qualitative research analysis of data

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Qualitative Data Analysis: What is it, Methods + Examples

In a world rich with information and narrative, understanding the deeper layers of human experiences requires a unique vision that goes beyond numbers and figures. This is where the power of qualitative data analysis comes to light.

In this blog, we’ll learn about qualitative data analysis, explore its methods, and provide real-life examples showcasing its power in uncovering insights.

What is Qualitative Data Analysis?

Qualitative data analysis is a systematic process of examining non-numerical data to extract meaning, patterns, and insights.

In contrast to quantitative analysis, which focuses on numbers and statistical metrics, the qualitative study focuses on the qualitative aspects of data, such as text, images, audio, and videos. It seeks to understand every aspect of human experiences, perceptions, and behaviors by examining the data’s richness.

Companies frequently conduct this analysis on customer feedback. You can collect qualitative data from reviews, complaints, chat messages, interactions with support centers, customer interviews, case notes, or even social media comments. This kind of data holds the key to understanding customer sentiments and preferences in a way that goes beyond mere numbers.

Importance of Qualitative Data Analysis

Qualitative data analysis plays a crucial role in your research and decision-making process across various disciplines. Let’s explore some key reasons that underline the significance of this analysis:

In-Depth Understanding

It enables you to explore complex and nuanced aspects of a phenomenon, delving into the ‘how’ and ‘why’ questions. This method provides you with a deeper understanding of human behavior, experiences, and contexts that quantitative approaches might not capture fully.

Contextual Insight

You can use this analysis to give context to numerical data. It will help you understand the circumstances and conditions that influence participants’ thoughts, feelings, and actions. This contextual insight becomes essential for generating comprehensive explanations.

Theory Development

You can generate or refine hypotheses via qualitative data analysis. As you analyze the data attentively, you can form hypotheses, concepts, and frameworks that will drive your future research and contribute to theoretical advances.

Participant Perspectives

When performing qualitative research, you can highlight participant voices and opinions. This approach is especially useful for understanding marginalized or underrepresented people, as it allows them to communicate their experiences and points of view.

Exploratory Research

The analysis is frequently used at the exploratory stage of your project. It assists you in identifying important variables, developing research questions, and designing quantitative studies that will follow.

Types of Qualitative Data

When conducting qualitative research, you can use several qualitative data collection methods , and here you will come across many sorts of qualitative data that can provide you with unique insights into your study topic. These data kinds add new views and angles to your understanding and analysis.

Interviews and Focus Groups

Interviews and focus groups will be among your key methods for gathering qualitative data. Interviews are one-on-one talks in which participants can freely share their thoughts, experiences, and opinions.

Focus groups, on the other hand, are discussions in which members interact with one another, resulting in dynamic exchanges of ideas. Both methods provide rich qualitative data and direct access to participant perspectives.

Observations and Field Notes

Observations and field notes are another useful sort of qualitative data. You can immerse yourself in the research environment through direct observation, carefully documenting behaviors, interactions, and contextual factors.

These observations will be recorded in your field notes, providing a complete picture of the environment and the behaviors you’re researching. This data type is especially important for comprehending behavior in their natural setting.

Textual and Visual Data

Textual and visual data include a wide range of resources that can be qualitatively analyzed. Documents, written narratives, and transcripts from various sources, such as interviews or speeches, are examples of textual data.

Photographs, films, and even artwork provide a visual layer to your research. These forms of data allow you to investigate what is spoken and the underlying emotions, details, and symbols expressed by language or pictures.

When to Choose Qualitative Data Analysis over Quantitative Data Analysis

As you begin your research journey, understanding why the analysis of qualitative data is important will guide your approach to understanding complex events. If you analyze qualitative data, it will provide new insights that complement quantitative methodologies, which will give you a broader understanding of your study topic.

It is critical to know when to use qualitative analysis over quantitative procedures. You can prefer qualitative data analysis when:

• Complexity Reigns: When your research questions involve deep human experiences, motivations, or emotions, qualitative research excels at revealing these complexities.
• Exploration is Key: Qualitative analysis is ideal for exploratory research. It will assist you in understanding a new or poorly understood topic before formulating quantitative hypotheses.
• Context Matters: If you want to understand how context affects behaviors or results, qualitative data analysis provides the depth needed to grasp these relationships.
• Unanticipated Findings: When your study provides surprising new viewpoints or ideas, qualitative analysis helps you to delve deeply into these emerging themes.
• Subjective Interpretation is Vital: When it comes to understanding people’s subjective experiences and interpretations, qualitative data analysis is the way to go.

You can make informed decisions regarding the right approach for your research objectives if you understand the importance of qualitative analysis and recognize the situations where it shines.

Qualitative Data Analysis Methods and Examples

Exploring various qualitative data analysis methods will provide you with a wide collection for making sense of your research findings. Once the data has been collected, you can choose from several analysis methods based on your research objectives and the data type you’ve collected.

There are five main methods for analyzing qualitative data. Each method takes a distinct approach to identifying patterns, themes, and insights within your qualitative data. They are:

Method 1: Content Analysis

Content analysis is a methodical technique for analyzing textual or visual data in a structured manner. In this method, you will categorize qualitative data by splitting it into manageable pieces and assigning the manual coding process to these units.

As you go, you’ll notice ongoing codes and designs that will allow you to conclude the content. This method is very beneficial for detecting common ideas, concepts, or themes in your data without losing the context.

Steps to Do Content Analysis

Follow these steps when conducting content analysis:

• Collect and Immerse: Begin by collecting the necessary textual or visual data. Immerse yourself in this data to fully understand its content, context, and complexities.
• Assign Codes and Categories: Assign codes to relevant data sections that systematically represent major ideas or themes. Arrange comparable codes into groups that cover the major themes.
• Analyze and Interpret: Develop a structured framework from the categories and codes. Then, evaluate the data in the context of your research question, investigate relationships between categories, discover patterns, and draw meaning from these connections.

Benefits & Challenges

There are various advantages to using content analysis:

• Structured Approach: It offers a systematic approach to dealing with large data sets and ensures consistency throughout the research.
• Objective Insights: This method promotes objectivity, which helps to reduce potential biases in your study.
• Pattern Discovery: Content analysis can help uncover hidden trends, themes, and patterns that are not always obvious.
• Versatility: You can apply content analysis to various data formats, including text, internet content, images, etc.

However, keep in mind the challenges that arise:

• Subjectivity: Even with the best attempts, a certain bias may remain in coding and interpretation.
• Complexity: Analyzing huge data sets requires time and great attention to detail.
• Contextual Nuances: Content analysis may not capture all of the contextual richness that qualitative data analysis highlights.

Example of Content Analysis

Suppose you’re conducting market research and looking at customer feedback on a product. As you collect relevant data and analyze feedback, you’ll see repeating codes like “price,” “quality,” “customer service,” and “features.” These codes are organized into categories such as “positive reviews,” “negative reviews,” and “suggestions for improvement.”

According to your findings, themes such as “price” and “customer service” stand out and show that pricing and customer service greatly impact customer satisfaction. This example highlights the power of content analysis for obtaining significant insights from large textual data collections.

Method 2: Thematic Analysis

Thematic analysis is a well-structured procedure for identifying and analyzing recurring themes in your data. As you become more engaged in the data, you’ll generate codes or short labels representing key concepts. These codes are then organized into themes, providing a consistent framework for organizing and comprehending the substance of the data.

The analysis allows you to organize complex narratives and perspectives into meaningful categories, which will allow you to identify connections and patterns that may not be visible at first.

Steps to Do Thematic Analysis

Follow these steps when conducting a thematic analysis:

• Code and Group: Start by thoroughly examining the data and giving initial codes that identify the segments. To create initial themes, combine relevant codes.
• Code and Group: Begin by engaging yourself in the data, assigning first codes to notable segments. To construct basic themes, group comparable codes together.
• Analyze and Report: Analyze the data within each theme to derive relevant insights. Organize the topics into a consistent structure and explain your findings, along with data extracts that represent each theme.

Thematic analysis has various benefits:

• Structured Exploration: It is a method for identifying patterns and themes in complex qualitative data.
• Comprehensive knowledge: Thematic analysis promotes an in-depth understanding of the complications and meanings of the data.
• Application Flexibility: This method can be customized to various research situations and data kinds.

However, challenges may arise, such as:

• Interpretive Nature: Interpreting qualitative data in thematic analysis is vital, and it is critical to manage researcher bias.
• Time-consuming: The study can be time-consuming, especially with large data sets.
• Subjectivity: The selection of codes and topics might be subjective.

Example of Thematic Analysis

Assume you’re conducting a thematic analysis on job satisfaction interviews. Following your immersion in the data, you assign initial codes such as “work-life balance,” “career growth,” and “colleague relationships.” As you organize these codes, you’ll notice themes develop, such as “Factors Influencing Job Satisfaction” and “Impact on Work Engagement.”

Further investigation reveals the tales and experiences included within these themes and provides insights into how various elements influence job satisfaction. This example demonstrates how thematic analysis can reveal meaningful patterns and insights in qualitative data.

Method 3: Narrative Analysis

The narrative analysis involves the narratives that people share. You’ll investigate the histories in your data, looking at how stories are created and the meanings they express. This method is excellent for learning how people make sense of their experiences through narrative.

Steps to Do Narrative Analysis

The following steps are involved in narrative analysis:

• Gather and Analyze: Start by collecting narratives, such as first-person tales, interviews, or written accounts. Analyze the stories, focusing on the plot, feelings, and characters.
• Find Themes: Look for recurring themes or patterns in various narratives. Think about the similarities and differences between these topics and personal experiences.
• Interpret and Extract Insights: Contextualize the narratives within their larger context. Accept the subjective nature of each narrative and analyze the narrator’s voice and style. Extract insights from the tales by diving into the emotions, motivations, and implications communicated by the stories.

There are various advantages to narrative analysis:

• Deep Exploration: It lets you look deeply into people’s personal experiences and perspectives.
• Human-Centered: This method prioritizes the human perspective, allowing individuals to express themselves.

However, difficulties may arise, such as:

• Interpretive Complexity: Analyzing narratives requires dealing with the complexities of meaning and interpretation.
• Time-consuming: Because of the richness and complexities of tales, working with them can be time-consuming.

Example of Narrative Analysis

Assume you’re conducting narrative analysis on refugee interviews. As you read the stories, you’ll notice common themes of toughness, loss, and hope. The narratives provide insight into the obstacles that refugees face, their strengths, and the dreams that guide them.

The analysis can provide a deeper insight into the refugees’ experiences and the broader social context they navigate by examining the narratives’ emotional subtleties and underlying meanings. This example highlights how narrative analysis can reveal important insights into human stories.

Method 4: Grounded Theory Analysis

Grounded theory analysis is an iterative and systematic approach that allows you to create theories directly from data without being limited by pre-existing hypotheses. With an open mind, you collect data and generate early codes and labels that capture essential ideas or concepts within the data.

As you progress, you refine these codes and increasingly connect them, eventually developing a theory based on the data. Grounded theory analysis is a dynamic process for developing new insights and hypotheses based on details in your data.

Steps to Do Grounded Theory Analysis

Grounded theory analysis requires the following steps:

• Initial Coding: First, immerse yourself in the data, producing initial codes that represent major concepts or patterns.
• Categorize and Connect: Using axial coding, organize the initial codes, which establish relationships and connections between topics.
• Build the Theory: Focus on creating a core category that connects the codes and themes. Regularly refine the theory by comparing and integrating new data, ensuring that it evolves organically from the data.

Grounded theory analysis has various benefits:

• Theory Generation: It provides a one-of-a-kind opportunity to generate hypotheses straight from data and promotes new insights.
• In-depth Understanding: The analysis allows you to deeply analyze the data and reveal complex relationships and patterns.
• Flexible Process: This method is customizable and ongoing, which allows you to enhance your research as you collect additional data.

However, challenges might arise with:

• Time and Resources: Because grounded theory analysis is a continuous process, it requires a large commitment of time and resources.
• Theoretical Development: Creating a grounded theory involves a thorough understanding of qualitative data analysis software and theoretical concepts.
• Interpretation of Complexity: Interpreting and incorporating a newly developed theory into existing literature can be intellectually hard.

Example of Grounded Theory Analysis

Assume you’re performing a grounded theory analysis on workplace collaboration interviews. As you open code the data, you will discover notions such as “communication barriers,” “team dynamics,” and “leadership roles.” Axial coding demonstrates links between these notions, emphasizing the significance of efficient communication in developing collaboration.

You create the core “Integrated Communication Strategies” category through selective coding, which unifies new topics.

This theory-driven category serves as the framework for understanding how numerous aspects contribute to effective team collaboration. This example shows how grounded theory analysis allows you to generate a theory directly from the inherent nature of the data.

Method 5: Discourse Analysis

Discourse analysis focuses on language and communication. You’ll look at how language produces meaning and how it reflects power relations, identities, and cultural influences. This strategy examines what is said and how it is said; the words, phrasing, and larger context of communication.

The analysis is precious when investigating power dynamics, identities, and cultural influences encoded in language. By evaluating the language used in your data, you can identify underlying assumptions, cultural standards, and how individuals negotiate meaning through communication.

Steps to Do Discourse Analysis

Conducting discourse analysis entails the following steps:

• Select Discourse: For analysis, choose language-based data such as texts, speeches, or media content.
• Analyze Language: Immerse yourself in the conversation, examining language choices, metaphors, and underlying assumptions.
• Discover Patterns: Recognize the dialogue’s reoccurring themes, ideologies, and power dynamics. To fully understand the effects of these patterns, put them in their larger context.

There are various advantages of using discourse analysis:

• Understanding Language: It provides an extensive understanding of how language builds meaning and influences perceptions.
• Uncovering Power Dynamics: The analysis reveals how power dynamics appear via language.
• Cultural Insights: This method identifies cultural norms, beliefs, and ideologies stored in communication.

However, the following challenges may arise:

• Complexity of Interpretation: Language analysis involves navigating multiple levels of nuance and interpretation.
• Subjectivity: Interpretation can be subjective, so controlling researcher bias is important.
• Time-Intensive: Discourse analysis can take a lot of time because careful linguistic study is required in this analysis.

Example of Discourse Analysis

Consider doing discourse analysis on media coverage of a political event. You notice repeating linguistic patterns in news articles that depict the event as a conflict between opposing parties. Through deconstruction, you can expose how this framing supports particular ideologies and power relations.

You can illustrate how language choices influence public perceptions and contribute to building the narrative around the event by analyzing the speech within the broader political and social context. This example shows how discourse analysis can reveal hidden power dynamics and cultural influences on communication.

How to do Qualitative Data Analysis with the QuestionPro Research suite?

QuestionPro is a popular survey and research platform that offers tools for collecting and analyzing qualitative and quantitative data. Follow these general steps for conducting qualitative data analysis using the QuestionPro Research Suite:

• Collect Qualitative Data: Set up your survey to capture qualitative responses. It might involve open-ended questions, text boxes, or comment sections where participants can provide detailed responses.
• Export Qualitative Responses: Export the responses once you’ve collected qualitative data through your survey. QuestionPro typically allows you to export survey data in various formats, such as Excel or CSV.
• Prepare Data for Analysis: Review the exported data and clean it if necessary. Remove irrelevant or duplicate entries to ensure your data is ready for analysis.
• Code and Categorize Responses: Segment and label data, letting new patterns emerge naturally, then develop categories through axial coding to structure the analysis.
• Identify Themes: Analyze the coded responses to identify recurring themes, patterns, and insights. Look for similarities and differences in participants’ responses.
• Generate Reports and Visualizations: Utilize the reporting features of QuestionPro to create visualizations, charts, and graphs that help communicate the themes and findings from your qualitative research.
• Interpret and Draw Conclusions: Interpret the themes and patterns you’ve identified in the qualitative data. Consider how these findings answer your research questions or provide insights into your study topic.
• Integrate with Quantitative Data (if applicable): If you’re also conducting quantitative research using QuestionPro, consider integrating your qualitative findings with quantitative results to provide a more comprehensive understanding.

Qualitative data analysis is vital in uncovering various human experiences, views, and stories. If you’re ready to transform your research journey and apply the power of qualitative analysis, now is the moment to do it. Book a demo with QuestionPro today and begin your journey of exploration.

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Qualitative Data Analysis: Step-by-Step Guide (Manual vs. Automatic)

When we conduct qualitative methods of research, need to explain changes in metrics or understand people's opinions, we always turn to qualitative data. Qualitative data is typically generated through:

• Interview transcripts
• Surveys with open-ended questions
• Contact center transcripts
• Texts and documents
• Audio and video recordings
• Observational notes

Compared to quantitative data, which captures structured information, qualitative data is unstructured and has more depth. It can answer our questions, can help formulate hypotheses and build understanding.

It's important to understand the differences between quantitative data & qualitative data . But unfortunately, analyzing qualitative data is difficult. While tools like Excel, Tableau and PowerBI crunch and visualize quantitative data with ease, there are a limited number of mainstream tools for analyzing qualitative data . The majority of qualitative data analysis still happens manually.

That said, there are two new trends that are changing this. First, there are advances in natural language processing (NLP) which is focused on understanding human language. Second, there is an explosion of user-friendly software designed for both researchers and businesses. Both help automate the qualitative data analysis process.

In this post we want to teach you how to conduct a successful qualitative data analysis. There are two primary qualitative data analysis methods; manual & automatic. We will teach you how to conduct the analysis manually, and also, automatically using software solutions powered by NLP. We’ll guide you through the steps to conduct a manual analysis, and look at what is involved and the role technology can play in automating this process.

More businesses are switching to fully-automated analysis of qualitative customer data because it is cheaper, faster, and just as accurate. Primarily, businesses purchase subscriptions to feedback analytics platforms so that they can understand customer pain points and sentiment.

We’ll take you through 5 steps to conduct a successful qualitative data analysis. Within each step we will highlight the key difference between the manual, and automated approach of qualitative researchers. Here's an overview of the steps:

The 5 steps to doing qualitative data analysis

• Gathering and collecting your qualitative data
• Organizing and connecting into your qualitative data
• Coding your qualitative data
• Analyzing the qualitative data for insights
• Reporting on the insights derived from your analysis

What is Qualitative Data Analysis?

Qualitative data analysis is a process of gathering, structuring and interpreting qualitative data to understand what it represents.

Qualitative data is non-numerical and unstructured. Qualitative data generally refers to text, such as open-ended responses to survey questions or user interviews, but also includes audio, photos and video.

Businesses often perform qualitative data analysis on customer feedback. And within this context, qualitative data generally refers to verbatim text data collected from sources such as reviews, complaints, chat messages, support centre interactions, customer interviews, case notes or social media comments.

How is qualitative data analysis different from quantitative data analysis?

Understanding the differences between quantitative & qualitative data is important. When it comes to analyzing data, Qualitative Data Analysis serves a very different role to Quantitative Data Analysis. But what sets them apart?

Qualitative Data Analysis dives into the stories hidden in non-numerical data such as interviews, open-ended survey answers, or notes from observations. It uncovers the ‘whys’ and ‘hows’ giving a deep understanding of people’s experiences and emotions.

Quantitative Data Analysis on the other hand deals with numerical data, using statistics to measure differences, identify preferred options, and pinpoint root causes of issues.  It steps back to address questions like "how many" or "what percentage" to offer broad insights we can apply to larger groups.

In short, Qualitative Data Analysis is like a microscope,  helping us understand specific detail. Quantitative Data Analysis is like the telescope, giving us a broader perspective. Both are important, working together to decode data for different objectives.

Qualitative Data Analysis methods

Once all the data has been captured, there are a variety of analysis techniques available and the choice is determined by your specific research objectives and the kind of data you’ve gathered.  Common qualitative data analysis methods include:

Content Analysis

This is a popular approach to qualitative data analysis. Other qualitative analysis techniques may fit within the broad scope of content analysis. Thematic analysis is a part of the content analysis.  Content analysis is used to identify the patterns that emerge from text, by grouping content into words, concepts, and themes. Content analysis is useful to quantify the relationship between all of the grouped content. The Columbia School of Public Health has a detailed breakdown of content analysis .

Narrative Analysis

Narrative analysis focuses on the stories people tell and the language they use to make sense of them.  It is particularly useful in qualitative research methods where customer stories are used to get a deep understanding of customers’ perspectives on a specific issue. A narrative analysis might enable us to summarize the outcomes of a focused case study.

Discourse Analysis

Discourse analysis is used to get a thorough understanding of the political, cultural and power dynamics that exist in specific situations.  The focus of discourse analysis here is on the way people express themselves in different social contexts. Discourse analysis is commonly used by brand strategists who hope to understand why a group of people feel the way they do about a brand or product.

Thematic Analysis

Thematic analysis is used to deduce the meaning behind the words people use. This is accomplished by discovering repeating themes in text. These meaningful themes reveal key insights into data and can be quantified, particularly when paired with sentiment analysis . Often, the outcome of thematic analysis is a code frame that captures themes in terms of codes, also called categories. So the process of thematic analysis is also referred to as “coding”. A common use-case for thematic analysis in companies is analysis of customer feedback.

Grounded Theory

Grounded theory is a useful approach when little is known about a subject. Grounded theory starts by formulating a theory around a single data case. This means that the theory is “grounded”. Grounded theory analysis is based on actual data, and not entirely speculative. Then additional cases can be examined to see if they are relevant and can add to the original grounded theory.

Challenges of Qualitative Data Analysis

While Qualitative Data Analysis offers rich insights, it comes with its challenges. Each unique QDA method has its unique hurdles. Let’s take a look at the challenges researchers and analysts might face, depending on the chosen method.

• Time and Effort (Narrative Analysis): Narrative analysis, which focuses on personal stories, demands patience. Sifting through lengthy narratives to find meaningful insights can be time-consuming, requires dedicated effort.
• Being Objective (Grounded Theory): Grounded theory, building theories from data, faces the challenges of personal biases. Staying objective while interpreting data is crucial, ensuring conclusions are rooted in the data itself.
• Complexity (Thematic Analysis): Thematic analysis involves identifying themes within data, a process that can be intricate. Categorizing and understanding themes can be complex, especially when each piece of data varies in context and structure. Thematic Analysis software can simplify this process.
• Generalizing Findings (Narrative Analysis): Narrative analysis, dealing with individual stories, makes drawing broad challenging. Extending findings from a single narrative to a broader context requires careful consideration.
• Managing Data (Thematic Analysis): Thematic analysis involves organizing and managing vast amounts of unstructured data, like interview transcripts. Managing this can be a hefty task, requiring effective data management strategies.
• Skill Level (Grounded Theory): Grounded theory demands specific skills to build theories from the ground up. Finding or training analysts with these skills poses a challenge, requiring investment in building expertise.

Benefits of qualitative data analysis

Qualitative Data Analysis (QDA) is like a versatile toolkit, offering a tailored approach to understanding your data. The benefits it offers are as diverse as the methods. Let’s explore why choosing the right method matters.

• Tailored Methods for Specific Needs: QDA isn't one-size-fits-all. Depending on your research objectives and the type of data at hand, different methods offer unique benefits. If you want emotive customer stories, narrative analysis paints a strong picture. When you want to explain a score, thematic analysis reveals insightful patterns
• Flexibility with Thematic Analysis: thematic analysis is like a chameleon in the toolkit of QDA. It adapts well to different types of data and research objectives, making it a top choice for any qualitative analysis.
• Deeper Understanding, Better Products: QDA helps you dive into people's thoughts and feelings. This deep understanding helps you build products and services that truly matches what people want, ensuring satisfied customers
• Finding the Unexpected: Qualitative data often reveals surprises that we miss in quantitative data. QDA offers us new ideas and perspectives, for insights we might otherwise miss.
• Building Effective Strategies: Insights from QDA are like strategic guides. They help businesses in crafting plans that match people’s desires.
• Creating Genuine Connections: Understanding people’s experiences lets businesses connect on a real level. This genuine connection helps build trust and loyalty, priceless for any business.

How to do Qualitative Data Analysis: 5 steps

Now we are going to show how you can do your own qualitative data analysis. We will guide you through this process step by step. As mentioned earlier, you will learn how to do qualitative data analysis manually , and also automatically using modern qualitative data and thematic analysis software.

To get best value from the analysis process and research process, it’s important to be super clear about the nature and scope of the question that’s being researched. This will help you select the research collection channels that are most likely to help you answer your question.

Depending on if you are a business looking to understand customer sentiment, or an academic surveying a school, your approach to qualitative data analysis will be unique.

Once you’re clear, there’s a sequence to follow. And, though there are differences in the manual and automatic approaches, the process steps are mostly the same.

The use case for our step-by-step guide is a company looking to collect data (customer feedback data), and analyze the customer feedback - in order to improve customer experience. By analyzing the customer feedback the company derives insights about their business and their customers. You can follow these same steps regardless of the nature of your research. Let’s get started.

Step 1: Gather your qualitative data and conduct research (Conduct qualitative research)

The first step of qualitative research is to do data collection. Put simply, data collection is gathering all of your data for analysis. A common situation is when qualitative data is spread across various sources.

Classic methods of gathering qualitative data

Most companies use traditional methods for gathering qualitative data: conducting interviews with research participants, running surveys, and running focus groups. This data is typically stored in documents, CRMs, databases and knowledge bases. It’s important to examine which data is available and needs to be included in your research project, based on its scope.

Using your existing qualitative feedback

As it becomes easier for customers to engage across a range of different channels, companies are gathering increasingly large amounts of both solicited and unsolicited qualitative feedback.

Most organizations have now invested in Voice of Customer programs , support ticketing systems, chatbot and support conversations, emails and even customer Slack chats.

These new channels provide companies with new ways of getting feedback, and also allow the collection of unstructured feedback data at scale.

The great thing about this data is that it contains a wealth of valubale insights and that it’s already there! When you have a new question about user behavior or your customers, you don’t need to create a new research study or set up a focus group. You can find most answers in the data you already have.

Typically, this data is stored in third-party solutions or a central database, but there are ways to export it or connect to a feedback analysis solution through integrations or an API.

Utilize untapped qualitative data channels

There are many online qualitative data sources you may not have considered. For example, you can find useful qualitative data in social media channels like Twitter or Facebook. Online forums, review sites, and online communities such as Discourse or Reddit also contain valuable data about your customers, or research questions.

If you are considering performing a qualitative benchmark analysis against competitors - the internet is your best friend. Gathering feedback in competitor reviews on sites like Trustpilot, G2, Capterra, Better Business Bureau or on app stores is a great way to perform a competitor benchmark analysis.

Customer feedback analysis software often has integrations into social media and review sites, or you could use a solution like DataMiner to scrape the reviews.

Step 2: Connect & organize all your qualitative data

Now you all have this qualitative data but there’s a problem, the data is unstructured. Before feedback can be analyzed and assigned any value, it needs to be organized in a single place. Why is this important? Consistency!

If all data is easily accessible in one place and analyzed in a consistent manner, you will have an easier time summarizing and making decisions based on this data.

The manual approach to organizing your data

The classic method of structuring qualitative data is to plot all the raw data you’ve gathered into a spreadsheet.

Typically, research and support teams would share large Excel sheets and different business units would make sense of the qualitative feedback data on their own. Each team collects and organizes the data in a way that best suits them, which means the feedback tends to be kept in separate silos.

An alternative and a more robust solution is to store feedback in a central database, like Snowflake or Amazon Redshift .

Keep in mind that when you organize your data in this way, you are often preparing it to be imported into another software. If you go the route of a database, you would need to use an API to push the feedback into a third-party software.

Computer-assisted qualitative data analysis software (CAQDAS)

Traditionally within the manual analysis approach (but not always), qualitative data is imported into CAQDAS software for coding.

In the early 2000s, CAQDAS software was popularised by developers such as ATLAS.ti, NVivo and MAXQDA and eagerly adopted by researchers to assist with the organizing and coding of data.  

The benefits of using computer-assisted qualitative data analysis software:

• Assists in the organizing of your data
• Opens you up to exploring different interpretations of your data analysis
• Allows you to share your dataset easier and allows group collaboration (allows for secondary analysis)

However you still need to code the data, uncover the themes and do the analysis yourself. Therefore it is still a manual approach.

Organizing your qualitative data in a feedback repository

Another solution to organizing your qualitative data is to upload it into a feedback repository where it can be unified with your other data , and easily searchable and taggable. There are a number of software solutions that act as a central repository for your qualitative research data. Here are a couple solutions that you could investigate:  

• Dovetail: Dovetail is a research repository with a focus on video and audio transcriptions. You can tag your transcriptions within the platform for theme analysis. You can also upload your other qualitative data such as research reports, survey responses, support conversations, and customer interviews. Dovetail acts as a single, searchable repository. And makes it easier to collaborate with other people around your qualitative research.
• EnjoyHQ: EnjoyHQ is another research repository with similar functionality to Dovetail. It boasts a more sophisticated search engine, but it has a higher starting subscription cost.

Organizing your qualitative data in a feedback analytics platform

If you have a lot of qualitative customer or employee feedback, from the likes of customer surveys or employee surveys, you will benefit from a feedback analytics platform. A feedback analytics platform is a software that automates the process of both sentiment analysis and thematic analysis . Companies use the integrations offered by these platforms to directly tap into their qualitative data sources (review sites, social media, survey responses, etc.). The data collected is then organized and analyzed consistently within the platform.

If you have data prepared in a spreadsheet, it can also be imported into feedback analytics platforms.

Once all this rich data has been organized within the feedback analytics platform, it is ready to be coded and themed, within the same platform. Thematic is a feedback analytics platform that offers one of the largest libraries of integrations with qualitative data sources.

Step 3: Coding your qualitative data

Your feedback data is now organized in one place. Either within your spreadsheet, CAQDAS, feedback repository or within your feedback analytics platform. The next step is to code your feedback data so we can extract meaningful insights in the next step.

Coding is the process of labelling and organizing your data in such a way that you can then identify themes in the data, and the relationships between these themes.

To simplify the coding process, you will take small samples of your customer feedback data, come up with a set of codes, or categories capturing themes, and label each piece of feedback, systematically, for patterns and meaning. Then you will take a larger sample of data, revising and refining the codes for greater accuracy and consistency as you go.

If you choose to use a feedback analytics platform, much of this process will be automated and accomplished for you.

The terms to describe different categories of meaning (‘theme’, ‘code’, ‘tag’, ‘category’ etc) can be confusing as they are often used interchangeably.  For clarity, this article will use the term ‘code’.

To code means to identify key words or phrases and assign them to a category of meaning. “I really hate the customer service of this computer software company” would be coded as “poor customer service”.

How to manually code your qualitative data

• Decide whether you will use deductive or inductive coding. Deductive coding is when you create a list of predefined codes, and then assign them to the qualitative data. Inductive coding is the opposite of this, you create codes based on the data itself. Codes arise directly from the data and you label them as you go. You need to weigh up the pros and cons of each coding method and select the most appropriate.
• Read through the feedback data to get a broad sense of what it reveals. Now it’s time to start assigning your first set of codes to statements and sections of text.
• Keep repeating step 2, adding new codes and revising the code description as often as necessary.  Once it has all been coded, go through everything again, to be sure there are no inconsistencies and that nothing has been overlooked.
• Create a code frame to group your codes. The coding frame is the organizational structure of all your codes. And there are two commonly used types of coding frames, flat, or hierarchical. A hierarchical code frame will make it easier for you to derive insights from your analysis.
• Based on the number of times a particular code occurs, you can now see the common themes in your feedback data. This is insightful! If ‘bad customer service’ is a common code, it’s time to take action.

We have a detailed guide dedicated to manually coding your qualitative data .

Using software to speed up manual coding of qualitative data

An Excel spreadsheet is still a popular method for coding. But various software solutions can help speed up this process. Here are some examples.

• CAQDAS / NVivo - CAQDAS software has built-in functionality that allows you to code text within their software. You may find the interface the software offers easier for managing codes than a spreadsheet.
• Dovetail/EnjoyHQ - You can tag transcripts and other textual data within these solutions. As they are also repositories you may find it simpler to keep the coding in one platform.
• IBM SPSS - SPSS is a statistical analysis software that may make coding easier than in a spreadsheet.
• Ascribe - Ascribe’s ‘Coder’ is a coding management system. Its user interface will make it easier for you to manage your codes.

Automating the qualitative coding process using thematic analysis software

In solutions which speed up the manual coding process, you still have to come up with valid codes and often apply codes manually to pieces of feedback. But there are also solutions that automate both the discovery and the application of codes.

Advances in machine learning have now made it possible to read, code and structure qualitative data automatically. This type of automated coding is offered by thematic analysis software .

Automation makes it far simpler and faster to code the feedback and group it into themes. By incorporating natural language processing (NLP) into the software, the AI looks across sentences and phrases to identify common themes meaningful statements. Some automated solutions detect repeating patterns and assign codes to them, others make you train the AI by providing examples. You could say that the AI learns the meaning of the feedback on its own.

Thematic automates the coding of qualitative feedback regardless of source. There’s no need to set up themes or categories in advance. Simply upload your data and wait a few minutes. You can also manually edit the codes to further refine their accuracy.  Experiments conducted indicate that Thematic’s automated coding is just as accurate as manual coding .

Paired with sentiment analysis and advanced text analytics - these automated solutions become powerful for deriving quality business or research insights.

You could also build your own , if you have the resources!

The key benefits of using an automated coding solution

Automated analysis can often be set up fast and there’s the potential to uncover things that would never have been revealed if you had given the software a prescribed list of themes to look for.

Because the model applies a consistent rule to the data, it captures phrases or statements that a human eye might have missed.

Complete and consistent analysis of customer feedback enables more meaningful findings. Leading us into step 4.

Step 4: Analyze your data: Find meaningful insights

Now we are going to analyze our data to find insights. This is where we start to answer our research questions. Keep in mind that step 4 and step 5 (tell the story) have some overlap . This is because creating visualizations is both part of analysis process and reporting.

The task of uncovering insights is to scour through the codes that emerge from the data and draw meaningful correlations from them. It is also about making sure each insight is distinct and has enough data to support it.

Part of the analysis is to establish how much each code relates to different demographics and customer profiles, and identify whether there’s any relationship between these data points.

Manually create sub-codes to improve the quality of insights

If your code frame only has one level, you may find that your codes are too broad to be able to extract meaningful insights. This is where it is valuable to create sub-codes to your primary codes. This process is sometimes referred to as meta coding.

Note: If you take an inductive coding approach, you can create sub-codes as you are reading through your feedback data and coding it.

While time-consuming, this exercise will improve the quality of your analysis. Here is an example of what sub-codes could look like.

You need to carefully read your qualitative data to create quality sub-codes. But as you can see, the depth of analysis is greatly improved. By calculating the frequency of these sub-codes you can get insight into which  customer service problems you can immediately address.

Correlate the frequency of codes to customer segments

Many businesses use customer segmentation . And you may have your own respondent segments that you can apply to your qualitative analysis. Segmentation is the practise of dividing customers or research respondents into subgroups.

Segments can be based on:

• Demographic
• And any other data type that you care to segment by

It is particularly useful to see the occurrence of codes within your segments. If one of your customer segments is considered unimportant to your business, but they are the cause of nearly all customer service complaints, it may be in your best interest to focus attention elsewhere. This is a useful insight!

Manually visualizing coded qualitative data

There are formulas you can use to visualize key insights in your data. The formulas we will suggest are imperative if you are measuring a score alongside your feedback.

If you are collecting a metric alongside your qualitative data this is a key visualization. Impact answers the question: “What’s the impact of a code on my overall score?”. Using Net Promoter Score (NPS) as an example, first you need to:

• Calculate overall NPS
• Calculate NPS in the subset of responses that do not contain that theme
• Subtract B from A

Then you can use this simple formula to calculate code impact on NPS .

You can then visualize this data using a bar chart.

You can download our CX toolkit - it includes a template to recreate this.

Trends over time

This analysis can help you answer questions like: “Which codes are linked to decreases or increases in my score over time?”

We need to compare two sequences of numbers: NPS over time and code frequency over time . Using Excel, calculate the correlation between the two sequences, which can be either positive (the more codes the higher the NPS, see picture below), or negative (the more codes the lower the NPS).

Now you need to plot code frequency against the absolute value of code correlation with NPS. Here is the formula:

The visualization could look like this:

These are two examples, but there are more. For a third manual formula, and to learn why word clouds are not an insightful form of analysis, read our visualizations article .

Using a text analytics solution to automate analysis

Automated text analytics solutions enable codes and sub-codes to be pulled out of the data automatically. This makes it far faster and easier to identify what’s driving negative or positive results. And to pick up emerging trends and find all manner of rich insights in the data.

Another benefit of AI-driven text analytics software is its built-in capability for sentiment analysis, which provides the emotive context behind your feedback and other qualitative textual data therein.

Thematic provides text analytics that goes further by allowing users to apply their expertise on business context to edit or augment the AI-generated outputs.

Since the move away from manual research is generally about reducing the human element, adding human input to the technology might sound counter-intuitive. However, this is mostly to make sure important business nuances in the feedback aren’t missed during coding. The result is a higher accuracy of analysis. This is sometimes referred to as augmented intelligence .

Step 5: Report on your data: Tell the story

The last step of analyzing your qualitative data is to report on it, to tell the story. At this point, the codes are fully developed and the focus is on communicating the narrative to the audience.

A coherent outline of the qualitative research, the findings and the insights is vital for stakeholders to discuss and debate before they can devise a meaningful course of action.

Creating graphs and reporting in Powerpoint

Typically, qualitative researchers take the tried and tested approach of distilling their report into a series of charts, tables and other visuals which are woven into a narrative for presentation in Powerpoint.

Using visualization software for reporting

With data transformation and APIs, the analyzed data can be shared with data visualisation software, such as Power BI or Tableau , Google Studio or Looker. Power BI and Tableau are among the most preferred options.

Visualizing your insights inside a feedback analytics platform

Feedback analytics platforms, like Thematic, incorporate visualisation tools that intuitively turn key data and insights into graphs.  This removes the time consuming work of constructing charts to visually identify patterns and creates more time to focus on building a compelling narrative that highlights the insights, in bite-size chunks, for executive teams to review.

Using a feedback analytics platform with visualization tools means you don’t have to use a separate product for visualizations. You can export graphs into Powerpoints straight from the platforms.

Conclusion - Manual or Automated?

There are those who remain deeply invested in the manual approach - because it’s familiar, because they’re reluctant to spend money and time learning new software, or because they’ve been burned by the overpromises of AI.  

For projects that involve small datasets, manual analysis makes sense. For example, if the objective is simply to quantify a simple question like “Do customers prefer X concepts to Y?”. If the findings are being extracted from a small set of focus groups and interviews, sometimes it’s easier to just read them

However, as new generations come into the workplace, it’s technology-driven solutions that feel more comfortable and practical. And the merits are undeniable.  Especially if the objective is to go deeper and understand the ‘why’ behind customers’ preference for X or Y. And even more especially if time and money are considerations.

The ability to collect a free flow of qualitative feedback data at the same time as the metric means AI can cost-effectively scan, crunch, score and analyze a ton of feedback from one system in one go. And time-intensive processes like focus groups, or coding, that used to take weeks, can now be completed in a matter of hours or days.

But aside from the ever-present business case to speed things up and keep costs down, there are also powerful research imperatives for automated analysis of qualitative data: namely, accuracy and consistency.

Finding insights hidden in feedback requires consistency, especially in coding.  Not to mention catching all the ‘unknown unknowns’ that can skew research findings and steering clear of cognitive bias.

Some say without manual data analysis researchers won’t get an accurate “feel” for the insights. However, the larger data sets are, the harder it is to sort through the feedback and organize feedback that has been pulled from different places.  And, the more difficult it is to stay on course, the greater the risk of drawing incorrect, or incomplete, conclusions grows.

Though the process steps for qualitative data analysis have remained pretty much unchanged since psychologist Paul Felix Lazarsfeld paved the path a hundred years ago, the impact digital technology has had on types of qualitative feedback data and the approach to the analysis are profound.  

If you want to try an automated feedback analysis solution on your own qualitative data, you can get started with Thematic .

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Qualitative Data Analysis Methods 101:

The “big 6” methods + examples.

By: Kerryn Warren (PhD) | Reviewed By: Eunice Rautenbach (D.Tech) | May 2020 (Updated April 2023)

Qualitative data analysis methods. Wow, that’s a mouthful. 

If you’re new to the world of research, qualitative data analysis can look rather intimidating. So much bulky terminology and so many abstract, fluffy concepts. It certainly can be a minefield!

Don’t worry – in this post, we’ll unpack the most popular analysis methods , one at a time, so that you can approach your analysis with confidence and competence – whether that’s for a dissertation, thesis or really any kind of research project.

What (exactly) is qualitative data analysis?

To understand qualitative data analysis, we need to first understand qualitative data – so let’s step back and ask the question, “what exactly is qualitative data?”.

Qualitative data refers to pretty much any data that’s “not numbers” . In other words, it’s not the stuff you measure using a fixed scale or complex equipment, nor do you analyse it using complex statistics or mathematics.

So, if it’s not numbers, what is it?

Words, you guessed? Well… sometimes , yes. Qualitative data can, and often does, take the form of interview transcripts, documents and open-ended survey responses – but it can also involve the interpretation of images and videos. In other words, qualitative isn’t just limited to text-based data.

So, how’s that different from quantitative data, you ask?

Simply put, qualitative research focuses on words, descriptions, concepts or ideas – while quantitative research focuses on numbers and statistics . Qualitative research investigates the “softer side” of things to explore and describe , while quantitative research focuses on the “hard numbers”, to measure differences between variables and the relationships between them. If you’re keen to learn more about the differences between qual and quant, we’ve got a detailed post over here .

So, qualitative analysis is easier than quantitative, right?

Not quite. In many ways, qualitative data can be challenging and time-consuming to analyse and interpret. At the end of your data collection phase (which itself takes a lot of time), you’ll likely have many pages of text-based data or hours upon hours of audio to work through. You might also have subtle nuances of interactions or discussions that have danced around in your mind, or that you scribbled down in messy field notes. All of this needs to work its way into your analysis.

Making sense of all of this is no small task and you shouldn’t underestimate it. Long story short – qualitative analysis can be a lot of work! Of course, quantitative analysis is no piece of cake either, but it’s important to recognise that qualitative analysis still requires a significant investment in terms of time and effort.

Need a helping hand?

In this post, we’ll explore qualitative data analysis by looking at some of the most common analysis methods we encounter. We’re not going to cover every possible qualitative method and we’re not going to go into heavy detail – we’re just going to give you the big picture. That said, we will of course includes links to loads of extra resources so that you can learn more about whichever analysis method interests you.

Without further delay, let’s get into it.

The “Big 6” Qualitative Analysis Methods 

There are many different types of qualitative data analysis, all of which serve different purposes and have unique strengths and weaknesses . We’ll start by outlining the analysis methods and then we’ll dive into the details for each.

The 6 most popular methods (or at least the ones we see at Grad Coach) are:

• Content analysis
• Narrative analysis
• Discourse analysis
• Thematic analysis
• Grounded theory (GT)
• Interpretive phenomenological analysis (IPA)

Let’s take a look at each of them…

QDA Method #1: Qualitative Content Analysis

Content analysis is possibly the most common and straightforward QDA method. At the simplest level, content analysis is used to evaluate patterns within a piece of content (for example, words, phrases or images) or across multiple pieces of content or sources of communication. For example, a collection of newspaper articles or political speeches.

With content analysis, you could, for instance, identify the frequency with which an idea is shared or spoken about – like the number of times a Kardashian is mentioned on Twitter. Or you could identify patterns of deeper underlying interpretations – for instance, by identifying phrases or words in tourist pamphlets that highlight India as an ancient country.

Because content analysis can be used in such a wide variety of ways, it’s important to go into your analysis with a very specific question and goal, or you’ll get lost in the fog. With content analysis, you’ll group large amounts of text into codes , summarise these into categories, and possibly even tabulate the data to calculate the frequency of certain concepts or variables. Because of this, content analysis provides a small splash of quantitative thinking within a qualitative method.

Naturally, while content analysis is widely useful, it’s not without its drawbacks . One of the main issues with content analysis is that it can be very time-consuming , as it requires lots of reading and re-reading of the texts. Also, because of its multidimensional focus on both qualitative and quantitative aspects, it is sometimes accused of losing important nuances in communication.

Content analysis also tends to concentrate on a very specific timeline and doesn’t take into account what happened before or after that timeline. This isn’t necessarily a bad thing though – just something to be aware of. So, keep these factors in mind if you’re considering content analysis. Every analysis method has its limitations , so don’t be put off by these – just be aware of them ! If you’re interested in learning more about content analysis, the video below provides a good starting point.

QDA Method #2: Narrative Analysis 

As the name suggests, narrative analysis is all about listening to people telling stories and analysing what that means . Since stories serve a functional purpose of helping us make sense of the world, we can gain insights into the ways that people deal with and make sense of reality by analysing their stories and the ways they’re told.

You could, for example, use narrative analysis to explore whether how something is being said is important. For instance, the narrative of a prisoner trying to justify their crime could provide insight into their view of the world and the justice system. Similarly, analysing the ways entrepreneurs talk about the struggles in their careers or cancer patients telling stories of hope could provide powerful insights into their mindsets and perspectives . Simply put, narrative analysis is about paying attention to the stories that people tell – and more importantly, the way they tell them.

Of course, the narrative approach has its weaknesses , too. Sample sizes are generally quite small due to the time-consuming process of capturing narratives. Because of this, along with the multitude of social and lifestyle factors which can influence a subject, narrative analysis can be quite difficult to reproduce in subsequent research. This means that it’s difficult to test the findings of some of this research.

Similarly, researcher bias can have a strong influence on the results here, so you need to be particularly careful about the potential biases you can bring into your analysis when using this method. Nevertheless, narrative analysis is still a very useful qualitative analysis method – just keep these limitations in mind and be careful not to draw broad conclusions . If you’re keen to learn more about narrative analysis, the video below provides a great introduction to this qualitative analysis method.

QDA Method #3: Discourse Analysis 

Discourse is simply a fancy word for written or spoken language or debate . So, discourse analysis is all about analysing language within its social context. In other words, analysing language – such as a conversation, a speech, etc – within the culture and society it takes place. For example, you could analyse how a janitor speaks to a CEO, or how politicians speak about terrorism.

To truly understand these conversations or speeches, the culture and history of those involved in the communication are important factors to consider. For example, a janitor might speak more casually with a CEO in a company that emphasises equality among workers. Similarly, a politician might speak more about terrorism if there was a recent terrorist incident in the country.

So, as you can see, by using discourse analysis, you can identify how culture , history or power dynamics (to name a few) have an effect on the way concepts are spoken about. So, if your research aims and objectives involve understanding culture or power dynamics, discourse analysis can be a powerful method.

Because there are many social influences in terms of how we speak to each other, the potential use of discourse analysis is vast . Of course, this also means it’s important to have a very specific research question (or questions) in mind when analysing your data and looking for patterns and themes, or you might land up going down a winding rabbit hole.

Discourse analysis can also be very time-consuming  as you need to sample the data to the point of saturation – in other words, until no new information and insights emerge. But this is, of course, part of what makes discourse analysis such a powerful technique. So, keep these factors in mind when considering this QDA method. Again, if you’re keen to learn more, the video below presents a good starting point.

QDA Method #4: Thematic Analysis

Thematic analysis looks at patterns of meaning in a data set – for example, a set of interviews or focus group transcripts. But what exactly does that… mean? Well, a thematic analysis takes bodies of data (which are often quite large) and groups them according to similarities – in other words, themes . These themes help us make sense of the content and derive meaning from it.

Let’s take a look at an example.

With thematic analysis, you could analyse 100 online reviews of a popular sushi restaurant to find out what patrons think about the place. By reviewing the data, you would then identify the themes that crop up repeatedly within the data – for example, “fresh ingredients” or “friendly wait staff”.

So, as you can see, thematic analysis can be pretty useful for finding out about people’s experiences , views, and opinions . Therefore, if your research aims and objectives involve understanding people’s experience or view of something, thematic analysis can be a great choice.

Since thematic analysis is a bit of an exploratory process, it’s not unusual for your research questions to develop , or even change as you progress through the analysis. While this is somewhat natural in exploratory research, it can also be seen as a disadvantage as it means that data needs to be re-reviewed each time a research question is adjusted. In other words, thematic analysis can be quite time-consuming – but for a good reason. So, keep this in mind if you choose to use thematic analysis for your project and budget extra time for unexpected adjustments.

QDA Method #5: Grounded theory (GT) 

Grounded theory is a powerful qualitative analysis method where the intention is to create a new theory (or theories) using the data at hand, through a series of “ tests ” and “ revisions ”. Strictly speaking, GT is more a research design type than an analysis method, but we’ve included it here as it’s often referred to as a method.

What’s most important with grounded theory is that you go into the analysis with an open mind and let the data speak for itself – rather than dragging existing hypotheses or theories into your analysis. In other words, your analysis must develop from the ground up (hence the name). 

Let’s look at an example of GT in action.

Assume you’re interested in developing a theory about what factors influence students to watch a YouTube video about qualitative analysis. Using Grounded theory , you’d start with this general overarching question about the given population (i.e., graduate students). First, you’d approach a small sample – for example, five graduate students in a department at a university. Ideally, this sample would be reasonably representative of the broader population. You’d interview these students to identify what factors lead them to watch the video.

After analysing the interview data, a general pattern could emerge. For example, you might notice that graduate students are more likely to read a post about qualitative methods if they are just starting on their dissertation journey, or if they have an upcoming test about research methods.

From here, you’ll look for another small sample – for example, five more graduate students in a different department – and see whether this pattern holds true for them. If not, you’ll look for commonalities and adapt your theory accordingly. As this process continues, the theory would develop . As we mentioned earlier, what’s important with grounded theory is that the theory develops from the data – not from some preconceived idea.

So, what are the drawbacks of grounded theory? Well, some argue that there’s a tricky circularity to grounded theory. For it to work, in principle, you should know as little as possible regarding the research question and population, so that you reduce the bias in your interpretation. However, in many circumstances, it’s also thought to be unwise to approach a research question without knowledge of the current literature . In other words, it’s a bit of a “chicken or the egg” situation.

Regardless, grounded theory remains a popular (and powerful) option. Naturally, it’s a very useful method when you’re researching a topic that is completely new or has very little existing research about it, as it allows you to start from scratch and work your way from the ground up .

QDA Method #6:   Interpretive Phenomenological Analysis (IPA)

Interpretive. Phenomenological. Analysis. IPA . Try saying that three times fast…

Let’s just stick with IPA, okay?

IPA is designed to help you understand the personal experiences of a subject (for example, a person or group of people) concerning a major life event, an experience or a situation . This event or experience is the “phenomenon” that makes up the “P” in IPA. Such phenomena may range from relatively common events – such as motherhood, or being involved in a car accident – to those which are extremely rare – for example, someone’s personal experience in a refugee camp. So, IPA is a great choice if your research involves analysing people’s personal experiences of something that happened to them.

It’s important to remember that IPA is subject – centred . In other words, it’s focused on the experiencer . This means that, while you’ll likely use a coding system to identify commonalities, it’s important not to lose the depth of experience or meaning by trying to reduce everything to codes. Also, keep in mind that since your sample size will generally be very small with IPA, you often won’t be able to draw broad conclusions about the generalisability of your findings. But that’s okay as long as it aligns with your research aims and objectives.

Another thing to be aware of with IPA is personal bias . While researcher bias can creep into all forms of research, self-awareness is critically important with IPA, as it can have a major impact on the results. For example, a researcher who was a victim of a crime himself could insert his own feelings of frustration and anger into the way he interprets the experience of someone who was kidnapped. So, if you’re going to undertake IPA, you need to be very self-aware or you could muddy the analysis.

How to choose the right analysis method

In light of all of the qualitative analysis methods we’ve covered so far, you’re probably asking yourself the question, “ How do I choose the right one? ”

Much like all the other methodological decisions you’ll need to make, selecting the right qualitative analysis method largely depends on your research aims, objectives and questions . In other words, the best tool for the job depends on what you’re trying to build. For example:

• Perhaps your research aims to analyse the use of words and what they reveal about the intention of the storyteller and the cultural context of the time.
• Perhaps your research aims to develop an understanding of the unique personal experiences of people that have experienced a certain event, or
• Perhaps your research aims to develop insight regarding the influence of a certain culture on its members.

As you can probably see, each of these research aims are distinctly different , and therefore different analysis methods would be suitable for each one. For example, narrative analysis would likely be a good option for the first aim, while grounded theory wouldn’t be as relevant. 

It’s also important to remember that each method has its own set of strengths, weaknesses and general limitations. No single analysis method is perfect . So, depending on the nature of your research, it may make sense to adopt more than one method (this is called triangulation ). Keep in mind though that this will of course be quite time-consuming.

As we’ve seen, all of the qualitative analysis methods we’ve discussed make use of coding and theme-generating techniques, but the intent and approach of each analysis method differ quite substantially. So, it’s very important to come into your research with a clear intention before you decide which analysis method (or methods) to use.

Start by reviewing your research aims , objectives and research questions to assess what exactly you’re trying to find out – then select a qualitative analysis method that fits. Never pick a method just because you like it or have experience using it – your analysis method (or methods) must align with your broader research aims and objectives.

Let’s recap on QDA methods…

In this post, we looked at six popular qualitative data analysis methods:

• First, we looked at content analysis , a straightforward method that blends a little bit of quant into a primarily qualitative analysis.
• Then we looked at narrative analysis , which is about analysing how stories are told.
• Next up was discourse analysis – which is about analysing conversations and interactions.
• Then we moved on to thematic analysis – which is about identifying themes and patterns.
• From there, we went south with grounded theory – which is about starting from scratch with a specific question and using the data alone to build a theory in response to that question.
• And finally, we looked at IPA – which is about understanding people’s unique experiences of a phenomenon.

Of course, these aren’t the only options when it comes to qualitative data analysis, but they’re a great starting point if you’re dipping your toes into qualitative research for the first time.

If you’re still feeling a bit confused, consider our private coaching service , where we hold your hand through the research process to help you develop your best work.

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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84 Comments

This has been very helpful. Thank you.

Thank you madam,

Thank you so much for this information

I wonder it so clear for understand and good for me. can I ask additional query?

Very insightful and useful

Good work done with clear explanations. Thank you.

Thanks so much for the write-up, it’s really good.

Thanks madam . It is very important .

thank you very good

This has been very well explained in simple language . It is useful even for a new researcher.

Great to hear that. Good luck with your qualitative data analysis, Pramod!

This is very useful information. And it was very a clear language structured presentation. Thanks a lot.

Thank you so much.

very informative sequential presentation

Precise explanation of method.

Hi, may we use 2 data analysis methods in our qualitative research?

Thanks for your comment. Most commonly, one would use one type of analysis method, but it depends on your research aims and objectives.

You explained it in very simple language, everyone can understand it. Thanks so much.

Thank you very much, this is very helpful. It has been explained in a very simple manner that even a layman understands

Thank nicely explained can I ask is Qualitative content analysis the same as thematic analysis?

Thanks for your comment. No, QCA and thematic are two different types of analysis. This article might help clarify – https://onlinelibrary.wiley.com/doi/10.1111/nhs.12048

This is my first time to come across a well explained data analysis. so helpful.

I have thoroughly enjoyed your explanation of the six qualitative analysis methods. This is very helpful. Thank you!

Thank you very much, this is well explained and useful

i need a citation of your book.

Thanks a lot , remarkable indeed, enlighting to the best

Hi Derek, What other theories/methods would you recommend when the data is a whole speech?

Keep writing useful artikel.

It is important concept about QDA and also the way to express is easily understandable, so thanks for all.

Thank you, this is well explained and very useful.

Very helpful .Thanks.

Hi there! Very well explained. Simple but very useful style of writing. Please provide the citation of the text. warm regards

The session was very helpful and insightful. Thank you

This was very helpful and insightful. Easy to read and understand

As a professional academic writer, this has been so informative and educative. Keep up the good work Grad Coach you are unmatched with quality content for sure.

Keep up the good work Grad Coach you are unmatched with quality content for sure.

Its Great and help me the most. A Million Thanks you Dr.

It is a very nice work

Very insightful. Please, which of this approach could be used for a research that one is trying to elicit students’ misconceptions in a particular concept ?

This is Amazing and well explained, thanks

great overview

What do we call a research data analysis method that one use to advise or determining the best accounting tool or techniques that should be adopted in a company.

Informative video, explained in a clear and simple way. Kudos

Waoo! I have chosen method wrong for my data analysis. But I can revise my work according to this guide. Thank you so much for this helpful lecture.

This has been very helpful. It gave me a good view of my research objectives and how to choose the best method. Thematic analysis it is.

Very helpful indeed. Thanku so much for the insight.

This was incredibly helpful.

Very helpful.

very educative

Nicely written especially for novice academic researchers like me! Thank you.

choosing a right method for a paper is always a hard job for a student, this is a useful information, but it would be more useful personally for me, if the author provide me with a little bit more information about the data analysis techniques in type of explanatory research. Can we use qualitative content analysis technique for explanatory research ? or what is the suitable data analysis method for explanatory research in social studies?

that was very helpful for me. because these details are so important to my research. thank you very much

I learnt a lot. Thank you

Relevant and Informative, thanks !

Well-planned and organized, thanks much! 🙂

I have reviewed qualitative data analysis in a simplest way possible. The content will highly be useful for developing my book on qualitative data analysis methods. Cheers!

Clear explanation on qualitative and how about Case study

This was helpful. Thank you

This was really of great assistance, it was just the right information needed. Explanation very clear and follow.

Wow, Thanks for making my life easy

This was helpful thanks .

Very helpful…. clear and written in an easily understandable manner. Thank you.

This was so helpful as it was easy to understand. I’m a new to research thank you so much.

so educative…. but Ijust want to know which method is coding of the qualitative or tallying done?

Thank you for the great content, I have learnt a lot. So helpful

precise and clear presentation with simple language and thank you for that.

very informative content, thank you.

You guys are amazing on YouTube on this platform. Your teachings are great, educative, and informative. kudos!

Brilliant Delivery. You made a complex subject seem so easy. Well done.

Beautifully explained.

Thanks a lot

Is there a video the captures the practical process of coding using automated applications?

Thanks for the comment. We don’t recommend using automated applications for coding, as they are not sufficiently accurate in our experience.

content analysis can be qualitative research?

THANK YOU VERY MUCH.

Thank you very much for such a wonderful content

do you have any material on Data collection

What a powerful explanation of the QDA methods. Thank you.

Great explanation both written and Video. i have been using of it on a day to day working of my thesis project in accounting and finance. Thank you very much for your support.

very helpful, thank you so much

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

Also see Research Methods

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Data Analysis for Qualitative Research: 6 Step Guide

Data analysis for qualitative research is not intuitive. This is because qualitative data stands in opposition to traditional data analysis methodologies: while data analysis is concerned with quantities, qualitative data is by definition unquantified . But there is an easy, methodical approach that anyone can take use to get reliable results when performing data analysis for qualitative research. The process consists of 6 steps that I’ll break down in this article:

• Perform interviews(if necessary )
• Gather all documents and transcribe any non-paper records
• Decide whether to either code analytical data, analyze word frequencies, or both
• Decide what interpretive angle you want to take: content analysis , narrative analysis, discourse analysis, framework analysis, and/or grounded theory
• Compile your data in a spreadsheet using document saving techniques (windows and mac)
• Identify trends in words, themes, metaphors, natural patterns, and more

To complete these steps, you will need:

• Microsoft word
• Microsoft excel
• Internet access

You can get the free Intro to Data Analysis eBook to cover the fundamentals and ensure strong progression in all your data endeavors.

What is qualitative research?

Qualitative research is not the same as quantitative research. In short, qualitative research is the interpretation of non-numeric data. It usually aims at drawing conclusions that explain why a phenomenon occurs, rather than that one does occur. Here’s a great quote from a nursing magazine about quantitative vs qualitative research:

“A traditional quantitative study… uses a predetermined (and auditable) set of steps to confirm or refute [a] hypothesis. “In contrast, qualitative research often takes the position that an interpretive understanding is only possible by way of uncovering or deconstructing the meanings of a phenomenon. Thus, a distinction between explaining how something operates (explanation) and why it operates in the manner that it does (interpretation) may be [an] effective way to distinguish quantitative from qualitative analytic processes involved in any particular study.” (bold added) (( EBN ))

Learn to Interpret Your Qualitative Data

This article explain what data analysis is and how to do it. To learn how to interpret the results, visualize, and write an insightful report, sign up for our handbook below.

Step 1a: Data collection methods and techniques in qualitative research: interviews and focus groups

Step 1 is collecting the data that you will need for the analysis. If you are not performing any interviews or focus groups to gather data, then you can skip this step. It’s for people who need to go into the field and collect raw information as part of their qualitative analysis.

Since the whole point of an interview and of qualitative analysis in general is to understand a research question better, you should start by making sure you have a specific, refined research question . Whether you’re a researcher by trade or a data analyst working on one-time project, you must know specifically what you want to understand in order to get results.

Good research questions are specific enough to guide action but open enough to leave room for insight and growth. Examples of good research questions include:

• Good : To what degree does living in a city impact the quality of a person’s life? (open-ended, complex)
• Bad : Does living in a city impact the quality of a person’s life? (closed, simple)

Once you understand the research question, you need to develop a list of interview questions. These questions should likewise be open-ended and provide liberty of expression to the responder. They should support the research question in an active way without prejudicing the response. Examples of good interview questions include:

• Good : Tell me what it’s like to live in a city versus in the country. (open, not leading)
• Bad : Don’t you prefer the city to the country because there are more people? (closed, leading)

Some additional helpful tips include:

• Begin each interview with a neutral question to get the person relaxed
• Limit each question to a single idea
• If you don’t understand, ask for clarity
• Do not pass any judgements
• Do not spend more than 15m on an interview, lest the quality of responses drop

Focus groups

The alternative to interviews is focus groups. Focus groups are a great way for you to get an idea for how people communicate their opinions in a group setting, rather than a one-on-one setting as in interviews.

In short, focus groups are gatherings of small groups of people from representative backgrounds who receive instruction, or “facilitation,” from a focus group leader. Typically, the leader will ask questions to stimulate conversation, reformulate questions to bring the discussion back to focus, and prevent the discussion from turning sour or giving way to bad faith.

Focus group questions should be open-ended like their interview neighbors, and they should stimulate some degree of disagreement. Disagreement often leads to valuable information about differing opinions, as people tend to say what they mean if contradicted.

However, focus group leaders must be careful not to let disagreements escalate, as anger can make people lie to be hurtful or simply to win an argument. And lies are not helpful in data analysis for qualitative research.

Step 1b: Tools for qualitative data collection

When it comes to data analysis for qualitative analysis, the tools you use to collect data should align to some degree with the tools you will use to analyze the data.

As mentioned in the intro, you will be focusing on analysis techniques that only require the traditional Microsoft suite programs: Microsoft Excel and Microsoft Word . At the same time, you can source supplementary tools from various websites, like Text Analyzer and WordCounter.

In short, the tools for qualitative data collection that you need are Excel and Word , as well as web-based free tools like Text Analyzer and WordCounter . These online tools are helpful in the quantitative part of your qualitative research.

Step 2: Gather all documents & transcribe non-written docs

Once you have your interviews and/or focus group transcripts, it’s time to decide if you need other documentation. If you do, you’ll need to gather it all into one place first, then develop a strategy for how to transcribe any non-written documents.

When do you need documentation other than interviews and focus groups? Two situations usually call for documentation. First , if you have little funding , then you can’t afford to run expensive interviews and focus groups.

Second , social science researchers typically focus on documents since their research questions are less concerned with subject-oriented data, while hard science and business researchers typically focus on interviews and focus groups because they want to know what people think, and they want to know today.

Non-written records

Other factors at play include the type of research, the field, and specific research goal. For those who need documentation and to describe non-written records, there are some steps to follow:

• Put all hard copy source documents into a sealed binder (I use plastic paper holders with elastic seals ).
• If you are sourcing directly from printed books or journals, then you will need to digitalize them by scanning them and making them text readable by the computer. To do so, turn all PDFs into Word documents using online tools such as PDF to Word Converter . This process is never full-proof, and it may be a source of error in the data collection, but it’s part of the process.
• If you are sourcing online documents, try as often as possible to get computer-readable PDF documents that you can easily copy/paste or convert. Locked PDFs are essentially a lost cause .
• Transcribe any audio files into written documents. There are free online tools available to help with this, such as 360converter . If you run a test through the system, you’ll see that the output is not 100%. The best way to use this tool is as a first draft generator. You can then correct and complete it with old fashioned, direct transcription.

Step 3: Decide on the type of qualitative research

Before step 3 you should have collected your data, transcribed it all into written-word documents, and compiled it in one place. Now comes the interesting part. You need to decide what you want to get out of your research by choosing an analytic angle, or type of qualitative research.

The available types of qualitative research are as follows. Each of them takes a unique angle that you must choose to get what information you want from the analysis . In addition, each of them has a different impact on the data analysis for qualitative research (coding vs word frequency) that we use.

Content analysis

Narrative analysis, discourse analysis.

• Framework analysis, and/or

Grounded theory

From a high level, content, narrative, and discourse analysis are actionable independent tactics, whereas framework analysis and grounded theory are ways of honing and applying the first three.

• Definition : Content analysis is identify and labelling themes of any kind within a text.
• Focus : Identifying any kind of pattern in written text, transcribed audio, or transcribed video. This could be thematic, word repetition, idea repetition. Most often, the patterns we find are idea that make up an argument.
• Goal : To simplify, standardize, and quickly reference ideas from any given text. Content analysis is a way to pull the main ideas from huge documents for comparison. In this way, it’s more a means to an end.
• Pros : The huge advantage of doing content analysis is that you can quickly process huge amounts of texts using simple coding and word frequency techniques we will look at below. To use a metaphore, it is to qualitative analysis documents what Spark notes are to books.
• Cons : The downside to content analysis is that it’s quite general. If you have a very specific, narrative research question, then tracing “any and all ideas” will not be very helpful to you.
• Definition : Narrative analysis is the reformulation and simplification of interview answers or documentation into small narrative components to identify story-like patterns.
• Focus : Understanding the text based on its narrative components as opposed to themes or other qualities.
• Goal : To reference the text from an angle closer to the nature of texts in order to obtain further insights.
• Pros : Narrative analysis is very useful for getting perspective on a topic in which you’re extremely limited. It can be easy to get tunnel vision when you’re digging for themes and ideas from a reason-centric perspective. Turning to a narrative approach will help you stay grounded. More importantly, it helps reveal different kinds of trends.
• Cons : Narrative analysis adds another layer of subjectivity to the instinctive nature of qualitative research. Many see it as too dependent on the researcher to hold any critical value.
• Definition : Discourse analysis is the textual analysis of naturally occurring speech. Any oral expression must be transcribed before undergoing legitimate discourse analysis.
• Focus : Understanding ideas and themes through language communicated orally rather than pre-processed on paper.
• Goal : To obtain insights from an angle outside the traditional content analysis on text.
• Pros : Provides a considerable advantage in some areas of study in order to understand how people communicate an idea, versus the idea itself. For example, discourse analysis is important in political campaigning. People rarely vote for the candidate who most closely corresponds to his/her beliefs, but rather for the person they like the most.
• Cons : As with narrative analysis, discourse analysis is more subjective in nature than content analysis, which focuses on ideas and patterns. Some do not consider it rigorous enough to be considered a legitimate subset of qualitative analysis, but these people are few.

Framework analysis

• Definition : Framework analysis is a kind of qualitative analysis that includes 5 ordered steps: coding, indexing, charting, mapping, and interpreting . In most ways, framework analysis is a synonym for qualitative analysis — the same thing. The significant difference is the importance it places on the perspective used in the analysis.
• Focus : Understanding patterns in themes and ideas.
• Goal : Creating one specific framework for looking at a text.
• Pros : Framework analysis is helpful when the researcher clearly understands what he/she wants from the project, as it’s a limitation approach. Since each of its step has defined parameters, framework analysis is very useful for teamwork.
• Cons : It can lead to tunnel vision.
• Definition : The use of content, narrative, and discourse analysis to examine a single case, in the hopes that discoveries from that case will lead to a foundational theory used to examine other like cases.
• Focus : A vast approach using multiple techniques in order to establish patterns.
• Goal : To develop a foundational theory.
• Pros : When successful, grounded theories can revolutionize entire fields of study.
• Cons : It’s very difficult to establish ground theories, and there’s an enormous amount of risk involved.

Step 4: Coding, word frequency, or both

Coding in data analysis for qualitative research is the process of writing 2-5 word codes that summarize at least 1 paragraphs of text (not writing computer code). This allows researchers to keep track of and analyze those codes. On the other hand, word frequency is the process of counting the presence and orientation of words within a text, which makes it the quantitative element in qualitative data analysis.

Video example of coding for data analysis in qualitative research

In short, coding in the context of data analysis for qualitative research follows 2 steps (video below):

• Reading through the text one time
• Adding 2-5 word summaries each time a significant theme or idea appears

Let’s look at a brief example of how to code for qualitative research in this video:

Click here for a link to the source text. 1

Example of word frequency processing

And word frequency is the process of finding a specific word or identifying the most common words through 3 steps:

• Decide if you want to find 1 word or identify the most common ones
• Use word’s “Replace” function to find a word or phrase
• Use Text Analyzer to find the most common terms

Here’s another look at word frequency processing and how you to do it. Let’s look at the same example above, but from a quantitative perspective.

Imagine we are already familiar with melanoma and KITs , and we want to analyze the text based on these keywords. One thing we can do is look for these words using the Replace function in word

• Locate the search bar
• Click replace
• Type in the word
• See the total results

Here’s a brief video example:

Another option is to use an online Text Analyzer. This methodology won’t help us find a specific word, but it will help us discover the top performing phrases and words. All you need to do it put in a link to a target page or paste a text. I pasted the abstract from our source text, and what turns up is as expected. Here’s a picture:

Step 5: Compile your data in a spreadsheet

After you have some coded data in the word document, you need to get it into excel for analysis. This process requires saving the word doc as an .htm extension, which makes it a website. Once you have the website, it’s as simple as opening that page, scrolling to the bottom, and copying/pasting the comments, or codes, into an excel document.

You will need to wrangle the data slightly in order to make it readable in excel. I’ve made a video to explain this process and places it below.

Step 6: Identify trends & analyze!

There are literally thousands of different ways to analyze qualitative data, and in most situations, the best technique depends on the information you want to get out of the research.

Nevertheless, there are a few go-to techniques. The most important of this is occurrences . In this short video, we finish the example from above by counting the number of times our codes appear. In this way, it’s very similar to word frequency (discussed above).

A few other options include:

• Ranking each code on a set of relevant criteria and clustering
• Pure cluster analysis
• Causal analysis

We cover different types of analysis like this on the website, so be sure to check out other articles on the home page .

How to analyze qualitative data from an interview

To analyze qualitative data from an interview , follow the same 6 steps for quantitative data analysis:

• Perform the interviews
• Transcribe the interviews onto paper
• Decide whether to either code analytical data (open, axial, selective), analyze word frequencies, or both
• Compile your data in a spreadsheet using document saving techniques (for windows and mac)
• Source text [ ↩ ]

About the Author

Noah is the founder & Editor-in-Chief at AnalystAnswers. He is a transatlantic professional and entrepreneur with 5+ years of corporate finance and data analytics experience, as well as 3+ years in consumer financial products and business software. He started AnalystAnswers to provide aspiring professionals with accessible explanations of otherwise dense finance and data concepts. Noah believes everyone can benefit from an analytical mindset in growing digital world. When he's not busy at work, Noah likes to explore new European cities, exercise, and spend time with friends and family.

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Article contents

Qualitative data analysis and the use of theory.

• Carol Grbich Carol Grbich Flinders University
• https://doi.org/10.1093/acrefore/9780190264093.013.554
• Published online: 23 May 2019

The role of theory in qualitative data analysis is continually shifting and offers researchers many choices. The dynamic and inclusive nature of qualitative research has encouraged the entry of a number of interested disciplines into the field. These discipline groups have introduced new theoretical practices that have influenced and diversified methodological approaches. To add to these, broader shifts in chronological theoretical orientations in qualitative research can be seen in the four waves of paradigmatic change; the first wave showed a developing concern with the limitations of researcher objectivity, and empirical observation of evidence based data, leading to the second wave with its focus on realities - mutually constructed by researcher and researched, participant subjectivity, and the remedying of societal inequalities and mal-distributed power. The third wave was prompted by the advent of Postmodernism and Post- structuralism with their emphasis on chaos, complexity, intertextuality and multiple realities; and most recently the fourth wave brought a focus on visual images, performance, both an active researcher and an interactive audience, and the crossing of the theoretical divide between social science and classical physics. The methods and methodological changes, which have evolved from these paradigm shifts, can be seen to have followed a similar pattern of change. The researcher now has multiple paradigms, co-methodologies, diverse methods and a variety of theoretical choices, to consider. This continuum of change has shifted the field of qualitative research dramatically from limited choices to multiple options, requiring clarification of researcher decisions and transparency of process. However, there still remains the difficult question of the role that theory will now play in such a high level of complex design and critical researcher reflexivity.

• qualitative research
• data analysis
• methodologies

Theory and Qualitative Data Analysis

Researchers new to qualitative research, and particularly those coming from the quantitative tradition, have often expressed frustration at the need for what appears to be an additional and perhaps unnecessary process—that of the theoretical interpretation of their carefully designed, collected, and analyzed data. The justifications for this process have tended to fall into one of two areas: the need to lift data to a broader interpretation beyond the Monty Pythonesque “this is my theory and it’s my very own,” to illumination of findings from another perspective—by placing the data in its relevant discipline field for comparison with previous theoretical data interpretations, while possibly adding something original to the field.

“Theory” is broadly seen as a set of assumptions or propositions, developed from observation or investigation of perceived realties, that attempt to provide an explanation of relationships or phenomena. The framing of data via theoretical imposition can occur at different levels. At the lowest level, various concepts such as “role,” “power,” “socialization,” “evaluation,” or “learning styles” refer to limited aspects of social organization and are usually applied to a specific group of people.

At a more complex level, theories of the Middle Range, identified by Robert Merton to link theory and practice, are used to build theory from empirical data. These tend to be discipline specific and incorporate concepts plus variables such as “gender,” “race,” or “class.” Concepts and variables are then combined into meaningful statements, which can be applied to more diverse social groups. For example, in education an investigation of student performance could emphasize such concepts as “safety,” “zero bullying,” “communication,” and “tolerance,” with variables such as “race” and “gender” to lead to a statement that good microsystems and a focus on individual needs are necessary for optimal student performance.

The third and most complex level uses the established or grand theories such as those of Sigmund Freud’s stages of children’s development, Jean Piaget’s theory of cognitive development, or Urie Bronfenbrenner’s ecological systems, which have been widely accepted as meaningful across a number of disciplines and provide abstract explanations of the uniformity of aspects of social organization, social behavior, and social change.

The trend in qualitative research regarding the application of chosen levels of theory has been generally either toward theory direction/verification or theory generation, although the two are often intertwined. In the first, a relevant existing theory is chosen early and acts as a point of critical comparison for the data to be collected. This approach requires the researcher to think theoretically as s/he designs the study, collects data, and collates it into analytical groupings. The danger of theory direction is that an over focus on a chosen theoretical orientation may limit what the researcher can access or “see” in the data, but on the upside, this approach can also enable the generation of new theoretical aspects, as it is rare that findings will fall precisely within the implications of existing statements. Theory generation is a much looser approach and involves either one or a range of relevant levels of theory being identified at any point in the research process, and from which, in conjunction with data findings, some new combination or distillation can enhance interpretation.

The question of whether a well-designed study should negate the need for theoretical interpretation has been minimally debated. Mehdi and Mansor ( 2010 ) identified three trends in the literature on this topic: that theory in qualitative research relates to integrated methodology and epistemology; that theory is a separate and additional element to any methodological underpinnings; and that theory has no solid relationship with qualitative research. No clear agreement on any of these is evident. Overall, there appears to be general acceptance that the process of using theory, albeit etically (imposed) or emically (integrated), enhances outcomes, and moves research away from being a-theoretical or unilluminated by other ideas. However, regarding praxis, a closer look at the issue of the use of theory and data may be in order. Theoretical interpretation, as currently practiced, has limits. To begin with, the playing field is not level. In the grounded theory tradition, Glaser and Strauss ( 1967 ) were initially clear that in order to prevent undue influence on design and interpretation, the researcher should avoid reviewing the literature on a topic until after some data collection and analysis had been undertaken. The presumption that most researchers would already be well versed in theory/ies and would have a broad spectrum to draw on in order to facilitate the constant comparative process from which data-based concepts could be generated was found to be incorrect. Glaser ( 1978 ) suggested this lack could be improved at the conceptual level via personal and professional reflexivity.

This issue became even more of a problem with the advent of practice-led disciplines such as education and health into the field of qualitative research. These groups had not been widely exposed to the theories of the traditional social sciences such as sociology, psychology, and philosophy, although in education they would have been familiar with John Dewey’s concept of “pragmatism” linking learning with hands-on activity, and were more used to developing and using models of practice for comparison with current realities. By the mid- 20th century , Education was more established in research and had moved toward the use of middle range theories and the late 20th-century grand theorists: Michel Foucault, with his emphasis on power and knowledge control, and Jurgen Habermas, with his focus on pragmatism, communication, and knowledge management.

In addition to addictive identification with particular levels of theory and discipline-preferred theories and methods, activity across qualitative research seems to fall between two extremes. At one end it involves separate processes of data collection and analysis before searching for a theoretical framework within which to discuss the findings—often choosing a framework that has gained traction in a specific discipline. This “best/most acceptable fit” approach often adds little to the relevant field beyond repetition and appears somewhat forced. At the other extreme there are those who weave methods, methodologies, data, and theory throughout the whole research process, actively critiquing and modifying it as they go, usually with the outcome of creating some new direction for both theory and practice. The majority of qualitative research practice, however, tends to fall somewhere between these two.

The final aspect of framing data lies in the impact of researchers themselves, and the early- 21st-century emphasis is on exposing relevant personal frames, particularly those of culture, gender, socioeconomic class, life experiences such as education, work, and socialization, and the researcher’s own values and beliefs. The twin purposes of this exposure are to create researcher awareness and encourage accountability for their impact on the data, as well as allowing the reader to assess the value of research outcomes in terms of potential researcher bias or prejudice. This critical reflexivity is supposed to be undertaken at all stages of the research but it is not always clear that it has occurred.

Paradigms: From Interactionism to Performativity

It appears that there are potentially five sources of theory: that which is generally available and can be sourced from different disciplines; that which is imbedded in the chosen paradigm/s; that which underpins particular methodologies; that which the researcher brings, and that which the researched incorporate within their stories. Of these, the paradigm/s chosen are probably the most influential in terms of researcher position and design. The variety of the sets of assumptions, beliefs, and researcher practices that comprise the theoretical paradigms, perspectives, or broad world views available to researchers, and within which they are expected to locate their individual position and their research approach, has shifted dramatically since the 1930s. The changes have been distinct and identifiable, with their roots located in the societal shifts prompted by political, social, and economic change.

The First Wave

The Positivist paradigm dominated research, largely unquestioned, prior to the early 20th century . It emphasized the distancing of the researcher from his/her subjects; researcher objectivity; a focus on objective, cause–effect, evidence-based data derived from empirical observation of external realities; experimental quantitative methods involving testing hypotheses; and the provision of finite answers and unassailable future predictions. From the 1930s, concerns about the limitations of findings and the veracity of research outcomes, together with improved communication and exposure to the worldviews of other cultures, led to the advent of the realist/post-positivist paradigm. Post-positivism, or critical realism, recognized that certainty in proving the truth of a hypothesis was unachievable and that outcomes were probably limited to falsification (Popper, 1963 ), that true objectivity was unattainable and that the researcher was most likely to impact on or to contaminate data, that both qualitative and quantitative approaches were valuable, and that methodological pluralism was desirable.

The Second Wave

Alongside the worldwide political shifts toward “people power” in the 1960s and 1970s, two other paradigms emerged. The first, the Interpretivist/Constructivist, focused on the social situations in which we as humans develop and how our construction of knowledge occurs through interactions with others in these contexts. This paradigm also emphasized the gaining of an understanding of the subjective views or experiences of the participants being researched, and recognized the impact of the researcher on researcher–researched mutually constructed realities. Here, theory generation is the preferred outcome to explain the what, how, and why of the findings. This usually involves the development of a conceptual model, forged from both the data gained and from the application/integration of relevant theory, to provide explanations for and interpretations of findings, together with a new perspective for the field/discipline.

The second paradigm, termed the Critical/Emancipatory, focused on locating, critiquing, and changing inequalities in society. The identification of the location of systemic power discrepancies or systematic power misuse in situations involving gender, sexuality, class, and race is expected to be followed by moves to right any oppression discovered. Here, the use of theory has been focused more on predetermined concept application for “fit.” This is because the very strong notion of problematic societal structures and power inappropriately wielded have been the dominant underpinnings.

In both the Interpretive and Critical paradigms, researcher position shifted from the elevated and distant position of positivism, to one of becoming equal with those being researched, and the notion of researcher framing emerged to cover this shift and help us—the readers—to “see” (and judge) the researcher and her/his processes of data management more clearly.

The Third Wave

In the 1980s, the next wave of paradigmatic options—postmodernism and poststructuralism—emerged. Postmodernism, with its overarching cultural implications, and poststructuralism, with its focus on language, severely challenged the construction, limitations, and claims to veracity of all knowledge and in particular the use of theory derived from siloed disciplines and confined research methods. Regardless of whether the postmodern/poststructural label is attached to grounded theory, ethnography, phenomenology, action, or evaluative designs, one general aspect that prevails is a focus on language. Language has become viewed as dubious, with notions of “slippage”—the multiple meanings of individual words, and “difference”—the difference and deferral of textual meaning (Derrida, 1970 , 1972 ), adding complexity. Double coding, irony, and juxtaposition are encouraged to further identify meaning, and to uncover aspects of social organization and behavior that have been previously marginalized or made invisible by existing discourses and discursive practices. Texts are seen as complex constructions, and intertextuality is favored, resulting in multiply constructed texts. The world is viewed as chaotic and unknowable; individuals are no longer seen as two dimensional—they are viewed as multifaceted with multiple realities. Complex “truths” are perceived as limited by time and context, requiring multiple data sets and many voices to illuminate them, and small-scale focused local research is seen as desirable. The role of researcher also changed: the politics of position and self-reflexivity dominate and the researcher needs to clearly expose past influences and formerly hidden aspects of his/her life. S/he inhabits the position of an offstage or decentered facilitator, presenting data for the reader to judge.

Theory is used mainly at the conceptual level with no particular approach being privileged. The researcher has become a “bricoleur” (Levi-Strauss, 1962 ) or handyman, using whatever methods or theories that are within reach, to adapt, craft, and meld technological skills with mythical intellectual reflection in order to create unique perspectives on the topic. Transitional interpretations dominate, awaiting further challenges and deconstruction by the next researcher in the field.

The need for multifaceted data sets in the 1990s led inevitably to a search for other research structures, and mixed and multiple methods have become topical. In crossing the divide between qualitative and quantitative approaches, the former initially developed its own sub-paradigms: pragmatist (complimentary communication and shared meanings) and transformative/emancipatory (inequalities in race, class, gender, and disability, to be righted). An increasing focus on multiple methods led to the advent of dialectics (multiple paradigm use) and critical realism (the acceptance of divergent results) (Shannon-Baker, 2016 ). The dilemmas of theory use raised by these changes include whether to segregate data sets and try to explain disparate outcomes in terms of diversity using different theories; whether to integrate them through a homogeneous “smoothing” process—one theory fits all, in order to promote a singular interpretation; or whether to let the strongest paradigm—in terms of data—dominate the theoretical findings.

The Fourth Wave

During the early 21st century , as the third wave was becoming firmly established, the Performative paradigm emerged. The incorporation of fine art–based courses into universities has challenged the prescribed rules of the doctoral thesis, initially resulting in a debate—with echoes of Glaser and Strauss—as to whether theory, if used initially, is too directive, thereby potentially contaminating the performance, or whether theory application should be an outcome to enhance performances, or even whether academic guidelines regarding theory use need to be changed to accommodate these disciplines (Bolt, 2004 ; Freeman, 2010 ; Riley & Hunter, 2009 ). Performativity is seen in terms of “effect,” a notion derived from John Austin’s ( 1962 ) assertion that words and speech utterances do not just act as descriptors of content, they have social force and impact on reality. Following this, a productive work is seen as capable of transforming reality (Bolt, 2016 ). The issue most heard here is the problem of how to judge this form of research when traditional guidelines of dependability, transformability, and trustworthiness appear to be irrelevant. Barbara Bolt suggests that drawing on Austin’s ( 1962 ) terms “locutionary” (semantic meaning), “illocutionary” (force), and “perlocutionary” (effect achieved on receivers), together with the mapping of these effects in material, effective, and discursive domains, may be useful, despite the fact that mapping transformation may be difficult to track in the short term.

During the second decade of the 21st century , however, discussions relating to the use of theory have increased dramatically in academic performative research and a variety of theoreticians are now cited apart from John Austin. These include Maurice Merleu-Ponty ( 1945 and the spatiality of lived events; Jacques Derrida ( 1982 ) on iterability, simultaneous sameness, and difference; Giles Deleuze and Felix Guatarri ( 1987 ) on rituals of material objects and transformative potential; Jean-Francois Lyotard ( 1988 ) on plurality of micro narratives, “affect,” and its silent disruption of discourse; and Bruno Latour ( 2005 ) with regard to actor network theory—where theory is used to engage with rather than to explain the world in a reflective political manner.

In performative doctoral theses, qualitative theory and methods are being creatively challenged. For example, from the discipline of theater and performance Lee Miller and Joanne/Bob Whalley ( 2010 ) disrupt the notion of usual spaces for sincere events by taking their six-hour-long performance Partly Cloudy, Chance of Rain , involving a public reaffirmation of their marriage vows, out of the usual habitats to a service station on a highway. The performance involves a choir, a band, a pianist, 20 performers dressed as brides and grooms, photographers, a TV crew, an Anglican priest, plus 50 guests. The theories applied to this event include an exploration of Marc Auge’s ( 1992 ) conception of the “non-place”; Mikhail Bakhtin’s ( 1992 ) concepts of “dialogism” (many voices) together with “heteroglossia” (juxtaposition of many voices in a dialogue); and Ludwig Wittgenstein’s ( 1953 ) discussion of the “duck rabbit”—once the rabbit is seen (participatory experience) the duck (audience) is always infected by its presence. This couple further challenged the guidelines of traditional doctoral theses by successfully negotiating two doctoral awards for a joint piece of research

A more formal example of a doctoral thesis (Reik, 2014 ) using traditional qualitative approaches has examined at school level the clash of paradigms of performative creative styles of teaching with the neoliberalist focus on testing, curriculum standardization, and student outcomes.

Leah Mercer ( 2012 ), an academic in performative studies, used the performative paradigm in her doctoral thesis to challenge and breach not only the methodological but also the theoretical silos of the quantitative–qualitative divide. The physics project is an original work using live performances of personal storytelling with video and web streaming to depict the memories, preoccupations, and the formative relationship of two women, an Australian and an American, living in contemporary mediatized society. Using scientific theory, Mercer explores personal identity by reframing the principles of contemporary physics (quantum mechanics and uncertainty principle) as aesthetic principles (uncertainty and light) with the physics of space (self), time (memory), light (inspiration), and complementarity (the reconciliation of opposites) to illuminate these experiences.

The performative paradigm has also shifted the focus on the reader, developed in postmodernism, to a broader group—an active audience. Multi-methods have been increased to include symbolic imagery, in particular visual images, as well as sound and live action. The researcher’s role here is often that of performer within a cultural frame, creating and investigating multiple realities and providing the link between the text/script and the audience/public. Theory is either minimized to the level of concepts or used to break through the silos of different disciplines to integrate and reconcile aspects from long-lasting theoretical divides.

In these chronological lines of paradigm shifts, changes in researcher position and changes in the application of theory can clearly be seen. The researcher has moved out of the shadows and into the mainstream; her/his role has shifted from an authoritarian collector and presenter of finite “truths” to a creator and often performer of multiple and disparate data images for the audience to respond to. Theory options have shifted from direction and generation within existing perspectives to creative amalgamations of concepts from disciplines previously rarely combined.

Methodologies: From Anthropology to Fine Arts

It would be a simple matter if all the researcher had to contend with was siting oneself in a particular paradigm/s. Unfortunately, not only have paradigms shifted in terms of researcher position and theoretical usage but so also have methodological choices and research design. One of the most popular methodologies, ethnography, with its roots in classical anthropology and its fieldwork-based observations of action and interaction in cultural contexts, can illustrate the process of methodological change following paradigm shift. If a researcher indicates that he/she has undertaken an ethnographic study, the reader will be most likely to query “which form?”: classical?, critical?, auto?, visual?, ethno drama?, cyber/net?, or performative? The following examples from this methodology should indicate how paradigm shifts have resulted in increasing complexity of design, methods, and interpretive options.

In c lassical ethnography the greatest borrowing is from traditional anthropology in terms of process and tools, and this can be seen with the inclusion of initial time spent in the setting to learn the language of the culture and to generally “bathe” oneself in the environment, often with minimal data collection. This process is supposed to help increase researcher understanding of the culture and minimize the problem of “othering” (treating as a different species/alien). Then a fairly lengthy amount of time is usually spent in the cultural setting either as an observer or as a participant observer to collect as much data as is relevant to answer the research question. This is followed by a return to post-check whether the findings previously gathered have stood the test of time. The analytical toolkit can involve domain analysis, freelists, pilesorts, triads and taxonomies, frame and social network, and event analysis. Truncated mini-ethnographies became more common as time became an issue, but these can still involve years of managing descriptive data, often collected by several participating researchers as seen in Douglas, Rasmussen, and Flanagan’s ( 1977 ) study of the culture of a nudist beach. Shorter versions undertaken by one researcher, for example Sohn ( 2015 ), have explored strategies of teacher and student learning in a science classroom. Theoretical interpretation can be by conceptual application for testing, such as Margaret Mead’s ( 1931 ) testing of the concept of “adolescence”—derived from American culture—in Samoan culture, or, more generally, by concept generation. The latter can be seen in David Rozenhan’s ( 1973 ) investigation of the experience of a group of researcher pseudo-patients admitted to hospitals for the mentally ill in the United States. The main concepts generated were labeling, powerlessness, and depersonalization.

De-colonial ethnography recognizes the “othering” frames of colonial and postcolonial research and takes a position that past colonial supremacy over Third World countries persists in political, economic, educational, and social constructions. Decolonizing requires a critical examination of language, attitudes, and research methods. Kakal Battacharya ( 2016 ) has exposed the micro-discourses of the continuing manifestation of colonial power in a parallel narrative written by a South Asian woman and a white American male. Concepts of colonialism and patriarchy, displayed through the discourses exposed, provide a theoretical critique.

Within critical ethnography , with its focus on power location and alleviation of oppression, Dale Spender ( 1980 ) used structured and timed observations of the styles, quality, and quantity of interaction between staff and students in a range of English classrooms. The theory-directive methodological frames of feminism and gender inequality were applied to identify and expose the lesser time and lesser quality of interaction that teachers had with female students in comparison with that assigned to male students. Widespread distribution of these results alerted education authorities and led to change, in some environments, toward introducing single-sex classrooms for certain topics. This was seen as progress toward alleviating oppressive behaviors. This approach has produced many excellent educational studies, including Peter Willis ( 1977 ) on the preparation of working-class kids for working-class jobs; Michele Fine ( 1991 ) on African American and Latino students who dropped out of a New York high school; Angela Valenzuela ( 1999 ) on emigrant and other under-achievers in American schools; Lisa Patel ( 2013 ) on inclusion and exclusion of immigrants into education; and Jean Anyon ( 1981 ) on social stratification of identical curriculum knowledge in different classrooms

A less concept-driven and more descriptive approach to critical ethnography was emphasized by Phil Carspecken’s hermeneutic approach ( 1996 ), which triggered a move toward data-generated theoretical concepts that could then be used to challenge mainstream theoretical positions.

Post-critical ethnography emphasizes power and ideology and the social practices that contribute to oppression, in particular objectivity, positionality, representation and reflexivity, and critical insufficiency or “antipower.”

Responsibility is shifted to the researcher for the world they create and critique when they interpret their research contexts (Noblit, Flores, & Murillo, 2004 ).

Autoethnography emerged from the postmodern paradigm, with its search for different “truths” and different relationships with readers, and prompted an emphasis on personal experience and documentation of the self in a particular cultural context (Ellis, 2004 ). In order to achieve this, the researcher has to inhabit the dual positions of being the focus of activities, feelings, and emotions experienced in the setting while at the same time being positioned distantly—observing and recording the behaviors of the self in that culture. Well-developed skills of critical reflexivity are required. The rejection of the power-laden discourses/grand theories of the past and the emphasis on transitional explanations has resulted in minimal theorizing and an emphasis on data display, the reader, and the reader’s response. Open presentations of data can be seen in the form of narrative storytelling, or re-presentations in the form of fiction, dramatic performances, and poetry. Carolyn Ellis ( 2004 ) has argued that “story is theory and theory is story” and our “making sense of stories” involves contributing to a broader understanding of human existence. Application/generation of concepts may also occur, and the term “Critical Autoethnography” has been used (Hughes & Pennington, 2017 ), particularly where experiences of race, class, or gender inequality are being experienced. Jennifer Potter ( 2015 ) used the concept “whiteness of silence” to introduce a critical race element into her autoethnographic experience of black–white racial hatred experiences within a university class on African American communication in which she was a student.

Visual ethnography uses a variety of tools, including photography, sketches, movies, social media, the Web and virtual reality, body art, clothing, painting, and sculpture, to demonstrate and track culture. This approach has been available for some time both as a methodology in its own right and as a method of data collection. An example of this approach, which mixes classical and visual ethnography, is Philippe Bourgois and Jeff Schonberg’s 12-year study of two dozen homeless heroin injectors and crack smokers living under a freeway overpass in San Francisco ( 2009 ). Their data comprised extensive black and white photos, dialogue, taped conversations, and fieldwork observation notes. The themes of violence, race relations, family trauma, power relations, and suffering were theoretically interpreted through reworked notions of “power” that incorporated Pierre Bourdieu’s ( 1977 , 1999 ) concepts of “symbolic violence”—linking observed practices to social domination, and “habitus”—an individual’s personal disposition comprising unique feelings and actions grounded in biography and history; Karl Marx’s “lumpen” from “lumpenproletariat” ( 1848 ), the residual class—the vagrants and beggars together with criminal elements that lie beneath the labor force; and Michel Foucault’s “biopower” ( 1978 , 2008 )—the techniques of subjugation used by the state on the population, and “governmentality” ( 1991 )—where individuals are disciplined through institutions and the “knowledge–power” nexus. The ideas of these three theorists were used to create and weave a theory of “lumpen abuse” to interpret the lives of the participants.

Ethno Drama involves transforming the results from an ethnographic study into a performance to be shared, for example the educational experiences of children and youth (Gabriel & Lester, 2013 ). The performance medium can vary from a film (Woo, 2008 ), an article presented in dramatic form (Carter, 2014 ), or more usually a play script to be staged for an audience in a theater (Ethno Theater). One of the main purposes is to provide a hearing space for voices that have been marginalized or previously silenced. These voices and their contexts can be presented by research participants, actors, or the research team, and are often directed at professionals from the field. Audience-based meetings to devise recommendations for further action may follow a performance. Because of the focus on inequality, critical theory has been the major theoretical orientation for this approach. The structure of the presentation invites audiences to identify situations of oppression, in the hope that this will inform them sufficiently to enable modification of their own practices or to be part of the development of recommendations for future change.

Lesnick and Humphrie ( 2018 ) explored the views of identity of LGBTQ+ youth between 14 and 24 years of age via interviews and online questionnaires, the transcriptions of which were woven into a script that was performed by actors presenting stories not congruent with their own racial/gender scripts in order to challenge audience expectations and labels. The research group encouraged the schools where they performed to structure discussion groups to follow the school-located performances. The scripts and discussions revealed and were lightly interpreted through concepts of homelessness, racism, and “oppression Olympics”—the way oppressed people sometimes view one another in competition rather than in solidarity. These issues were found to be relevant to both school and online communities. Support for these young people was discovered to be mostly from virtual sources, being provided by dialogues within Facebook groups.

Cyber/net or/virtual ethnographies involve the study of online communities within particular cultures. Problems which have emerged from the practice of this approach include; discovery of the researcher lurking without permission on sites, gaining prior permission which often disturbs the threads of interaction, gaining permission post–data collection but having many furious people decline participation, the “facelessness” of individuals who may have uncheckable multiple personas, and trying to make sense of very disparate data in incomplete and non-chronological order.. There has been acceptance that online and offline situations can influence each other. Dibbell ( 1993 ) demonstrated that online sexual violence toward another user’s avatar in a text-based “living room” reduced the violated person to tears as she posted pleas for the violator to be removed from the site. Theoretical interpretation at the conceptual level is common; Michel Foucault’s concept of heterotopia ( 1967 , 1984 ) was used to explain such spatio-temporal prisons as online rooms. Heterotropic spaces are seen as having the capacity to reflect and distort real and imagined experiences.

Poststructural ethnography tracks the instability of concepts both culturally and linguistically. This can be demonstrated in the deconstruction of language in education (Lather, 2001 ), particularly the contradictions and paradoxes of sexism, gender, and racism both in texts and in the classroom. These discourses are implicated in relations of power that are dynamic and within which resistance can be observed. Poststructuralism accepts that texts are multiple, as are the personas of those who created them, and that talk such as that which occurs in a classroom can be linked with knowledge control. Walter Humes ( 2000 ) discovered that the educational management discourses of “community,” “leadership,” and “participation” could be disguised by such terms as “learning communities” and “transformational leadership.” He analyzed the results with a conceptual framework derived from management theory and policy studies and linked the findings with political power.

Performative ethnography , from the post-postmodern paradigm, integrates the performances of art and theater with the focus on culture of ethnography (Denzin, 2003 ). A collaborative performance ethnography (van Katwyk & Seko, 2017 ) used a poem re-presenting themes from a previous research study on youth self-harming to form the basis of the creation of a performative dance piece. This process enabled the researcher participants to explore less dominant ways of knowing through co-learning and through the discovery of self-vulnerability. The research was driven by a social justice-derived concern that Foucault’s notion of “sovereignty” was being implemented through a web of relations that commodified and limited knowledge, and sanctioned the exploitation of individuals and communities.

This exploration of the diversity in ethnographic methods, methodologies, and interpretive strategies would be repeated in a similar trek through the interpretive, critical, postmodern, and post-postmodern approaches currently available for undertaking the various versions of grounded theory, phenomenology, feminist research, evaluation, action, or performative research.

Implications of Changes for the Researcher

The onus is now less on finding the “right” (or most familiar in a field) research approaches and following them meticulously, and much more on researchers making their own individual decisions as to which aspects of which methodologies, methods and theoretical explanations will best answer their research question. Ideally this should not be constrained by the state of the discipline they are part of; it should be equally as easy for a fine arts researcher to carry out a classical ethnography with a detailed theoretical interpretation derived from a grand theorist/s as it would be for a researcher in law to undertake a performative study with the minimum of conceptual insights and the maximum of visual and theoretical performances. Unfortunately, the reality is that trends within disciplines dictate publication access, thereby reinforcing the prevailing boundaries of knowledge.

However, the current diversity of choice has indeed shifted the field of qualitative research dramatically away from the position it was in several decades ago. The moves toward visual and performative displays may challenge certain disciplines but these approaches have now become well entrenched in others, and in qualitative research publishing. The creativity of the performative paradigm in daring to scale the siloed and well-protected boundaries of science in order to combine theoretical physics with the theories of social science, and to re-present data in a variety of newer ways from fiction to poetry to researcher performances, is exciting.

Given that theoretical as well as methodological and methods’ domains are now wide open to researchers to pick and choose from, two important aspects—justification and transparency of process—have become essential elements in the process of convincing the reader.

Justification incorporates the why of decision-making. Why was the research question chosen? Why was the particular paradigm, or paradigms, chosen best for the question? Why were the methodology and methods chosen most appropriate for both the paradigm/s and research question/s? And why were the concepts used the most appropriate and illuminating for the study?

Transparency of process not only requires that the researcher clarifies who they are in the field with relation to the research question and the participants chosen, but demands an assessment of what impact their background and personal and professional frames have had on research decisions at all stages from topic choice to theoretical analysis. Problems faced in the research process and how they were managed or overcome also requires exposition as does the chronology of decisions made and changed at all points of the research process.

Now to the issue of theory and the question of “where to?” This brief walk through the paradigmatic, methodological, and theoretical changes has demonstrated a significant move from the use of confined paradigms with limited methodological options to the availability of multiple paradigms, co-methodologies, and methods of many shades, for the researcher to select among Regarding theory use, there has been a clear move away from grand and middle range theories toward the application of individual concepts drawn from a variety of established and minor theoreticians and disciplines, which can be amalgamated into transitory explanations. The examples of theoretical interpretation presented in this article, in my view, very considerably extend, frame, and often shed new light on the themes that have been drawn out via analytical processes. Well-argued theory at any level is a great enhancer, lifting data to heights of illumination and comparison, but it could equally be argued that in the presence of critical researcher reflexivity, complex, layered, longitudinal, and well-justified design, meticulous analysis, and monitored audience response, it may no longer be essential.

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The Ultimate Guide to Qualitative Research - Part 2: Handling Qualitative Data

• Handling qualitative data
• Transcripts
• Field notes
• Survey data and responses
• Visual and audio data
• Data organization
• Data coding
• Coding frame
• Auto and smart coding
• Organizing codes
• Introduction

What is qualitative data analysis?

Qualitative data analysis methods, how do you analyze qualitative data, content analysis, thematic analysis.

• Thematic analysis vs. content analysis
• Narrative research

Phenomenological research

Discourse analysis, grounded theory.

• Deductive reasoning
• Inductive reasoning
• Inductive vs. deductive reasoning
• Qualitative data interpretation
• Qualitative analysis software

Qualitative data analysis

Analyzing qualitative data is the next step after you have completed the use of qualitative data collection methods . The qualitative analysis process aims to identify themes and patterns that emerge across the data.

In simplified terms, qualitative research methods involve non-numerical data collection followed by an explanation based on the attributes of the data . For example, if you are asked to explain in qualitative terms a thermal image displayed in multiple colors, then you would explain the color differences rather than the heat's numerical value. If you have a large amount of data (e.g., of group discussions or observations of real-life situations), the next step is to transcribe and prepare the raw data for subsequent analysis.

Researchers can conduct studies fully based on qualitative methodology, or researchers can preface a quantitative research study with a qualitative study to identify issues that were not originally envisioned but are important to the study. Quantitative researchers may also collect and analyze qualitative data following their quantitative analyses to better understand the meanings behind their statistical results.

Conducting qualitative research can especially help build an understanding of how and why certain outcomes were achieved (in addition to what was achieved). For example, qualitative data analysis is often used for policy and program evaluation research since it can answer certain important questions more efficiently and effectively than quantitative approaches.

Qualitative data analysis can also answer important questions about the relevance, unintended effects, and impact of programs, such as:

• Were expectations reasonable?
• Did processes operate as expected?
• Were key players able to carry out their duties?
• Were there any unintended effects of the program?

The importance of qualitative data analysis

Qualitative approaches have the advantage of allowing for more diversity in responses and the capacity to adapt to new developments or issues during the research process itself. While qualitative analysis of data can be demanding and time-consuming to conduct, many fields of research utilize qualitative software tools that have been specifically developed to provide more succinct, cost-efficient, and timely results.

Qualitative data analysis is an important part of research and building greater understanding across fields for a number of reasons. First, cases for qualitative data analysis can be selected purposefully according to whether they typify certain characteristics or contextual locations. In other words, qualitative data permits deep immersion into a topic, phenomenon, or area of interest. Rather than seeking generalizability to the population the sample of participants represent, qualitative research aims to construct an in-depth and nuanced understanding of the research topic.

Secondly, the role or position of the researcher in qualitative analysis of data is given greater critical attention. This is because, in qualitative data analysis, the possibility of the researcher taking a ‘neutral' or transcendent position is seen as more problematic in practical and/or philosophical terms. Hence, qualitative researchers are often exhorted to reflect on their role in the research process and make this clear in the analysis.

Thirdly, while qualitative data analysis can take a wide variety of forms, it largely differs from quantitative research in the focus on language, signs, experiences, and meaning. In addition, qualitative approaches to analysis are often holistic and contextual rather than analyzing the data in a piecemeal fashion or removing the data from its context. Qualitative approaches thus allow researchers to explore inquiries from directions that could not be accessed with only numerical quantitative data.

Establishing research rigor

Systematic and transparent approaches to the analysis of qualitative data are essential for rigor . For example, many qualitative research methods require researchers to carefully code data and discern and document themes in a consistent and credible way.

Perhaps the most traditional division in the way qualitative and quantitative research have been used in the social sciences is for qualitative methods to be used for exploratory purposes (e.g., to generate new theory or propositions) or to explain puzzling quantitative results, while quantitative methods are used to test hypotheses .

After you’ve collected relevant data , what is the best way to look at your data ? As always, it will depend on your research question . For instance, if you employed an observational research method to learn about a group’s shared practices, an ethnographic approach could be appropriate to explain the various dimensions of culture. If you collected textual data to understand how people talk about something, then a discourse analysis approach might help you generate key insights about language and communication.

The qualitative data coding process involves iterative categorization and recategorization, ensuring the evolution of the analysis to best represent the data. The procedure typically concludes with the interpretation of patterns and trends identified through the coding process.

To start off, let’s look at two broad approaches to data analysis.

Deductive analysis

Deductive analysis is guided by pre-existing theories or ideas. It starts with a theoretical framework , which is then used to code the data. The researcher can thus use this theoretical framework to interpret their data and answer their research question .

The key steps include coding the data based on the predetermined concepts or categories and using the theory to guide the interpretation of patterns among the codings. Deductive analysis is particularly useful when researchers aim to verify or extend an existing theory within a new context.

Inductive analysis

Inductive analysis involves the generation of new theories or ideas based on the data. The process starts without any preconceived theories or codes, and patterns, themes, and categories emerge out of the data.

The researcher codes the data to capture any concepts or patterns that seem interesting or important to the research question . These codes are then compared and linked, leading to the formation of broader categories or themes. The main goal of inductive analysis is to allow the data to 'speak for itself' rather than imposing pre-existing expectations or ideas onto the data.

Deductive and inductive approaches can be seen as sitting on opposite poles, and all research falls somewhere within that spectrum. Most often, qualitative analysis approaches blend both deductive and inductive elements to contribute to the existing conversation around a topic while remaining open to potential unexpected findings. To help you make informed decisions about which qualitative data analysis approach fits with your research objectives, let's look at some of the common approaches for qualitative data analysis.

Content analysis is a research method used to identify patterns and themes within qualitative data. This approach involves systematically coding and categorizing specific aspects of the content in the data to uncover trends and patterns. An often important part of content analysis is quantifying frequencies and patterns of words or characteristics present in the data .

It is a highly flexible technique that can be adapted to various data types , including text, images, and audiovisual content . While content analysis can be exploratory in nature, it is also common to use pre-established theories and follow a more deductive approach to categorizing and quantifying the qualitative data.

Thematic analysis is a method used to identify, analyze, and report patterns or themes within the data. This approach moves beyond counting explicit words or phrases and focuses on also identifying implicit concepts and themes within the data.

Researchers conduct detailed coding of the data to ascertain repeated themes or patterns of meaning. Codes can be categorized into themes, and the researcher can analyze how the themes relate to one another. Thematic analysis is flexible in terms of the research framework, allowing for both inductive (data-driven) and deductive (theory-driven) approaches. The outcome is a rich, detailed, and complex account of the data.

Grounded theory is a systematic qualitative research methodology that is used to inductively generate theory that is 'grounded' in the data itself. Analysis takes place simultaneously with data collection , and researchers iterate between data collection and analysis until a comprehensive theory is developed.

Grounded theory is characterized by simultaneous data collection and analysis, the development of theoretical codes from the data, purposeful sampling of participants, and the constant comparison of data with emerging categories and concepts. The ultimate goal is to create a theoretical explanation that fits the data and answers the research question .

Discourse analysis is a qualitative research approach that emphasizes the role of language in social contexts. It involves examining communication and language use beyond the level of the sentence, considering larger units of language such as texts or conversations.

Discourse analysts typically investigate how social meanings and understandings are constructed in different contexts, emphasizing the connection between language and power. It can be applied to texts of all kinds, including interviews , documents, case studies , and social media posts.

Phenomenological research focuses on exploring how human beings make sense of an experience and delves into the essence of this experience. It strives to understand people's perceptions, perspectives, and understandings of a particular situation or phenomenon.

It involves in-depth engagement with participants, often through interviews or conversations, to explore their lived experiences. The goal is to derive detailed descriptions of the essence of the experience and to interpret what insights or implications this may bear on our understanding of this phenomenon.

Whatever your data analysis approach, start with ATLAS.ti

Qualitative data analysis done quickly and intuitively with ATLAS.ti. Download a free trial today.

Now that we've summarized the major approaches to data analysis, let's look at the broader process of research and data analysis. Suppose you need to do some research to find answers to any kind of research question, be it an academic inquiry, business problem, or policy decision. In that case, you need to collect some data. There are many methods of collecting data: you can collect primary data yourself by conducting interviews, focus groups , or a survey , for instance. Another option is to use secondary data sources. These are data previously collected for other projects, historical records, reports, statistics – basically everything that exists already and can be relevant to your research.

The data you collect should always be a good fit for your research question . For example, if you are interested in how many people in your target population like your brand compared to others, it is no use to conduct interviews or a few focus groups . The sample will be too small to get a representative picture of the population. If your questions are about "how many….", "what is the spread…" etc., you need to conduct quantitative research . If you are interested in why people like different brands, their motives, and their experiences, then conducting qualitative research can provide you with the answers you are looking for.

Let's describe the important steps involved in conducting research.

Step 1: Planning the research

As the saying goes: "Garbage in, garbage out." Suppose you find out after you have collected data that

• you talked to the wrong people
• asked the wrong questions
• a couple of focus groups sessions would have yielded better results because of the group interaction, or
• a survey including a few open-ended questions sent to a larger group of people would have been sufficient and required less effort.

Think thoroughly about sampling, the questions you will be asking, and in which form. If you conduct a focus group or an interview, you are the research instrument, and your data collection will only be as good as you are. If you have never done it before, seek some training and practice. If you have other people do it, make sure they have the skills.

Step 2: Preparing the data

When you conduct focus groups or interviews, think about how to transcribe them. Do you want to run them online or offline? If online, check out which tools can serve your needs, both in terms of functionality and cost. For any audio or video recordings , you can consider using automatic transcription software or services. Automatically generated transcripts can save you time and money, but they still need to be checked. If you don't do this yourself, make sure that you instruct the person doing it on how to prepare the data.

• How should the final transcript be formatted for later analysis?
• Which names and locations should be anonymized?
• What kind of speaker IDs to use?

What about survey data ? Some survey data programs will immediately provide basic descriptive-level analysis of the responses. ATLAS.ti will support you with the analysis of the open-ended questions. For this, you need to export your data as an Excel file. ATLAS.ti's survey import wizard will guide you through the process.

Other kinds of data such as images, videos, audio recordings, text, and more can be imported to ATLAS.ti. You can organize all your data into groups and write comments on each source of data to maintain a systematic organization and documentation of your data.

Step 3: Exploratory data analysis

You can run a few simple exploratory analyses to get to know your data. For instance, you can create a word list or word cloud of all your text data or compare and contrast the words in different documents. You can also let ATLAS.ti find relevant concepts for you. There are many tools available that can automatically code your text data, so you can also use these codings to explore your data and refine your coding.

For instance, you can get a feeling for the sentiments expressed in the data. Who is more optimistic, pessimistic, or neutral in their responses? ATLAS.ti can auto-code the positive, negative, and neutral sentiments in your data. Naturally, you can also simply browse through your data and highlight relevant segments that catch your attention or attach codes to begin condensing the data.

Step 4: Build a code system

Whether you start with auto-coding or manual coding, after having generated some first codes, you need to get some order in your code system to develop a cohesive understanding. You can build your code system by sorting codes into groups and creating categories and subcodes. As this process requires reading and re-reading your data, you will become very familiar with your data. Counting on a tool like ATLAS.ti qualitative data analysis software will support you in the process and make it easier to review your data, modify codings if necessary, change code labels, and write operational definitions to explain what each code means.

Step 5: Query your coded data and write up the analysis

Once you have coded your data, it is time to take the analysis a step further. When using software for qualitative data analysis , it is easy to compare and contrast subsets in your data, such as groups of participants or sets of themes.

For instance, you can query the various opinions of female vs. male respondents. Is there a difference between consumers from rural or urban areas or among different age groups or educational levels? Which codes occur together throughout the data set? Are there relationships between various concepts, and if so, why?

Step 6: Data visualization

Data visualization brings your data to life. It is a powerful way of seeing patterns and relationships in your data. For instance, diagrams allow you to see how your codes are distributed across documents or specific subpopulations in your data.

Exploring coded data on a canvas, moving around code labels in a virtual space, linking codes and other elements of your data set, and thinking about how they are related and why – all of these will advance your analysis and spur further insights. Visuals are also great for communicating results to others.

Step 7: Data presentation

The final step is to summarize the analysis in a written report . You can now put together the memos you have written about the various topics, select some salient quotes that illustrate your writing, and add visuals such as tables and diagrams. If you follow the steps above, you will already have all the building blocks, and you just have to put them together in a report or presentation.

When preparing a report or a presentation, keep your audience in mind. Does your audience better understand numbers than long sections of detailed interpretations? If so, add more tables, charts, and short supportive data quotes to your report or presentation. If your audience loves a good interpretation, add your full-length memos and walk your audience through your conceptual networks and illustrative data quotes.

Qualitative data analysis begins with ATLAS.ti

For tools that can make the most out of your data, check out ATLAS.ti with a free trial.

The world’s most powerful AI-based qualitative data analysis solution.

QualAI utilizes advanced AI technology to increase researcher efficiency, enhance data reliability, and mitigate bias.

researchers

QualAI aids researchers with data codification, thematic analyses, and content summaries to increase data reliability and mitigate bias.

organizations

QualAI helps organizations with market research, consumer analysis, business development, data aggregation and interpretation.

See how QualAI helps students analyze large-scale qualitative data sets, codify transcripts, and generate themes to reduce bias and increase efficiency.

ERIK ALANSON, Ph.d.

Co-Founder, QualAI

Academic Researcher

University Professor

tonkia bridges, ed.d.

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Qualitative Data Analysis Methodologies and Methods

Qualitative data analysis involves interpreting non-numerical data to identify patterns, themes, and insights. There are several methodologies and methods used in qualitative data analysis.

In this article, we will explore qualitative data analysis techniques in great detail, with each method providing a different perspective on how to interpret qualitative data.

Table of Content

Types of Qualitative Data Analysis Methodologies

1. content analysis, 2. thematic analysis, 3. narrative analysis, 4. discourse analysis, 5. grounded theory analysis, 6. text analysis, 7. ethnographic analysis, advantages and disadvantages of different qualitative data analysis methodologies, best practices for qualitative data analysis, qualitative data analysis methods- faq’s.

Lets weigh the benefits and disadvantages of each:

Content analysis involves systematically reading textual content or other types of communication to perceive patterns, themes, and meanings within the content. It provides a dependent technique to inspecting huge volumes of records to discover insights or trends. Researchers categorize and code the content material based on predetermined criteria or emergent themes, taking into consideration quantitative and qualitative interpretation of the facts. Content analysis is regularly an iterative procedure, with researchers revisiting and refining the coding scheme, collecting additional facts, or accomplishing in addition analysis as needed to deepen know-how or cope with new studies questions.

There are 3 fundamental techniques to content analysis:

• Conventional Content Analysis : In conventional content analysis, researchers technique the records with out preconceived categories or theoretical frameworks. Instead, they allow classes and themes to emerge evidently from the statistics through an iterative system of coding and analysis. This technique is exploratory and bendy, allowing for the discovery of latest insights and styles inside the content material.
• Directed Content Analysis : Directed content material analysis entails studying the statistics based totally on existing theories or principles. Researchers start with predefined categories or subject matters derived from theoretical frameworks or previous research findings. The analysis is focused on confirming, refining, or extending present theories in place of coming across new ones. Directed content analysis is specifically beneficial whilst researchers intention to test hypotheses or explore particular concepts in the statistics.
• Summative Content Analysis : Summative content material analysis focuses on quantifying the presence or frequency of precise content within the information. Researchers expand predetermined classes or coding schemes primarily based on predefined criteria, after which systematically code the statistics in line with those classes. The emphasis is on counting occurrences of predefined attributes or topics to provide a numerical summary of the content. Summative content material analysis is frequently used to track modifications over time, examine unique assets of content material, or verify the superiority of specific subject matters inside a dataset.

When to Use Content Analysis?

• Exploratory Research : Content analysis is appropriate for exploratory research in which the goal is to uncover new insights, discover emerging developments, or recognize the breadth of communique on a particular subject matter.
• Comparative Analysis: It is useful for comparative analysis, permitting researchers to compare conversation throughout extraordinary sources, time periods, or cultural contexts.
• Historical Analysis : Content analysis can be carried out to historical research, allowing researchers to analyze ancient files, media content, or archival substances to apprehend conversation styles over the years.
• Policy Analysis: It is valuable for policy analysis, supporting researchers look at the portrayal of problems in media or public discourse and informing coverage-making methods.
• Market Research: Content analysis is usually utilized in market research to investigate advertising and marketing substances, social media content, and customer critiques, presenting insights into patron perceptions and possibilities.

Thematic analysis is a method for identifying, analyzing, and reporting styles or topics within qualitative records. It entails systematically coding and categorizing information to become aware of not unusual issues, styles, or ideas that emerge from the dataset. Researchers interact in a method of inductive reasoning to generate topics that capture the essence of the facts, making an allowance for interpretation and exploration of underlying meanings.

Thematic analysis is appropriate when researchers are seeking for to become aware of, analyze, and document patterns or issues inside qualitative records. It is especially beneficial for exploratory studies where the intention is to find new insights or recognize the breadth of studies and views associated with a specific phenomenon.

Thematic analysis offers a bendy and systematic approach for identifying and reading styles or topics within qualitative statistics, making it a treasured method for exploring complex phenomena and producing insights that inform concept, exercise, and policy.

When to use Thematic analysis?

• Psychology : Thematic analysis is used to explore mental phenomena, which include coping mechanisms in reaction to strain, attitudes towards mental fitness, or stories of trauma.
• Education : Researchers practice thematic analysis to apprehend student perceptions of getting to know environments, teaching methods, or academic interventions.
• Healthcare : Thematic analysis enables take a look at affected person reports with healthcare offerings, attitudes towards treatment alternatives, or obstacles to gaining access to healthcare.
• Market Research: Thematic analysis is applied to research purchaser remarks, perceive product options, or recognize emblem perceptions in marketplace research research.

Narrative analysis entails analyzing and interpreting the memories or narratives that people use to make feel of their stories. It focuses on the shape, content, and which means of narratives to apprehend how people construct and speak their identities, values, and ideals via storytelling. It is especially beneficial for exploring how people assemble and communicate their identities, values, and beliefs through storytelling.

When to use Narrative Analysis?

It’s extensively used throughout numerous disciplines, which includes sociology, psychology, anthropology, literary research, and verbal exchange studies. Some applications of narrative analysis in qualitative statistics analysis methodologies are:

• Understanding Identity Construction : Narrative analysis can be used to explore how people construct their identities through the tales they tell approximately themselves. Researchers can examine the issues, plot systems, and language utilized in narratives to uncover how individuals perceive themselves and their place inside the world.
• Exploring Life Experiences : Researchers frequently use narrative analysis to research the lived reports of people or groups. By inspecting the narratives shared by using members, researchers can advantage insights into the demanding situations, triumphs, and extensive events that shape people’s lives.
• Examining Cultural Meanings and Practices: Narrative analysis can provide treasured insights into cultural meanings and practices. By studying the stories shared within a selected cultural context, researchers can find shared values, ideals, and norms that influence behavior and social interactions.
• Exploring Trauma and Healing : Narrative analysis is usually utilized in studies on trauma and restoration tactics. By studying narratives of trauma survivors, researchers can explore how individuals make experience of their studies, deal with adversity, and embark on trips of restoration and resilience.
• Analyzing Media and Popular Culture : Narrative analysis also can be applied to analyze media texts, inclusive of films, tv suggests, and literature. Researchers can have a look at the narratives constructed within these texts to understand how they reflect and shape cultural beliefs, ideologies, and norms.

Narrative analysis offers a powerful technique for exploring the structure, content, and that means of narratives or stories instructed by people, providing insights into their lived reports, identities, and perspectives. However, researchers need to navigate the interpretive subjectivity, time-extensive nature, and moral concerns related to reading narratives in qualitative studies.

Discourse analysis examines the approaches wherein language is used to construct that means, form social interactions, and reproduce electricity members of the family inside society. It makes a speciality of studying spoken or written texts, in addition to the wider social and cultural contexts in which communique happens. Researchers explore how language displays and shapes social norms, ideologies, and power dynamics.

Discourse analysis is employed when researchers are seeking to investigate social interactions, power dynamics, and identity creation through language. It is applied to take a look at how language shapes social relations, constructs identities, and reflects cultural norms and values.

When to use Discourse Analysis?

• Linguistics and Language Studies : Discourse analysis is foundational to linguistics and language research, where it’s miles used to study language use, communique patterns, and discourse structures. Linguists behavior discourse analysis to investigate how language shapes social interactions, constructs identities, and reflects cultural norms. Discourse analysis facilitates uncover the underlying meanings, ideologies, and energy dynamics embedded in language.
• Media and Communication : Discourse analysis is applied in media and conversation research to have a look at media representations, discursive practices, and ideological frameworks. Researchers conduct discourse analysis to analyze media texts, information coverage, and political speeches, exploring how language constructs and disseminates social meanings and values. Discourse analysis informs media literacy efforts, media grievance, and media coverage debates.
• Political Science : Discourse analysis is applied in political science to look at political rhetoric, public discourse, and policymaking tactics. Researchers behavior discourse analysis to research political speeches, party manifestos, and coverage files, analyzing how language constructs political identities, legitimizes authority, and shapes public opinion. Discourse analysis informs political verbal exchange techniques, political campaigning, and policy advocacy.

Grounded theory analysis is an inductive studies approach used to broaden theories or causes based on empirical data. It includes systematically studying qualitative information to perceive ideas, categories, and relationships that emerge from the statistics itself, rather than testing preconceived hypotheses. Researchers have interaction in a procedure of constant assessment and theoretical sampling to refine and increase theoretical insights.

Grounded theory analysis is hired whilst researchers are seeking for to find styles, relationships, and tactics that emerge from the records itself, with out implementing preconceived hypotheses or theoretical assumptions.

When to use Grounded Theory Analysis?

Grounded concept analysis is applied throughout various disciplines and studies contexts, such as:

• Social Sciences Research : Grounded Theory Analysis is significantly used in sociology, anthropology, psychology, and related disciplines to discover diverse social phenomena together with organization dynamics, social interactions, cultural practices, and societal structures.
• Healthcare Research : In healthcare, Grounded Theory can be implemented to apprehend affected person reviews, healthcare provider-patient interactions, healthcare delivery procedures, and the impact of healthcare guidelines on individuals and communities.
• Organizational Studies : Researchers use Grounded Theory to examine organizational conduct, leadership, place of work subculture, and worker dynamics. It enables in knowledge how groups function and the way they may be advanced.
• Educational Research : In training, Grounded Theory Analysis can be used to discover teaching and getting to know processes, scholar studies, educational regulations, and the effectiveness of educational interventions.

Text analysis involves examining written or verbal communique to extract meaningful insights or styles. It encompasses numerous techniques which includes sentiment analysis, subject matter modeling, and keyword extraction. For instance, in a have a look at on patron opinions of a eating place, textual content analysis is probably used to become aware of established topics along with food first-class, service enjoy, and atmosphere. Key additives and strategies worried in text analysis:

• Sentiment Analysis : This approach includes determining the sentiment expressed in a piece of textual content, whether or not it is high quality, bad, or impartial. Sentiment analysis algorithms use natural language processing (NLP) to analyze the words, phrases, and context within the text to deduce the overall sentiment. For instance, in customer reviews of a eating place, sentiment analysis could be used to gauge purchaser delight levels based totally on the emotions expressed within the critiques.
• Topic Modeling : Topic modeling is a statistical technique used to become aware of the underlying topics or issues present within a group of documents or text statistics. It entails uncovering the latent patterns of co-occurring phrases or terms that constitute awesome topics. Techniques like Latent Dirichlet Allocation (LDA) and Latent Semantic Analysis (LSA) are normally used for topic modeling. In the context of eating place opinions, subject matter modeling should assist identify not unusual subject matters inclusive of meals excellent, provider revel in, cleanliness, etc., across a large corpus of opinions.
• Keyword Extraction : Keyword extraction includes figuring out and extracting the most applicable phrases or phrases from a bit of text that seize its essence or major topics. This technique enables to summarize the important thing content material or subjects mentioned within the textual content. For instance, in eating place analysiss, key-word extraction ought to identify often referred to terms like “scrumptious meals,” “friendly group of workers,” “lengthy wait times,” etc., presenting a quick analysis of customer sentiments and concerns.

When to use Text Analysis?

Text analysis has numerous programs throughout diverse domain names, including:

• Business and Marketing: Analyzing purchaser remarks, sentiment analysis of social media posts, brand monitoring, and market fashion analysis.
• Healthcare: Extracting scientific statistics from scientific notes, analyzing patient comments, and detecting unfavorable drug reactions from textual content information.
• Social Sciences: Studying public discourse, political communique, opinion mining, and discourse analysis in social media.
• Academic Research: Conducting literature analysiss, analyzing studies articles, and identifying rising studies topics and trends.
• Customer Experience : Understanding purchaser sentiments, identifying product or service problems, and improving client satisfaction via text-based totally comments analysis.

Ethnographic analysis involves immersing in a selected cultural or social setting to understand the views, behaviors, and interactions of the human beings within that context. Researchers conduct observations, interviews, and participant observations to gain insights into the culture, practices, and social dynamics of the community under study. It is is suitable when researchers aim to gain an in-depth understanding of a particular cultural or social setting, including the perspectives, behaviors, and interactions of the people within that context. Particularly beneficial for reading complex social phenomena of their natural environment, wherein observations and interactions arise organically.

When to use Ethnographic Analysis?

• Cultural Understanding : Ethnographic analysis is right whilst researchers goal to gain deep insights into the lifestyle, ideals, and social practices of a selected institution or community.
• Behavioral Observation : It is beneficial while researchers want to observe and apprehend the behaviors, interactions, and each day activities of individuals within their natural surroundings.
• Contextual Exploration : Ethnographic analysis is valuable for exploring the context and lived stories of individuals, presenting wealthy, exact descriptions of their social and cultural worlds.
• Complex Social Dynamics: It is suitable whilst analyzing complex social phenomena or phenomena which might be deeply embedded within social contexts, including rituals, traditions, or network dynamics.
• Qualitative Inquiry: Ethnographic analysis is desired while researchers are seeking for to conduct qualitative inquiry targeted on know-how the subjective meanings and perspectives of individuals inside their cultural context.

Ethnographic analysis gives a effective method for analyzing complex social phenomena of their herbal context, offering rich and nuanced insights into the cultural practices, social dynamics, and lived experiences of individuals inside a particular community. However, researchers need to cautiously bear in mind the time commitment, ethical considerations, and potential biases associated with ethnographic studies.

• Clearly Defined Research Question : Ground analysis in a clear and targeted research question. This will manual for information series and preserve you on the right track at some point of analysis.
• Systematic Coding : Develop a coding scheme to categorize facts into significant topics or concepts. Use software gear to assist in organizing and dealing with codes.
• Constant Comparison : Continuously examine new facts with current codes and subject matters to refine interpretations and make sure consistency.
• Triangulation : Validate findings by the use of a couple of records sources, strategies, or researchers to corroborate consequences and beautify credibility.

Refine subject matters and interpretations through engaging in repeated cycles of gathering, coding, and analysis.

Qualitative data analysis techniques are effective means of revealing deep insights and comprehending intricate phenomena in both practice and study. Through the use of rigorous analytical approaches, researchers may convert qualitative data into significant ideas, interpretations, and narratives that further knowledge and support evidence-based decision-making.

Is it possible to mix quantitative and qualitative methodologies for data analysis?

A: In order to triangulate results and get a thorough grasp of study concerns, researchers do, in fact, often use mixed methods techniques.

How can I choose the best approach for analyzing qualitative data for my study?

A: To choose the best approach, take the research topic, the properties of the data, and the theoretical framework into consideration.

What are some tactics I might do to improve the reliability and validity of my qualitative data analysis?

Aim for peer debriefing and member verification to improve validity, and maintain transparency, reflexivity, and methodological coherence throughout the analytic process.

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• Published: 13 May 2024

Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes

• Léa Solh Dost   ORCID: orcid.org/0000-0001-5767-1305 1 , 2 ,
• Giacomo Gastaldi   ORCID: orcid.org/0000-0001-6327-7451 3 &
• Marie P. Schneider   ORCID: orcid.org/0000-0002-7557-9278 1 , 2  

BMC Health Services Research volume  24 , Article number:  620 ( 2024 ) Cite this article

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Metrics details

Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted.

Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence.

Conclusions

The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients’ difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients’ needs, increase their safety, and standardize physicians’, pharmacists’, and nurses’ roles and responsibilities.

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Introduction

Continuity of patient care is characterized as the collaborative engagement between the patient and their physician-led care team in the ongoing management of healthcare, with the mutual objective of delivering high-quality and cost-effective medical care [ 1 ]. Continuity of care is under great pressure during the transition of care from hospital to outpatient care, with a risk of compromising patients’ safety [ 2 , 3 ]. The early post-discharge period is a high-risk and fragile transition: once discharged, one in five patients experience at least one adverse event during the first three weeks following discharge, and more than half of these adverse events are drug-related [ 4 , 5 ]. A retrospective study examining all discharged patients showed that adverse drug events (ADEs) account for up to 20% of 30-day hospital emergency readmissions [ 6 ]. During hospitalization, patients’ medications are generally modified, with an average of nearly four medication changes per patient [ 7 ]. Information regarding medications such as medication changes, the expected effect, side effects, and instructions for use are frequently poorly communicated to patients during hospitalization and at discharge [ 8 , 9 , 10 , 11 ]. Between 20 and 60% of discharged patients lack knowledge of their medications [ 12 , 13 ]. Consideration of patients’ needs and their active engagement in decision-making during hospitalization regarding their medications are often lacking [ 11 , 14 , 15 ]. This can lead to unsafe discharge and contribute to medication adherence difficulties, such as non-implementation of newly prescribed medications [ 16 , 17 ].

Patients with multiple comorbidities and polypharmacy are at higher risk of ADE [ 18 ]. Type 2 diabetes is one of the chronic health conditions most frequently associated with comorbidities and patients with type 2 diabetes often lack care continuum [ 19 , 20 , 21 ]. The prevalence of patients hospitalized with type 2 diabetes can exceed 40% [ 22 ] and these patients are at higher risk for readmission due to their comorbidities and their medications, such as insulin and oral hypoglycemic agents [ 23 , 24 , 25 ].

Interventions and strategies to improve patient care and safety at transition have shown mixed results worldwide in reducing cost, rehospitalization, ADE, and non-adherence [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. However, interventions that are patient-centered, with a patient follow-up and led by interprofessional healthcare teams showed promising results [ 34 , 35 , 36 ]. Most of these interventions have not been implemented routinely due to the extensive time to translate research into practice and the lack of hybrid implementation studies [ 37 , 38 , 39 , 40 , 41 ]. In addition, patient-reported outcomes and perspectives have rarely been considered, yet patients’ involvement is essential for seamless and integrated care [ 42 , 43 ]. Interprofessional collaboration in which patients are full members of the interprofessional team, is still in its infancy in outpatient care [ 44 ]. Barriers and facilitators regarding medications at the transition of care have been explored in multiple qualitative studies at one given time in a given setting (e.g., at discharge, one-month post-discharge) [ 8 , 45 , 46 , 47 , 48 ]. However, few studies have adopted a holistic methodology from the hospital to the outpatient setting to explore changes in patients’ perspectives over time [ 49 , 50 , 51 ]. Finally, little is known about whether, how, and when patients return to their daily routine following hospitalization and the impact of hospitalization weeks after discharge.

In Switzerland, continuity of care after hospital discharge is still poorly documented, both in terms of contextual analysis and interventional studies, and is mainly conducted in the hospital setting [ 31 , 35 , 52 , 53 , 54 , 55 , 56 ]. The first step of an implementation science approach is to perform a contextual analysis to set up effective interventions adapted to patients’ needs and aligned to healthcare professionals’ activities in a specific context [ 41 , 57 ]. Therefore, the main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and on their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Study design

This qualitative longitudinal study, conducted from October 2020 to July 2021, used a qualitative descriptive methodology through four consecutive in-depth semi-structured interviews per participant at three, 10-, 30- and 60-days post-discharge, as illustrated in Fig.  1 . Longitudinal qualitative research is characterized by qualitative data collection at different points in time and focuses on temporality, such as time and change [ 58 , 59 ]. Qualitative descriptive studies aim to explore and describe the depth and complexity of human experiences or phenomena [ 60 , 61 , 62 ]. We focused our qualitative study on the 60 first days after discharge as this period is considered highly vulnerable and because studies often use 30- or 60-days readmission as an outcome measure [ 5 , 63 ].

This qualitative study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779).

Recruitment took place during participants’ hospitalization in the general internal medicine divisions at the Geneva University Hospitals in the canton of Geneva (500 000 inhabitants), Switzerland. Interviews took place at participants’ homes, in a private office at the University of Geneva, by telephone or by secure video call, according to participants’ preference. Informal caregivers could also participate alongside the participants.

Study flowchart

Researcher characteristics

All the researchers were trained in qualitative studies. The diabetologist and researcher (GG) who enrolled the patients in the study was involved directly or indirectly (advice asked to the Geneva University Hospital diabetes team of which he was a part) for most participants’ care during hospitalization. LS (Ph.D. student and community pharmacist) was unknown to participants and presented herself during hospitalization as a “researcher” and not as a healthcare professional to avoid any risk of influencing participants’ answers. This study was not interventional, and the interviewer (LS) invited participants to contact a healthcare professional for any questions related to their medication or medical issues.

Population and sampling strategy

Patients with type 2 diabetes were chosen as an example population to describe polypharmacy patients as these patients usually have several health issues and polypharmacy [ 20 , 22 , 25 ]. Inclusions criteria for the study were: adult patients with type 2 diabetes, with at least two other comorbidities, hospitalized for at least three days in a general internal medicine ward, with a minimum of one medication change during hospital stay, and who self-managed their medications once discharged home. Exclusion criteria were patients not reachable by telephone following discharge, unable to give consent (patients with schizophrenia, dementia, brain damage, or drug/alcohol misuse), and who could not communicate in French. A purposive sampling methodology was applied aiming to include participants with different ages, genders, types, and numbers of health conditions by listing participants’ characteristics in a double-entry table, available in Supplementary Material 1 , until thematic saturation was reached. Thematic saturation was considered achieved when no new code or theme emerged and new data repeated previously coded information [ 64 ]. The participants were identified if they were hospitalized in the ward dedicated to diabetes care or when the diabetes team was contacted for advice. The senior ward physician (GG) screened eligible patients and the interviewer (LS) obtained written consent before hospital discharge.

Data collection and instruments

Sociodemographic (age, gender, educational level, living arrangement) and clinical characteristics (reason for hospitalization, date of admission, health conditions, diabetes diagnosis, medications before and during hospitalization) were collected by interviewing participants before their discharge and by extracting participants’ data from electronic hospital files by GG and LS. Participants’ pharmacies were contacted with the participant’s consent to obtain medication records from the last three months if information regarding medications before hospitalization was missing in the hospital files.

Semi-structured interview guides for each interview (at three, 10-, 30- and 60-days post-discharge) were developed based on different theories and components of health behavior and medication adherence: the World Health Organization’s (WHO) five dimensions for adherence, the Information-Motivation-Behavioral skills model and the Social Cognitive Theory [ 65 , 66 , 67 ]. Each interview explored participants’ itinerary in the healthcare system and their perspectives on their medications. Regarding medications, the following themes were mentioned at each interview: changes in medications, patients’ understanding and implication; information on their medications, self-management of their medications, and patients’ medication adherence. Other aspects were mentioned in specific interviews: patients’ hospitalization and experience on their return home (interview 1), motivation (interviews 2 and 4), and patient’s feedback on the past two months (interview 4). Interview guides translated from French are available in Supplementary Material 2 . The participants completed self-reported and self-administrated questionnaires at different interviews to obtain descriptive information on different factors that may affect medication management and adherence: self-report questionnaires on quality of life (EQ-5D-5 L) [ 68 ], literacy (Schooling-Opinion-Support questionnaire) [ 69 ], medication adherence (Adherence Visual Analogue Scale, A-VAS) [ 70 ] and Belief in Medication Questionnaire (BMQ) [ 71 ] were administered to each participant at the end of selected interviews to address the different factors that may affect medication management and adherence as well as to determine a trend of determinants over time. The BMQ contains two subscores: Specific-Necessity and Specific-Concerns, addressing respectively their perceived needs for their medications, and their concerns about adverse consequences associated with taking their medication [ 72 ].

Data management

Informed consent forms, including consent to obtain health data, were securely stored in a private office at the University of Geneva. The participants’ identification key was protected by a password known only by MS and LS. Confidentiality was guaranteed by pseudonymization of participants’ information and audio-recordings were destroyed once analyzed. Sociodemographic and clinical characteristics, medication changes, and answers to questionnaires were securely collected by electronic case report forms (eCRFs) on RedCap®. Interviews were double audio-recorded and field notes were taken during interviews. Recorded interviews were manually transcribed verbatim in MAXQDA® (2018.2) by research assistants and LS and transcripts were validated for accuracy by LS. A random sample of 20% of questionnaires was checked for accuracy for the transcription from the paper questionnaires to the eCRFs. Recorded sequences with no link to the discussed topics were not transcribed and this was noted in the transcripts.

Data analysis

A descriptive statistical analysis of sociodemographic, clinical characteristics and self-reported questionnaire data was carried out. A thematic analysis of transcripts was performed, as described by Braun and Clarke [ 73 ], by following six steps: raw data was read, text segments related to the study objectives were identified, text segments to create new categories were identified, similar or redundant categories were reduced and a model that integrated all significant categories was created. The analysis was conducted in parallel with patient enrolment to ensure data saturation. To ensure the validity of the coding method, transcripts were double coded independently and discussed by the research team until similar themes were obtained. The research group developed and validated an analysis grid, with which LS coded systematically the transcriptions and met regularly with the research team to discuss questions on data analysis and to ensure the quality of coding. The analysis was carried out in French, and the verbatims of interest cited in the manuscript were translated and validated by a native English-speaking researcher to preserve the meaning.

In this analysis, we used the term “healthcare professionals” when more than one profession could be involved in participants’ medication management. Otherwise, when a specific healthcare professional was involved, we used the designated profession (e.g. physicians, pharmacists).

Patient and public involvement

During the development phase of the study, interview guides and questionnaires were reviewed for clarity and validity and adapted by two patient partners, with multiple health conditions and who experienced previously a hospital discharge. They are part of the HUG Patients Partners + 3P platform for research and patient and public involvement.

Interviews and participants’ descriptions

A total of 75 interviews were conducted with 21 participants. In total, 31 patients were contacted, seven refused to participate (four at the project presentation and three at consent), two did not enter the selection criteria at discharge and one was unreachable after discharge. Among the 21 participants, 15 participated in all interviews, four in three interviews, one in two interviews, and one in one interview, due to scheduling constraints. Details regarding interviews and participants characteristics are presented in Tables  1 and 2 .

The median length of time between hospital discharge and interviews 1,2,3 and 4 was 5 (IQR: 4–7), 14 (13-20), 35 (22-38), and 63 days (61-68), respectively. On average, by comparing medications at hospital admission and discharge, a median of 7 medication changes (IQR: 6–9, range:2;17) occurred per participant during hospitalization and a median of 7 changes (5–12) during the two months following discharge. Details regarding participants’ medications are described in Table  3 .

Patient self-reported adherence over the past week for their three most challenging medications are available in Supplementary Material 3 .

Qualitative analysis

We defined care transition as the period from discharge until the first medical appointment post-discharge, and outpatient care as the period starting after the first medical appointment. Data was organized into three key themes (A. Medication management, B. Medication understanding, and C. Medication adherence) divided into subthemes at three time points (1. Hospitalization, 2. Care transition and 3. Outpatient care). Figure  2 summarizes and illustrates the themes and subthemes with their influencing factors as bullet points.

Participants’ medication management, understanding and adherence during hospitalization, care transition and outpatient care

A. Medication management

A.1 medication management during hospitalization: medication management by hospital staff.

Medications during hospitalization were mainly managed by hospital healthcare professionals (i.e. nurses and physicians) with varying degrees of patient involvement: “At the hospital, they prepared the medications for me. […] I didn’t even know what the packages looked like.” Participant 22; interview 1 (P22.1) Some participants reported having therapeutic education sessions with specialized nurses and physicians, such as the explanation and demonstration of insulin injection and glucose monitoring. A patient reported that he was given the choice of several treatments and was involved in shared decision-making. Other participants had an active role in managing and optimizing dosages, such as rapid insulin, due to prior knowledge and use of medications before hospitalization.

A.2 Medication management at transition: obtaining the medication and initiating self-management

Once discharged, some participants had difficulties obtaining their medications at the pharmacy because some medications were not stored and had to be ordered, delaying medication initiation. To counter this problem upstream, a few participants were provided a 24-to-48-hour supply of medications at discharge. It was sometimes requested by the patient or suggested by the healthcare professionals but was not systematic. The transition from medication management by hospital staff to self-management was exhausting for most participants who were faced with a large amount of new information and changes in their medications: “ When I was in the hospital, I didn’t even realize all the changes. When I came back home, I took away the old medication packages and got out the new ones. And then I thought : « my God, all this…I didn’t know I had all these changes » ” P2.1 Written documentation, such as the discharge prescription or dosage labels on medication packages, was helpful in managing their medication at home. Most participants used weekly pill organizers to manage their medications, which were either already used before hospitalization or were introduced post-discharge. The help of a family caregiver in managing and obtaining medications was reported as a facilitator.

A.3 Medication management in outpatient care: daily self-management and medication burden

A couple of days or weeks after discharge, most participants had acquired a routine so that medication management was less demanding, but the medication burden varied depending on the participants. For some, medication management became a simple action well implemented in their routine (“It has become automatic” , P23.4), while for others, the number of medications and the fact that the medications reminded them of the disease was a heavy burden to bear on a daily basis (“ During the first few days after getting out of the hospital, I thought I was going to do everything right. In the end, well [laughs] it’s complicated. I ended up not always taking the medication, not monitoring the blood sugar” P12.2) To support medication self-management, some participants had written documentation such as treatment plans, medication lists, and pictures of their medication packages on their phones. Some participants had difficulties obtaining medications weeks after discharge as discharge prescriptions were not renewable and participants did not see their physician in time. Others had to visit multiple physicians to have their prescriptions updated. A few participants were faced with prescription or dispensing errors, such as prescribing or dispensing the wrong dosage, which affected medication management and decreased trust in healthcare professionals. In most cases, according to participants, the pharmacy staff worked in an interprofessional collaboration with physicians to provide new and updated prescriptions.

B. Medication understanding

B.1 medication understanding during hospitalization: new information and instructions.

The amount of information received during hospitalization varied considerably among participants with some reporting having received too much, while others saying they received too little information regarding medication changes, the reason for changes, or for introducing new medications: “They told me I had to take this medication all my life, but they didn’t tell me what the effects were or why I was taking it.” P5.3

Hospitalization was seen by some participants as a vulnerable and tiring period during which they were less receptive to information. Information and explanations were generally given verbally, making it complicated for most participants to recall it. Some participants reported that hospital staff was attentive to their needs for information and used communication techniques such as teach-back (a way of checking understanding by asking participants to say in their own words what they need to know or do about their health or medications). Some participants were willing to be proactive in the understanding of their medications while others were more passive, had no specific needs for information, and did not see how they could be engaged more.

B.2 Medication understanding at transition: facing medication changes

At hospital discharge, the most challenging difficulty for participants was to understand the changes made regarding their medications. For newly diagnosed participants, the addition of new medications was more difficult to understand, whereas, for experienced participants, changes in known medications such as dosage modification, changes within a therapeutic class, and generic substitutions were the most difficult to understand. Not having been informed about changes caused confusion and misunderstanding. Therefore, medication reconciliation done by the patient was time-consuming, especially for participants with multiple medications: “ They didn’t tell me at all that they had changed my treatment completely. They just told me : « We’ve changed a few things. But it was the whole treatment ». ” P2.3 Written information, such as the discharge prescription, the discharge report (brief letter summarizing information about the hospitalization, given to the patient at discharge), or the label on the medication box (written by the pharmacist with instructions on dosage) helped them find or recall information about their medications and diagnoses. However, technical terms were used in hospital documentations and were not always understandable. For example, this participant said: “ On the prescription of valsartan, they wrote: ‘resume in the morning once profile…’[once hypertension profile allows]… I don’t know what that means.” P8.1 In addition, some documents were incomplete, as mentioned by a patient who did not have the insulin dosage mentioned on the hospital prescription. Some participants sought help from healthcare professionals, such as pharmacists, hospital physicians, or general practitioners a few days after discharge to review medications, answer questions, or obtain additional information.

B.3 Medication understanding in the outpatient care: concerns and knowledge

Weeks after discharge, most participants had concerns about the long-term use of their medications, their usefulness, and the possible risk of interactions or side effects. Some participants also reported having some lack of knowledge regarding indications, names, or how the medication worked: “I don’t even know what Brilique® [ticagrelor, antiplatelet agent] is for. It’s for blood pressure, isn’t it?. I don’t know.” P11.4 According to participants, the main reasons for the lack of understanding were the lack of information at the time of prescribing and the large number of medications, making it difficult to search for information and remember it. Participants sought information from different healthcare professionals or by themselves, on package inserts, through the internet, or from family and friends. Others reported having had all the information needed or were not interested in having more information. In addition, participants with low medication literacy, such as non-native speakers or elderly people, struggled more with medication understanding and sought help from family caregivers or healthcare professionals, even weeks after discharge: “ I don’t understand French very well […] [The doctor] explained it very quickly…[…] I didn’t understand everything he was saying” P16.2

C. Medication adherence

C.2 medication adherence at transition: adopting new behaviors.

Medication adherence was not mentioned as a concern during hospitalization and a few participants reported difficulties in medication initiation once back home: “I have an injection of Lantus® [insulin] in the morning, but obviously, the first day [after discharge], I forgot to do it because I was not used to it.” P23.1 Participants had to quickly adopt new behaviors in the first few days after discharge, especially for participants with few medications pre-hospitalization. The use of weekly pill organizers, alarms and specific storage space were reported as facilitators to support adherence. One patient did not initiate one of his medications because he did not understand the medication indication, and another patient took her old medications because she was used to them. Moreover, most participants experienced their hospitalization as a turning point, a time when they focused on their health, thought about the importance of their medications, and discussed any new lifestyle or dietary measures that might be implemented.

C.3 Medication adherence in outpatient care: ongoing medication adherence

More medication adherence difficulties appeared a few weeks after hospital discharge when most participants reported nonadherence behaviors, such as difficulties implementing the dosage regimen, or intentionally discontinuing the medication and modifying the medication regimen on their initiative. Determinants positively influencing medication adherence were the establishment of a routine; organizing medications in weekly pill-organizers; organizing pocket doses (medications for a short period that participants take with them when away from home); seeking support from family caregivers; using alarm clocks; and using specific storage places. Reasons for nonadherence were changes in daily routine; intake times that were not convenient for the patient; the large number of medications; and poor knowledge of the medication or side effects. Healthcare professionals’ assistance for medication management, such as the help of home nurses or pharmacists for the preparation of weekly pill-organizers, was requested by participants or offered by healthcare professionals to support medication adherence: “ I needed [a home nurse] to put my pills in the pillbox. […] I felt really weak […] and I was making mistakes. So, I’m very happy [the doctor] offered me [home care]. […] I have so many medications.” P22.3 Some participants who experienced prehospitalization non-adherence were more aware of their non-adherence and implemented strategies, such as modifying the timing of intake: “I said to my doctor : « I forget one time out of two […], can I take them in the morning? » We looked it up and yes, I can take it in the morning.” P11.2 In contrast, some participants were still struggling with adherence difficulties that they had before hospitalization. Motivations for taking medications two months after discharge were to improve health, avoid complications, reduce symptoms, reduce the number of medications in the future or out of obligation: “ I force myself to take them because I want to get to the end of my diabetes, I want to reduce the number of pills as much as possible.” P14.2 After a few weeks post-hospitalization, for some participants, health and illness were no longer the priority because of other life imperatives (e.g., family or financial situation).

This longitudinal study provided a multi-faceted representation of how patients manage, understand, and adhere to their medications from hospital discharge to two months after discharge. Our findings highlighted the varying degree of participants’ involvement in managing their medications during their hospitalization, the individualized needs for information during and after hospitalization, the complicated transition from hospital to autonomous medication management, the adaptation of daily routines around medication once back home, and the adherence difficulties that surfaced in the outpatient care, with nonadherence prior to hospitalization being an indicator of the behavior after discharge. Finally, our results confirmed the lack of continuity in care and showed the lack of patient care standardization experienced by the participants during the transition from hospital to outpatient care.

This in-depth analysis of patients’ experiences reinforces common challenges identified in the existing literature such as the lack of personalized information [ 9 , 10 , 11 ], loss of autonomy during hospitalization [ 14 , 74 , 75 ], difficulties in obtaining medication at discharge [ 11 , 45 , 76 ] and challenges in understanding treatment modifications and generics substitution [ 11 , 32 , 77 , 78 ]. Some of these studies were conducted during patients’ hospitalization [ 10 , 75 , 79 ] or up to 12 months after discharge [ 80 , 81 ], but most studies focused on the few days following hospital discharge [ 9 , 11 , 14 , 82 ]. Qualitative studies on medications at transition often focused on a specific topic, such as medication information, or a specific moment in time, and often included healthcare professionals, which muted patients’ voices [ 9 , 10 , 11 , 47 , 49 ]. Our qualitative longitudinal methodology was interested in capturing the temporal dynamics, in-depth narratives, and contextual nuances of patients’ medication experiences during transitions of care [ 59 , 83 ]. This approach provided a comprehensive understanding of how patients’ perspectives and behaviors evolved over time, offering insights into the complex interactions of medication management, understanding and adherence, and turning points within their medication journeys. A qualitative longitudinal design was used by Fylan et al. to underline patients’ resilience in medication management during and after discharge, by Brandberg et al. to show the dynamic process of self-management during the 4 weeks post-discharge and by Lawton et al. to examine how patients with type 2 diabetes perceived their care after discharge over a period of four years [ 49 , 50 , 51 ]. Our study focused on the first two months following hospitalization and future studies should focus on following discharged and at-risk patients over a longer period, as “transitions of care do not comprise linear trajectories of patients’ movements, with a starting and finishing point. Instead, they are endless loops of movements” [ 47 ].

Our results provide a particularly thorough description of how participants move from a state of total dependency during hospitalization regarding their medication management to a sudden and complete autonomy after hospital discharge impacting medication management, understanding, and adherence in the first days after discharge for some participants. Several qualitative studies have described the lack of shared decision-making and the loss of patient autonomy during hospitalization, which had an impact on self-management and created conflicts with healthcare professionals [ 75 , 81 , 84 ]. Our study also highlights nuanced patient experiences, including varying levels of patient needs, involvement, and proactivity during hospitalization and outpatient care, and our results contribute to capturing different perspectives that contrast with some literature that often portrays patients as more passive recipients of care [ 14 , 15 , 74 , 75 ]. Shared decision-making and proactive medication are key elements as they contribute to a smoother transition and better outcomes for patients post-discharge [ 85 , 86 , 87 ].

Consistent with the literature, the study identifies some challenges in medication initiation post-discharge [ 16 , 17 , 88 ] but our results also describe how daily routine rapidly takes over, either solidifying adherence behavior or generating barriers to medication adherence. Participants’ nonadherence prior to hospitalization was a factor influencing participants’ adherence post-hospitalization and this association should be further investigated, as literature showed that hospitalized patients have high scores of non-adherence [ 89 ]. Mortel et al. showed that more than 20% of discharged patients stopped their medications earlier than agreed with the physician and 25% adapted their medication intake [ 90 ]. Furthermore, patients who self-managed their medications had a lower perception of the necessity of their medication than patients who received help, which could negatively impact medication adherence [ 91 ]. Although participants in our study had high BMQ scores for necessity and lower scores for concerns, some participants expressed doubts about the need for their medications and a lack of motivation a few weeks after discharge. Targeted pharmacy interventions for newly prescribed medications have been shown to improve medication adherence, and hospital discharge is an opportune moment to implement this service [ 92 , 93 ].

Many medication changes were made during the transition of care (a median number of 7 changes during hospitalization and 7 changes during the two months after discharge), especially medication additions during hospitalization and interruptions after hospitalization. While medication changes during hospitalization are well described, the many changes following discharge are less discussed [ 7 , 94 ]. A Danish study showed that approximately 65% of changes made during hospitalization were accepted by primary healthcare professionals but only 43% of new medications initiated during hospitalization were continued after discharge [ 95 ]. The numerous changes after discharge may be caused by unnecessary intensification of medications during hospitalization, delayed discharge letters, lack of standardized procedures, miscommunication, patient self-management difficulties, or in response to an acute situation [ 96 , 97 , 98 ]. During the transition of care, in our study, both new and experienced participants were faced with difficulties in managing and understanding medication changes, either for newly prescribed medication or changes in previous medications. Such difficulties corroborate the findings of the literature [ 9 , 10 , 47 ] and our results showed that the lack of understanding during hospitalization led to participants having questions about their medications, even weeks after discharge. Particular attention should be given to patients’ understanding of medication changes jointly by physicians, nurses and pharmacists during the transition of care and in the months that follow as medications are likely to undergo as many changes as during hospitalization.

Implication for practice and future research

The patients’ perspectives in this study showed, at a system level, that there was a lack of standardization in healthcare professional practices regarding medication dispensing and follow-up. For now, in Switzerland, there are no official guidelines on medication prescription and dispensation during the transition of care although some international guidelines have been developed for outpatient healthcare professionals [ 3 , 99 , 100 , 101 , 102 ]. Here are some suggestions for improvement arising from our results. Patients should be included as partners and healthcare professionals should systematically assess (i) previous medication adherence, (ii) patients’ desired level of involvement and (iii) their needs for information during hospitalization. Hospital discharge processes should be routinely implemented to standardize hospital discharge preparation, medication prescribing, and dispensing. Discharge from the hospital should be planned with community pharmacies to ensure that all medications are available and, if necessary, doses of medications should be supplied by the hospital to bridge the gap. A partnership with outpatient healthcare professionals, such as general practitioners, community pharmacists, and homecare nurses, should be set up for effective asynchronous interprofessional collaboration to consolidate patients’ medication management, knowledge, and adherence, as well as to monitor signs of deterioration or adverse drug events.

Future research should consolidate our first attempt to develop a framework to better characterize medication at the transition of care, using Fig. 2   as a starting point. Contextualized interventions, co-designed by health professionals, patients and stakeholders, should be tested in a hybrid implementation study to test the implementation and effectiveness of the intervention for the health system [ 103 ].

Limitations

This study has some limitations. First, the transcripts were validated for accuracy by the interviewer but not by a third party, which could have increased the robustness of the transcription. Nevertheless, the interviewer followed all methodological recommendations for transcription. Second, patient inclusion took place during the COVID-19 pandemic, which may have had an impact on patient care and the availability of healthcare professionals. Third, we cannot guarantee the accuracy of some participants’ medication history before hospitalization, even though we contacted the participants’ main pharmacy, as participants could have gone to different pharmacies to obtain their medications. Fourth, our findings may not be generalizable to other populations and other healthcare systems because some issues may be specific to multimorbid patients with type 2 diabetes or to the Swiss healthcare setting. Nevertheless, issues encountered by our participants regarding their medications correlate with findings in the literature. Fifth, only 15 out of 21 participants took part in all the interviews, but most participants took part in at least three interviews and data saturation was reached. Lastly, by its qualitative and longitudinal design, it is possible that the discussion during interviews and participants’ reflections between interviews influenced participants’ management, knowledge, and adherence, even though this study was observational, and no advice or recommendations were given by the interviewer during interviews.

Discharged patients are willing to take steps to better manage, understand, and adhere to their medications, yet they are also faced with difficulties in the hospital and outpatient care. Furthermore, extensive changes in medications not only occur during hospitalization but also during the two months following hospital discharge, for which healthcare professionals should give particular attention. The different degrees of patients’ involvement, needs and resources should be carefully considered to enable them to better manage, understand and adhere to their medications. At a system level, patients’ experiences revealed a lack of standardization of medication practices during the transition of care. The healthcare system should provide the ecosystem needed for healthcare professionals responsible for or involved in the management of patients’ medications during the hospital stay, discharge, and outpatient care to standardize their practices while considering the patient as an active partner.

Data availability

The anonymized quantitative survey datasets and the qualitative codes are available in French from the corresponding author on reasonable request.

Abbreviations

adverse drug events

Adherence Visual Analogue Scale

Belief in Medication Questionnaire

Consolidated Criteria for Reporting Qualitative Research

case report form

standard deviation

World Health Organization

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Acknowledgements

The authors would like to thank all the patients who took part in this study. We would also like to thank the Geneva University Hospitals Patients Partners + 3P platform as well as Mrs. Tourane Corbière and Mr. Joël Mermoud, patient partners, who reviewed interview guides for clarity and significance. We would like to thank Samuel Fabbi, Vitcoryavarman Koh, and Pierre Repiton for the transcriptions of the audio recordings.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Open access funding provided by University of Geneva

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LS, GG, and MS conceptualized and designed the study. LS and GG screened and recruited participants. LS conducted the interviews. LS, GG, and MS performed data analysis and interpretation. LS drafted the manuscript and LS and MS worked on the different versions. MS and GG approved the final manuscript.

Corresponding authors

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Ethics approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779), and informed consent to participate was obtained from all participants.

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Solh Dost, L., Gastaldi, G. & Schneider, M. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 24 , 620 (2024). https://doi.org/10.1186/s12913-024-10784-9

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Received : 28 June 2023

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Published : 13 May 2024

DOI : https://doi.org/10.1186/s12913-024-10784-9

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The Concerns of Community-Dwelling Older Women Living with Urinary Incontinence: Qualitative Research

• Original Article
• Published: 13 May 2024

Cite this article

• Elnaz Talebi 1 ,
• Monir Nobahar   ORCID: orcid.org/0000-0001-8800-5620 2 , 3 ,
• Mahshid Foroughan 4 &
• Mohammad Reza Asgari 2 , 3  

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Introduction and Hypothesis

The world including Iran is facing population aging. Urinary incontinence (UI) is one of the most common health concerns of older women that can be accompanied by an increased sense of loneliness, social restrictions, and disruption in activities of daily living in addition to the regular challenges of old age. This study was aimed at explaining the concerns of community-dwelling older women living with UI.

This study used the conventional, qualitative, content analysis approach with purposive sampling. Twenty interviews were conducted with 18 participants, including 15 community-dwelling older women with UI and three family members (a husband and two daughters), over the span of 14 months (from August 2021 to October 2022). The data were collected via semi-structured, face-to-face interviews until data saturation was achieved, and were analyzed using Graneheim and Lundman’s method.

The findings revealed that the concerns of older women with UI include the impasse of UI, being powerless in life, distorted social identity, and marital frustration, which fell under the main theme of sense of inadequacy.

Conclusions

Recognizing the concerns of older women with UI can make health care teams more sensitive to the importance of resolving these concerns and can offer some insight into how best to provide targeted training, support, and counseling services at individual, family, and society levels, to eventually resolve the older adult’s sense of inadequacy.

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Data availability.

The datasets generated and analyzed during the current study are not publicly available owing to an agreement with the participants on the confidentiality of the data, but are available from the corresponding author on reasonable request.

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Acknowledgements

This research is part of a doctoral dissertation. The authors wish to express their gratitude to the Deputy of Research of Semnan and Rofiedeh Rehabilitation Hospital for supporting this project.

The authors received no financial support for the research, authorship, and/or publication of this article.

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Elnaz Talebi

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Monir Nobahar & Mohammad Reza Asgari

Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran

Iranian Research Center On Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

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All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

E.T.: conceptualization, methodology, investigation, data curation, writing the original draft, writing review and editing; M.N.: conceptualization, methodology, investigation, data curation, writing the original draft, writing review and editing, supervision, project administration; M.F.: conceptualization, data curation, writing the original draft, writing review and editing; M.R.A.: conceptualization, data curation, writing the original draft, writing review and editing.

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Talebi, E., Nobahar, M., Foroughan, M. et al. The Concerns of Community-Dwelling Older Women Living with Urinary Incontinence: Qualitative Research. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05810-7

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• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

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There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

Peer Review reports

Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

Author information

Olivia R. Phillips and Cerian Harries share joint first authorship.

Authors and Affiliations

Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

Joanne R. Morling

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Contributions

Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

Corresponding author

Correspondence to Olivia R. Phillips .

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40900_2024_580_MOESM1_ESM.docx

Additional file 1: Search strings: Description of data: the search strings and filters used in each of the 5 databases in this review

Additional file 2: Quality appraisal questions: Description of data: CASP quality appraisal questions

40900_2024_580_moesm3_esm.docx.

Additional file 3: Table 1: Description of data: elements of the data extraction table that are not in the main manuscript

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Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

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Received : 28 November 2023

Accepted : 25 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s40900-024-00580-4

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