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Development and use of research vignettes to collect qualitative data from healthcare professionals: a scoping review, dominique tremblay.
1 School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
2 Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
Nassera touati.
3 École Nationale d’Administration Publique, Montreal, Quebec, Canada
4 School of Public Health, Université de Montréal, Montreal, Quebec, Canada
5 Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
6 Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
7 Susan E. French Chair in Nursing Research and Innovative Practice, Montreal, Quebec, Canada
8 Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
9 Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
10 Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
Émilie giordano, associated data.
bmjopen-2021-057095supp001.pdf
bmjopen-2021-057095supp002.pdf
All data relevant to the study are included in the article or uploaded as supplementary information.
To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies involving healthcare professionals.
Scoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.
Electronic databases: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX (January 2000–December 2020).
Empirical studies in English or French with a qualitative design including an explicit methodological description of the development and/or use of vignettes to collect qualitative data from healthcare professionals. Titles and abstracts were screened, and full text was reviewed by pairs of researchers according to inclusion/exclusion criteria.
Data extraction included study characteristics, definition, development and utilisation of a vignette, as well as strengths, limitations and recommendations from authors of the included articles. Systematic qualitative thematic analysis was performed, followed by data matrices to display the findings according to the scoping review questions.
Ten articles were included. An explicit definition of vignettes was provided in only half the studies. Variations of the development process (steps, expert consultation and pretesting), data collection and analysis demonstrate opportunities for improvement in rigour and transparency of the whole research process. Most studies failed to address quality criteria of the wider qualitative design and to discuss study limitations.
Vignette-based studies in qualitative research appear promising to deepen our understanding of sensitive and challenging situations lived by healthcare professionals. However, vignettes require conceptual clarification and robust methodological guidance so that researchers can systematically plan their study. Focusing on quality criteria of qualitative design can produce stronger evidence around measures that may help healthcare professionals reflect on and learn to cope with adversity.
Vignettes are commonly referred to as short hypothetical accounts reflecting real-world situations. Vignettes are presented to knowledgeable individuals who are invited to respond. 1 Generally speaking, vignettes allow participants to clarify and share their perceptions on sensitive topics such as dealing with adversity in challenging environments, discussing team functioning issues or moral dilemmas they face daily, and reflect on potential solutions. Vignette-based methodology in qualitative research appears useful to our research team, which is currently piloting an intervention to co-construct, implement and assess resilience at work among cancer teams, as a means of integrating the knowledge of cancer professionals on how to face adversity. The objective of the scoping review is to learn from prior use of vignette-based methodology in qualitative research in healthcare settings.
Team resilience at work refers to the capacity of team members to face and adapt to adverse situations. 2 Cancer care offers a valuable clinical context to study team resilience at work because professionals face daily adversity with overlapping challenges such as delivering news of a new cancer diagnosis or disease progression, constant changes in therapeutic regimens, frequent staff turn-over and shortages, and increased administrative tasks. 3–7 Cancer team members are exposed to mental health threats such as high stress, anxiety, compassion fatigue and loss of a sense of coherence 8 associated with absenteeism, burnout or depression. 4 5 9–12 While these negative effects of adversity have grown exponentially with each wave of the COVID-19 pandemic, 13 14 solutions to manage and minimise these effects remain understudied. Cancer team members must manage and learn from difficult situations related to their practice context and the pandemic environment. The vignette-based methodology provides an opportunity to reflect and plan supportive interventions and offers an empirically based research approach that is well suited to this complex context.
Vignette-based methodology in qualitative research explores and interprets contextualised phenomena to identify influential factors and understand how participants perceive moral issues or sensitive experiences. 15 It also enables reflexive learning from practice, stimulates exchange on professional responses to difficult situations and supports tailored actions to make sense of adversity. Vignette-based methodology is of interest in disciplines such as psychology, social science, education, medicine and nursing. 16–20 It has been developed and used to collect data on perceptions, beliefs, attitudes and knowledge, 17 19 from individuals or teams, 19 21 through individual or group interviews or questionnaires. 15 18 21 Commonly formatted as written narratives, vignettes can also be presented as audio segments, photographs or videos. 18 21
Empirical studies use different definitions of the vignette and provide little detail about how it is developed and used to collect data. 15 19 21 Such methodological inconsistencies raise questions about the quality criteria of this qualitative approach. 17 Concerns have also been expressed around whether data collection approaches ensure an appropriate distance between the occurrence of sensitive events and the interview 19 and around the need to mitigate the risk that participants provide socially desirable responses. 15 Finally, our preliminary search for studies using vignette-based methodology to collect qualitative data from professionals in cancer care found only one study. 22 These factors emphasise the need to arrive at a working definition of this approach to inform data collection in subsequent qualitative studies and provide the rationale for this scoping review. 23 24
This study aims to clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in empirical studies involving healthcare professionals.
This scoping review mobilises the Joanna Briggs Institute’s methodological guidelines, 23 which build on the seminal works of Arksey and O’Malley 25 and Levac et al . 26 Scoping reviews examine the number, range and nature of studies relevant to a particular research question and are used to analyse and report available evidence. 27 The present scoping review follows the steps described by Peters et al . 23 The Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist criteria 24 are followed to report results ( online supplemental appendix 1 ). The protocol was registered prospectively with the Open Science Framework on 1 July 2020 ( https://osf.io/muz4x/?view_only=5943aa0ffb6541d6979ebeedba7464cb ).
Patient and public involvement.
No patients or public involved in carrying out this scoping review.
The questions of the scoping review have a methodological focus: (1) how has vignette-based methodology in qualitative research been defined?; (2) what steps have been involved in developing vignettes to collect qualitative data in studies involving healthcare professionals?; and (3) how is vignette-based methodology used to collect qualitative data from healthcare professionals?
The Population/participants, Concept and Context (PCC) framework, with the addition of the type of evidence source (type of study and type of publication), is used to guide the selection of eligibility criteria and the search strategy. 23 28 PCC generally allows a wide range of articles to be considered for inclusion. The concept of interest is the vignette as used in qualitative research. A preliminary search of qualitative vignette-based methodology development and utilisation with cancer team members found only one study. Therefore, the search was expanded to include qualitative studies as well as systematic and scoping reviews (type of evidence source) in healthcare contexts other than oncology (context), with healthcare professionals in both practice and educational settings (population/participants).
Inclusion criteria were: (A) empirical studies with specific focus and/or statements about the development or utilisation of vignettes in qualitative studies involving healthcare professionals in clinical practice, training or continuing education; (B) qualitative study design (action research, intervention research with clinical or educational application and professional practice-based initiatives); (C) written in English or French; and (D) published between January 2000 and December 2020 in journals listed in electronic databases. The search was limited to 2000 due to the very small number of publications prior to that year using vignettes in qualitative research involving healthcare professionals. Exclusion criteria were: (A) absence of the word ‘vignette’ in title, in order to target studies with a clear focus on methodological development or use in qualitative research; (B) background articles or other articles that did not report outcomes from use of vignettes in qualitative data collection; (C) studies using vignette with quantitative or mixed methods design; (D) studies reported in grey literature; and (E) articles without an abstract.
Research team members including researchers and professionals from various disciplines (eg, nursing, psychology, economics, human resources management and medicine) were involved in search strategy preplanning. An academic librarian contributed to determining the databases, search terms, boolean operators and query modifiers ( online supplemental appendix 2 ). A total of five peer-reviewed online databases were searched: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX. The search was supplemented by hand-searching reference lists.
Articles were uploaded to Rayyan, a cloud-based application for systematic reviews. 29 Duplicates were removed before undertaking the three-step screening process 30 : title, abstract and full-text assessment. Two reviewers (DT and AT) independently completed each screening step. 31 Disagreements on article selection and on reasons for exclusion were resolved by consensus through discussion between the two reviewers and two other team members (SL and EG). Reviewers selected and applied the highest reason for exclusion from a screening criteria priority list, which was agreed on ahead of time.
Data extraction was performed in two cycles, according to Peters et al ’s recommendations on key information to extract. 23 The first cycle aimed to describe study characteristics (eg, authors, country and year of publication, study phenomenon and setting). The second cycle was based on a thematic analysis for data condensation. 32 The coding grid aligned with our review questions: vignette definition; vignette development (steps described, actors involved/developers, source and format of vignette content); vignette utilisation (study participants, delivery method, introduction items, vignette presentation and handling, interview process, design and strategy for data analysis); and strengths and limitations relating to vignette development or utilisation, advantages or disadvantages of using the vignette and recommendations reported by authors. The coding approach was defined by consensus between research team members (DT, AT, SL and EG). Data extraction was performed using QDA Miner (V.5.0.34). 33
A thematic analysis on the development and utilisation of vignettes, as well as recommendations from authors that emerged from the reviewed articles, were synthesised in charting tables. Several research team meetings were carried out during the iterative data extraction and analysis process. Data matrices were used to display the findings according to the scoping review questions.
The removal of duplicates and the addition of one record from hand-searching left 157 potentially eligible articles. Screening by title excluded 127 articles, while screening of abstracts excluded 14 more. Full-text assessment excluded an additional six articles. The main reasons for exclusion were wrong concept (not vignette-based methodology in qualitative research) and wrong population (not healthcare professionals). A total of 10 articles were eligible for inclusion in the review. Search results are presented in a flow diagram 34 ( figure 1 ).
PRISMA flow diagram of article selection process. Adapted from: Page et al . 34 PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Included studies are published between 2002 and 2020 and involve healthcare professionals from four countries: Australia, 35 Canada, 22 36 Norway 37 and the UK. 38–43 Study settings include oncology, primary care, mental health, public health, hospital care, health and social work, health education and critical care. Various phenomena are investigated, such as quality of care related to professional practices, understanding of policy issues, appreciation of health services, perceptions towards patients and moral or ethical issues. These characteristics are included in tables in the next sections.
The first question in this review concerns how studies define the vignette-based methodology in qualitative research. While a definition is missing in two articles, 40 41 four articles 22 36 38 39 provide an original definition informed by one or more key references. For example, Morrison (p. 362) 36 defines vignettes as ‘ carefully designed short stories about a specific scenario presented to informants to prompt discussion related to their perceptions, beliefs, and attitudes ’. The other four articles refer to key authors without giving an explicit definition. 35 37 42 43
Vignettes are referred to as short stories about hypothetical characters in specified circumstances that participants are invited to respond to. 35 36 38 42 43 Other elements specified in definitions include the form of the vignette (eg, text), 39 the nature of the stories or scenarios (eg, simulations of real events, fictional or composite) 38 43 or the aim of the vignette (eg, to elicit individuals’ perceptions, attitudes, beliefs and social norms). 36 38
The second question of interest pertains to the methodological steps involved in developing a vignette to collect qualitative data from healthcare professionals. Table 1 presents a description of the vignettes in each study, the extent to which development steps are reported, as well as the steps and actors involved in vignette development.
Description of vignette development in included studies
Study | Vignette | Number of steps* | Development steps with actors involved | ||||||||
Content (based on) | Format | Choice of approach | Interview questions | Preliminary versions | Anticipated responses | External validation/review | Pretest | Final version | |||
Andrews 2020 UK Primary care – self-monitoring of blood pressure | Six short sections on multiple points of care | M | R (S) | W | – | R | – | – | – | R, E | R |
Cazale 2006 Canada Oncology – professional practices in cancer care | Clinical vignette, sequence of four events from the care coordination of a cancer patient | 6 | R (Li) | W | R | – | R, E | R | – | R, A | R |
Holley and Gillard, 2018 UK Mental health – understandings of risk and recovery | Five sequential scenarios on issues of living in the community with serious mental illness | 2 | R, A (Li, S) | W | – | R | R | R | – | R, A | R |
Jackson 2015 Australia Public health – promotion of unhealthy foods and beverages | 10 scenarios of marketing practices of a fictional multinational confectionery company | 8 | R (Li) | W | R | – | R | – | R, E | R, A | R |
Johnson 2005 UK Hospital and primary care – role of advice in diabetes foot care | Continuous story in six stages of a patient with diabetes-related foot complications | DD | R (Li) | W | R | R | R | – | – | R, E | R |
Morrison, 2015 Canada Oncology – support in cancer survivors’ work integration | Seven combinations of photographs and narratives, reflective of cancer survivors’ experiences of work integration | DD | R (S) | P, W | – | R | R | – | – | R | R |
Østby and Bjørkly, 2011 Norway Health and social work – ethical challenges in interactions | Four short, open-ended descriptions of interactions between people with intellectual disabilities and care staff | 6 | R (S) | W | – | R | R | – | R, A | – | R |
Richman and Mercer, 2002 UK Psychiatric hospital – discursive structures of nurses | 12 short scenarios detailing case histories of a high-risk patient (six white/six black) | M | R (Li) | W | R | – | – | – | – | – | R |
Spalding and Phillips, 2007 UK Health education – preoperative education practice | One snapshot, 20 portraits and one composite, within an action research to improve preoperative education | DD | R (S) | W | R | – | R | – | R, E | – | R |
Thompson , 2003 UK Critical care – adherence to advance directives | One clinical vignette of a fictitious patient who had signed an advance directive before developing dementia | M | R (–) | W | – | R | – | – | – | – | R |
*, number if clearly stated; –, not reported; A, targeted audience; DD, diffusely discussed; E, experts; Li, literature, including knowledge from reviews, existing frameworks or guidelines; M, minimally or not discussed; P, photographs; R, researcher(s); S, empirical study conducted; W, written.
Vignettes are designed as stories, 40 scenarios, 35 38 42 43 clinical situations emerging along the cancer trajectory 22 or descriptions of a plausible individual or social situation. 36 37 39 41 Including 1–20 situations, they are presented in written narrative form in all studies but one, which combines narratives and photographs. 36 Three studies use temporally sequenced vignettes. 22 38 40 To emphasise the plausibility of the content, six articles mention the source of inspiration: real-life clinical situations or patient experiences, 22 36 39 41 observational research 43 or situations involving ethical challenges seen in field study. 37
The steps used to develop the vignette are clearly described in four studies. In the other studies, authors are either vague about the steps 36 40 43 or provide minimal to no information. 39 41 42 Although the number of steps ranges from 2 to 8, with various degrees of specification, design and pretesting appear as the most common steps to arrive at the version of the research vignette delivered in interviews. Other steps involve establishing the vignette content and format and choosing a delivery approach (eg, individual or group interview). Drawn either from literature (eg, knowledge from reviews, existing frameworks or guidelines) or from empirical studies, the content is either developed by researchers, sometimes with input from clinical experts 22 or exploratory focus groups of individuals similar to research participants. 38
Strategies are described to improve the internal validity of vignettes (relevance, reliability, effectiveness, completeness, familiarity and intelligibility). Three studies stress the importance of reviewing vignette content, conducting a survey with respondents similar to the targeted audience 37 or obtaining feedback from experts. 35 43 Vignettes are pretested in six studies, through piloting with experts 39 40 or individuals 35 or through group discussion 22 38 ; one study mentions testing the vignettes and interview protocol without providing further detail. 36 Other strategies to improve internal validity include: use of a panel of experts, 38–40 43 use of primary research data 36–39 or framework 22 to develop the content; removal of elements from the vignettes that may bias the interviews 37 ; and selecting a small number of scenarios (up to four) to be included in the vignette. 37
Strategies to increase generalisability include making the vignettes realistic 36 37 43 and comparing pretest responses from experts with responses anticipated by the research team. 22 Researchers 22 35 37 38 40 43 also mention making changes to content, format or delivery method as needed throughout validation and/or pretesting steps to assure internal and external validity.
The third question we explore in the review is how vignette-based methodology is used to collect qualitative data from healthcare professionals ( table 2 ).
Description of vignette-based methodology utilisation in included studies
Study | Participants | Delivery approach | Introduction | Presentation / Handling | Interview process | Design and data analysis |
Andrews 2020 UK Primary care – self-monitoring of blood pressure | Physicians (n=14); nurses (n=7) Total (n=21) | |||||
Cazale 2006 Canada Oncology – professional practices in cancer care | Interdisciplinary teams of clinicians in oncology. Total (n=41) | |||||
Holley and Gillard, 2018 UK Mental health – understandings of risk and recovery | Psychiatrists, mental health professionals (n=8); service users (n=8) Total (n=16) | |||||
Jackson 2015 Australia Public health – promotion of unhealthy foods and beverages | Public health professionals (n=10); marketing and industry professionals (n=11) Total (n=21) | |||||
Johnson 2005 UK Hospital and primary care – role of advice in diabetes foot care | Healthcare professionals, consultants, physicians and specialists (n=15); patients (n=15) Total (n=30) | |||||
Morrison, 2015 Canada Oncology – support in cancer survivors’ work integration | Oncologists (n=5); physicians (n=5) Total (n=10) | |||||
Østby and Bjørkly, 2011 Norway Health and social work – ethical challenges in interactions | Social educators Total (n=8) | |||||
Richman and Mercer, 2002 UK Psychiatric hospital – discursive structures of nurses | Clinical nurses Total (n=30) | |||||
Spalding and Phillips, 2007 UK Health education – preoperative education practice | Healthcare professionals also presenters of education programme. Total (n=not reported) | |||||
Thompson 2003 UK Critical care – adherence to advance directives | Healthcare professionals and specialists from various disciplines. Total (n=46) |
Studies employ convenience 37 or purposive 35 36 38 39 41 sampling to determine inclusion and exclusion criteria for participants. Sociodemographics (age, gender or sex and years of experience) are reported in three studies, 37 39 41 while participants’ profession is reported in all studies.
Vignettes are delivered through individual interviews in seven studies. 35–38 40–42 The number of individuals varies from 8 to 30. Four studies present the vignettes in group interviews 22 39 41 or team meetings 43 of 2–14 participants. Johnson et al 40 consider that individual interviews are best suited to explore professionals’ personal views, for logistical reasons and to reduce the risk of inhibiting expression due to power differentials between participants. In contrast, Cazale et al 22 use focus groups to observe the interaction between participants, which seems promising to generate data in their study aimed at assessing the quality of care provided by interdisciplinary teams. One study 41 uses both individual and group interviews, without explicit justification.
Six studies report that researchers introduced study objectives to participants, explained ground rules such as confidentiality, the interview procedure and assured them there were no right or wrong answers. This is similar to other qualitative methods.
Various interviewing approaches are adopted in the studies: open discussion, semistructured or structured. Interview guides are used in five studies. 36–40 All studies include questions about the participants’ perceptions, views or beliefs regarding their own experiences or practices. One study includes questions to elicit participants’ thoughts on whether the vignette content reflects their personal experience (plausibility). 38 Another adds questions on how others may have interpreted or behaved in a similar situation, which helps verify that the vignettes describe real-life practice situations and thus contributes to establishing their validity. 37
Some note that the method is generally well received by participants, 35 36 despite two health professionals who ‘ opined that the vignettes were unnecessary to facilitate the dialogue that could have been accomplished by direct questioning ’ (p. 369). 36 Certain issues are also reported regarding the quality of the answers elicited (eg, answers from own perspective instead of others’; answers to avoid disclosing confidential or problematic information; answers tailored to social desirability). 35 37 38
Various qualitative design and data analysis approaches are employed, including thematic analysis of interview responses, hermeneutic analysis, framework analysis, interpretive description or modified grounded theory. Only three studies include information on reliability assessment using content validation by experts, pretest or interview modalities. 22 39 41
A synthesis of the recommendations on vignette development and utilisation is presented in table 3 . These are based on analysis of the strengths and limitations reported in the 10 studies included in this scoping review.
Synthesis of strengths (S), limitations (L) and authors’ recommendations in included studies
Study | Vignette development | Vignette utilisation |
Andrews 2020 UK Primary care – self-monitoring of blood pressure | ||
Cazale 2006 Canada Oncology – professional practices in cancer care | ||
Holley and Gillard, 2018 UK Mental health – understandings of risk and recovery | ||
Jackson 2015 Australia Public health – promotion of unhealthy foods and beverages | ||
Johnson 2005 UK Hospital and primary care – role of advice in diabetes foot care | ||
Morrison, 2015 Canada Oncology – support in cancer survivors’ work integration | ||
Østby and Bjørkly, 2011 Norway Health and social work – ethical challenges in interactions | ||
Richman and Mercer, 2002 UK Psychiatric hospital – discursive structures of nurses | ||
Spalding and Phillips, 2007 UK Health education – preoperative education practice | ||
Thompson 2003 UK Critical care – adherence to advance directives |
Researchers in all the studies report that vignette-based methodology in qualitative research is an effective means of exploring sensitive or difficult topics and eliciting in-depth responses and reflexivity.
Eight authors’ recommendations emerge from our scoping review around the methodology for development of vignettes in qualitative research: (1) follow a rigorous stepwise development process 22 42 ; (2) involve experts who are knowledgeable informants or a multidisciplinary team in refining content 22 38 ; (3) use credible sources such as primary research data, frameworks or literature reviews to develop content 22 38 39 43 ; (4) be mindful of participants’ availability when determining the number of sections or vignettes 35 36 ; (5) avoid content that uses unclear terminology, 38 lacks information (eg, not the full clinical picture), 38 includes too many variables 22 35 or leads to particular interpretations or choices 22 37 ; (6) provide vignettes that are meaningful and allow participants to identify with and reflect on the story 36 38 43 ; (7) use validation strategies and test the quality of the vignette 37 40 ; and (8) pay attention to the delivery, including semistructured interview questions and form of probing 36–38 (eg, a third person format can help create safe distance to explore difficult topics 36 ; consistency in the format: mixing second and third person questions can lead participants to answer most questions based on their personal experience). 36
Our scoping review further suggests a number of recommendations regarding the utilisation of vignette-based methodology: (1) use the vignette consistently with each participant or group of participants to allow systematic data collection 22 35 40 ; (2) make sure the interviewer has the skills to conduct individual or group interviews 22 35 36 ; (3) recognise and try to discourage socially desirable responses 35 ; (4) be cautious about the extent to which it reflects real-world situations for the participants 35 40 41 ; (5) add one facilitator and one observer during focus groups 22 ; (6) reach saturation in data collection 36 37 ; and (7) use validation strategies in data analysis (eg, intercoder reliability assessment; theme validation) 39 and triangulation to reinforce the quality of results. 22 35
This scoping review contributes to clarify the definition of vignette-based methodology in qualitative research, details its development steps, describes its utilisation and assesses its strengths and limitations based on quality criteria for qualitative studies. It can inform planning of future research employing this qualitative approach. Ten studies are included that involve healthcare professionals in various settings.
Our results suggest an expanded use of the vignette as a qualitative methodology. Vignette-based methodology is not commonly used in qualitative studies involving healthcare professionals, despite being recognised as a suitable approach for ‘reflecting-on’ and ‘reflecting-in’ practice. 44 The methodology is well suited to intervention research, establishing partnership between knowledgeable actors from the field and researchers to define a problem and potential solutions. 45
During the article-screening process, 112 out of 156 articles were excluded due to ‘wrong concept’ (71,7%); that is, they did not address or use vignette-based methodology in qualitative research (see figure 1 ). One contributing factor to the high exclusion rate is that many articles used the term ‘vignette’ without defining the term. Vignettes are used in the scientific literature in various ways (clinical case reports, training materials, evaluations of clinician knowledge, etc). Our review findings reveal the need to clearly state ‘what’ is vignette-based methodology in qualitative research and describe the logic of its use by researchers.
Vignettes can be used to describe a phenomenon in multiple contexts that are different from qualitative research. We acknowledge that variation may be appropriate across vignette utilisation. However, in qualitative studies, a number of basic principles are considered necessary to assure reliability of analysis: explicit description of the study context and procedures used in data collection and analysis to produce knowledge. 32 Our scoping review shows that vignette-based qualitative research studies often fail to fully describe how these three principles are met. This points to a lack of engagement with standards for reporting qualitative research 46 and compromises replicability and the utilisation of knowledge arising from vignette-based studies. Finally, standards for reporting qualitative research suggest that the title indicates that the study is qualitative or include a commonly used term that identifies the approach. 47
In sum, an article title that states the research method and a clear definition of ‘vignette’ in the report contribute to aligning the research objectives, study design and methods. They allow readers and reviewers to understand the type of vignette study at hand and support the reliability, transferability and usefulness of results. 48
Despite the efforts of authors to clarify the concept, less than half the studies included in our review provide an explicit definition. Based on our scoping review, the vignette-based methodology in qualitative research can be defined as evidence- and practice-informed short stories, scenarios, events or situations in specified circumstances, to which individuals or groups are invited to respond. 1 22 36 39
Details of vignette development are only scarcely reported. Less than half of the studies explicitly report all steps in development. The range of development steps reflects the lack of standardised quality criteria for reporting vignette-based methodology in qualitative research. Greater transparency is needed to establish internal validity and enable study replication, notably around knowledgeable informant involvement in establishing vignette content and/or participating in validation steps.
Our results highlight that vignettes are delivered through individual interviews in most studies, but that some researchers opt for or add group interviews to meet their study objectives. The choice may depend on whether the study seeks to elicit personal views or interaction between participants. However, the choice of interview approach is not always explained.
Our synthesis of strengths, limitations and authors’ recommendations in included articles (see table 3 ) provides an overview of what vignette-based methodology adds to the studies. Some advantages highlighted in included articles are not specific to the vignette development and use. For example, it has been mentioned that it allows the interview to be structured, provides a systematic way of collecting data and facilitates saturation. Other contributions appear to be more specific, notably increasing acceptability to participants when the study phenomenon is sensitive, such as with ethical issues, practice gaps or recovery from challenging clinical situations. By creating a safe distance through use of a fictitious scenario, the method encourages respondents to engage in deeper reflection on sensitive topics that they may otherwise prefer to avoid. More marginally, some authors appreciate the potential flexibility of the vignette (eg, manipulation of certain characteristics). 42 Some authors 22 37 recommend using the vignette in combination with other methods to compensate for limitations. Additionally, Morrison considers that the vignette is a static approach that does not leave enough room for interactions. 36 This point of view suggests that the vignette may not elicit authentic discussion among participants unless the interviewer has the skills to facilitate exchanges.
Our results raise the need to explicitly consider and report strategies to ensure rigour and transparency in both the development of the vignette and the quality criteria of the wider qualitative study design (credibility, dependability, confirmability and transferability). 49 Even with well-designed vignette-based studies, limitations in external validity must be documented.
The vignette-based methodology in qualitative research has an added value in intervention research in which the definition of problems and solutions is carried out in partnership between healthcare professionals and researchers. 50 After expert consultation and pretesting, a vignette content that allows an in-depth understanding of a complex and highly contextualised phenomenon where a multitude of factors can, alone or in combination, influence the practice in clinical settings. Vignette-based qualitative studies offer the possibility of reflecting on challenging topics and supporting evidence-based decision making and action in practice and in future research.
Although strategies are employed to ensure the rigour of the review process, we recognise several limitations. This scoping review was conducted to inform qualitative data collection from healthcare professionals using a reflexive approach, which explains why quantitative studies were excluded. We recognise that there is considerable use of vignettes in quantitative research. Their purpose and therefore the quality criteria for their use are categorically different than for qualitative studies, in terms of both vignette development and utilisation. Stakeholders can better understand the complex world of health professionals if researchers move throughout complementary approach to better understand complex issues. 51
The search strategy is limited to empirical studies retrieved from electronic databases after 2000 and excludes grey literature. It covers only a proportion of published literature using vignettes as a qualitative research approach. We are aware that various search terms (eg, vignette, scenario, case report and snapshot) carry meanings that may be used interchangeably. What we attempt is not a meta-level synthesis of vignette-based qualitative research, but the pooling of content from included studies in our scoping review. 52 Because our initial interest is to learn from prior use of vignettes in research in healthcare settings, it is possible that included articles reflect a selection bias related to our methodological focus. The small number of eligible studies reduces the robustness of recommendations for the development and utilisation of vignette-based methodology in qualitative research. The number may reflect our decision to include only articles that feature ‘vignette’ in their title. Moreover, screening was challenging because studies provided little detail about how the eligibility of professional participants was determined or what qualitative approach was used, and mixed-methods was an exclusion criteria in our search strategy.
Despite these limitations, we consider that the evidence around the development steps and utilisation of vignettes that emerges from our scoping review helps deepen our understanding of the method and provides valuable recommendations for future research. While Peters et al 23 suggest that information scientists, stakeholders and/or experts may be consulted to validate the interpretations of scoping reviews, this step appears unnecessary given the diversity of our research team and the small number of included articles.
This scoping review generates a summary of vignette-based methodology and offers guidance regarding the development and use of vignettes in qualitative research involving healthcare professionals, which can be applied in various settings including oncology. Future research may contribute to overcoming identified risks to quality by reporting: (1) an explicit definition of vignette-based methodology as for all qualitative study design; (2) details about vignette development steps (internal validity); (3) rich description of vignette utilisation (external validity); and (4) strengths and limitations based on quality criteria for qualitative studies.
It is expected that future research will more systematically plan and document the development and utilisation of vignette-based methodology and report the research process with sufficient detail to establish how the plausible content of the vignette is associated with study results. Future publications should take into account recommendations from the studies reported in this scoping review and integrate reporting on quality criteria.
Acknowledgments.
We would like to thank Marie-France Vachon for her expertise regarding vignettes for healthcare professionals in oncology, as well as Nathalie St-Jacques, academic librarian at the Université de Sherbrooke, for her support with the search strategy.
Contributors: DT designed and coordinated the study and led the entire scoping review process. DT (guarantor) accepts full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish. She drafted the first version of the manuscript with AT and SL. AT and NT were involved in the data analysis and data charting. NT, TGP, KK, KB, SL and EG assisted with study planning, data collection and final interpretation. All authors critically revised the draft version and read and approved the final manuscript.
Funding: This study was funded by the Réseau de recherche en interventions en sciences infirmières du Québec – Quebec Network on Nursing Intervention Research (RRISIQ) (Award/Grant number is not applicable; grant awarded under the 'Projets Intégrateurs 2019' Program: https://rrisiq.com/fr/soutien-la-formation-et-la-recherche/liste-octrois/projets-integrateurs ). Complementary support was also provided by the 'Chaire sur l'amélioration de la qualité et la sécurité des soins aux personnes atteintes de cancer' and by the School of Nursing of the Université de Sherbrooke (award/grant number is not applicable).
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Ethics statements, patient consent for publication.
Not applicable.
This study does not involve human participants. No research ethics board approval was required since the data were publicly accessible.
Home » Research Methods » Qualitative Methods "How-To" Guides
Qualitative Methods "How-To" Guides Edited by Patricia Leavy
This series provides researchers and students with step-by-step, practical instruction on established and emerging qualitative methods. Authors are leaders in their respective areas of expertise who demystify the research process and share innovative practices and invaluable insider advice. The basics of each method are addressed, including philosophical underpinnings, and guidance is offered on designing studies; generating, analyzing, interpreting, and representing data; and evaluating the quality of research. With accessible writing, robust examples, and ample pedagogical features, books in this series are ideal for use in courses or by individual researchers.
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Speaker 1: Hi, Dr. Eli Lee over here of DEDUCE. My training is as a quantitative psychologist and I've been working in the field for over 20 years. But over the last 15, I really dove into doing mixed methods research. We found out a long time ago that there really weren't any tools to help us do the kinds of work that we wanted to do when we were using methods from psychology, anthropology, sociology, marketing, research. So we came up with a tool. It's evolved over the last 10 years and now we're really happy to show you what DEDUCE can do for qualitative research and mixed methods research. So what are mixed methods? Well, most people are pretty familiar with quantitative research methods. Quantitative methods are great for learning about what kinds of things there are, what kinds of people are they, and how many. So we might ask questions about people's demographics, their gender, age, income level. We might get scores. We might have them rate on a 1 to 10 scale how important to you is education, religion, family. And we might have them fill out other kinds of scales like depression. How happy are you on a scale of 1 to 100 or a bunch of items that we fold together to make scale scores. And so what do we do with these things? We can analyze them as individual variables like age group, 1, 2, 3, how many, what percentage of our population sits in each of those categories. We can do bivariate relationships looking at age by sex, for example. So here's the age group here, but when we break it out by males and females, we see there's a different percentage in each of those groups. And we can do multivariate types of analysis as well. So here's an average rating of how important family is to you broken out by the age group and by sex. There's all kinds of great and powerful things that we can do with quantitative data analysis, and we're not here to talk about that. Qualitative methods seek to understand human behavior and the reasons for those behaviors. A lot of people are less familiar with qualitative research methods than they are with quantitative. But basically qualitative data and the methods that generate them are seeking answers for why people do the things that they do and how they do them. What motivates them? What feelings drive the kinds of decisions that people make? What values? What things about their cultural background are important in understanding why they act the way that they do? So as a simple illustration, let's say we're interested in understanding why people make certain decisions about hotels. We go out to the field and have people just tell us stories about their most recent hotel decision. Typical approach to these data from qualitative research perspective would be to go through those texts and look for the themes that people talk about in a consistent way. So let's say for example after we look at a whole bunch of these stories, we hear people talking about luxury, sophistication, and intimacy on a pretty regular basis. The next thing that we do is go through those stories looking for sections of text where people talk about one or more of these things. We can also apply a weighting system. Here we've got an example of a 1 to 10 weight scale based on how important it is. So let's say in this story here's a piece of text where they're talking about luxury and intimacy. So we'll say 1 and 3 are the codes and they really thought luxury was the most important factor. So we'll give that a weight of 10 and intimacy was moderately important, we'll give that a 7. So we continue going through those texts looking for all the sections where people talk about one or more of these texts. So here's another one. They're talking about sophistication. Sophistication they say, well you know people talk about that but it's really not that important to me. So we'll give that a weight of 2. Here's one more. They're talking about luxury and sophistication. Again sophistication is really low, luxury remains really high. But wouldn't it be cool if we could put all these methods together? Some famous researchers have talked about the fact that all research methods have flaws. So by mixing methods together we seek to capitalize on the strengths of each and avoid some of the weaknesses. Deduce is great just for qualitative data analysis but when people are trying to bring it all together in a true mixed method design that's where deduce really shines. That's why we built it and that's what it was designed to accomplish as efficiently as possible. These studies can be really complex and people are looking for answers as efficiently as they can. With today's technologies we were able to put together a tool that accomplishes all of this and gets you to your answers very quickly. So come check it out. Alright welcome to my computer. I'm going to just log in to deduce but remember as a web application anywhere I have a computer and internet access I can log in to my project. So here's our hotel project. Our resources are here. Here are the tags we've already created. Here's some excerpts that we've already created and tagged. Our descriptor data are over here. Here's the fields that we've defined and here are the data themselves. And right here on our dashboard we get a glimpse of the many data visualizations that deduce produces automatically. Most of them can be modified and all are dynamically linked to the qualitative data that they represent. So if we're interested in drilling down to those excerpts from the 50 plus age group that were tagged with cost, simply click on that bar, pulls those excerpts up and we can go ahead and exam them further. Also deduce is very transparent and allows you to move seamlessly throughout your database. So if we pull up excerpts that we're interested in and we want to drill in a little bit deeper simply clicking on that excerpt takes us to the excerpt itself in the context of its original source. So let's go back home. It's also important to point out that all the charts, graphs, list of excerpts, descriptor data can all be exported from deduce with a simple click to be popped right into presentations or imported into other software. So let me show you one of the other important set up activities, getting your documents or resources into deduce. I'm going to go ahead and just import a document, prompts me to find the resource on my computer. I'll go ahead and give it a title, submit that to the database. You can see that deduce supports images in virtually any language. So here's some example text from the hotel study. So I'm going to go ahead and just block a piece of text to create an excerpt. I'll right click, create excerpt. Now I can go ahead and attach tags to it. This person talks about sexiness factor but that's not particularly important for them. Also sophistication is reasonably important. We'll give that seven. Go ahead and create another excerpt here. Service is high on their list. Let's go ahead and create an excerpt there. Give service a ten. Another thing that we need to do when we put resources into a project is attach it to the appropriate individual so that it's linked to the descriptor data. Let's go ahead and attach that person here. Okay, so we can see that one descriptor has been attached now. Now the really fun part. Let's get over to the analysis center. There are a wide variety of charts, graphs, plots and tables in deduce. There's really too much to show in this brief introduction so let's go after answers to just a couple of questions. You see that there are lots of charts, tables and plots that are available in deduce. Let's go ahead and look at something based on our tagging activity. We'll look at tag co-occurrence for example. What we see here is code by code matrix. This shows where two tags have been used on the same excerpt. The numbers, the tagging activity and all the descriptor data expose the patterns in our data. The qualitative data that sits behind those images is what really gives us the richness in this mixed methods research. We see here that 13 times luxury and cost were used on the same excerpt. If it's meaningful to our research that people talk about cost and luxury at the same time, we might want to go and look at those excerpts. Here we can pull them up. We can explore them. Again we can jump back to the resource and export these as well. Let's go ahead and close that. In terms of exposing patterns, bubble plots are really illuminating. This plot gives us information about the average weights or importance or sentiments that were associated with our tagging activity. I'm going to go ahead and break things out by age group. Let's use the tags luxury, sophistication and intimacy. This plot actually gives us four dimensions to look at our data. The plots themselves can communicate a great deal, can be exported and popped into presentations. We can also learn a lot more about the pattern by drilling down into the excerpts themselves. This bubble here represents the age group 50 plus and this group was relatively low in the importance of luxury but relatively high in sophistication and intimacy in their hotel decisions. If we're putting together a marketing message, we want to come up with something that's really going to resonate with this particular subgroup. We go ahead and open up those excerpts and we can really get a feel for how people are talking about these things and understand the reasons for why they feel the particular characteristics are more or less important when they're making their decisions. There's so much more I'd love to show you about deduce but I think we're out of time. Thanks for checking in. We've got a number of other videos on our website that give you step-by-step instructions about how to set projects up and how to get the best out of deducing your work.
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The vignette-based methodology in qualitative research has an added value in intervention research in which the definition of problems and solutions is carried out in partnership between healthcare professionals and researchers.50 After expert consultation and pretesting, a vignette content that allows an in-depth understanding of a complex and ...
2. What Is Vignette Research Methodology? Vignette research methodology uses narratives with pragmatic manipulation of case characteristics/variables to explore decisions, beliefs, and/or attitudes of the respondents [9,10,11].The vignette methods are underutilized in healthcare [10,12].They are commonly used in the social sciences to describe decisions and behaviors that respondents may ...
Developing vignettes is a purposeful, conscious process. It is equally important to ensure that vignettes are derived from literature, have an evidence base, are carefully constructed and peer-reviewed, and are suitable to achieve the research's aims. Conclusion: Using and analysing a vignette enables novice researchers to make sense of aspects ...
Participatory group research is an effective method for developing vignettes. A vignette was incorporated into qualitative interview discussion guides and used successfully in rural Africa to draw out barriers to PMTCT service use; vignettes may also be valuable in HIV, health service use and drug adherence research in this setting.
Using vignettes in qualitative research to explore barriers and facilitating factors to the uptake of prevention of mother-to-child transmission services in rural Tanzania: A critical analysis. BMC Medical Research Methodology , 14(1), 21.
Objectives: To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies involving healthcare professionals. Design: Scoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for ...
vignette-based methodology in qualitative research in healthcare settings. Team resilience at work refers to the capacity of team members to face and adapt to adverse situations. 2 Cancer care offers a valuable clinical context to study team resil-ience at work because professionals face daily adversity
Vignettes have been used in many disciplines to collect data on individuals or teams through individual or group interviews or questionnaires (Barter & Renold, 1999; Hughes, 1998; Hughes & Huby, 2002). In qualitative research, vignettes have shown potential to deeply un-derstand healthcare professionals' experiences
We present a novel mixed methods design, the qualitative vignette experiment, defined as the use of vignettes designed to introduce experimentally controlled variation in information within qualitative semistructured interviews. ... "I wanna tell you a story": Exploring the application of vignettes in qualitative research with children and ...
Developing validated vignettes is essential when used to measure outcomes in education and in research. This three-phase method of vignette development and validation is feasible and effective in improving content validity of vignettes and can be used in other education and research projects. ... Using a qualitative vignette to explore a ...
Objectives: To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical ...
Abstract: There seems to be relatively little scholarship on the use of vignettes in qualitative research, despite their long-time application in these approaches. They appear to be a helpful tool ... with particular research methods by scholars. There is a common, implicit assumption in the survey-oriented literature (e.g., FINCH, 1987; HUGHES
Drawing on research where vignettes have been used as the central instrument for data collection, we argue that methodological consistency is achieved when the research aims, methodologies and vignette methods are aligned, and this helps satisfy internal validity and supports the findings.
The adequate presentation of empirical research findings poses an essential, yet often neglected challenge in qualitative methodology. This article contributes to the debate by proposing the research vignette as a mediating position between conventional and experimental forms of writing.
In qualitative research, vignettes enable participants to define the situation in their own terms. ... (1998) Focus Group Methodology: A Review, International Journal of Social Research Methodology Theory and Practice, 1 (3) pp.181-203. Social Research Update is published by: Department of Sociology University of Surrey Guildford GU2 7XH United ...
Different methods can govern a qualitative interview (one of the leading techniques in qualitative research). One of them is the scenario method, also called "vignettes". In this article, we discuss the use of real-life scenarios to simplify the respondents' speaking […] Different methods can govern a qualitative interview (one of the ...
Vignette methodology has been designated as a compromise between retrospective and in-situ self-report methods in cognitive and educational psychology about a decade ago (Frenzel, 2014), although its use in educational research dates back to the 1990s (e.g., Walen & Hirstein, 1995). In applied linguistics, it has only recently been introduced ...
Both dissertations used vignettes to generate discussion within the context of face-to-face in-depth qualitative interviews with Pakistani women and parents, respectively. In this case study, we consider what vignettes are, when they can be used, what they can add to the qualitative data-making process, and, finally, how they can be constructed.
The use of vignettes has become more common in social science in recent decades. However, it is arguably the case that they could make an even greater contribution to qualitative research methods and be more broadly applied across a range of research studies.
The use of vignettes in qualitative research in Social Research Update Vol. 25. Barter, C. and E. Renold, 2000 'I Wanna Tell You a Story': Exploring the Application of Vignettes in Qualitative Research with Children and Young People International Journal of Social Research Methodology 3(4):307-23. Collett, J. L. and E. Childs, 2011
The vignette-based methodology in qualitative research has an added value in intervention research in which the definition of problems and solutions is carried out in partnership between healthcare professionals and researchers. 50 After expert consultation and pretesting, a vignette content that allows an in-depth understanding of a complex ...
This series provides researchers and students with step-by-step, practical instruction on established and emerging qualitative methods. Authors are leaders in their respective areas of expertise who demystify the research process and share innovative practices and invaluable insider advice. The basics of each method are addressed, including philosophical underpinnings, and guidance is offered ...
Despite emerging interest in mixing experimental and qualitative methods, a gap exists in integrating qualitative vignettes and experimental design. ... "I wanna tell you a story": Exploring the application of vignettes in qualitative research with children and young people. International Journal of Social Research Methodology, 3(4), 307 ...
Qualitative methods seek to understand human behavior and the reasons for those behaviors. A lot of people are less familiar with qualitative research methods than they are with quantitative. But basically qualitative data and the methods that generate them are seeking answers for why people do the things that they do and how they do them.
Wilson, J. and While, A. (1998) 'Methodological Issues Surrounding the Use of Vignettes in Qualitative Research', Journal of Interprofessional Care 12: 79-87 . Google Scholar. Values play an important role in the construction of social workers' professional identities. However current accounts of social work ethics can have difficulty ...