectives and social context in shaping how we know about health inequalities. In other words, our knowledge of health inequalities is subjective and incomplete. Our approach was critical in orientation ( Braun and Clarke, 2024 ) in that, we sought to unpack and interrogate participants’ accounts to provide causal explanations of health inequalities and make recommendations that are relevant and beneficial to YP. We conducted a qualitative study to understand YP’s perceptions and experiences of health inequalities, with a focus on explaining the causal mechanisms of health inequalities.

Positionality

As a team of public health researchers, our work is rooted in explaining and addressing health inequalities. Based on our knowledge of the literature, we assumed that YP have a more individualistic explanation of the causes of, and solutions to health inequalities. We believe that YP have a right to good health and they should be supported to live to their fullest potential. We made a conscious effort to include disadvantaged and marginalized voices. However, we recognized the power imbalance as we are older, well-educated and ‘relatively advantaged’ (though this term masks some variation in the research team, such as variation in social backgrounds, job security, housing security and other intersecting equity dimensions). Therefore, we took a participatory approach to research in our attempt to balance power dynamics and meaningfully include YP of disadvantaged backgrounds in discussions on health inequalities. Engaging in a process of reflexivity, we acknowledge that our analysis is informed by our prior understandings of health equity, including pre-held assumptions that social determinants, as described by Marmot et al. (2020) , are particularly important for both explaining and tackling health inequalities. We acknowledge that our research findings extend from our subjective experience of the research, influenced by our social and professional backgrounds, and our particular interactions with the YP who participated.

Sampling and recruitment

We recruited YP aged 13–21 years through six youth groups across three geographical areas in England; London, South Yorkshire and North East. Our original sampling frame targeted YP living in areas with contrasting levels of deprivation and geography (e.g. rural and urban). This was hampered by the COVID-19 pandemic, so we recruited YP from youth groups with whom we had established relationships, all of which were located in areas in the most deprived quintile based on the 2019 English indices of multiple deprivation. Furthermore, while we initially aimed to work with YP aged 13–17 years, we took an inclusive approach as some of our youth groups also included YP over 18.

Data collection

We conducted a series of three interlinked focus groups with YP from each of the six youth groups between February 2021 and June 2021, resulting in a total of 18 focus group sessions. The focus groups were planned to be in-person, but we switched to an online format for all but three sessions with one youth group in the North East due to the UK’s lockdown and social distancing restrictions during the COVID-19 pandemic.

Session 1 used a participatory concept mapping activity ( Jessiman et al. , 2021 ) to explore perceptions of what influences YP’s opportunities to be healthy in their local area. Session 2 examined YP’s understanding of health inequalities through prompted discussion of selected health-related news headlines, including FSMs, fast food and advertising of less healthy food. Session 3 focused on YP’s priorities for change to improve health in their area.

Facilitators used a topic guide (see Supplementary Material ) that had been piloted with youth organizations to aid discussions. At least two researchers facilitated each focus group, accompanied by a youth worker for safeguarding purposes and to support YP if required ( Woodrow et al. , 2022 ). Focus groups lasted between 90 and 100 minutes and were audio-recorded with consent. Participants also provided information on ethnicity, age and residential postcode (used to determine area deprivation level). We gave participants £20 vouchers at the end of each focus group as a token of appreciation for their time.

The study has ethics approval from the School of Health and Related Research (SCHARR) Ethics Committee at the University of Sheffield (ref: 037145). All participants provided written consent. For participants under the age of 16 years, opt-in consent was also obtained from parents/guardians.

Data analysis

Prior to analysis, audio recordings were transcribed verbatim and anonymized by approved transcription services. The research in this article drew on data from a wider study exploring YP’s perceptions of what influences their opportunities to be healthy within their local area and their understanding of health inequalities ( Fairbrother et al. , 2022 ). Here, we only include discussions about food as data. We analysed the data using reflective thematic analysis ( Braun and Clarke, 2022 ) as it is theoretically flexible and fits with a critical realist approach. Using this approach, we examined the mechanisms and structures that give rise to diet-related inequalities by focusing on participants’ accounts and situating them within the contexts (realities) that participants live in. This requires continual reflexivity and critical engagement with the data and the analytical process.

V.E. and M.C. read the transcripts and applied a mix of semantic (surface meaning) and latent coding (underlying meaning), aided by a qualitative analysis software, NVivo 12. During the coding process, V.E. and M.C. met regularly to discuss the meaning of the data to ensure reflexivity and expand the interpretation of the data. We analysed the data deductively by using two frameworks as a lens to make sense of the data: Smith and Anderson’s (2018) framework for lay perspectives of socioeconomic health inequalities, and Pearce et al.’s (2019) conceptual model of pathways to inequalities in child health. We combined it with inductive analysis as we were open to the possibility that the data may not fit these frameworks.

Upon reflection, we decided that Giddens’s (1989) structuration theory which posits social practices as an interplay between agency and social structure, was a better fit for the data and used it to inform the conceptualization of themes. We focused on how diet-related inequalities were produced, by contextualizing YP’s eating practices and interactions with their local food environment, and connecting it with the social history and structure of the area where they live. The themes were further developed by V.E. and M.C. alongside discussions with C.S. and H.F. to ensure the themes capture the central meanings and patterns identified from the data and answer the research questions. V.E. wrote a narrative for each theme, with the scope of each theme being iteratively defined and refined with inputs from M.C., C.S., M.E. and H.F.

Our final sample consisted of 42 YP aged 13–21 living in urban and rural areas, and of different genders and ethnicity (see Table 1 ).

Participant characteristics

.	London ( = 13) .	South Yorkshire ( = 14) .	North East ( = 15) .
	16–21	15–17	13–20
)
Female	10	6	2
Male	3	7	9
Non-binary	–	–	2
Gender-fluid	–	1	–
Trans male	–	–	2
)
White British	1	14	15
Asian/Asian British	6	–	–
Black/Black British	3	–	–
Mixed/Multiple ethnic group	2	–	–
Chinese	1	–	–

.	London ( = 13) .	South Yorkshire ( = 14) .	North East ( = 15) .
	16–21	15–17	13–20
)
Female	10	6	2
Male	3	7	9
Non-binary	–	–	2
Gender-fluid	–	1	–
Trans male	–	–	2
)
White British	1	14	15
Asian/Asian British	6	–	–
Black/Black British	3	–	–
Mixed/Multiple ethnic group	2	–	–
Chinese	1	–	–

The YP in this study perceived eating a healthy diet as unattainable due to intersecting inequalities that manifested in their daily food practices and environment. YP’s agency to eat healthily was constrained by structural inequalities, mainly economic inequality and low availability and access to healthy food in deprived areas. We identified three key themes: (i) impact of economic inequality on family food practices, (ii) availability and access to hot food takeaways in areas of high deprivation and (iii) making healthy food more accessible to families.

(i) Perceived impacts of economic inequality on family food practices

This theme captures YP’s understanding of economic inequality. They viewed economic inequality through a ‘place’ lens, whereby some regions or neighbouring local areas in the UK were viewed as more economically disadvantaged than others. A recurring view suggested a mechanism whereby places with economic problems had poorer employment opportunities for YP and their parents. This in turn led to two types of barriers to healthy eating. Firstly, low incomes—YP believed that healthy foods tend to be more expensive than unhealthy food and that low-income families may have to choose between healthy diets and other essentials such as heating and school uniforms. Secondly, YP perceived that for many low-income families, there is less opportunity to prepare healthy meals at home due to a lack of time as a result of working long hours and/or multiple jobs.

Though YP acknowledged the importance of nutrition knowledge and cooking skills for healthy eating, they were acutely aware of how family income (or lack of it) restricted their ability to have an adequate and healthy diet.

I see it sort of like if you have a run down job, you don’t have as much pay to pay for the food. Meanwhile, if you have a high job and you have the high society, you have more pay, therefore you’re able to take on more food. Which brings in the inequality with food discussed tonight. (North East Group 2, Session 2)

There was a common perception among YP that unhealthy food is cheap while healthy food (described mainly as fresh fruits and vegetables) is expensive and thus unattainable on a low income.

things like salads they’re expensive man, like five, six quid then the opposite of that, like portion of chips is like a quid…Even the prices of fruit and veg, I don’t know why they price up a bit too much. (London Group 1, Session 1) I’d say so because like there’s a lot of income inequality where we are especially, so a lot of like poorer households find it hard to buy the more healthy stuff. They tend to be more expensive, especially in supermarkets… (South Yorkshire Group 2, Session 1)

YP also knew of low-income families having to prioritize household bills and expenses over food. A few spoke from experience about their parents having to spend less on food to pay for essentials such as school uniforms. The need to make trade-offs came to the fore while discussing the impact of the COVID-19 pandemic. YP noted that some in their community could hardly afford to pay utility bills and were thus unable to store and/or cook fresh food, resorting to the convenience of fast-food or hot food takeaways.

I think, with fast food, it doesn’t need to be maintained in a sense, so like, let’s say you can’t afford electricity bills, you can’t afford to keep your fridge running, or something. Buying healthy stuff isn’t, it’s not going to last, so just buying fast food, might be cheese and everything, is like OK, I’ve bought it, I can eat it, through it in a day, like it’s finished. (London Group 1, Session 2) …that goes back to the budgeting thing. Some people, especially people who don’t necessarily have a lot of money might want to spend less on food and more on making sure that their child has the right stuff for school. (South Yorkshire Group 1, Session 1)

While YP made direct reference to low income as a barrier to healthy eating, they also demonstrated an in-depth understanding of inequalities in employment conditions faced by those working in low-paid jobs, and how that negatively impacts one’s ability to eat a healthy diet. They pointed out that those in low-paid jobs often lack time to prepare and cook meals as they tend to work long hours or multiple jobs. The North-South (England) divide in economic opportunities was regularly brought up by YPs from the North East. According to one YP, movement restrictions during the COVID-19 pandemic further highlighted the inequalities experienced by those in low-paid jobs (e.g. bus drivers and delivery drivers) as they were less able to work from home.

We did talk a bit about how people in the North, the sort of jobs that we have, it’s less likely that you’ll be able to work from home. So if you are working from home – which predominantly, especially if you’re in the South because a lot of the economies, they’re very knowledge-based – you can afford to do that sort of thing from home…So they have certainly got more time and more time that they can dedicate to something like cooking. (North East Group 1, Session 2)

(ii) Availability and access to hot food takeaways in areas of high deprivation

This theme describes how YP felt physically surrounded by hot food takeaways in their local neighbourhood, and digitally surrounded via food delivery apps. They showed an understanding of how different elements of underserved communities intersect to encourage negative health practices.

YP cited the high density of hot food takeaways in their local area and a lack of food retail shops selling affordable and healthy options as barriers to healthy eating. As a YP related:

I wanted to talk about like fast food joints, like in [Name of location] like there’s a lot of like fried chicken shops, a lot of like and they’ve renamed themselves to grills…like to get like more consumer support. And basically like, what I was saying was like it makes it harder for me. (London Group 2, Session 1).

In terms of family food practices, the constant exposure to hot food takeaway was perceived as offering easy access to food for those whose home situations made it challenging to prepare home-cooked meals. For example, YP described how parents in low-income families worked long hours, leading YP and their families to take the ‘easier option’ of purchasing and consuming readily available hot food takeaways. Even though they were aware that hot food takeaways are unhealthy, they felt that they had to choose convenience over the nutritional quality of their meals.

Because it could be quite a busy job that involves travel where they’d be an air hostess or a conductor for a train. It just might take a lot of time away from their family, so that has to force them to do – in a way – irrational things. Such as constantly sending a fast food order instead of healthy objects. (North East Group 2, Session 2) Like if you come from a lower, like a poor area, maybe – like I knew someone who his mum would give him a quid and he’d go to the shop and just buy something and have it for his tea and he’d be out all night until like 10. His upbringings, obviously it’s not going to be the same as someone who has home-cooked meals every night that are prepared with nutritional value in mind. (South Yorkshire Group 2, Session 3)

YP also talked about how the high availability of cheap and ‘tasty’ hot food takeaways, particularly around the school vicinity, made it convenient for YP to purchase and consume them. It was clear during the discussions that hot food takeaway outlets had become part of the social fabric of local life even though YP were critical of the ubiquitousness of these outlets where they live. They were considered by some YP as the ‘place to go’ after school as there was not much to do for YP in their local area, which also highlighted the lack of services and facilities that cater to youths in areas of high deprivation. Inadvertently, YPs socialized at hot food takeaway outlets and ended up consuming food deemed to be less healthy despite their intentions.

When probed about the high density of hot food takeaways, a YP highlighted the complex interdependency of individual and structural factors that affect one’s ability to eat healthily. Specifically, they explained that demand for cheap and quick meals resulted in the opening of hot food takeaway outlets, which in turn created high visibility and high consumption. This then reinforced the need for more outlets. In contrast, the cycle could be broken or disrupted by the lower demand for ‘cheap’ hot food takeaways in more affluent neighbourhoods.

And then I guess because I think, like, yeah, if you’re in an area where demand is higher you’re going to have more takeaway so then if you’ve got more takeaway then that’s, kind of, what you see most of the time then you’re going to end up going to those takeaways more maybe. And seeing that, like, seeing it as more of an option compared to in a wealthier area where if at first you’re not, like, if there isn’t too much demand for fast food in wealthier areas then the takeaways aren’t really going to go there and then, because, like, and it is then, it is also easier to just go to the supermarket and, like, get stuff. (London Group 2, Session 3)

YP’s narratives also suggested that hot food takeaways have a prominent online presence in their everyday lives. They related their experience of being inundated with advertising of HFSS sold by hot food takeaways in their local area when using food delivery applications, and though healthier options were available, they were more expensive and deemed unaffordable.

…there’s about, I think it’s about 20 on my app just around me, because I live near a load of take aways. (South Yorkshire Group 1, Session 2) …and like delivery companies, some of them actually offer the, the opportunity to like buy healthier options. Some of them do salads and all sort of meals that are meant to be healthier. But it’s like those options are very expensive, compared to the junk food, so called junk food options. So it still leaves you with no choice than to go for the junk food rather than the healthier option. (London Group 1, Session 2)

(iii) Making healthy food more accessible to families

This theme presents YP’s views on public policies or interventions to address inequalities in accessing healthy food. YP had strong views on policies to tackle food inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Discussions about interventions, especially those targeted at low-income families were strongly tied to the stigma of poverty. YP in general were not in favour of a targeted FSM approach as they perceived it to be stigmatizing. As recounted by a participant: ‘ There’s an element of shame to it as to whether or not you will accept for yourself that you need that help, feeding your kids and feeding your family’ (North East Group 1, Session 2) .

Although YP from low-income families who were eligible for FSM appreciated the assistance from the government, their accounts of receiving FSM referred to shame and centred on who was ‘poor enough’ to receive government assistance. One YP felt guilty for receiving FSM because their parents held ‘decent’ jobs (i.e. perceived to be well-paid) with full-time employment, and did not consider themselves to be impoverished.

My mum’s a teacher and my dad works at the NHS, but a couple of years ago we were eligible for free school meals because it was something like me mum wasn’t earning enough so we therefore qualified. We felt kind of guilty, like we were robbing it from someone… because there are literally people on it who are choosing between feeding the kids at lunch or clothes for school uniform. (South Yorkshire Group 1, Session 2)

One focus group referred to food voucher schemes, of the kind administered by some schools during the COVID-19 epidemic. Vouchers were seen as a way of giving families a way to decide how best to meet dietary needs and food preferences. This came up while discussing FSM provision during the COVID-19 pandemic, whereby most schools provided food parcels to students. There were strong criticisms of the quality of food parcels as the items were not nutritious and were overpriced. In contrast, another YP who received food vouchers shared how that gave her family the freedom to purchase food according to their needs, and thus they were able to maximize the value of the vouchers:

So for instance, I get them (food vouchers) and we go shopping every month so we just save up all the vouchers and spend it on different places…We get tinned vegetables, like peas and carrots and that, but we don’t really like fresh veg or owt like that because it runs out of date really quickly. There’s no point really getting it. (South Yorkshire Group 1, Session 2)

Most YP demonstrated empathy for those who were perceived to be worst off, for example, those who had to use food banks. Alongside feelings of shame and guilt for receiving FSM, YP shared concerns about the proliferation of food banks in their area and the stigma associated with going to one, particularly the fear of parents being blamed for their inability to provide food for their children. YP’s empathy also extended to local business owners. Although they recognized the adverse impact of hot food takeaways, YP did not want these outlets to be closed or restricted by local authorities—a planning policy that can be introduced by local authorities to limit the number of hot food takeaways, especially within the school vicinity. They expressed concern about the potential loss of income for the businesses and more importantly, loss of employment for workers at the outlets. In terms of supporting customer choice, YP often framed this as wishing to see healthier food options at local outlets as this is where they felt the choice was limited. Incentivizing customers to purchase healthier meals through a loyalty scheme was one of the examples given by YP.

And, I don’t know, I was thinking incentives so, like, in a fast food chain, because you can’t shut them and you don’t really want to disturb their business, but if there was something, like, if you buy a certain number of the healthier meals and you get one of the less healthy meals for free or something, kind of, like a loyalty card…because I don’t think awareness alone necessarily helps because I think people are generally aware but it’s a case of actually, like, putting that into action and I think that can be quite tricky. (London Group 2, Session 3)

This article examines YP’s views on and experiences of inequalities in relation to their access to healthy food and diets. While previous studies have explored YP’s views of healthy eating ( Shepherd et al. , 2006 ; Rees et al. , 2014 ; Munt et al. , 2017 ), there is little evidence on YP’s views of how inequalities in healthy eating occur and how to address them.

The YP we spoke to viewed inequalities in food and health partly in terms of how different people were more or less likely to consume healthy food (with fast food often used by participants as an archetypal ‘unhealthy’ food type). YP discussed inequalities in more explicit food poverty terms: showing awareness that some individuals and families struggle to afford sufficient food. Low income, coupled with the high cost of healthier food products, was singled out as a significant barrier to eating a healthy diet by YP. This is supported by analyses of food costs in the USA, UK and Europe ( Kern et al. , 2017 ; Penne and Goedemé, 2021 ; The Food Foundation, 2023 ), which demonstrated that the cost of healthier food products was higher than less healthy products (two times more in the UK). Furthermore, one in five households in the UK would have to spend almost half of their disposable income to achieve a healthy diet, leaving little for other expenditures ( The Food Foundation, 2023 ). YP also linked low income to inequality in employment opportunities, specifically low access to, and availability of higher paying jobs where they live, and its impact on their diet. This was raised by participants in all three study sites, but more prominently in the North East of England, which has one of the highest rates of unemployment and proportion of benefit claimants ( Office for National Statistics, 2023b ), and the lowest average weekly salary in England ( Office for National Statistics, 2023a ).

We found that YP in our study had a less individualistic understanding of inequality than was suggested in the literature ( Backett-Milburn et al. , 2003 ; Vromen et al. , 2015 ; L’Hôte et al. , 2018 ; Smith and Anderson, 2018 ). While acknowledging the importance of dietary knowledge and cooking skills, our study participants showed an understanding of how structural inequalities impact their ability to acquire and consume a healthy diet. For example, YP were able to articulate the reinforcing connection between availability (supply) and purchase (demand) of hot food takeaways in their local area, which in turn made it easier for them to consume energy-dense and nutrient-poor food. The literature supports YP’s view that disparities in both physical and online food availability reinforce area inequalities. The high density of affordable but less healthy hot food takeaway outlets in deprived areas, both physically and online, has been well-documented ( Fleischhacker et al. , 2011 ; Maguire et al. , 2015 ; Keeble et al. , 2021 ). There is also evidence that it is often the same communities who experience both low income and high exposure to fast-food takeaway in the UK. Burgoine et al. (2018) , for example, demonstrating the double burden of low income and exposure to fast-food takeaway and its impact, found that the lowest income combined with the highest fast-food outlet proportion was associated with greater odds of obesity (odds ratio = 2.43, 95% confidence intervals: 2.09, 2.84). Another study in the UK found that within 4 years of Gateshead Council’s ban on planning permission for fast-food outlets, there was a 13.88% reduction in the proportion of fast-food outlets compared to five other local authorities in the North East of England which did not implement the ban ( Brown et al. , 2022 ). The ban was associated with a decrease in the prevalence of overweight and obesity among children in year 6, living in areas that have a high density of fast-food outlets ( Xiang et al. , 2022 ). This further demonstrates that obesity (as measured by body mass index) is a manifestation of social inequalities in health.

Previous reviews have found that health tends to be deprioritized in YP’s accounts of food, body shape and weight. The previous evidence suggests that YP focus instead on what they like and dislike, particularly on social factors such as social norms and peer expectations relating to body shape, and the social isolation that may result from not living up to those norms ( Shepherd et al. , 2006 ; Rees et al. , 2014 ; Munt et al. , 2017 ). The previous reviews have little to say on health inequalities, perhaps reflecting YP’s apparent lack of interest in health per se . However, some reviewers pointed out that many authors of included studies neglected to provide data on health equity dimensions. In contrast, many of the YP we spoke to were willing to discuss food in relation to health and health inequalities. Possibly, this is because we (the researchers) made our interest in health inequalities known to participants, in contrast to some previously published studies where the researcher's interest in health inequalities may not have been apparent. However, we think it reasonable to hypothesize that health and inequalities may have been more present in YP’s minds at the time of our data collection, given that it occurred during the COVID-19 pandemic. The study also took place in an era where food poverty and food charity (such as food banks) have become more prominent in UK discourse ( The Food Foundation, 2023 ).

Whilst we present YP’s interest in health inequality as a finding from our study, we are careful not to exaggerate the point. The YP we spoke to were also capable of discussing food availability and access in more social terms. For example, participants viewed fast-food chains as places where YP can socialize with friends. This is consistent with findings from a qualitative study of local (adults) perceptions and experiences of chicken shops in a deprived area in East London, which found the shops described as a part of everyday life and valued community spaces ( Thompson et al. , 2018 ). Some participants of our study even felt protective towards local businesses, not wishing to see them shut down. YP’s attitudes towards measures intended to address food poverty were also shaped by more than food considerations. The thought of using welfare or charity was associated by some YP with stigma—and also guilt that seeking help to obtain food could prevent assistance from going to someone with a greater need. These attitudes present insights into what YP regard as social responsibility: supporting local businesses (even unhealthy ones), and assuming that charity and welfare are finite resources best targeted at those in greatest need.

YP’s attitude to universalism was complex. Some appeared to support universal approaches, for example, universal FSMs as a means of reducing stigma. Some wanted further intervention from the government to extend the FSM funding to include after-school and holiday meals. This is in line with the findings of two studies with YP in the UK ( Fairbrother et al. , 2012 ; Knight et al. , 2018 ) which emphasized government and corporate responsibility for ensuring adequate nutrition and a healthy diet is affordable for families. However, other studies on the public’s attitudes towards inequalities have revealed a reticence towards government intervention and a preference for educational (information) and individual behavioural change interventions instead ( Backett-Milburn et al. , 2003 ; Vromen et al. , 2015 ; Smith and Anderson, 2018 ). A comparison study of YP’s view on inequality in the USA, UK and Australia, also found most participants focused on individualized (agency) explanations of, and solutions for inequalities, with little critical engagement of the structural causes of inequalities ( Vromen et al. , 2015 ).

Implications

Our findings show YP have a nuanced appreciation of bounded agency: that is, the way social, cultural and economic factors shape individual choice and practices. However, public health policymakers might view some of the YP’s views with mixed feelings. On the one hand, there is evidence of YP’s understanding of health inequalities, and social determinants, and a clear desire for improvement. On the other hand, this section of the public holds views on social responsibility that do not all fit neatly within the kind of universalist and regulatory approaches to health equity that many UK public health practitioners have long espoused ( Bambra et al. , 2011 ; L’Hôte et al. , 2018 ; Marmot et al. , 2020 ). We found evidence of common ground between YP and public health viewpoints, but further bridging work between the public health community and the public is still required.

We believe that our study can contribute to a re-imagining and updating of the evidence base about YP’s views about food and inequalities. In contrast with previous evidence, this re-imagining recognizes that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities—including considerations of both individual behaviour and social determinants. While different findings between studies may reflect methodological differences, there are also plausible reasons for hypothesizing that times have changed, and that YP’s views have changed with them. This hypothesis should be explored further in future research.

Strengths and limitations

We recruited YP living in areas of high deprivation. Using a place lens coupled with participatory concept mapping was an accessible way of eliciting YP’s views on diet-related health inequalities. It made tangible the structural inequalities that manifest in everyday life and impact YP’s ability to eat a healthy diet. It also allowed us to explore YP’s diet in multiple aspects of their life and a range of settings, including school, home and community.

Though our study showed that YP’s agency of purchasing and consuming a healthy diet was constrained by individual and area-level economic inequalities, we were unable to explore how that differs by levels of autonomy and agency. A Lancet series on dietary intake among adolescents (aged 10–24 years) emphasized the need to view adolescents as unique; each with different development trajectories within diverse sociocultural contexts ( Neufeld et al. , 2022 ), rather than being defined by age only. Most of our participants still lived at home and thus conversations about food centred around school meals and hot food takeaways. However, a few participants who had more independence and agency felt that they were being forgotten and not supported by existing policies to obtain and consume a healthy diet. In two of the three study sites, all participants were white British. Although these areas have a high proportion of White population, we may have obtained more diverse views if we had included YP of different ethnicity. There were mentions of value for money as a key factor influencing food purchases in our study. A deeper exploration would enhance our understanding of what value for money means to YP, and its implications.

Individual and area-level economic inequalities constrain YP’s ability to eat a healthy diet. The YP we spoke to appeared to be aware of this. We hypothesize that this awareness may reflect changing contextual factors such as the experience of the COVID-19 pandemic and widely discussed concerns about food poverty. YP are potential sources of support for health equity strategies that include social determinist approaches. However, it would be a mistake to assume this support can be relied on without further efforts to shape and promote policies that resonate with YP and address both their health and wider social concerns.

H.F., C.S. and M.E. conceived the study. V.E., M.C., E.H., N.W. and N.G. collected and analysed the data. V.E. wrote the first draft. All interpreted the data, edited and reviewed drafts and approved the final version of the manuscript.

We would like to thank the young people and the youth organizations who took part in the study. Thanks also to Phillippa Kyle and Nicky Knights for their contribution to data collection and analysis.

This study was funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number PD-SPH-2015). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

We do not have any conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.

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SAGE Open Nurs
v.10; Jan-Dec 2024
PMC11337188

Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study

Puvaneswari kanagaraj.

1 Department of Nursing, College of Applied Medical Sciences, University of Bisha, Bisha, Kingdom of Saudi Arabia

Judie Arulappan

2 Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Al Khoudh, Muscat, Sultanate of Oman

Arpita Pradhan

3 Narayana Multi Specialty Hospital, Kolkata, West Bengal, India

* Current address: Durgapur City Hospital and Clinic Pvt. Limited, Durgapur, West Bengal, India.

Shimmaa Mansour Moustafa Mohammed

4 Faculty of Nursing, Zagazig University, Zagazig, Egypt

Associated Data

Supplemental material, sj-docx-1-son-10.1177_23779608241272484 for Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study by Puvaneswari Kanagaraj, Judie Arulappan, Arpita Pradhan and Shimmaa Mansour Moustafa Mohammed in SAGE Open Nursing

Supplemental material, sj-docx-2-son-10.1177_23779608241272484 for Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study by Puvaneswari Kanagaraj, Judie Arulappan, Arpita Pradhan and Shimmaa Mansour Moustafa Mohammed in SAGE Open Nursing

Introduction

The COVID-19 outbreak disrupted the nursing education across the world. The nursing students faced many challenges in their learning process.

The study explored the experiences and challenges faced by nursing students who had virtual education in India.

The study adopted an exploratory sequential mixed-methods design. The study was conducted as two phases. Phase 1: Qualitative data were collected using direct focus group interview with 18 students. Phase 2: Quantitative data were collected from 477 students using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. The analysis was done using the descriptive and inferential statistics and thematic analysis.

Phase 1: The analyzed data produced seven themes and 10 sub-themes; (1) technical issues—a concern, (2) regular rhythm in educational training—but not complete, (3) stress and strain, (4) evaluation—a concern, (5) communication, (6) comfort zone, and (7) easy distraction. Phase 2: Majority of the students (54.71%) experienced high-level challenges with the nursing education during pandemic. The overall mean and SD of all the domain-wise challenges were 103.39 + 7.11 with the range from 30 to 150. The mean and SD with educational challenges were (20.27 + 3.04), environmental challenges (6.92 + 1.66), communication challenges (17.61 + 4.01), technical challenges (17.39 + 3.75), evaluation challenges (7.09 + 1.94), physical and mental challenges (20.47 + 4.33), career challenges (7.06 + 1.91), and financial challenges (6.61 + 2.1). The demographic variable gender ( P = 0.045) showed a statistically significant association with the challenges.

Considering the experiences and challenges faced by the nursing students, the nursing administrators shall design educational strategies to mitigate these challenges in nursing education during a pandemic.

Implication

Virtual nursing education offers flexibility in teaching and learning, self-paced learning opportunity, lower the costs, career advancement, comfortable learning environment, more opportunities for participation, easier to track documentation and improves skills in technology. Therefore, the challenges in virtual nursing education should be lessened to have successful teaching learning experiences.

Introduction/Background

The world faced unprecedented challenges during COVID-19 global pandemic ( World Health Organization, 2020 ). The pandemic changed the lives of people at different levels. Additionally, social distancing shaped the social relationship and behavior ( Kaveh et al., 2022 ). COVID-19 significantly strained the healthcare system. In addition, it affected the education in academic institutions and universities to a greater extent ( Dewart et al., 2020 ). As a preventive and control measure, all the schools, colleges, and universities were closed ( Mustafa, 2020 ). In April 2020, 94% of learners worldwide were affected by the pandemic, representing 1.58 billion children and youth in 200 countries ( De Giusti, 2020 ). Likewise, nursing education has undergone many radical changes both in developed and developing countries. The situation affected the learning opportunities of nursing students as their clinical placements were suspended and the face-to-face teaching moved into online teaching. Additionally, the pre-clinical activities such as laboratory and simulation-based teaching were affected due to social and organizational restrictions to limit unnecessary access and contact with others ( Tomietto et al., 2020 ).

To continue the teaching–learning activity, the academic institutions adopted various digital platforms including Zoom, Google meet, WebEx, Udemy, Edmodo, Google classroom, etc. ( Mishra et al., 2020 ). Moreover, web-based conferences were routinely organized by educational institutions during this pandemic ( Kaware, 2022 ). In addition, educational institutions have placed greater emphasis on ERP systems, library modules, fee modules, and examination modules. The virtual learning enhanced the comfort, accessibility, and encouraged remote learning ( Mukhtar et al., 2020 ). Similarly, the learners found it easy to access the online material, were able to record meetings and sessions and retrieve information ( Alsayed & Althaqafi, 2022 ). The faculty and students expressed that online education is useful during the COVID-19 pandemic; it was convenient, flexible, cost low, and encouraged self-learning ( Almahasees et al., 2021 ). Likewise, online education improved the flexibility, ability to teach large classes, increased interaction between the teachers and students and increased learning opportunities for the learners ( Hako, 2021 ). Ultimately, these educational technologies have had significant positive impact on the learning of the students. Additionally, it paves the way toward the blending of technology synchronously or asynchronously into education ( Thaheem et al., 2022 ).

Review of Literature

Although online education was beneficial to both the teachers and learners, it posed various challenges to the faculty and students ( Nimavat et al., 2021 ). Poor student attendance, loneliness, issues with internet connectivity and lack of information and technology skills were reported as challenges of online education ( Hako, 2021 ). The faculty and students indicated that efficacy of online teaching and learning is less effective than face–face teaching and learning. Moreover, online learning is ineffective for deaf and hard of hearing students. Likewise, online education is linked to lack of interaction and motivation, data privacy and security and technical issues ( Almahasees & Amin, 2021 ; Alsayed & Althaqafi, 2022 ). Furthermore, online education was inefficient in terms of maintaining academic integrity ( Mukhtar et al., 2020 ). The teachers reported difficulties in motivating the students without visual connection during online teaching ( Moustakas & Robrade, 2022 ). Also, Atout et al., (2022) reported lack of resources for the clinical learning, distracting home environment and challenging evaluation of learners as the barriers for virtual learning.

The challenges faced by the instructors includes transitional difficulties from offline to online teaching, communication barriers, changes in the teaching style and additional time and resources for preparation of teaching. The institutions experienced challenges such as need for additional training for faculty and students, technical and multimedia support, online counselling sessions for teachers and the need to have technical troubleshooting team. Students experienced challenges related to having technical skills to learn online, lack of readiness, network and speed issues, and lack of identity, interaction and participation. There were challenges related to content such as development of new material, regular assignments, multimedia tools, and checking assignments and sharing regular feedback with the students. Technological challenges included device suitability, network stability and speed, tools of conferencing software for online teaching and ease of use. Lastly, the motivational factors included lack of sense of job security, non-availability of salary on time, and lack of family support, mental and emotional support from colleagues and higher authorities ( Siddiquei & Kathpal, 2021 ).

To enhance the online teaching and learning, technical aptitude enhancement, resource management and utilization, time management, control over the learning environment and help seeking are essential ( Barrot et al., 2021 ). Furthermore, formal training for the teachers, and enhancement of psychosocial wellbeing of both the learners and teachers are necessary to curb the feelings of loneliness and isolation. Moreover, the nature of the problems related to the shift from face to face to online learning should be identified to combat these challenges ( Hako, 2021 ). In India, both the undergraduate and postgraduate students were badly affected during the COVID-19 pandemic and experienced many challenges with online education ( Joshi et al., 2020 ; Kamal & Illiyan, 2021 ; Muthuprasad et al., 2021 ; Pandit & Agrawal, 2022 ; Rannaware et al., 2022 ; Sengupta, 2022 ). However, very few studies explored the challenges encountered by the nursing students during the online learning ( Gaur et al., 2020a ; George et al., 2022 ; Kanagaraj et al., 2022 ; Lata & Kudi, 2022 ). Therefore, the authors decided to understand the experiences and challenges encountered by nursing students in their nursing education during the COVID-19 pandemic. We believe that the study finding will be beneficial to the educational authorities, curriculum developers, and policy makers to design appropriate measures and strategies to enhance effective learning both in nursing education and practice.

An exploratory sequential mixed-methods design was utilized in this study. The study integrated qualitative data into quantitative data to understand the experiences and challenges experienced by nursing students’ during the pandemic.

Research Setting

The study was conducted among nursing students of Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India. These colleges initiated virtual classes from April 2020. Therefore, these colleges were selected as settings for the study.

The target population of the study included both Diploma and BSN students. The accessible population included both Diploma and BSN students studying in Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India.

Sample, Sample Size, and Sampling Techniques

Three nursing colleges were conveniently selected for the study. In Phase 1, the researchers used purposive sampling technique to collect the qualitative data from six students in each college (Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India). The data collection was done face to face. Thus, in total, 18 students participated in the focused group interview during phase I. For Phase 2, the sample size calculation was done based on the previous cross-sectional study ( Thapa et al., 2021 ). Having the expected proportion of challenges experienced by nursing students as 15%, with 95% confidence interval, and with the precision, the minimum required sample size was 400. In total, all the three nursing colleges had 654 students. Convenient sampling technique was used to collect the data in phase II.

Inclusion and Exclusion Criteria

The study included nursing students who were enrolled for Diploma and BSN program, exposed to online learning, and second, third, and fourth year nursing students. The study excluded those who were not willing to participate, and first year nursing students as they had limited exposure to the virtual theory and clinical classes, which may give a limited and inaccurate data. Considering the inclusion and exclusion criteria, 477 students participated in the study.

Description and Interpretation of Study Instrument

The instruments used in the study were prepared by the researchers of the study. The qualitative data collected during the first phase of the study was utilized in preparing the tool used for the quantitative phase of the study. It included four parts namely demographic variables, background variables, open-ended questions to explore the participant's experiences and challenges and Likert scale to assess the challenges.

Part 1 included the demographic variables of the participants including age, gender, course of study, year of study, residence, and place of attending online classes.

Part 2 comprised of the background variables such as gadgets used for attending online classes, source of internet, mode of theory classes taken during the last 6 months, mode of practical training, methods of teaching theory classes, audio visual aids used, and the virtual platform used.

Part 3 consisted of a questionnaire related to students’ experiences and challenges. It included 15 open-ended questions related to the aspects of theoretical learning, practical learning, study materials, teaching methodology, evaluation process, issues related to physical and mental health, issues related to technology and issues related to finance.

Lastly, Part 4 included a Likert scale on challenges having 30 questions with eight domains; educational challenges (six items), environmental challenges (two items), communication challenges (five items), technical challenges (five items), evaluation challenges (two items), physical challenges (six items), career challenges (two items), and financial challenges (two items). Dimensions were evaluated using 5-point Likert scale varying from strongly disagree (1), disagree (2), neutral (3), agree (4) and strongly agree (5). The total score ranges from 30 to 150. The domain-wise challenges were interpreted as 1–50 = low challenges, 51–100 = moderate challenges, 101–150 = high challenges. The instrument was prepared in English and no translations were done.

Reliability and Validity of the Tool

Content validity was obtained from eight experts in the field of nursing education. The calculated content validity index was 0.80. Pilot study was conducted with 10% of the study participants (42 students) to test the reliability of the tool before administering to the main study participants. Using Cronbach's alpha (inter-item reliability), the internal consistency assessed was 0.89, which is highly reliable. The participants participated in the pilot study were excluded from the main study.

Ethical Considerations

Ethical approval was obtained from the Research and Ethics Committee of Narayana Hrudayalaya College of Nursing (NHH/AEC-CL.2022-BI5 dated 22/3/2022), Kirubhanidhi College of Nursing (KCC/22/22 dated 04/3/2022), and Koshy's College of Nursing (KCN/15 dated 07/3/2022) and Institutional review board. After getting the ethical approvals, formal permission was obtained from the Head of Nursing colleges to collect data. The researchers explained the purpose of the study to the participants involved in both quantitative and qualitative data collection. The participants were informed that their participation in the study was voluntary. Since the participants were not forced to participate in the study, they were given the freedom to withdraw from the study at any time without any penalty. The participants signed the informed consent and responded to all the questions and returned the completed questionnaire. All the audio recordings were coded and password protected. It was explained to the participants that they were not exposed to any kind of risk. To keep the data anonymous, no identifying information was collected from the participants. The researchers maintained confidentiality of information throughout the study period. All the collected data were stored in a password protected file. Only, the investigators of the study had access to the data.

Data Collection (Qualitative Phase)

In Phase I of the study, three focus groups were selected using purposive sampling technique. Each group included six participants with a total of 18 nursing students. After getting the consent, the participants shared their experiences and challenges faced during their educational training in the pandemic. The interviews were conducted from 25/2/2022 to 25/3/2022 and each interview lasted for 1.30 h to 2 h. The first and third authors conducted the interview. The first author is a PhD and the third author is a BSN holder. The first author is an assistant professor and the third author is a staff nurse. Both of them were females. Both of them were trained in qualitative data collection. The researchers established rapport with the study participants. The researcher used 15 open-ended probing questions and the participants were given the freedom to express additional views and comments. All the interviews were conducted in person in the college and audio recorded with their consent. Focus group discussions were continued till the data saturation occurred. The transcripts were returned to the participants for their correction.

Data Collection (Quantitative Phase)

In Phase II, the quantitative data were collected using convenient sampling technique. The total number of students participated in the study were 477. The questionnaires were transferred to Google forms and were circulated to the students after explaining the objectives and getting the informed consent. The quantitative data were collected from 11/04/2022 to 20 /04/2022. The response rate was 72.9% (477) which included Narayana Hrudayalaya College of nursing (88 participants), Koshy's College of nursing (235 participants) and Kirubanidhi College of nursing (154 participants).

Data Analysis (Qualitative Phase)

The data were analyzed using thematic analysis. The collected data were transcribed and analyzed using Braun and Clarke's thematic analysis. Reflexive thematic analysis was performed in this study ( Clarke & Braun, 2017 ).

Data Analysis (Quantitative Phase)

The quantitative data were analyzed using descriptive and inferential statistics using SPSS version 22.

Credibility, Dependability, and Transferability

To ensure credibility of the data, the researcher strongly engaged with the focused group interviews by means of observation, documentation, and taking notes. Dependability was achieved through reviews and comments given by the research guide, who is the second author of the study who has full knowledge of the study design and methodology. The data collected from participants and the findings could be applicable to other contexts, situations, times, and populations and the study setting. It ensures transferability.

The researcher adhered to rigor by carefully collecting data via audio recordings and by taking field notes. Each focus group interview was transcribed immediately after the interview. The transcripts were given to the participants for cross-checking and approval. In addition to ensuring rigor through trustworthiness criteria, the authors followed mixed-methods research legitimation criteria by ensuring design quality, design suitability, within design consistency, design fidelity, and analytic adequacy ( Teddlie & Tashakkori, 2009 ).

Trustworthiness

Trustworthiness was established by using an unbiased approach in selecting the participants and by participant's being honest, clearly recorded, and accurately presented inputs. The transcriptions, coding, and themes–subthemes were discussed by the research team for their verification. Then based on the themes and subthemes the quantitative questionnaire was created by the researchers.

Phase 1 Qualitative Phase

Table 1 shows the frequency and percentage distribution of background variables of 18 participants who shared their experiences and challenges faced during their educational training in the pandemic. Table 2 shows the frequency and percentage distribution of participants’ background variables.

Table 1.

Frequency and Percentage Distribution of Demographic Variables of Nursing Students.

Demographic variables	Qualitative data		Quantitative data
	Frequency		Frequency
	Phase 1 ( = 18)	Percentage	Phase II ( = 477)	Percentage

18–23 years	16	88.9	432	90.6
23–29 years	2	11.1	45	9.4
Gender
Male	4	22.2	111	23.3
Female	14	77.8	366	76.7
Course
B.Sc. Nursing	14	77.8	331	69.4
GNM	4	22.2	146	30.6
Year of study
Second year	4	22.2	226	47.4
Third year	9	50	226	47.4
Fourth year	5	27.8	25	5.2
Residence
Urban	11	61.1	216	45.3
Semi-urban	2	11.1	113	23.7
Rural	5	27.8	148	31
From where you attended the online classes most of the time
Home	7	38.9	79	16.6
Hostel	11	61.1	398	83.4

Table 2.

Frequency and Percentage Distribution of Baseline Variables of Nursing Students.

Demographic variables	Qualitative data		Quantitative data
	Frequency		Frequency
	Phase 1 ( = 18)	Percentage	Phase II ( = 477)	Percentage
Gadget used for attending online classes (multiple choice)
Mobile	18	100	469	98.3
Laptop	2	11.11	52	10.9
Tablet	1	5.55	13	2.7
Desktop			4	0.8
Source of internet (multiple choice)
WiFi	3	16.66	87	18.2
LAN	-	-	1	0.2
Mobile data	18	100	451	94.5
Mode of theory classes taken for the last 6 months
Online	1	5.6	69	14.5
Offline	5	27.7	157	32.9
Both online and offline	12	66.7	251	52.6
Mode of the practical training
Online	1	5.6	50	10.5
Offline	7	38.9	289	60.6
Both online and offline	10	55.5	138	28.9
Methods of teaching used for theory classes (multiple choice)
Lecture cum discussion	18	100	451	94.5
Seminar	1	5.55	98	20.5
Role play	-	-	38	8
AV aids used (multiple options)
Power point presentation	17	94.4	445	93.3
Videos	7	38.9	218	45.7
White / Black board	-	-	88	18.4
Virtual platform used (multiple options)
Zoom	8	44.4	250	52.4
Google meet platform	10	55.6	286	60
Cisco	-	-	106	22.2
Web-ex	4	22.2	179	37.5

Experiences and Challenges Faced by the Nursing Students

In Phase 1, the experiences and challenges experienced by nursing students with their educational training during the pandemic were analyzed using thematic analysis. Table 3 reports seven themes and 10 sub-themes. The themes identified includes: (1) technical issues—a concern, (2) regular rhythm in educational training—but not complete, (3) stress and strain, (4) evaluation—a concern, (5) communication, (6) comfort zone, and (7) easy distraction. The sub-themes were: (1.1) problems with internet connectivity, (1.2) issues with the digital platform, (2.1) theoretical learning experience-better, (2.2) deficient practical skills, (3.1) physical stress, (3.2) mental stress, (4.1) unfair evaluation and lack of feedback, (5.1) decreased quality of communication, (6.1) very convenient, and (7.1) difficult to concentrate.

Table 3.

Themes and Subthemes of Experiences and Challenges Faced by Nursing Students.

S. no.	Themes	Sub-themes
	Technical issues—a concern	1.1. Problems with internet connectivity
	Technical issues—a concern	1.2. Issues with the digital platform
	Regular rhythm in educational training—but not complete	2.1. Theoretical learning experience-Better
	Regular rhythm in educational training—but not complete	2.2.Deficient practical skills
	Stress and strain	3.1.Physical stress
	Stress and strain	3.2.Mental stress
	Evaluation—a concern	4.1.Unfair evaluation
	Communication	5.1.Decreased quality of communication
	Comfort zone	6.1.Very convenient
	Easy distraction	7.1.Difficult to concentrate

Theme 1: Technical Issues: A Concern

Modern technology is progressive in all sectors. With this technology, it was possible to deliver training in all educational sectors including nursing education during COVID-19. Though it was helpful, technical problems interrupted the teaching–learning process. Most of the participants expressed their concern related to technical issues. It includes issues with internet connectivity, and issues with the digital platform.

Subtheme 1: Problems with Internet Connectivity

Constant network issues were an unavoidable fact for many students. Students could not be connected to the virtual class on time due to the internet connectivity issues and they had to miss attending the classes.

“Sometimes it keeps on showing error code and by the time I get connected the class is completed by the faculty” (5A).

Students stated that they faced technical and network issues while attending the classes.

“During online classes, we have faced a lot of technical and network issues” (2A).

In addition, fluctuations in the network connectivity were another technical issue faced by students and it affected the virtual learning of the students.

“I faced fluctuations in my network during a natural calamity in my place so I missed many classes during that time” (13A).

Subtheme 2: Issues with the Digital Platform

There are various platforms used to deliver online educational training. The participants expressed their difficulties as they had hitches in updating the digital platforms, and mentioned that the lack of experience in using the platforms affected their learning.

Digital platform did not work if the application is not updated on time. This was stated as below;

“If I did not update the app on time, it will not work” (1A).

Students faced problems in joining the virtual platform due to issues with the virtual platform.

“Sometimes I faced problems with joining with the virtual platform” (8A).

Lack of experience in using the virtual platform by both the faculty and student was another challenge stated by the students.

“Had struggle to join the meeting initially for both students and faculties because it was very new to us” (5A).

Students faced difficulties in submitting the assignments and answer sheets, as they did not have previous experience in submitting it through digital platforms.

“I struggled while submitting the answer sheets /assignment through digital platforms” (4A).

Theme 2: Regular Rhythm in Educational Training: But not Complete

Virtual education is a boon during pandemic. It took the education system in a rhythmic manner. Though the online lectures were beneficial, at times, students faced few challenges.

Subtheme 1: Online Theoretical Learning Experience

The students utilized the opportunities to learn from online classes with few challenges in attending online classes.

Commencement of online classes helped the students to have continuity in their studies. As the online classes were started on time immediately, it did not affect their theoretical learning.

“…It was not at all possible for the colleges to continue the offline classes so that the apex body instructed to start with online classes and it's good that we were in touch with our studies” (12A).

Different methods and techniques of teaching adopted during online classes enhanced interest in their learning.

“During online classes teacher used to teach with PPTs, and some good videos to make the session interesting. Sometimes they used to conduct lecture cum discussion. That time I was interested to listen to the class” (15A).

“I was interested to attend the online theory classes when teachers used to take a class by showing some videos related to theory content. It was good” (16A).

Students encountered issues with the storage of study materials as they had minimal storage space in their gadgets.

“Teachers used to send notes in PDF form in the mail or by WhatsApp. When I have storage issues in my gadgets, I deleted the content because of storage issues” (18A).

Subtheme 2: Deficient Practical Skills

Practical training is a major part of nursing profession. Students faced many challenges while attending online practical classes.

Most of the students stated that their theoretical learning through virtual mode was excellent. However, students felt that learning practical skills through direct clinical experience is rewarding than learning through virtual platform.

“…theory classes were very good. But in case of practical, like IV infusion, it was very easy to watch the procedure in a virtual platform, but it was very difficult to perform. I feel offline clinical exposure is better than online” (3A).

Students stated that they learnt basic nursing skills through direct clinical experience before the pandemic. However, the students lack confidence in performing the skills that they learnt through videos. The students felt nervous while performing the skills directly on the patients, as they did not get hands-on experience during virtual learning.

“…During my first-year clinical posting, I learnt basic procedure like vital signs checking, wound care, surgical dressing, etc with the direct clinical experience, suddenly everything goes on online, the faculty used to show us best videos. While watching videos I feel I can do. But when it's time to do directly, my hands were shivering and I was not confident. I feel offline exposure is better, we can get more exposure” (1A).

Huge gap in practical learning due to the pandemic affected the learning of the students. Thus, the students did not recommend online learning for learning the skills.

“I did not get adequate practical posting in my first year because of COVID-19. It continued with the second year too. So I have a huge gap with practical learning. For practical learning, online learning is not appropriate” (7A).

Theme 3: Stress and Strain

Prolonged online training affects the students’ physical as well as mental health. They felt more stressful.

Subtheme 1: Physical Stress

Students experienced physical symptoms such as strain in the eyes, neck pain, back pain and numbness in the legs due to prolonged usage of phone and sitting.

“I have to write my notes by seeing my phone. Every time I need to continuously see my mobile and make notes. It was straining my eyes and stressful for me” (16A).

“While attending online classes I used to keep my video on and listen to the class. Due to prolonged sitting, I have neck pain, eye strain also” (5A).

“I felt back pain and numbness in my leg while attending the online classes with prolonged sitting. I used to walk in between for some time to reduce the numbness” (12A).

Subtheme 2: Mental Stress

Students were anxious, as they could not complete the given tasks in online classes.

“I was anxious because I did not complete my task given in online classes, I was lazy” (4A).

As the students did not get practical experience in the clinical area, their confidence levels were low during the pandemic. Moreover, as the students did not get any opportunity to practice directly in the clinical area during the pandemic, they felt tensed and lacked confidence to directly practice on the patient after the pandemic.

“Due to lack of practice in clinical, my confidence had come down” (8A).

“I felt stressed out when I am thinking about my practical learning. I did not get adequate opportunity to practice” (10A).

“After lockdown when I came in the clinical setting, I was tensed about how I will handle the patient” (15A).

Theme 4: Evaluation: A Concern

Evaluation is the process of providing feedback to the students to improve themselves. The test, examination, assignment, and evaluation were new for the students and faculty during the pandemic and there were malpractice incidences by the students.

Sub-Theme 1 - Unfair Evaluation and Lack of Feedback

Students felt conducting exam using Google form as useful.

“Some faculties conducted few exams in Google Form, it was good because at that time I studied and attend the exam” (16A).

Malpractice in the online exam could be observed in the students during virtual learning.

“For the online exam, I never used to study because I can copy from PPT, my screenshots, or from Google and score good marks” (2A, 8A, 17A, 18A).

Students stated that they did not get proper feedback on their assignments.

“In my point of view, some faculties did not give us proper feedback on my assignment writing” (6A).

One student stated the unfair evaluation as the students copied scored well.

“I feel very bad when I write without copying and score very less marks; while the students who did malpractice scored well. So the evaluation was going very wrong” (4A).

Theme 5: Communication

It is necessary to build proper communication between the teachers and students to continue a smooth training session online. However, students felt that this distance learning created a communication gap between teachers and students.

Sub Theme 1- Decreased Quality of Communication

Limited and disrupted communication with the friends and teachers created distress in the students.

“It was not possible for me to communicate face to face with my friends and teachers during the online classes. It was quite distressing” (1A).

“Online class communication was the major problem. We could not communicate with faculties and peers like offline” (18A).

Students felt that they could not clarify their doubts with the faculty. However, faculty responded to their queries through WhatsApp and social media.

“If it comes to communication, it was very limited… During offline we can directly ask doubts to the faculty, but not now” (2A).

“During the online classes communication was not easy like face to face communication. But teachers were responding by WhatsApp and other social media after class time also” (6A).

Theme 6: Comfort Zone

Online classes were attended by the students either from hostel or home.

Subtheme 1: Very Convenient

Students felt comfortable staying home and attending online classes.

“It was convenient for me. Because I can stay at home, take care of my family and attend class also” (8A).

“For me, it was convenient, I got more time and can get up late to attend classes” (2A, 3A, 7A).

Students expressed that their transport expenses could be minimized, as they were not required to travel during the pandemic.

“I could save time. Even transport expenses could be minimized” (10A).

Theme 7: Distraction

Distraction was very high in online classes.

Sub-Theme 1: Difficult to Concentrate

Students were distracted during the online classes due to many notifications received from other online applications and disturbance from their siblings.

“As my internet is on I will get many notifications from other apps during class, it was a distraction for me” (4A, 9A, 11A).

“I attended online classes from my home only. I had disturbance from siblings, during my online classes” (7A, 16A).

Students themselves got distracted as they were using social media in between the online classes.

“I used to browse on Facebook, Instagram, YouTube, etc. during the online classes” (13A).

Phase 2: Quantitative Phase

Table 1 shows the frequency and percentage distribution of participant's demographic variables. Majority (90.6%) of the participants were in the age group between 18 and 23 years. Most of them were females (76.7%). 69.4% of the students were undergraduate (BSN) nursing students, while the rest were in Diploma nursing program. 47.4% of the participants were in their second and 47.4% were in their third year of study. Nearly half (45.3%) were from urban areas and 23.7 were from semi-urban areas, while the remaining (31%) were from rural areas. A large number (83.4%) of students attended the online classes from their hostels.

Table 2 outlines the frequency and percentage distribution of participants’ background variables. The results showed that the majority (98.3%) of the students used mobile phones to attend online classes. Most of them (94.5%) used the mobile data to have the internet connection. Almost half of the participants (52.6%) attended both online and offline classes. More than half (52.6%) of the participants had both online and offline practical exposure, and around 33% had offline clinical exposure. Most of the students (94.5%) attended lecture and discussion sessions. A huge number (93.3%) used power point presentation, and 45.7% of them used videos for teaching. Majority (60%) used Google Meet, while 52.4% used Zoom. The remaining used multiple platforms like Cisco, and Webex.

Figure 1 describes the frequency and percentage of distribution of level of challenges. It was classified as low, moderate, and high level of challenges. Majority of them (54.71%) experienced high-level challenges, 44.6% encountered moderate-level challenges, and the remaining experienced low-level challenges related to their nursing education during the pandemic.

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Object name is 10.1177_23779608241272484-fig1.jpg

Frequency and Percentage Distribution of Challenges Faced by Nursing Students During Their Educational Training.

The domain-wise challenges with nursing education during pandemic were shown in Table 4 . The eight domains included educational challenges, environmental challenges, communication challenges, technical challenges, evaluation challenges, physical and mental challenges, career challenges, and financial challenges. The mean and standard deviations for educational challenges is (20.27 ± 3.04), environmental challenges (6.92 ± 1.66), communication challenges (17.61 ± 4.01), technical challenges (17.39 ± 3.75), evaluation challenges (7.09 ± 1.94), physical and mental challenges (20.47 ± 4.33), career challenges (7.06 ± 1.91), and financial challenges (6.61 ± 2.1). The overall mean and S.D. of all the domain was 103.39 ± 1 7.11 with the range from 30 to 150.

Table 4.

Assessment of Mean and Standard Deviation of Domain-Wise Challenges Faced by the Nursing Students n = 477.

Domain-wise challenges	Mean	Standard deviation	Range
Educational challenges	20.27	3.04	6–30
Environmental challenges	6.92	1.66	2–10
Communication challenges	17.61	4.01	5–25
Technical challenges	17.39	3.75	5–25
Evaluation challenges	7.09	1.94	2–10
Physical and mental challenges	20.47	4.33	6–30
Career challenges	7.06	1.91	2–10
Financial challenges	6.61	2.1	2–10
Total

Table 5 displays the item-wise challenges. The results of Educational Challenges indicated that almost 38.57% responded that they lack interest in learning. 15.93% either strongly agreed or agreed that face-to-face learning is very effective than E-learning. A larger portion (78.62%) of participants mentioned that the notes and lectures were inadequate. More than half of the participants (54.3%) agreed that virtual demonstration is not very effective for the practical patient care, and 61.21% mentioned that they lack confidence while taking care of patients. The participants provided similar responses during the qualitative phase of the study. The students lack confidence in performing the skills that they learnt through videos. Similarly, the students felt nervous while performing the skills directly on the patients, as they did not get hands-on experience during virtual learning. However, one third of the respondents (33.75%) expressed that they could learn the modern ways of handling patients through videos.

Table 5.

Item-Wise/Domain-Wise Analysis of Challenges Faced by Nursing Students.

S. no	Items	Strongly agree		Agree		Neutral		Disagree		Strongly disagree
S. no	Items	f	%	f	%	f	%	F	%	f	%

1	Lack of interest in learning	74	15.51	110	23.06	214	44.86	43	9.01	36	7.55
2	Face-to-face learning is more effective than E-learning	30	6.29	46	9.64	140	29.35	126	26.42	130	27.25
3	Notes/Lecture content are not adequate	224	46.96	151	31.66	72	15.09	16	3.35	14	2.94
4	Virtual demonstration is not very effective—practical patient care.	113	23.69	146	30.61	155	32.49	35	7.34	28	5.87
5	Lack of confidence while taking care of patients	162	33.96	130	27.25	117	24.53	44	9.22	24	5.03
6	Learnt modern ways of handling patients through videos.	56	11.74	105	22.01	185	38.78	80	16.77	51	10.69

7	Distracted very easily while attending online classes	142	29.77	139	29.14	133	27.88	38	7.97	25	5.24
8	My environment was very comfortable during pandemic to attend online classes	85	17.82	113	23.69	150	31.45	77	16.14	52	10.9

9	Difficulty in sharing my view with the teachers	83	17.4	141	29.56	169	35.43	55	11.53	29	6.08
10	Process of teacher–students interaction became passive.	74	15.51	145	30.4	197	41.3	48	10.06	13	2.73
11	Socializing with peer groups has decreased	109	22.85	167	35.01	151	31.66	27	5.66	23	4.82
12	Experience of loneliness without interacting much with peer groups.	115	24.11	155	32.49	151	31.66	32	6.71	24	5.03
13	Missed interaction with my seniors/college mates	94	19.71	138	28.93	167	35.01	43	9.01	35	7.34

14	Uncertain internet connection interrupts the learning process.	70	14.68	140	29.35	174	36.48	63	13.21	30	6.29
15	Teachers had difficulty in using technical aspects of the online platforms.	69	14.47	109	22.85	143	29.98	87	18.24	69	14.47
16	Good internet connection was there at my place.	140	29.35	148	31.03	125	26.21	38	7.97	26	5.45
17	Faced technical issues with learning platform /device.	114	23.9	151	31.66	146	30.61	37	7.76	29	6.08
18	Difficulty while submitting the answer sheets /assignment through digital platforms	140	29.35	144	30.19	122	25.58	44	9.22	27	5.66

19	Online evaluation may create irrational discrimination between students.	99	20.75	145	30.4	168	35.22	39	8.18	26	5.45
20	Evaluation/test conducted online was unfair	121	25.37	127	26.62	158	33.12	39	8.18	32	6.71

21	Experience of physical strain like headache, backache, neck pain, eye strain	147	30.82	149	31.24	158	23.27	43	9.01	27	5.66
22	I did not feel much mental stress	47	9.85	92	19.29	165	34.59	106	22.22	67	14.05
23	Developed insomnia	88	18.45	137	28.72	162	33.96	54	11.32	36	7.55
24	Addicted to phone due to prolonged using of phone other than learning purpose.	96	20.13	127	26.62	149	31.24	64	13.42	41	8.6
25	Regular life style has changed	125	26.21	146	30.61	148	31.03	38	7.97	20	4.19
26	Worry about online teaching applications that lack proper security system	99	20.75	131	27.46	160	33.54	55	11.53	32	6.71

27	Virtual practical training will affect my career as a registered nurse.	115	24.11	154	32.29	151	31.66	38	7.97	19	3.98
28	I may not be able to work as a skillful nurse	91	19.08	143	29.98	152	31.87	56	11.74	35	7.34

29	Extra money for my expenses for good internet package	149	31.24	128	26.83	126	26.42	40	8.39	34	7.13
30	Bought a new laptop/mobile/electric gadgets to attend virtual classes.	89	18.66	94	19.71	111	23.27	68	14.26	115	24.11

With regard to Environmental challenges , 41.51% expressed that they were comfortable with their home or hostel environment to attend online classes. However, more than half (58.91%) said that they were easily distracted while attending classes. Similar findings were seen in the qualitative phase of the study. Students were distracted during the online classes due to many notifications received from other online applications and disturbance from their siblings. Further, the students were distracted as they were using social media during the online class.

In terms of Communication challenges , almost half of them (46.96%) expressed that they had difficulty in sharing their view with the teachers, and 45.91% said that teacher–student interaction was passive. More than half (57.86%) of them expressed that peer group socialization has decreased, missed interaction (48.64%) with other college mates/seniors and experienced loneliness (56.6%) without interacting much with peer groups. Similar to these findings in the quantitative phase, in qualitative phase, the students mentioned that limited and disrupted communication with the friends and teachers created distress in the students. Moreover, the students could not clarify their doubts with the faculty.

Regarding Technical challenges , 44.03% had uncertain internet connection that interrupted the learning process. Around 37.32% expressed that the teachers had difficulty in using technical aspects of the online platforms initially. Around 39.63% had internet issues in their place. Almost 55.56% students faced technical issues with learning platform/device and around 59.54% had difficulty while submitting the answer sheets/assignment through digital platforms. Likewise, the qualitative findings revealed that the students faced technical and network issues while attending the classes. In addition, fluctuation in the network connectivity was another technical issue faced by students and it affected virtual learning. The participants expressed their concerns as they had difficulties in updating the digital platforms, and mentioned that the lack of experience in using the platforms affected their learning. Students faced difficulties in submitting the assignments and answer sheets, as they did not have previous experience in submitting it through digital platforms.

Related to Evaluation challenges , almost half of them (51.15%) mentioned that the online evaluation might create irrational discrimination between students with network issues, and 51.99% of them said that the evaluation/test conducted online was unfair. Consistent findings could be noted during the qualitative phase of study. Students mentioned that malpractice in the online exam occurred and it affected their grades. In addition, students stated that they did not get proper feedback on their assignments.

With respect to Physical and mental challenges , more than half 62.06% experienced physical strain like headache, backache, neck pain, and eye strain, 47.17% experienced insomnia, around 70.86% had mental stress, 46.75% got addicted to phone due to prolonged usage other than for learning purpose, 56.82% mentioned that the regular life style has changed, and lastly 48.21% were worried about the online teaching applications which lack proper security system. Likewise, same results are discovered in the qualitative phase of the study. Students experienced physical symptoms such as strain in the eyes, neck pain, back pain, and numbness in the legs due to prolonged sitting and continuous usage of phone. Additionally, students were anxious, as they could not complete the given tasks in online classes. Further, as the students did not get practical experience in the clinical area, their confidence levels were low and they felt tensed and lacked self-confidence to directly practice on the patients after the pandemic.

In terms of Career challenges , 56.4% agreed that virtual practical training may affect their career as a registered nurse, and 49.06% agreed that they may not be able to work as a skillful nurse with the virtual learning. Regarding Financial challenges , almost 58.07% agreed that extra money was spent for good internet package and 38.37% bought a new laptop/mobile/electric gadget to attend virtual classes.

With regard to association of demographic variables, only gender (χ 2 = 6.218, p = 0.045) has shown statistically significant association with problems or challenges faced by the nursing students during educational training in the pandemic at p < 0.05 level of significance.

During COVID-19 pandemic, face-to-face teaching and learning were converted to virtual learning and the clinical experiences were suspended to protect the students from the pandemic ( Agu et al., 2021 ). The experiences with the online classes were very new for the nursing students. Moreover, the online education became unavoidable and was a good choice for the faculty and students during this pandemic across the world. Even though, the students and teachers had a positive view of the technology, which helped in the teaching–learning process during pandemic, it posted many challenges ( Mousavizadeh, 2022 ).

We conducted a mixed-methods study to explore the experiences and challenges faced by nursing students in their education during COVID-19 in India. The study adopted an exploratory sequential mixed-methods design. The study was conducted as two phases; the qualitative data were collected during Phase I using focus group interview with the students. The qualitative data collected during the first phase of the study was utilized in preparing the tool for the quantitative phase of the study. The quantitative data were collected using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. During Phase 1, the analyzed data produced seven themes and 10 sub-themes on the challenges. These themes produced during the qualitative phase further explained the challenges experienced by the nursing students in their education during COVID-19 pandemic in the quantitative phase.

Educational Challenges

Learning motivation encourages learners’ activities and directs and maintains their progress, allowing students to immerse themselves in learning ( Kim, 2020 ). However, virtual learning decreased students’ attention and interest in classes, which then decreased their motivation to learn ( Morfaki & Skotis, 2022 ). Likewise, in the current study most of the students expressed that they lost interest in their learning. Student's interest is very important for academic achievement, so different methods of teaching and learning need to be adopted in future to improve the learning among students during online education ( Mousavizadeh, 2022 ).

During COVID-19 pandemic, the medical and nursing institutions used learning management systems (LMS) and uploaded various reading materials, videos, quizzes, and presentations to encourage the engagement of students in asynchronous learning activities. In addition, online discussion forums were created to facilitate the virtual learning process ( Atwa et al., 2022 ). Some students preferred online learning as it provides structured learning materials and enables studying from home at their own pace and convenience ( Paechter et al., 2010 ; Zheng et al., 2021 ). However, most of the students in different studies conducted across the world preferred face-to-face learning for acquiring motor skills, for establishing interpersonal relationships, and for achieving student learning outcomes ( Arias et al., 2018 ; Faidley, 2021 ; Ramani & Deo, 2021 ; Lim et al., 2021 ). Similarly, Muthuprasad et al. (2021) advocated that the online mode of learning may not be a viable option for practical/skill-oriented courses and therefore hybrid/blended curriculum involving both face to face and online modes of learning shall be adopted by the institutions.

The faculty used different methods of teaching and audio visual aids to enhance the teaching–learning process during the pandemic ( Reimers et al., 2020 ). However, students in the present study mentioned that the notes/lecture content were inadequate. Similar findings were reported in other studies that the quality and effectiveness of lecture were low; and inconsistencies were observed in some professor's lecture during COVID-19 ( Cengiz et al., 2022 ; Dziurka et al., 2022 ; Mousavizadeh, 2022 ; Mukasa et al., 2021 ; Rohde et al., 2022 ). This warrants the educational institutions to monitor the quality of teaching delivered by the faculty to their students during this pandemic. In addition, the faculty should take self-initiatives for the professional empowerment ( Osmanovic Zajic et al., 2022 ).

The professional preparation of nurses involves many hours of practical and theoretical classes which is conducted face to face, which gives a real learning experience ( Dziurka et al., 2022 ). However, COVID-19 pandemic caused alterations, restrictions, limited clinical placements and simulation training in the campus ( Rohde et al., 2022 ). Thus, many nursing institutions adopted virtual theoretical and practical learning modes. Various studies across the world including the present study reported that virtual practical learning was inappropriate and ineffective in doing practical skills. Additionally, the nursing students lack confidence in taking care of the patients as they did not have hands on training ( Cengiz et al., 2022 ; Dziurka et al., 2022 ; Gheshlagh et al., 2022 ; Mukasa et al., 2021 ; Rohde et al., 2022 ; Wajid & Gedik, 2022 ). Therefore, in addition to direct face-to-face practical training in the clinical areas, more nursing simulations, virtual reality, artificial intelligence and telenursing should be utilized to enhance the practical learning of nursing students ( Dziurka et al., 2022 ).

Environmental Challenges

Student engagement during the virtual classes are very essential. The students are expected to actively participate, show positive conduct, self-regulated, display deep learning and understanding, and should demonstrate positive reactions to the learning environment, peers, and teachers ( Bond et al., 2020 ). However, students in the current study and many other studies were distracted very easily while attending online classes, which limited their learning during pandemic ( Bergdahl, 2022 ; Farrell & Brunton, 2020 ; Fazza & Mahgoub, 2021 ; Hollister et al., 2022 ). Therefore, more peer-to-peer conversations and faculty–student exchanges are recommended to enhance the engagement and learning during the pandemic.

Communication Challenges

Effective communication between the educator and the students enhances the learning experience and creates a positive learning environment. In addition, it improves the exchange of ideas, knowledge, and thought to fulfill the purpose of teaching and learning. However, ineffective communication creates frustration, impaired interpersonal relationships, and lack of motivation ( Alawamleh e al., 2020 ). In consistent to this study, the present participants had difficulty in sharing their view with the teachers, could not socialize with peer groups, and experienced loneliness. Furthermore, studies reported that impaired communication during online learning creates uncertainties and insufficiencies in learning ( Cengiz et al., 2022 ; Mousavizadeh, 2022 ; Mukasa et al., 2021 ). Thus, effective communication with the students should be streamlined for successful virtual learning ( Mukasa et al., 2021 ).

Technical Challenges

Online education can be effectively integrated in the nursing curriculum as it guarantees effective problem-based learning. However, the nursing colleges were not adequately prepared to effectively utilize the online teaching and learning in developing and under developed countries ( Molefe & Mabunda, 2022 ). Technical aptitude was lacking among the faculty and students, which posed various challenges ( Barrot et al., 2021 ). Moreover, technical challenges limited the satisfaction of students and faculty toward online teaching and learning ( Mahyoob, 2020 ). Furthermore, failure of internet services, website failures, problems in logging into the site disrupted the teaching–learning process during the pandemic ( Fuchs, 2022 ; Gaur et al., 2020b ). Similar to these studies, the present study participants mentioned that they experienced uncertain internet connection, faced technical issues with learning platform/device, and had difficulty while submitting the answer sheets /assignment through digital platforms. In addition, the teachers had difficulty in using technical aspects of the online platforms. This calls for improving the instructional design and pedagogical methods by training the faculty and students to utilize the digital platforms effectively, which might improve the motivation and engagement of faculty and students during the online education ( Aivaz & Teodorescu, 2022 ).

Evaluation Challenges

Significant changes in the teaching and learning during the pandemic created profound opportunities and threats. Stakeholders and students reported that the evaluation during online learning was biased and ineffective ( Krishnamurthy, 2020 ) and experienced uncertainty toward the examination ( Idris et al., 2021 ). Besides, online learning affects the test scores and grades, student outcomes, attitude, and overall satisfaction with learning ( Szopiński & Bachnik, 2022 ). In the same way, the students in the current study mentioned that the online evaluation created irrational discrimination between students and the evaluation conducted online was unfair. Therefore, standard setting in the evaluation is an essential step considering the learners and educator's perspective, which would improve the teaching–learning process ( Wasfy et al., 2021 ).

Physical and Mental Challenges

COVID-19 pandemic disproportionately affected the physical and mental health of students ( Ro et al., 2021 ). Students missed eating, did not participate in extracurricular activities, and experienced computer-related physical stress ( Idris et al., 2021 ). Likewise, students experienced increased stress due to homework, social isolation and lack of social interactions ( Rao & Rao, 2021 ). In congruent with these study findings, the participants in the present study experienced headache, backache, neck pain, eye strain, insomnia, and mental stress. The authors recommend addressing the physical and mental health issues of the students by promoting the utilization of physical, emotional, and mental health support programs ( Idris et al., 2021 ).

Career Challenges

COVID-19 pandemic impacted the career preference, career perspective, and ideal workplace ( Wang et al., 2022 ). In the same way, the students struggled with the career decision-making process during the pandemic ( Jemini-Gashi & Kadriu, 2022 ). Likewise, working students lost their jobs, which affected their lives, studies, and health ( Tsurugano et al., 2021 ). In line with these studies, students of the present study expressed that virtual practical training will affect their career as a registered nurse and they may not be able to work as a skillful nurse. This calls for the initiation of a structured and well-designed practical training program for the nursing students in the hospitals before their placement as a registered nurse in the clinical practice.

Financial Challenges

The pandemic put a number of students under financial strain, which severely affected their mental well-being ( Negash et al., 2021 ). Similarly, the university students were disproportionately affected by the economic consequences of the pandemic, which escalated the economic uncertainty ( Gewalt et al., 2022 ). The students who lost their economic resources during pandemic experienced higher prevalence of depressive symptoms ( Tancredi et al., 2022 ). Participants in the current study mentioned that they had to spend extra money for good internet package and bought a new laptop/mobile /electric gadget to attend virtual classes, which increased their economic burden. To counterbalance these economic challenges, financial aid schemes for students need to be made available to relieve distress and allow students to focus on their studies ( Gewalt et al., 2022 ).

Strengths and Limitations

The study findings are limited to only few nursing colleges in India. Therefore, the study findings may not be generalizable to other states of India. As the study population was not selected through probability sampling strategy, the representativeness of samples might be lacking in the current study. Moreover, the study instruments were prepared by the investigators of the study that did not undergo rigorous standardization process, which might limit the strength of the study. Based on the study findings, the institutions where the study was conducted should design strategies to mitigate the challenges to have effective teaching and learning.

Implications for Practice

Virtual nursing education can be improved by refining the content and delivery methods, training of nursing faculty to use online educational strategies, and by reducing the technical and environmental barriers. Hybrid and blended teaching–learning strategies may further improve the learning among nursing students.

Virtual education can be very successful if we address the challenges and experiences of the students by performing appropriate groundwork by upgrading the required hardware and software, teaching how to use the facilities, and developing innovative teaching techniques and standard protocols for virtual education.

Supplemental Material

Acknowledgments.

The authors thank the students and faculty members who participated in this study. The authors are thankful to the Deanship of Graduate Studies and Scientific Research at University of Bisha, Saudi Arabia for supporting this work through the Fast-Track Research Support Program. The authors would like to acknowledge the nursing students who have participated in the study. Special thanks to the administrators and faculty members of the institutions for their motivation and support during data collection.

Author Contributions: PK designed and conducted the study and wrote the initial draft of the manuscript. JA edited and added additional content and refined the manuscript. AP collected the data. SM edited the manuscript.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval: Ethical approval was obtained from the Research and Ethics Committee of Narayana Hrudayalaya College of Nursing (NHH/AEC-CL.2022-BI5 dated 22/3/2022), Kirubhanidhi College of Nursing (KCC/22/22 dated 04/3/2022), and Koshy's College of Nursing (KCN/15 dated 07/3/2022).

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors are thankful to the Deanship of Graduate Studies and Scientific Research at University of Bisha, Saudi Arabia for supporting this work through the Fast-Track Research Support Program.

ORCID iDs: Judie Arulappan https://orcid.org/0000-0003-2788-2755

Shimmaa Mansour Moustafa Mohammed https://orcid.org/0000-0002-2956-610X

Supplemental Material: Supplemental material for this article is available online.

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Reflexivity in Qualitative Research: Why You'll Never Be An Objective
(PDF) Reflexive methodology: new vistas for qualitative research
(PDF) Reflexive Accounts and Accounts of Reflexivity in Qualitative
(PDF) Reflexivity in Qualitative Research: A Journey of Learning
Reflexive journals in qualitative research
(PDF) Reflexive disclosure in qualitative research publications in

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Full article: A practical guide to reflexivity in qualitative research
Abstract. Qualitative research relies on nuanced judgements that require researcher reflexivity, yet reflexivity is often addressed superficially or overlooked completely during the research process. In this AMEE Guide, we define reflexivity as a set of continuous, collaborative, and multifaceted practices through which researchers self ...
Challenging perspectives: Reflexivity as a critical approach to
In qualitative research, reflexivity has become a means of understanding knowledge production. The process involves reflecting on the knowledge that researchers produce and their role in producing that knowledge (Braun and Clarke, 2013).Since qualitative social sciences challenge the dominance of realism: 'There are no objective observations, only observations situated in the worlds of the ...
Keeping and Using Reflective Journals in the Qualitative Research Process
Keeping and Using Reflective Journals in the Qualitative Research Process . Abstract . The problem of bias in qualitative research particularly is still debated in methodology texts and there is a lack of agreement on how much researcher influence is acceptable, whether or not it needs to be "controlled," and how it might be accounted for.
Reflexivity in Qualitative Research
All qualitative research is contextual; it occurs within a specific time and place between two or more people. If a researcher clearly describes the contextual intersecting relationships between the participants and themselves (reflexivity), it not only increases the creditability of the findings but also deepens our understanding of the work.
Reflexive journals in qualitative research
Reflexive journals in qualitative research. It is common practice for researcher to keep a journal or diary during the research process, regardless of discipline or methodology. These are sometimes called reflexive diaries, self-reflexive journals, research journals or research diaries. They are all basically the same thing - a written (or ...
Reflexive Content Analysis: An Approach to Qualitative Data Analysis
There has been growing recognition of the role of reflexivity in rigorous qualitative research (Braun & Clarke, 2019, 2021b; Campbell et al., 2021; Lazard & McAvoy, 2020). However, understanding what reflexivity represents can be particularly challenging to grasp, especially for those new to qualitative research. ... Qualitative Research ...
A practical guide to reflexivity in qualitative research: AMEE Guide No
Reflexivity; qualitative research; qualita-tive methods Introduction As qualitative research has gained credibility in health pro-fessions education (HPE) scholarship (Varpio and Meyer 2017), the field's understanding of rigorous research proc-esses has been refined. In this orientation, markers for research rigor are fundamentally different ...
A practical guide to reflexivity in qualitative research: AMEE ...
Abstract. Qualitative research relies on nuanced judgements that require researcher reflexivity, yet reflexivity is often addressed superficially or overlooked completely during the research process. In this AMEE Guide, we define reflexivity as a set of continuous, collaborative, and multifaceted practices through which researchers self ...
How to be reflexive: Foucault, ethics and writing qualitative research
Reflexivity and its critiques. Reflexivity, as both concept and practice, has thoroughly permeated the discourse of qualitative research, in large part as a response to questions of representation and legitimacy in post-positivist inquiry (Pillow Citation 2003).Discussions of reflexivity as a practice have become commonplace in both research books and articles, particularly those aimed at ...
Chapter 6. Reflexivity
Nearly every great qualitative researcher maintains a reflexive journal (there are exceptions that prove the rule), a type of diary where they record their thinking on the research process itself. This might include writing about the research design (chapter 2), plotting out strategies for sample selection (chapter 6), or talking through what ...
(PDF) A practical guide to reflexivity in qualitative research: AMEE
In this AMEE. Guide, we define reflex ivity as a set of continuous, co llaborative, and multiface ted practices. through which researcher s self-consciously critique, app raise, and evaluate how ...
Reflexivity and Positionality in Qualitative Research: On Being an
The impact of sensitive research on the researcher: Preparedness and positionality. International Journal of Qualitative Methods, 18, 1-8. Article Google Scholar Finlay, L. (2002). Negotiating the swamp: the opportunity and challenge of reflexivity in research practice. Qualitative Research, 2(2), 209-230.
Practising reflexivity: Ethics, methodology and theory construction
Reflexivity as a concept and practice is widely recognized and acknowledged in qualitative social science research. In this article, through an account of the 'reflexive moments' I encountered during my doctoral research, which employed critical theory perspective and constructivist grounded theory methodology, I elaborate how ethics, methodology and theory construction are intertwined.
RWJF
Reflexivity. Reflexivity is an attitude of attending systematically to the context of knowledge construction, especially to the effect of the researcher, at every step of the research process. "A researcher's background and position will affect what they choose to investigate, the angle of investigation, the methods judged most adequate for ...
How to … be reflexive when conducting qualitative research
Reflexivity can be a complex concept to grasp when entering the world of qualitative research. In this article, we aim to encourage new qualitative researchers to become reflexive as they develop their critical research skills, differentiating between the familiar concept of reflection and reflective practice and that of reflexivity.
Reflective journals in qualitative inquiry
The reflective journal in qualitative research is a written record by the researchers themselves and is written throughout the research process. A reflective journal includes the details of what the researchers did, thought, and felt while analyzing the data. Then, the rationale behind those thoughts and percepts are recorded.
The Importance of Reflexivity in Qualitative Research
How to Keep a Reflexive Journal in Qualitative Research. It is generally good practice to keep a reflexive journal when practicing qualitative research in order to keep a log of your thoughts, reflections, and decision-making as you make meaning from data. There is no right or wrong way to keep a reflexive journal.
Maintaining reflexivity in qualitative nursing research
Reflexivity in qualitative research is an important strategy to ensure trustworthiness of the research. However, reflexive accounts are underreported in nursing research. ... Reflexive account of unintended outcomes from spiritual care qualitative research. Journal of Research in Nursing, 20 (3), 234-248. 10.1177/1744987115578185 ...
Reflexivity in Qualitative Research: Why You'll Never Be An Objective
In qualitative research, reflexivity is the process of consciously examining how your own subjective point of view shapes (and is shaped by) your research. Product. products. ... That means that, if you aren't keeping an ongoing reflexivity journal for yourself throughout your research career, you should at least begin the reflexive process ...
Reflections from the Field: Questions to Stimulate Reflexivity Among
A reflexive exercise that is totally open and non-directional can be good, but it is also useful to consider particular questions that help stimulate reflective thoughts. Here are a few key questions for the researcher's reflexive journal: Broad Takeaways from the Research Event (e.g., the IDI, the focus group, the observation)
(Self-) Reflection / Reflexivity in Sensitive, Qualitative Research: A
In qualitative research, reflexivity has become a major strategy 'to secure credibility, trustworthiness, and nonexploitative research by self-scrutinization of the lens through which the researcher views the phenomenon studied' (Berger, 2015, p. 229). However, how this strategy can be implemented is far less clear as it is nuanced and complex.
Reflectivity in Research Practice: An Overview of Different
Reflection is a crucial cognitive practice in the research field (Dahlberg, Drew, & Nyström, 2002; Steier, 1995).Starting from the "interpretive turn," reflexivity is largely practiced in qualitative research, where it is used to legitimate and validate research procedures.
Young people's views and experience of diet-related inequalities in
This requires continual reflexivity and critical engagement with the data and the analytical process. V.E. and M.C. read the transcripts and applied a mix of semantic (surface meaning) and latent coding (underlying meaning), aided by a qualitative analysis software, NVivo 12.
Nursing Students' Experiences and Challenges in Their Education During
Phase 1: Qualitative data were collected using direct focus group interview with 18 students. Phase 2: Quantitative data were collected from 477 students using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. ... International Journal of Research in Medical Sciences, 8 ...
Incorporating Perspective Taking in Reflexivity:
Facing the complexity of the researcher position, the role of reflexivity has been increasingly recognized in qualitative research (Naples & Sachs, 2000).Specifically, researchers are encouraged to acknowledge their own presence and characterize their role in the formation of knowledge and to self-monitor the impact of their biases, beliefs, and experiences on their research to "maintain the ...
Removing the Veil of Whiteness in Qualitative Research Using Sista
We present lessons learned from doing qualitative research centering on the community practices of Black women doctoral students using sista circle methodology. ... I'm not a reflective person in the way that I can write about a specific topic in a reflective way, but I can definitely talk about it. ... International Journal of Qualitative ...