qualitative research on social work

• Technical Support
• Find My Rep

You are here

Qualitative Studies in Social Work Research

• Catherine Kohler Riessman - Boston College, USA
• Description

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

For instructors

Select a purchasing option, related products.

Site Content

Qualitative research in social work.

second edition

Edited by Anne E. Fortune, William J. Reid, and Robert L. Miller

Columbia University Press

Pub Date: May 2013

ISBN: 9780231161398

Format: Paperback

List Price: $75.00 £62.00

Shipping Options

Purchasing options are not available in this country.

ISBN: 9780231161381

Format: Hardcover

List Price: $150.00 £125.00

ISBN: 9780231535441

Format: E-book

List Price: $74.99 £62.00

• EPUB via the Columbia UP App
• PDF via the Columbia UP App

This edition continues with an emphasis on qualitative program evaluation and ends with some exemplary studies in strong practice domains in our field. Deborah Gioia, University of Maryland, School of Social Work

About the Author

• Social Work: Research Methods
• Social Work

• Find My Rep

You are here

Qualitative Research in Social Work

• Ian Shaw - University of York, UK
• Nick Gould - University of Bath, UK
• Description

'The back cover of the book proclaims that "Qualitative Research in Social Work will be essential reading for all students, practitioners and researchers undertaking social work research." That just about sums it up for me' - British Journal of Social Work

`This book is a significant milestone in the development of social work research. It is characterized by an unparalleled command of the field of qualitative research in social work, and by a commitment to an understanding of the demands and potential of day-to-day social work practice' - Mike Fisher, Director of Research, National Institute for Social Research

` Qualitative Research in Social Work edited by Ian Shaw and Nick Gould, provides a state-of-the-art exposition and analysis of qualitative inquiry in relation to social work.... The book has an unusual degree of coherence for one with several authors. The five chapters by the editors (parts one and three) do an exceptional job of providing the necessary background information and setting the context for the six application chapters and of highlighting and discussing the issues raised in those chapters. The editors are respected scholars

well-versed in the theory and practice of qualitative research. Similarly, the contributing authors represent both considerable experience in this field and a diversity of interests. This combination makes Qualitative Research in Social Work an excellent text for students, practitioners, and researchers alike. It is a benchmark for social work progress in this area and points the way for the continued development of qualitative inquiry' - Professor Stanley L Witkin, Department of Social Work, University of Vermont

There is a clear need for a book which treats qualitative research as a substantive theme within social work, setting epistemological and methodological issues in a context whereby the agenda is set by, and is relevant to, social work. Qualitative Research in Social Work is just such a book and will be immensely useful for students, practitioners and researchers interested in and undertaking social work research.

In the introductory chapters the co-authors set qualitative research within a context of social work developments and problems. The central section provides additional topicality and directness through specially commissioned chapters from leading figures in this field each covering key qualitative methods and relating them to social work settings, and the final section which reviews qualitative research in social work, and aims to exemplify ways in which social work thought and practice can be advanced through research.   PART ONE: THE SOCIAL WORK AGENDA FOR QUALITATIVE RESEARCH   The Social Work Context for Qualitative Research   A Review of Qualitative Research in Social Work   PART TWO: EXEMPLIFYING QUALITATIVE SOCIAL WORK RESEARCH Tom Hall Caught Not Taught Ethnographic Research at a Young People's Accomodation Project

`A really fine book... an impressive work that adds much to the development of the use of qualitative methodology in social work research' - William J Reid, University at Albany

`Qualitative Research in Social Work edited by Ian Shaw and Nick Gould, provides a state-of-the-art exposition and analysis of qualitative inquiry in relation to social work.... The book has an unusual degree of coherence for one with several authors. The five chapters by the editors (parts one and three) do an exceptional job of providing the necessary background information and setting the context for the six application chapters and of highlighting and discussing the issues raised in those chapters. The editors are respected scholars

For anyone wanting to locate the importance of this research method within the wider context of the paradigm wars, this text is essential for social work academics and practitioners in research.

Preview this book

For instructors.

Please select a format:

Select a Purchasing Option

• Electronic Order Options VitalSource Amazon Kindle Google Play eBooks.com Kobo

Related Products

SAGE Research Methods is a research methods tool created to help researchers, faculty and students with their research projects. SAGE Research Methods links over 175,000 pages of SAGE’s renowned book, journal and reference content with truly advanced search and discovery tools. Researchers can explore methods concepts to help them design research projects, understand particular methods or identify a new method, conduct their research, and write up their findings. Since SAGE Research Methods focuses on methodology rather than disciplines, it can be used across the social sciences, health sciences, and more.

With SAGE Research Methods, researchers can explore their chosen method across the depth and breadth of content, expanding or refining their search as needed; read online, print, or email full-text content; utilize suggested related methods and links to related authors from SAGE Research Methods' robust library and unique features; and even share their own collections of content through Methods Lists. SAGE Research Methods contains content from over 720 books, dictionaries, encyclopedias, and handbooks, the entire “Little Green Book,” and "Little Blue Book” series, two Major Works collating a selection of journal articles, and specially commissioned videos.

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

29 Conceptualization in qualitative research

Chapter outline

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

15.2 Multiparadigmatic research: An example

15.3 idiographic causal relationships, 15.4 qualitative research questions.

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

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

17.1 Alternative paradigms: Interpretivism, critical, and pragmatism

Learning objectives.

Students will be able to…

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

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

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

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

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

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

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

How do scientific ideas change over time?

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

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

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

Paradigm vs. theory

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

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

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

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

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

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

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

Interpretivism: Researcher as “empathizer”

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

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

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

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

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

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

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

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

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

Is interpretivism right for your project?

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

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

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

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

Critical paradigm: Researcher as “activist”

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

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

Is the critical paradigm right for your project?

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

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

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

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

Pragmatism: Researcher as “strategist”

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

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

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

Adopt a multi-paradigmatic perspective

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

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

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

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

Key Takeaways

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

Learners will be able to…

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

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

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

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

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

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

Designing a study using paradigm and theory: An example

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

Thinking as an expert: Positivism

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

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

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

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

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

Thinking like an empathizer: Interpretivism

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

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

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

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

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

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

Thinking like an activist: Critical

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

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

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

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

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

Conceptualization is an iterative process

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

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

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

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

The hypothetico-deductive method

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

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

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

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

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

Whose truth does science establish?

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

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

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

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

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

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

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

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

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

What do idiographic causal explanations look like?

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

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

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

Understanding “why?”

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

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

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

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

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

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

Theory building and theory testing

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

Through inductive reasoning and idiographic causal explanations!

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

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

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

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

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

Complementary approaches

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Qualitative research questions often contain words or phrases like “lived experience,” “personal experience,” “understanding,” “meaning,” and “stories.”
• Qualitative research questions can change and evolve over the course of the study.
• Using the guidance in this chapter, write a qualitative research question. You may want to use some of the keywords mentioned above.
• Kivuna, C. & Kuyini, A. B. (2017). Understanding and applying research paradigms in educational contexts. International Journal of Higher Education, 6 (5), 26-41. https://eric.ed.gov/?id=EJ1154775 ↵
• Kuhn, T. (1962). The structure of scientific revolutions . Chicago: University of Chicago Press. ↵
• Fleuridas, C., & Krafcik, D. (2019). Beyond four forces: The evolution of psychotherapy. Sage Open ,  9 (1), 2158244018824492. ↵
• Shneider, A. M. (2009). Four stages of a scientific discipline; four types of scientist. Trends in Biochemical Sciences 34 (5), 217-233. https://doi.org/10.1016/j.tibs.2009.02.00 ↵
• Burrell, G. & Morgan, G. (1979). Sociological paradigms and organizational analysis . Routledge. Guba, E. (ed.) (1990). The paradigm dialog . SAGE. ↵
• Routledge. Guba, E. (ed.) (1990). The paradigm dialog . SAGE. ↵
• Burrell, G. & Morgan, G. (1979). Sociological paradigms and organizational analysis . Here is a summary of Burrell & Morgan from Babson College , and our classification collapses radical humanism and radical structuralism into the critical paradigm, following Guba and Lincoln's three-paradigm framework. We feel this approach is more parsimonious and easier for students to understand on an introductory level. ↵
• For more about how the meanings of hand gestures vary by region, you might read the following blog entry: Wong, W. (2007). The top 10 hand gestures you’d better get right . Retrieved from: http://www.languagetrainers.co.uk/blog/2007/09/24/top-10-hand-gestures ↵
• Rosario, M., Schrimshaw, E. W., Hunter, J., & Levy-Warren, A. (2009). The coming-out process of young lesbian and bisexual women: Are there butch/femme differences in sexual identity development?. Archives of sexual behavior ,  38 (1), 34-49. ↵
• Calhoun, C., Gerteis, J., Moody, J., Pfaff, S., & Virk, I. (Eds.). (2007). Classical sociological theory  (2nd ed.). Malden, MA: Blackwell. ↵
• Fraser, N. (1989).  Unruly practices: Power, discourse, and gender in contemporary social theory . Minneapolis, MN: University of Minnesota Press. ↵
• Here are links to two HBSE open textbooks, if you are unfamiliar with social work theories and would like more background. https://uark.pressbooks.pub/hbse1/ and https://uark.pressbooks.pub/humanbehaviorandthesocialenvironment2/ ↵
• Box, G. E. P.. (1976). Science and statistics. Journal of the American Statistical Association, 71 (356), 791. ↵
• Heineman-Pieper, J., Tyson, K., & Pieper, M. H. (2002). Doing good science without sacrificing good values: Why the heuristic paradigm is the best choice for social work.  Families in Society ,  83 (1), 15-28. ↵
• Crasnow, S. (2020). Feminist perspectives on science. In E. N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Winter 2020 Edition). Retrieved from: https://plato.stanford.edu/entries/feminist-science/ ↵
• Grogan, K.E. (2019) How the entire scientific community can confront gender bias in the workplace. Nature Ecology & Evolution, 3 ,  3–6. doi:10.1038/s41559-018-0747-4 ↵
• Tasca, C., Rapetti, M., Carta, M. G., & Fadda, B. (2012). Women and hysteria in the history of mental health. Clinical practice and epidemiology in mental health: Clinical practice & epidemiology in mental health ,  8 , 110-119. ↵
• Klonsky, E. D., Jane, J. S., Turkheimer, E., & Oltmanns, T. F. (2002). Gender role and personality disorders.  Journal of personality disorders ,  16 (5), 464-476. ↵
• Smith, L. T. (2013). Decolonizing methodologies: Research and indigenous peoples . Zed Books Ltd. ↵
• Fricker, M. (2011). Epistemic injustice: Power and the ethics of knowing . Oxford University Press. ↵

The highest level of measurement. Denoted by mutually exclusive categories, a hierarchy (order), values can be added, subtracted, multiplied, and divided, and the presence of an absolute zero.

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

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

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

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

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

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

research that describes or defines a particular phenomenon

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

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

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

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

Share This Book

Social Work Research Methods That Drive the Practice

Social workers advocate for the well-being of individuals, families and communities. But how do social workers know what interventions are needed to help an individual? How do they assess whether a treatment plan is working? What do social workers use to write evidence-based policy?

Social work involves research-informed practice and practice-informed research. At every level, social workers need to know objective facts about the populations they serve, the efficacy of their interventions and the likelihood that their policies will improve lives. A variety of social work research methods make that possible.

Data-Driven Work

Data is a collection of facts used for reference and analysis. In a field as broad as social work, data comes in many forms.

Quantitative vs. Qualitative

As with any research, social work research involves both quantitative and qualitative studies.

Quantitative Research

Answers to questions like these can help social workers know about the populations they serve — or hope to serve in the future.

• How many students currently receive reduced-price school lunches in the local school district?
• How many hours per week does a specific individual consume digital media?
• How frequently did community members access a specific medical service last year?

Quantitative data — facts that can be measured and expressed numerically — are crucial for social work.

Quantitative research has advantages for social scientists. Such research can be more generalizable to large populations, as it uses specific sampling methods and lends itself to large datasets. It can provide important descriptive statistics about a specific population. Furthermore, by operationalizing variables, it can help social workers easily compare similar datasets with one another.

Qualitative Research

Qualitative data — facts that cannot be measured or expressed in terms of mere numbers or counts — offer rich insights into individuals, groups and societies. It can be collected via interviews and observations.

• What attitudes do students have toward the reduced-price school lunch program?
• What strategies do individuals use to moderate their weekly digital media consumption?
• What factors made community members more or less likely to access a specific medical service last year?

Qualitative research can thereby provide a textured view of social contexts and systems that may not have been possible with quantitative methods. Plus, it may even suggest new lines of inquiry for social work research.

Mixed Methods Research

Combining quantitative and qualitative methods into a single study is known as mixed methods research. This form of research has gained popularity in the study of social sciences, according to a 2019 report in the academic journal Theory and Society. Since quantitative and qualitative methods answer different questions, merging them into a single study can balance the limitations of each and potentially produce more in-depth findings.

However, mixed methods research is not without its drawbacks. Combining research methods increases the complexity of a study and generally requires a higher level of expertise to collect, analyze and interpret the data. It also requires a greater level of effort, time and often money.

The Importance of Research Design

Data-driven practice plays an essential role in social work. Unlike philanthropists and altruistic volunteers, social workers are obligated to operate from a scientific knowledge base.

To know whether their programs are effective, social workers must conduct research to determine results, aggregate those results into comprehensible data, analyze and interpret their findings, and use evidence to justify next steps.

Employing the proper design ensures that any evidence obtained during research enables social workers to reliably answer their research questions.

Research Methods in Social Work

The various social work research methods have specific benefits and limitations determined by context. Common research methods include surveys, program evaluations, needs assessments, randomized controlled trials, descriptive studies and single-system designs.

Surveys involve a hypothesis and a series of questions in order to test that hypothesis. Social work researchers will send out a survey, receive responses, aggregate the results, analyze the data, and form conclusions based on trends.

Surveys are one of the most common research methods social workers use — and for good reason. They tend to be relatively simple and are usually affordable. However, surveys generally require large participant groups, and self-reports from survey respondents are not always reliable.

Program Evaluations

Social workers ally with all sorts of programs: after-school programs, government initiatives, nonprofit projects and private programs, for example.

Crucially, social workers must evaluate a program’s effectiveness in order to determine whether the program is meeting its goals and what improvements can be made to better serve the program’s target population.

Evidence-based programming helps everyone save money and time, and comparing programs with one another can help social workers make decisions about how to structure new initiatives. Evaluating programs becomes complicated, however, when programs have multiple goal metrics, some of which may be vague or difficult to assess (e.g., “we aim to promote the well-being of our community”).

Needs Assessments

Social workers use needs assessments to identify services and necessities that a population lacks access to.

Common social work populations that researchers may perform needs assessments on include:

• People in a specific income group
• Everyone in a specific geographic region
• A specific ethnic group
• People in a specific age group

In the field, a social worker may use a combination of methods (e.g., surveys and descriptive studies) to learn more about a specific population or program. Social workers look for gaps between the actual context and a population’s or individual’s “wants” or desires.

For example, a social worker could conduct a needs assessment with an individual with cancer trying to navigate the complex medical-industrial system. The social worker may ask the client questions about the number of hours they spend scheduling doctor’s appointments, commuting and managing their many medications. After learning more about the specific client needs, the social worker can identify opportunities for improvements in an updated care plan.

In policy and program development, social workers conduct needs assessments to determine where and how to effect change on a much larger scale. Integral to social work at all levels, needs assessments reveal crucial information about a population’s needs to researchers, policymakers and other stakeholders. Needs assessments may fall short, however, in revealing the root causes of those needs (e.g., structural racism).

Randomized Controlled Trials

Randomized controlled trials are studies in which a randomly selected group is subjected to a variable (e.g., a specific stimulus or treatment) and a control group is not. Social workers then measure and compare the results of the randomized group with the control group in order to glean insights about the effectiveness of a particular intervention or treatment.

Randomized controlled trials are easily reproducible and highly measurable. They’re useful when results are easily quantifiable. However, this method is less helpful when results are not easily quantifiable (i.e., when rich data such as narratives and on-the-ground observations are needed).

Descriptive Studies

Descriptive studies immerse the researcher in another context or culture to study specific participant practices or ways of living. Descriptive studies, including descriptive ethnographic studies, may overlap with and include other research methods:

• Informant interviews
• Census data
• Observation

By using descriptive studies, researchers may glean a richer, deeper understanding of a nuanced culture or group on-site. The main limitations of this research method are that it tends to be time-consuming and expensive.

Single-System Designs

Unlike most medical studies, which involve testing a drug or treatment on two groups — an experimental group that receives the drug/treatment and a control group that does not — single-system designs allow researchers to study just one group (e.g., an individual or family).

Single-system designs typically entail studying a single group over a long period of time and may involve assessing the group’s response to multiple variables.

For example, consider a study on how media consumption affects a person’s mood. One way to test a hypothesis that consuming media correlates with low mood would be to observe two groups: a control group (no media) and an experimental group (two hours of media per day). When employing a single-system design, however, researchers would observe a single participant as they watch two hours of media per day for one week and then four hours per day of media the next week.

These designs allow researchers to test multiple variables over a longer period of time. However, similar to descriptive studies, single-system designs can be fairly time-consuming and costly.

Learn More About Social Work Research Methods

Social workers have the opportunity to improve the social environment by advocating for the vulnerable — including children, older adults and people with disabilities — and facilitating and developing resources and programs.

Learn more about how you can earn your  Master of Social Work online at Virginia Commonwealth University . The highest-ranking school of social work in Virginia, VCU has a wide range of courses online. That means students can earn their degrees with the flexibility of learning at home. Learn more about how you can take your career in social work further with VCU.

From M.S.W. to LCSW: Understanding Your Career Path as a Social Worker

How Palliative Care Social Workers Support Patients With Terminal Illnesses

How to Become a Social Worker in Health Care

Gov.uk, Mixed Methods Study

MVS Open Press, Foundations of Social Work Research

Open Social Work Education, Scientific Inquiry in Social Work

Open Social Work, Graduate Research Methods in Social Work: A Project-Based Approach

Routledge, Research for Social Workers: An Introduction to Methods

SAGE Publications, Research Methods for Social Work: A Problem-Based Approach

Theory and Society, Mixed Methods Research: What It Is and What It Could Be

READY TO GET STARTED WITH OUR ONLINE M.S.W. PROGRAM FORMAT?

Bachelor’s degree is required.

VCU Program Helper

This AI chatbot provides automated responses, which may not always be accurate. By continuing with this conversation, you agree that the contents of this chat session may be transcribed and retained. You also consent that this chat session and your interactions, including cookie usage, are subject to our privacy policy .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

The PMC website is updating on October 15, 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J Grad Med Educ
• v.7(4); 2015 Dec

Choosing a Qualitative Research Approach

Associated data.

Editor's Note: The online version of this article contains a list of further reading resources and the authors' professional information .

The Challenge

Educators often pose questions about qualitative research. For example, a program director might say: “I collect data from my residents about their learning experiences in a new longitudinal clinical rotation. If I want to know about their learning experiences, should I use qualitative methods? I have been told that there are many approaches from which to choose. Someone suggested that I use grounded theory, but how do I know this is the best approach? Are there others?”

What Is Known

Qualitative research is the systematic inquiry into social phenomena in natural settings. These phenomena can include, but are not limited to, how people experience aspects of their lives, how individuals and/or groups behave, how organizations function, and how interactions shape relationships. In qualitative research, the researcher is the main data collection instrument. The researcher examines why events occur, what happens, and what those events mean to the participants studied. 1 , 2

Qualitative research starts from a fundamentally different set of beliefs—or paradigms—than those that underpin quantitative research. Quantitative research is based on positivist beliefs that there is a singular reality that can be discovered with the appropriate experimental methods. Post-positivist researchers agree with the positivist paradigm, but believe that environmental and individual differences, such as the learning culture or the learners' capacity to learn, influence this reality, and that these differences are important. Constructivist researchers believe that there is no single reality, but that the researcher elicits participants' views of reality. 3 Qualitative research generally draws on post-positivist or constructivist beliefs.

Qualitative scholars develop their work from these beliefs—usually post-positivist or constructivist—using different approaches to conduct their research. In this Rip Out, we describe 3 different qualitative research approaches commonly used in medical education: grounded theory, ethnography, and phenomenology. Each acts as a pivotal frame that shapes the research question(s), the method(s) of data collection, and how data are analyzed. 4 , 5

Choosing a Qualitative Approach

Before engaging in any qualitative study, consider how your views about what is possible to study will affect your approach. Then select an appropriate approach within which to work. Alignment between the belief system underpinning the research approach, the research question, and the research approach itself is a prerequisite for rigorous qualitative research. To enhance the understanding of how different approaches frame qualitative research, we use this introductory challenge as an illustrative example.

The clinic rotation in a program director's training program was recently redesigned as a longitudinal clinical experience. Resident satisfaction with this rotation improved significantly following implementation of the new longitudinal experience. The program director wants to understand how the changes made in the clinic rotation translated into changes in learning experiences for the residents.

Qualitative research can support this program director's efforts. Qualitative research focuses on the events that transpire and on outcomes of those events from the perspectives of those involved. In this case, the program director can use qualitative research to understand the impact of the new clinic rotation on the learning experiences of residents. The next step is to decide which approach to use as a frame for the study.

The table lists the purpose of 3 commonly used approaches to frame qualitative research. For each frame, we provide an example of a research question that could direct the study and delineate what outcomes might be gained by using that particular approach.

Methodology Overview

How You Can Start TODAY

• 1 Examine the foundations of the existing literature: As part of the literature review, make note of what is known about the topic and which approaches have been used in prior studies. A decision should be made to determine the extent to which the new study is exploratory and the extent to which findings will advance what is already known about the topic.
• 2 Find a qualitatively skilled collaborator: If you are interested in doing qualitative research, you should consult with a qualitative expert. Be prepared to talk to the qualitative scholar about what you would like to study and why . Furthermore, be ready to describe the literature to date on the topic (remember, you are asking for this person's expertise regarding qualitative approaches—he or she won't necessarily have content expertise). Qualitative research must be designed and conducted with rigor (rigor will be discussed in Rip Out No. 8 of this series). Input from a qualitative expert will ensure that rigor is employed from the study's inception.
• 3 Consider the approach: With a literature review completed and a qualitatively skilled collaborator secured, it is time to decide which approach would be best suited to answering the research question. Questions to consider when weighing approaches might include the following:
• • Will my findings contribute to the creation of a theoretical model to better understand the area of study? ( grounded theory )
• • Will I need to spend an extended amount of time trying to understand the culture and process of a particular group of learners in their natural context? ( ethnography )
• • Is there a particular phenomenon I want to better understand/describe? ( phenomenology )

What You Can Do LONG TERM

• 1 Develop your qualitative research knowledge and skills : A basic qualitative research textbook is a valuable investment to learn about qualitative research (further reading is provided as online supplemental material). A novice qualitative researcher will also benefit from participating in a massive online open course or a mini-course (often offered by professional organizations or conferences) that provides an introduction to qualitative research. Most of all, collaborating with a qualitative researcher can provide the support necessary to design, execute, and report on the study.
• 2 Undertake a pilot study: After learning about qualitative methodology, the next best way to gain expertise in qualitative research is to try it in a small scale pilot study with the support of a qualitative expert. Such application provides an appreciation for the thought processes that go into designing a study, analyzing the data, and reporting on the findings. Alternatively, if you have the opportunity to work on a study led by a qualitative expert, take it! The experience will provide invaluable opportunities for learning how to engage in qualitative research.

Supplementary Material

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Navy, the Department of Defense, or the US government.

References and Resources for Further Reading

Breadcrumbs Section. Click here to navigate to respective pages.

Qualitative Research Skills for Social Work

DOI link for Qualitative Research Skills for Social Work

Get Citation

Malcolm Carey provides social work students, academics and practitioners with a practical guide to completion of a small-scale qualitative research project or dissertation. This clear text takes the reader through the process of beginning and developing a research problem or question, defining their objectives and undertaking empirical or literature-based research that involves data collection, analysis, writing up and dissemination. The book also highlights and details potential obstacles, essential techniques and methods, types of theory and methodology used, and presents case studies and ongoing debates involved in qualitative social work research. It suggests ways by which sometimes difficult processes (such as the literature review, interviews with practitioners, etc.) can be made easier to complete and explores traditional methods such as the focus group or interview alongside less conventional methodologies such as participative, narrative, discourse or ICT-related approaches. Recent investigation has highlighted the lack of research skills held by many social workers in practice. This book overcomes these problems by providing an essential and easily accessible guidebook to qualitative research methods for social work students and practitioners as well as being of interest to tutors who teach research methods to social work students or supervise dissertations.

TABLE OF CONTENTS

Part | 2  pages, part 1: foundations of qualitative social work research, chapter 1 | 14  pages, introducing qualitative social work research, chapter 2 | 14  pages, the research process, chapter 3 | 14  pages, core social work research concepts, chapter 4 | 12  pages, the literature review, chapter 5 | 12  pages, literature-based research and methodologies, chapter 6 | 14  pages, theoretical and philosophical perspectives, chapter 7 | 14  pages, methodology, chapter 8 | 10  pages, research ethics, part 2: qualitative methodology and methods, chapter 9 | 18  pages, interviews and questionnaires, chapter 10 | 8  pages, focus groups, chapter 11 | 12  pages, grounded theory and case studies, chapter 12 | 16  pages, ethnography, chapter 13 | 10  pages, life histories and biographical research, chapter 14 | 12  pages, narrative and discourse analysis, chapter 15 | 12  pages, participative research, chapter 16 | 18  pages, internet research, part 3: analysis, writing and dissemination, chapter 17 | 16  pages, chapter 18 | 12  pages, writing up and dissemination.

• Privacy Policy
• Terms & Conditions
• Cookie Policy
• Taylor & Francis Online
• Taylor & Francis Group
• Students/Researchers
• Librarians/Institutions

Connect with us

Registered in England & Wales No. 3099067 5 Howick Place | London | SW1P 1WG © 2024 Informa UK Limited

SWK 327: Social Work Research Methods: Qualitative

• Quantitative
• Finding Empirical Articles
• Qualitative
• APA Resources
• Literature Review

Tyoes of Qualitative Research

Examples of Common Techniques:

• Interviews , which may be structured, semi-structured or unstructured;
• Focus groups , which involve multiple participants discussing an issue;
• Secondary data , including diaries, written accounts of past events, and company reports; and
• Observational - (in a controlled setting), which may be on site, or under ‘laboratory conditions’, for example, where participants are asked to role-play a situation to show what they might do; or , for example (in a public space), which may include places like a mall food court, a playground, a bus stop or other locations where there is no expectation of privacy.

Article location Strategies for Qualitative research

The most efficient method of locating Qualitative research articles is to determine a topic and a method you are interested in.  For example, if you are interested in research article on how owning a pet affects homeless teens or the elderly, you could use:

• homeless AND "pet ownership" AND interview
• homeless AND qualitative AND pets
• "homeless people" AND "pet ownership" AND qualitative

Each of the search strategies (above) will produce results in ProQuest.  But which search resulted in the best results? 

Qualitative Research: Sample Journals

• Qualitative Social Work: Research & Practice
• Qualitative Research
• Qualitative Studies

Information about Qualitative research and Social Work Practice

• Evaluating Qualitative Research for Social Work Practitioners The purpose of this article is to provide students and practitioners some orientation regarding qualitative research methods and to highlight some strategies to evaluate the trustworthiness and quality of qualitative research.

• << Previous: Finding Empirical Articles
• Next: APA Resources >>
• Last Updated: Jun 12, 2024 4:09 PM
• URL: https://slulibrary.saintleo.edu/c.php?g=555966

Evaluating Qualitative Research for Social Work Practitioners

• September 2010
• Advances in Social Work 11(2):188-202
• 11(2):188-202

• Arizona State University

• Grand Canyon University

Discover the world's research

• 25+ million members
• 160+ million publication pages
• 2.3+ billion citations

• Patrick McLaughlin

• Rebecca Ofundem Bessong

• Afeez Abiola Hazzan

• Cornelia Vorster
• Liana le Roux

• Elca Erlank
• Rhulani Sherlock Bopape

• Paula Isabel Becerra-Villarroel
• Lorena Patricia Gallardo-Peralta
• RES SOCIAL WORK PRAC

• Matthew O. Howard

• J Evid Base Soc Work
• C. Aaron McNeece

• Carol L. Langer
• Rich Furman

• Recruit researchers
• Join for free
• Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google Welcome back! Please log in. Email · Hint Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google No account? Sign up

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Journal Proposal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

“ it is as if i gave a gift to myself ”: a qualitative phenomenological study on working adults’ leisure meaning, experiences, and participation.

1. Introduction

1.1. leisure definition, 1.2. leisure participation and meaning, 1.3. leisure in working adults, 1.4. leisure and well-being, 1.5. flow and leisure, 1.6. leisure as a right and occupational justice, 1.7. objective of the study, 2. materials and methods, 2.1. study design, 2.2. sampling and participant recruitment, 2.3. instrument, 2.4. data collection, 2.5. data analysis, 3.1. sociodemographic data of participants, 3.2. qualitative data analysis results.

• Meaning of leisure

“ When I say free time, it makes people feel like I have an obligation and you’re getting rid of it. For example, use your free time as if you were under arrest and go out to the courtyard. We live with responsibility and anxiety, and when we feel happy, it feels like being free. ” (Dilara, 26 yo, F, Psychologist, lives in Aksaray province)

“ I do my leisure on Sundays… I do it by putting them in order. I can’t do it due to busy weekdays. Now I have to plan, as I have very little time left. I do what I want; everything I do, I do willingly. ”

“ Free time is like a time period when I watch something meaningless on Netflix that will completely empty my mind. ”

“ A human being has feelings and emotions; they are not merely like machines. He desires to use time in a different way. Some people do this through walking, while others do it through other activities, such as making art or having fun with their kids. ”

“ In my opinion, what distinguishes me from a departed person—what sets me apart from someone who has passed away—are my leisure activities… If I only come and go between work and home for the next 30 years, I would consider this to be a life I have never experienced. The process is analogous to story writing. ”

“ When I think of leisure, I think of things where I can be alone with myself and do stuff with quality. You can do what you want to do, and it is your moments of pleasure that you set aside for yourself. ”

“ I give up my sleep in the morning. I’ll go to work early and make myself coffee. I motivate myself there. No matter how busy you are, you can always find a few minutes to yourself. ” Neriman (44 yo, Government Official, F, lives in Istanbul province)

“ I am very relaxed (took a deep breath and exhaled). I mean, when I do something outside of work and outside of the normal routine, if we go out, I feel such a relief. ”

“ I define leisure as things you can do to improve yourself. (Ozan, 31 yo, M, Engineer, lives in Istanbul province)

“ Leisure is also considered the activity that people do to renew themselves and complete their personal development. ” (Ahmet, 31 yo, M, Engineer, lives in Düzce province)

“ I feel mentally relaxed with that. If I do something on the weekend and forget what I did on Friday, I am happy to try to remember it on Monday morning. I try to provide mental relaxation. (Ali, 37 yo, Engineer, lives in Istanbul province)

“ I think of leisure as the time when people can relax. But this rest should include not only physical but also mental rest. Resting is actually being able to calm down for me. ” (Sude, Speech and Language Therapist, 26 yo, F, lives in Aydın province)

“ We can say that it is a work-related problem, because if I had a few more days of annual leave, I could go to Eskişehir province (her hometown) to visit my family and friends. When I can’t participate in my leisure, that bothers me the most. There is really limited time after work. Sometimes I feel so bad when I can’t do the things I want to do. There are times when I even get sleepy and postpone going to sleep for the sake of leisure time ” (Sude, Speech and Language Therapist, 26 yo, F, lives in Aydın province)

“ My husband is my biggest facilitator for my leisure time and my life too. ” (Fatma, 41 yo, Government Official, F, lives in Mersin province)

“ It makes easier to have an understanding partner. The circle of friends makes it easier. ” (Orhan, 38 yo, Teacher, M, lives in Muş province)

“ I also have colleagues who are much older than me. It already creates a generational problem with them. Your expectations and wishes are different. Other than that, I am the only one who is single; everyone is married. That’s why nothing happens. People are constantly involved in their own plans. ”

“ It is close, which makes my leisure time easier… I also have a bicycle. I reach there in ten minutes. As a facilitator, it leaves time for what I will do. ”

“ There is a significant difference between before and after I have my own car.” If you do not have a car, you are going places by taxi. For a woman, having her own car is a wonderful thing. It’s great to have that key in your pocket. ”

“ It is very different because of the city I live in. For example, when I was in North Cyprus, everything was different at night. Now that I leave work at 6 p.m., it’s eight until I say, come home and eat. What can I do after 8 p.m.? It’s a small city, after all. ” Dilara (26 yo, Psychologist, F)

“ Of course, there are obstacles, especially because I have a problem allocating time…I remember feeling very good when I was able to have me time, and sometimes I miss it. You know, it’s good to get married, but there is also a reverse side to getting married: you have to transfer your leisure time to the family. I spend time with my family. Since our child is younger, we cannot participate in many social activities. ” (Ahmet, 31 yo, M, Engineer, lives in Düzce province)

“ Because my wife is taking care of our young children, she cannot participate much in her leisure time… In the evenings, we-as parents- prepare meals for the children, play games, and help with their homework. Responsibilities continues after work. ” (Orhan, 38 yo, Teacher, M, lives in Muş province)

“ I feel very good about doing something for myself. I listen to myself… I am very happy with the value that I give to myself… I think it gives you a lot of pleasure. It’s like happiness and pride combined. ” (Dilara, 26 yo, F, Psychologist, lives in Aksaray province)

“I feel the pleasure of this happiness .” (Seda, 27 yo, F, Teacher, lives in Hakkari province)

“It is as if I gave a gift to myself.” (Güneş, 31 yo, Lecturer, lives in Istanbul province)

“ Leisure is legendary for me. I’ve never been ahead of it; I’ve always tried to do it, but I wasn’t upset when I couldn’t. If I couldn’t today, let today pass; I’ll do it tomorrow. I say that this is how it should be, and I say that there is good in it.I am happy. Isn’t that the purpose of life? ” (Şahin, Basketball Coach, 34 yo, lives in Kilis province)

“ Leisure keeps me motivated. Life is what drives me. You live in a world of ups and downs. Let me tell you, I love to be happy. ”

“ When I can’t do something or when I can’t do something with my friends, I get restless. I’m concentrating on doing that job. It gives me uneasiness. Because doing it gives me peace of mind. It gives me restlessness and unhappiness when I can’t do it…I am losing my mood; my energy is low. ” (Gökçe, 35 yo, Lecturer, F, lives in Istanbul province)

“ For example, that day, I get very uneasy if I can’t read the Holy Quran first… But when I don’t read books, I am very angry with myself. I say you left yourself behind, Zehra, again…I think I left myself behind. I feel very sad. For example, I think that I don’t take time for myself when I go for a walk. Again, I say you ignored yourself, Zehra. ”

“ Of course, when you can’t participate to your leisure time there is boredom, both because you can’t do it and because your time is wasted ”

“ When I can’t meet my friends, I sometimes feel good, but generally I feel incomplete. I feel restless when I don’t have time for myself. Even if I am not so tired, I still feel like I am not fully mentally rested.”

“ When I think the times, I cannot able to do my leisure…For instance, I think about myself in quarantine for COVID disease. I stand like this and wait to be picked. I am sour. The front of my house is open and has a view of a field). I looked straight ahead. But it’s meaningless. I probably wouldn’t want my whole life to be like this. It’s like a Nuri Bilge Ceylan movie. ” (Özge, 30 yo, F, Research Assistant, lives in Ankara province)

“ Progression, for instance, modifies a number of your behaviours. Habits that you once enjoyed may now seem absurd, or you may now be able to appreciate activities you once considered impossible. In the end, man is a constantly evolving organism. Our beliefs, health, and mental state are all evolving. There are many factors that contribute to change. There are internal factors. All external factors have an effect. Even a person’s negative experiences influence every aspect of his life. At that time, I was hanging out with friends more, doing things like hiking and going out. Much rarer now. Maybe it’s because of age; it could be because everyone got married. We started to work. I don’t want it too much anymore; it’s more attractive to stay at home. My habits have changed. The pandemic has changed our habits a lot. ”

4. Discussion

4.1. leisure definition, 4.2. meaning of leisure, 4.3. flow of the life.

“ Habits that you once enjoyed may now seem absurd, or you may now be able to appreciate activities you once considered impossible. In the end, man is a constantly evolving organism ” (Erhan)

4.4. Facilitators–Barriers

“ I am a nurse. I want to learn the language by myself. I study German in my spare time, usually. It takes most of my time. I want to work abroad and practise my profession there. I have a purpose.” (Erhan)

4.5. Recovery and Well-Being

4.6. occupational injustice, 5. conclusions, 6. implications, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

• American Occupational Therapy Association. Occupational Therapy Practice Framework: Domain et Process ; American Occupational Therapy Association: Bethesda, MD, USA, 2020. [ Google Scholar ]
• Primeau, L.A. Play and Leisure. In Willard & Spackman’s Occupational Therapy , 10th ed.; Willard, H.S., Cohn, E.S., Boyt Schell, B.A., Spackman, C.S., Blesedell Crepeau, E., Eds.; Lippincott Williams and Wilkins: Philadelphia, PA, USA, 2003; pp. 633–658. ISBN 978-0781727983. [ Google Scholar ]
• Raz-Yurovich, L. Leisure: Definitions, Trends, and Policy Implications. Popul. Res. Policy Rev. 2022 , 41 , 981–1019. [ Google Scholar ] [ CrossRef ]
• Newman, D.B.; Tay, L.; Diener, E. Leisure and Subjective Well-Being: A Model of Psychological Mechanisms as Mediating Factors. J. Happiness Stud. 2014 , 15 , 555–578. [ Google Scholar ] [ CrossRef ]
• Mansfield, L. Leisure and Health—Critical Commentary. Ann. Leis. Res. 2021 , 24 , 283–294. [ Google Scholar ] [ CrossRef ]
• Law, M.; Polatajko, H.; Baptiste, S.; Townsend, E. Core Concepts of Occupational Therapy. Enabling Occup. Occup. Ther. Perspect. 1997 , 29 , 56. [ Google Scholar ]
• Oliver, K.G.; Collin, P.; Burns, J.; Nicholas, J. Building Resilience in Young People through Meaningful Participation. Aust. E-J. Adv. Ment. Health 2006 , 5 , 34–40. [ Google Scholar ] [ CrossRef ]
• Jenq, S.-N.; Chen, M.-R. Research on Leisure Needs, Leisure Participation and Leisure Obstacles of Family Caregivers with Intellectual Disabilities. Open Access Libr. J. 2021 , 8 , 1–22. [ Google Scholar ] [ CrossRef ]
• Nakamura, J.; Csikzentmihalyi, M. The Construction of Meaning through Vital Engagement. In Flourishing: Positive Psychology and the Life Well-Lived ; American Psychological Association: Washington, DC, USA, 2003; pp. 83–104. [ Google Scholar ] [ CrossRef ]
• Iwasaki, Y. Leisure and meaning-making: The pursuit of a meaningful life through leisure. In Global Leisure and the Struggle for a Better World ; Beniwal, A., Jain, R., Spracklen, K., Eds.; Palgrave Macmillan: Basingstoke, UK, 2018. [ Google Scholar ]
• Porter, H.; Iwasaki, Y.; Shank, J. Conceptualizing Meaning-Making through Leisure Experiences. Loisir Société/Soc. Leis. 2010 , 33 , 167–194. [ Google Scholar ] [ CrossRef ]
• Iwasaki, Y. Pathways to Meaning-Making Through Leisure-Like Pursuits in Global Contexts. J. Leis. Res. 2008 , 40 , 231–249. [ Google Scholar ] [ CrossRef ]
• Iwasaki, Y.; Messina, E.; Shank, J.; Coyle, C. Role of Leisure in Meaning-Making for Community-Dwelling Adults with Mental Illness. J. Leis. Res. 2015 , 47 , 538–555. [ Google Scholar ] [ CrossRef ]
• Sonnentag, S.; Cheng, B.H.; Parker, S.L. Recovery from Work: Advancing the Field Toward the Future. Annu. Rev. Organ. Psychol. Organ. Behav. 2022 , 9 , 33–60. [ Google Scholar ] [ CrossRef ]
• Imms, C.; Adair, B.; Keen, D.; Ullenhag, A.; Rosenbaum, P.; Granlund, M. ‘Participation’: A Systematic Review of Language, Definitions, and Constructs Used in Intervention Research with Children with Disabilities. Dev. Med. Child Neurol. 2016 , 58 , 29–38. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chun, S.; Heo, J.; Ryu, J. Leisure Participation, Physical Health, and Mental Health in Older Adults. Act. Adapt. Aging 2023 , 47 , 195–213. [ Google Scholar ] [ CrossRef ]
• Kim, J.; Yamada, N.; Heo, J.; Han, A. Health Benefits of Serious Involvement in Leisure Activities among Older Korean Adults. Int. J. Qual. Stud. Health Well-Being 2014 , 9 , 24616. [ Google Scholar ] [ CrossRef ]
• Elsden, E.; Bu, F.; Fancourt, D.; Mak, H.W. Frequency of Leisure Activity Engagement and Health Functioning over a 4-Year Period: A Population-Based Study amongst Middle-Aged Adults. BMC Public Health 2022 , 22 , 1275. [ Google Scholar ] [ CrossRef ]
• Li, J.; Hsu, C.-C.; Lin, C.-T. Leisure Participation Behavior and Psychological Well-Being of Elderly Adults: An Empirical Study of Tai Chi Chuan in China. Int. J. Environ. Res. Public Health 2019 , 16 , 3387. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Argan, M.; Tokay Argan, M.; Dursun, M. Examining Relationships Among Well-Being, Leisure Satisfaction, Life Satisfaction, and Happiness. Int. J. Med. Res. Health Sci. 2018 , 7 , 49–59. [ Google Scholar ]
• Mansfield, L.; Daykin, N.; Kay, T. Leisure and Wellbeing. Leis. Stud. 2020 , 39 , 1–10. [ Google Scholar ] [ CrossRef ]
• Morse, K.F.; Fine, P.A.; Friedlander, K.J. Creativity and Leisure During COVID-19: Examining the Relationship Between Leisure Activities, Motivations, and Psychological Well-Being. Front. Psychol. 2021 , 12 , 609967. [ Google Scholar ] [ CrossRef ]
• Garmabi, K.M.; Rezaee, M.; Pashmdarfard, M. Factors Associated with Participation of Community-Dwelling Older Adults in Activities Related to Leisure and Social Participation: A Systematic Review. Middle East J. Rehabil. Health Stud. 2023 , 10 , e131146. [ Google Scholar ] [ CrossRef ]
• Sardina, A.; Tan, S.C.; Gamaldo, A. Leisure Barriers Among Older Adults in Low-Income Housing: Demographic, Health, and Contextual Correlates. Innov. Aging 2020 , 4 (Suppl. S1), 577. [ Google Scholar ] [ CrossRef ]
• Hassett, L.; Shields, N.; Cole, J.; Owen, K.; Sherrington, C. Comparisons of Leisure-Time Physical Activity Participation by Adults with and without a Disability: Results of an Australian Cross-Sectional National Survey. BMJ Open Sport Exerc. Med. 2021 , 7 , e000991. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Cantor, P.; Polakowska, M.; Proietti, A.; Tran, V.; Lebire, J.; Roy, L. Leisure Possibilities of Adults Experiencing Poverty: A Community-Based Participatory Study. Can. J. Occup. Ther. 2022 , 89 , 103–114. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Csikszentmihalyi, M. Flow: The Psychology of Optimal Experience ; Harper and Row: New York, NY, USA, 1990. [ Google Scholar ]
• Stebbins, R.A. Challenging Mountain Nature: Risk, Motive, and Lifestyle in Three Hobbyist Sports ; Detselig Enterprises Ltd.: Calgary, AB, Canada, 2005. [ Google Scholar ]
• Tse, D.C.K.; Nakamura, J.; Csikszentmihalyi, M. Beyond Challenge-Seeking and Skill-Building: Toward the Lifespan Developmental Perspective on Flow Theory. J. Posit. Psychol. 2020 , 15 , 171–182. [ Google Scholar ] [ CrossRef ]
• Hurd, A.; Anderson, D.M.; Mainieri, T. Kraus’ Recreation and Leisure in Modern Society ; Jones & Bartlett Learning: Burlington, USA, 2021. [ Google Scholar ]
• Tse, D.C.K.; Nakamura, J.; Csikszentmihalyi, M. Flow Experiences Across Adulthood: Preliminary Findings on the Continuity Hypothesis. J. Happiness Stud. 2022 , 23 , 2517–2540. [ Google Scholar ] [ CrossRef ]
• Sivan, A.; Veal, A.J. Leisure and Human Rights: The World Leisure Organization Charter for Leisure: Past, Present and Future. World Leis. J. 2021 , 63 , 133–140. [ Google Scholar ] [ CrossRef ]
• Universal Declaration of Human Rights at 70: 30 Articles on 30 Articles—Article 24. OHCHR. Available online: https://www.ohchr.org/en/press-releases/2018/12/universal-declaration-human-rights-70-30-articles-30-articles-article-24 (accessed on 4 February 2024).
• Wilcock, A.A.; Hocking, C. An Occupational Perspective of Health , 3rd ed.; Slack: Thorofare, NJ, USA, 2015. [ Google Scholar ]
• Hammell, K.W. Reflections on … Well-Being and Occupational Rights. Can. J. Occup. Ther. 2008 , 75 , 61–64. [ Google Scholar ] [ CrossRef ]
• Durocher, E.; Gibson, B.E.; Rappolt, S. Occupational Justice: A Conceptual Review. J. Occup. Sci. 2014 , 21 , 418–430. [ Google Scholar ] [ CrossRef ]
• Hosseini, S.M.S.; Sarhady, M.; Nurani Gharaborghe, S.; Mazdeh, M. Leisure of People With Multiple Sclerosis: A Content Analysis. Iran. Rehabil. J. 2017 , 15 , 23–30. [ Google Scholar ] [ CrossRef ]
• Edwards, L.; Owen-Booth, B. An Exploration of Engagement in Community Based Creative Activities as an Occupation for Older Adults. Ir. J. Occup. Ther. 2021 , 49 , 51–57. [ Google Scholar ] [ CrossRef ]
• Berglund, M.; Westin, L.; Svanström, R.; Sundler, A. Suffering Caused by Care—Patients’ Experiences from Hospital Settings. Int. J. Qual. Stud. Health Well-Being 2012 , 7 , 18688. [ Google Scholar ] [ CrossRef ]
• Lopez, K.A.; Willis, D.G. Descriptive Versus Interpretive Phenomenology: Their Contributions to Nursing Knowledge. Qual Health Res. 2004 , 14 , 726–735. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tuffour, I. A Critical Overview of Interpretative Phenomenological Analysis: A Contemporary Qualitative Research Approach. J. Healthc. Commun. 2017 , 2 , 52. [ Google Scholar ] [ CrossRef ]
• Peat, G.; Rodriguez, A.; Smith, J. Interpretive Phenomenological Analysis Applied to Healthcare Research. Evid. Based Nurs. 2019 , 22 , 7–9. [ Google Scholar ] [ CrossRef ]
• Collingridge, D.S.; Gantt, E.E. The Quality of Qualitative Research. Am. J. Med. Qual. 2019 , 34 , 439. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Valerio, M.A.; Rodriguez, N.; Winkler, P.; Lopez, J.; Dennison, M.; Liang, Y.; Turner, B.J. Comparing Two Sampling Methods to Engage Hard-to-Reach Communities in Research Priority Setting. BMC Med. Res. Methodol. 2016 , 16 , 146. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Leighton, K.; Kardong-Edgren, S.; Schneidereith, T.; Foisy-Doll, C. Using Social Media and Snowball Sampling as an Alternative Recruitment Strategy for Research. Clin. Simul. Nurs. 2021 , 55 , 37–42. [ Google Scholar ] [ CrossRef ]
• Zickar, M.J.; Keith, M.G. Innovations in Sampling: Improving the Appropriateness and Quality of Samples in Organizational Research. Annu. Rev. Organ. Psychol. Organ. Behav. 2023 , 10 , 315–337. [ Google Scholar ] [ CrossRef ]
• Alase, A. The Interpretative Phenomenological Analysis (IPA): A Guide to a Good Qualitative Research Approach. Int. J. Educ. Lit. Stud. 2017 , 5 , 9–19. [ Google Scholar ] [ CrossRef ]
• Nehls, K.; Smith, B.D.; Schneider, H.A. Video-Conferencing Interviews in Qualitative Research. In Enhancing Qualitative and Mixed Methods Research with Technology ; IGI Global: Hershey, PA, USA, 2015; pp. 140–157. [ Google Scholar ] [ CrossRef ]
• Azungah, T. Qualitative Research: Deductive and Inductive Approaches to Data Analysis. Qual. Res. J. 2018 , 18 , 383–400. [ Google Scholar ] [ CrossRef ]
• Richards, L. Writing a Qualitative Thesis or Grant Application. In So Where’s YourResearch Profile? A Resource Book for Academics ; Beattie, K., Ed.; Union of Australian College Academics: South Melbourne, Australia, 1993. [ Google Scholar ]
• Perry, C.; Jensen, O. Approaches to combining induction and deduction in one research study In Proceedings of the Conference of the Australian and New Zealand Marketing Academy, Auckland, New Zealand, 1–5 December 2001.
• Demirbaş, G. Locating Leisure as the Route to Well-Being: Challenges of Researching Women’s Leisure in Turkey. In Leisure and Wellbeing ; Mansfield, L., Naykin, D., Eds.; Routledge: New York, NY, USA, 2022. [ Google Scholar ]
• Pindek, S.; Shen, W.; Andel, S. Finally, Some “Me Time”: A New Theoretical Perspective on the Benefits of Commuting. Organ. Psychol. Rev. 2023 , 13 , 44–66. [ Google Scholar ] [ CrossRef ]
• Rowe, D. Complexity and the Leisure Complex. Ann. Leis. Res. 2016 , 19 , 1–6. [ Google Scholar ] [ CrossRef ]
• Hutteman, R.; Hennecke, M.; Orth, U.; Reitz, A.K.; Specht, J. Developmental Tasks as a Framework to Study Personality Development in Adulthood and Old Age. Eur. J. Pers. 2014 , 28 , 267–278. [ Google Scholar ] [ CrossRef ]
• Aktu, Y. Levinson’un kuramında ilk yetişkinlik döneminin yaşam yapısı. Psikiyatr. Güncel Yaklaşımlar 2016 , 8 , 162–177. [ Google Scholar ] [ CrossRef ]
• Kim, C.; Cho, Y. Working Conditions and Leisure-Time Physical Activity among Waged Workers in South Korea: A Cross-Sectional Study. J. Occup. Health 2015 , 57 , 259–267. [ Google Scholar ] [ CrossRef ]
• Gürbüz, B.; Henderson, K.A. Leisure Activity Preferences and Constraints: Perspectives from Turkey. World Leis. J. 2014 , 56 , 300–316. [ Google Scholar ] [ CrossRef ]
• Ayotte, B.J.; Margrett, J.A.; Hicks-Patrick, J. Physical Activity in Middle-Aged and Young-Old Adults: The Roles of Self-Efficacy, Barriers, Outcome Expectancies, Self-Regulatory Behaviors and Social Support. J. Health Psychol. 2010 , 15 , 173–185. [ Google Scholar ] [ CrossRef ]
• Bauman, A.E.; Reis, R.S.; Sallis, J.F.; Wells, J.C.; Loos, R.J.; Martin, B.W. Correlates of Physical Activity: Why Are Some People Physically Active and Others Not? Lancet 2012 , 380 , 258–271. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Scarapicchia, T.M.F.; Amireault, S.; Faulkner, G.; Sabiston, C.M. Social Support and Physical Activity Participation among Healthy Adults: A Systematic Review of Prospective Studies. Int. Rev. Sport Exerc. Psychol. 2017 , 10 , 50–83. [ Google Scholar ] [ CrossRef ]
• White, C.M.; Hutchinson, S.; Gallant, K.; Hamilton-Hinch, B. Beyond the Barriers: First-Voice Perspectives on Facilitators of Leisure Participation. Can. J. Community Ment. Health 2020 , 39 , 119–131. [ Google Scholar ] [ CrossRef ]
• Kurumsal. 5 December 2022. Consumer Price Index, November 2022. Available online: https://data.tuik.gov.tr/Bulten/Index?p=Tuketici-Fiyat-Endeksi-Kasim-2022-45800 (accessed on 5 February 2024).
• Mathes, E.W. Maslow’s Hierarchy of Needs as a Guide for Living. J. Humanist. Psychol. 1981 , 21 , 69–72. [ Google Scholar ] [ CrossRef ]
• Pawsey, H.; Cramer, K.M.; DeBlock, D. Life Satisfaction and Maslow’s Hierarchy of Needs: An International Analysis of the World Values Survey. Int. J. Happiness Dev. 2023 , 8 , 66–79. [ Google Scholar ] [ CrossRef ]
• Arora, N.; Robinson, K.; Charm, T.; Grimmelt, A.; Ortega, M.; Staack, Y.; Whitehead, S.; Yamakawa, N. Consumer Sentiment and Behavior Continue to Reflect the Uncertainty of the COVID-19 Crisis ; McKinsey Company: New York City, NY, USA, 2020; Available online: https://www.mckinsey.com/capabilities/growth-marketing-and-sales/our-insights/a-global-view-of-how-consumer-behavior-is-changing-amid-covid-19 (accessed on 5 February 2024).
• Living Standards, Poverty and İnequality in the UK: 2023; Institute for Fiscal Studies: London, UK. Available online: https://ifs.org.uk/publications/living-standards-poverty-and-inequality-uk-2023 (accessed on 5 February 2024).
• Freund, A.M. The Bucket List Effect: Why Leisure Goals Are Often Deferred until Retirement. Am. Psychol. 2020 , 75 , 499–510. [ Google Scholar ] [ CrossRef ]
• Kuykendall, L.; Lei, X.; Zhu, Z.; Hu, X. Leisure Choices and Employee Well-Being: Comparing Need Fulfillment and Well-Being during TV and Other Leisure Activities. Appl. Psychol. Health Well-Being 2020 , 12 , 532–558. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Iso-Ahola, S.E.; Baumeister, R.F. Leisure and Meaning in Life. Front. Psychol. 2023 , 14 , 1074649. [ Google Scholar ] [ CrossRef ]
• Denovan, A.; Macaskill, A. Building Resilience to Stress through Leisure Activities: A Qualitative Analysis. Ann. Leis. Res. 2017 , 20 , 446–466. [ Google Scholar ] [ CrossRef ]
• Takiguchi, Y.; Matsui, M.; Kikutani, M.; Ebina, K. The Relationship between Leisure Activities and Mental Health: The Impact of Resilience and COVID-19. Appl. Psychol. Health Well-Being 2023 , 15 , 133–151. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sonnentag, S.; Fritz, C. The Recovery Experience Questionnaire: Development and Validation of a Measure for Assessing Recuperation and Unwinding from Work. J. Occup. Health Psychol. 2007 , 12 , 204–221. [ Google Scholar ] [ CrossRef ]
• Lu, L.; Argyle, M. Leisure Satisfaction and Happiness as a Function of Leisure Activity. Gaoxiong Yi Xue Ke Xue Za Zhi 1994 , 10 , 89–96. [ Google Scholar ]
• Mitas, O.; Qian, X.L.; Yarnal, C.; Kerstetter, D. “The Fun Begins Now!”: Broadening and Building Processes in Red Hat Society ® Participation. J. Leis. Res. 2011 , 43 , 30–55. [ Google Scholar ] [ CrossRef ]
• Huppert, F.A.; Baylis, N.; Keverne, B.; Fredrickson, B.L. The Broaden–and–Build Theory of Positive Emotions. Philos. Trans. R. Soc. Lond. Ser. B Biol. Sci. 2004 , 359 , 1367–1377. [ Google Scholar ] [ CrossRef ]
• Wegner, L.; Stirrup, S.; Desai, H.; de Jongh, J.-C. “This Pandemic Has Changed Our Daily Living”: Young Adults’ Leisure Experiences during the COVID-19 Pandemic in South Africa. J. Occup. Sci. 2022 , 29 , 323–335. [ Google Scholar ] [ CrossRef ]
• Chen, S.-T.; Hyun, J.; Graefe, A.R.; Mowen, A.J.; Almeida, D.M.; Sliwinski, M.J. The Influence of Leisure Engagement on Daily Emotional Well-Being. Leis. Sci. 2022 , 44 , 995–1012. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Olafsen, A.H.; Bentzen, M. Benefits of Psychological Detachment From Work: Does Autonomous Work Motivation Play a Role? Front. Psychol. 2020 , 11 , 527448. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kelly, C.M.; Strauss, K.; Arnold, J.; Stride, C. The Relationship between Leisure Activities and Psychological Resources That Support a Sustainable Career: The Role of Leisure Seriousness and Work-Leisure Similarity. J. Vocat. Behav. 2020 , 117 , 103340. [ Google Scholar ] [ CrossRef ]
• Darawsheh, W.B. Exploration of Occupational Deprivation Among Syrian Refugees Displaced in Jordan. Am. J. Occup. Ther. 2019 , 73 , 7304205030p1–7304205030p9. [ Google Scholar ] [ CrossRef ]
• Benjamin-Thomas, T.E.; Rudman, D.L.; McGrath, C.; Cameron, D.; Abraham, V.J.; Gunaseelan, J.; Vinothkumar, S.P. Situating Occupational Injustices Experienced by Children with Disabilities in Rural India within Sociocultural, Economic, and Systemic Conditions. J. Occup. Sci. 2022 , 29 , 97–114. [ Google Scholar ] [ CrossRef ]
• Whiteford, G.; Jones, K.; Rahal, C.; Suleman, A. The Participatory Occupational Justice Framework as a Tool for Change: Three Contrasting Case Narratives. J. Occup. Sci. 2018 , 25 , 497–508. [ Google Scholar ] [ CrossRef ]
• Ammann, B.; Satink, T.; Andresen, M. Experiencing Occupations with Chronic Hand Disability: Narratives of Hand-Injured Adults. Hand Ther. 2012 , 17 , 87–94. [ Google Scholar ] [ CrossRef ]
• Crabtree, J.L.; Wall, J.M.; Ohm, D. Critical Reflections on Participatory Action Research in a Prison Setting: Toward Occupational Justice. OTJR Occup. Ther. J. Res. 2016 , 36 , 244–252. [ Google Scholar ] [ CrossRef ]

Click here to enlarge figure

Share and Cite

Sezer, K.S.; Aki, E. “ It Is as if I Gave a Gift to Myself ”: A Qualitative Phenomenological Study on Working Adults’ Leisure Meaning, Experiences, and Participation. Behav. Sci. 2024 , 14 , 833. https://doi.org/10.3390/bs14090833

Sezer KS, Aki E. “ It Is as if I Gave a Gift to Myself ”: A Qualitative Phenomenological Study on Working Adults’ Leisure Meaning, Experiences, and Participation. Behavioral Sciences . 2024; 14(9):833. https://doi.org/10.3390/bs14090833

Sezer, Kubra Sahadet, and Esra Aki. 2024. "“ It Is as if I Gave a Gift to Myself ”: A Qualitative Phenomenological Study on Working Adults’ Leisure Meaning, Experiences, and Participation" Behavioral Sciences 14, no. 9: 833. https://doi.org/10.3390/bs14090833

Article Metrics

Further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

Qualitative assessment of the enablers and barriers of COVID-19 vaccination integration, into routine immunization Programme at primary health care facilities in Ekiti state, Nigeria

• Open access
• Published: 18 September 2024
• Volume 21 , article number  94 , ( 2024 )

Cite this article

You have full access to this open access article

• Akolade Uthman Jimoh 1 ,
• Oyebanji Filani 2 ,
• Dapo Awobeku 3 ,
• Saheed Dipo Isiaka 4 ,
• Mahfus Dauda 4 ,
• Esther Opeyemi Adeshina 4 ,
• Olugbemisola Wuraola Samuel 4 ,
• Oluwafisayo Azeez Ayodeji 1 ,
• Segun Adekanmi Adenipekun 5 ,
• Chukwudinma Okoh 1 ,
• Kehinde Adediran 1 ,
• Sunday Atobatele 1 , 4 ,
• Sidney Sampson 1 , 4 ,
• Tobiloba Tinuoye 1 ,
• Ayodele Seluwa 2 ,
• Nicholas Ojo 2 &
• Sunday Omoya 2  

The introduction of the COVID-19 vaccine influenced discussions to explore integrating COVID-19 vaccination into routine immunization (RI) programs. Subsequently, the WHO Strategic Advisory Group Experts (SAGE) on immunization plausibly advised countries to leverage the COVID-19 vaccination rollout as a transformative opportunity to establish a resilient immunization system, through an integrated immunization system, resulting in strengthened primary healthcare services.

This study assessed the enablers and barriers to integrating COVID-19 vaccination into the routine immunization programme in Ekiti state, Nigeria.

This study utilized a qualitative research approach to obtain information from 40 participants selected purposively across the primary healthcare facilities, LGA, and state levels. A three-tier approach was employed to select the LGAs. At the same time, In-depth interviews were conducted to elicit relevant information on the assessment of enablers and barriers to integrating COVID-19 vaccination into routine immunization through an interview guide. All the audio interview files were transcribed into English Language, coded, and presented using a thematic approach.

A total of 40 healthcare workers across Ekiti state were selected to participate in this study. Our study found the enablers of integrating COVID-19 into routine immunization to include demand generation and social mobilization, health education, health workers training, data validation, financing, and supervision. However, rumors, demand for incentives, Adverse Events Following Immunization (AEFI), manpower shortage, poor internet network services, and bad road networks were reported as barriers to integrating COVID-19 vaccination into routine immunization in Ekiti state.

While the enablers of integrating COVID-19 vaccination into routine immunization may outweigh its barriers, it is pertinent to know that the efforts towards integrating COVID–19 vaccination in the RI Program is a call to all stakeholders to ensure sustainability. The identified barriers in the study must be addressed to ensure a strengthened health system. Therefore, achieving a successful integration and uptake of vaccination/immunization is anchored on driving demand generation, social mobilization, health education, availability of healthcare workers, integrated supervision, and financing.

Explore related subjects

• Artificial Intelligence

Avoid common mistakes on your manuscript.

Text box 1: contributions to literature

This paper described the enablers and barriers to integrating COVID-19 vaccination into routine immunization in primary health care facilities in Ekiti state, Nigeria

Clients’ demand for incentives, the fear of adverse events following immunization, poor internet services, and road networks are barriers to vaccine uptake

Demand generation, social mobilization, and health education for caregivers are essential to integrated service delivery

Health workers’ training and improved data reporting structure aided quality service delivery

2 Background

The initial outbreak of COVID-19 was reported in December 2019 in China [ 1 ], which propelled into a multifaceted health challenge within three months of its emergence across the globe [ 2 ], subsequently resulting in its declaration as a pandemic in March 2020 by the World Health Organization [ 3 , 4 ]. Aside from being an unknown threat to the global populace at the onset, it equally orchestrated the disruption of several existing public health interventions [ 5 , 6 ], especially in low and middle-income countries (LMICs) [ 7 , 8 ]

According to Ihekwazu [ 9 ], these challenges resulted from the limited convergence of vertical disease program resources to strengthen the entire health system in LMICs. One of many health programs affected by the COVID-19 menace was the immunization services offered to children 0–59 months, through Routine Immunization (RI) [ 10 , 11 ]. RI is considered the hub of healthcare services for children, and a preventable channel for reducing under-five mortality rates, by preventing them from various infectious diseases [ 12 , 13 , 14 ]. The World Health Organization [ 15 ] and Adamu et al., [ 16 ] predicted that the halting of RI services increased the susceptibility of about 80 million children across 68 countries to various vaccine-preventable diseases including diphtheria, measles, and polio, thereby endangering the lives of these children.

Following the emergence of COVID-19 vaccines, scholars such as Adamu et al., [ 16 ] contended the importance of exploring the integration of COVID-19 vaccination into routine immunization. Subsequently, the WHO Strategic Advisory Group Experts (SAGE) on immunization plausibly advised countries to leverage the COVID-19 vaccination rollout as a transformative opportunity to establish a resilient immunization system, through an integrated immunization strategy, resulting in strengthened primary healthcare services [ 17 , 18 ].

The National Primary Healthcare Development Agency (NPHCDA) defined the eligible population for the COVID-19 vaccines in Nigeria to include adults over 18 years of age [ 19 ], but in rare cases of students traveling outside the country to school, children who are 16 years and above were allowed to be vaccinated [ 20 ]. This was adopted across all states in the country. On the other hand, while RI is offered to children from 0 to 59 months based on the National RI guidelines [ 21 ], many of the children who received RI during the intervention on integration in Ekiti state, were less than 2 years of age. The children are expected to have received about 22 antigens including yellow fever, Hepatitis B, measles 1 and 2, and polio vaccines, to be considered fully immunized [ 22 , 23 ]

Mirza et al. [ 24 ] in a study across 11 African countries (including Nigeria), reported that COVID-19 vaccines facilitated a gateway for high-priority populations (like the elderly, health workers, and people living with comorbidities) outside of the traditional system for children and women of reproductive age, providing opportunities for integrating other health interventions. This also fostered multi-sectoral collaboration between ministries and private sectors. Lava et al. [ 25 ] also found that aside from the increased COVID-19 vaccination coverage, integrating the COVID-19 vaccine services into primary healthcare improved individuals’ access to healthcare in the Philippines. However, poor strategic planning, an overburdened health workforce, and the unavailability of a supply chain logistics management system posed threats to this integration in some African countries [ 24 , 26 ].

Thus, this approach of integrating into routine immunization programs was adopted across all states in Nigeria. The Ekiti State Primary Healthcare Development Agency (ESPHCDA through the National Primary Healthcare Development Agency (NPHCDA), and the collaborative partnerships with local and international implementing partners adopted an integrated immunization strategy premised on a fixed team and mobile team approaches. The fixed team operates from the health facilities and is usually the immunization team in the health facilities. On the other hand, the mobile team is often more in number and tasked with visiting villages and communities. Against this backdrop, this study assessed the enablers and barriers of integrating COVID-19 vaccination into the routine immunization programme in Ekiti state, Nigeria.

2.1 Research methods

This study adopted a qualitative research approach to obtain information from 40 participants selected purposively across the primary healthcare facilities, Local Government Area (LGA), and state levels. A three-tier approach was used to select the LGAs. At the same time, In-depth interviews were conducted to elicit relevant information on the assessment of enablers and barriers to integrating COVID-19 vaccination into routine immunization through an interview guide.

2.2 Study settings

The study was conducted in Ekiti State, southwest Nigeria. Bordered by Kwara, Kogi, Ondo, and Osun states, Ekiti was founded from a portion of Ondo State in 1996 and has Ado-Ekiti as its capital. The state is named after the Ekiti people, a Yoruba subgroup that makes up the bulk of the state's population. The study participants are health workers at the facility, local government, and the state primary healthcare levels. These categories of health workers are all in the immunization unit of the primary health care agency. The health workers at the facility level include the RI focal Person and a recorder. Health workers at the LGA level include the Local Immunization Officer (LIO), the LGA Monitoring and Evaluation (M&E), and the Local Health Education Officer (LHEO). At the state level, participants include the State Immunization Officer (SIO), the State M&E, and the State Health Education Officer (SHEO).

2.3 Study participants and selection

This study utilized a three-tier purposive sampling to reach the target audience. In the first stage, the study purposively selected 9 LGAs across the three senatorial districts in the state. In the second stage, apex primary healthcare facilities were selected in each of the selected 9 LGAs. In the third stage, participants were identified at the Primary Health Care (PHC) facilities, and the LGA levels in the state. Two health facility officials (the facility Recorder and the RI Focal Person) and two health officials at the LGA level (LIO and LHEO) were purposively selected because of their depth of knowledge and experience on the subject matter. The study also purposively identified state-level health officials (SIO, M&E, SHEO) as custodians and implementers of the integration approach. A total of 40 interviews were conducted among the study participants ( Please see Table  1 ).

2.4 Data collection

A semi-structured in-depth interview guide was developed for participants at the facility, LGA, and state levels, to obtain the data needed for the study. The interview guide was structured using the WHO Health System Building Blocks Framework [ 27 ] in line with the objective of this study. Verbal consent was obtained from the respondents before all the interviews were conducted, by asking participants to give their go-ahead before the commencement of the interviews. Additionally, participants were informed that their participation was voluntary and that they had the right to withdraw at any point. All interviews were conducted in English Language to facilitate easy communication. The interviews lasted under 60 min, were recorded, and stored on an audio smart device.

2.5 Data analysis

The recorded interviews and discussions were transcribed in Word format by professional transcribers. The transcripts were validated by the research team and subsequently uploaded into Dedoose software. A thematic analysis using the WHO Health System Building Blocks Framework (27), combining deductive and inductive approaches, was adopted for analysis.

A codebook was then developed and uploaded to the software to guide the analysis of the transcripts. A spreadsheet of the excerpts from the codes was exported as analysis output from the software depicting the quotes from the transcripts of each participant that fit within the identified themes. The excerpts were reviewed to make connections between and within participants to seek explanations for the patterns of the themes.

3.1 Socio-demographic characteristics of participants

A total of 40 healthcare workers across Ekiti state were selected to participate in this study. The majority (87%) of the participants were females. Nearly 2 out of every 5 (38%) study participants had post-secondary certificates from nursing school and community health institutions, while 52% were first-degree (BSc) holders. The mean age of the study participants is 46.4 years. ( Please see Table  2 ).

3.2 Participants’ knowledge of COVID-19 vaccination into routine immunization integrated approach

3.2.1 health workers’ description of integration.

In exploring the integration of COVID-19 vaccination into routine immunization (RI) within health facilities in Ekiti, it was highly pivotal that we assess the participants’ understanding of integrating COVID-19 vaccination into RI services in the state, particularly at the health facility level. Therefore, the study participants were asked to express their interpretation of integrating COVID-19 into RI services in the state. All the participants believed and mentioned that it means combining two services organized to achieve similar goals. The following are feedback from the study participants:

“Thank you. Integration is the joining together of small bodies to become a whole. The integration of COVID-19 into RI is how we administer COVID-19 vaccination and routine immunization together.” (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

“Well, with the word integration, the two services and other services were provided together. And with the COVID-19 and the RI vaccination, it's increasing the coverage for RI and the COVID vaccination in Ekiti” (IDI/LGA Immunization Officer/IKERE LGA/).

“One of the thematic areas was the integration part, which was integrating COVID-19 into the routine immunization services at the facility level, and how it played out was that it played out in two parts, we had the outreach team and the fixed team. Outreach teams were charged with the duty of visiting various settlements, especially hard-to-reach environments, and tracking those who have been defaulting on taking their first dose, … while the facility teams were charged with the duty of vaccinating those who come into the facility to do something or get treatment for one ailment or the other”. (IDI/Assistant Technical Adviser/Ekiti State).

3.2.2 Perceived benefits of the integration

Findings from the study revealed that participants expressed their opinions on the benefit of the integrated approach adopted for optimizing COVID-19 vaccination into routine immunization. Participants agreed that the benefits of the adopted strategy improved vaccination coverage for both exercises. The following excerpts provide more context:

“The benefit of integration has improved the uptake of the COVID-19 vaccine such that it has increased women’s uptake of the vaccine, and it has helped in opening the minds of our patients to the importance of vaccination”. (IDI/Recorder/Ikere LGA).

“The benefits of the program include helping us to reach the unreached and through that, it also assisted us to have more coverage in all our antigens. Before the program in these areas, we have been experiencing dropouts … But during that program, we were able to cover those areas, to reach all those children and we were able to vaccinate them”. (IDI/LGA Immunization Officer/Ifelodun LGA).

“The benefit is that it increased the coverage and allowed the defaulter to be tracked at the health facility level. During the integration, we used to track defaulters. We also monitored and completed the doses received during the campaign and conducted house-to-house visitations”. (IDI/M&E/ESPHCDA).

3.2.3 Integration as a facilitator of improved coverage

Participants said the adopted integration strategy influenced the increased coverage of COVID-19 and routine immunization through leveraging opportunities associated with the integration. In other words, the availability of a child for immunization ensures the availability of the caregiver/mother for vaccination, depending on the caregiver’s vaccination status, and vice-versa (that is if the adult has an eligible child). In essence, participants stated that:

“The way it has helped is how it makes people come out of their houses because, for several people, it is burdensome for them to bring their children for immunization at the facility. So, it has helped our immunization work increase and that of COVID-19”. (IDI/Recorder/Emure LGA).

“In Emure local government, the integration of COVID-19 with RI has helped in coverage because since it has been integrated, even when a mother brings her child to the facility, she has access to the COVID-19 vaccine. So, they have access to the vaccine when they need It”. (IDI/LHEO/Emure LGA).

“An illustration that we want to give towards improved coverage is that there are people who find it difficult to come into the facility probably because they have one challenge or another thinking they will pay before they can get vaccinated and some because they are not even interested in COVID-19 vaccination but because there are some other vaccines that their child have to take and, in the process, they are already being informed. They will then explain to the caregiver and give the child and caregiver their vaccines” (IDI/Assistant Technical Adviser/Ekiti State).

3.3 Enablers of integrating COVID-19 into routine immunization

To effectively assess the drivers of integrating COVID-19 vaccination into routine immunization, we employed the WHO Health System Building Blocks Framework, utilizing the six components, to easily disaggregate the immunization structure in the state.

3.4 Service delivery

To ensure a good understanding of how service delivery has aided the integration of COVID-19 vaccination into routine immunization, the service delivery component was further divided into sub-themes that comprehensively address the provision of health services in the immunization unit of primary healthcare.

3.4.1 (i) Demand Generation and Social Mobilization

The study participants (health workers) explained that their demand generation activities are dichotomized into two major areas to ensure reaching the people in the rural communities. The following are the steps adopted by the team when engaging community stakeholders.

3.4.1.1 a.) Stakeholders Engagement.

Responses from the study revealed that the team commenced their activities with community entry by establishing adequate connections with stakeholders at the community levels. They obtain the buy-in of all community leaders to facilitate easy access to community members. Participants enunciated that:

“First of all, we started with advocacy, we paid advocacy visits to influential people in Ekiti state, and we involved all the chairmen in Ekiti state and all the traditional leaders, religious leaders, and civil society organizations like Rotary club in Ekiti state. We normally hold meetings with them to sensitize them in their palace. … we leveraged their monthly meeting and Iyaloja’s (Women Market leaders)”. (IDI/SHE/EKITI).

“The demand and awareness generation campaign started with traditional leaders because the mode of entry into any community is always important. After that, we held town hall meetings, age group meetings, and compound meetings”. (IDI/LHE/IFELODUN LGA).

3.4.1.2 b.) Awareness Creation/Community Sensitization

The health workers at the state and LGA levels took the next step of creating awareness and sensitizing community members on the importance of receiving COVID-19 vaccination into routine immunization. They aimed to ensure that residents of the communities willingly accept, to receive either the routine immunization for their children or the COVID-19 vaccination for themselves (especially if they have not accepted their first dose, or/and have missed subsequent doses). Therefore, participants expressed that:

“We did radio jingles and media chats. We did live workshop programs on both TV and radio stations. Apart from this, we have our platforms where we normally share all the information. If we produce a jingle, we share it on this platform for everybody and we also encourage all our leaders, religious leaders, and the Iyalojas that when we throw it to their platform, they will help us to also send it to all the platforms they belong” (IDI/State Health Education Officer/Ekiti State).

“During the antenatal clinic, any clinic whatsoever, or any community gathering, we sensitize people about it, that now you can bring your child to the facility and receive your COVID-19 vaccination. It helped and supported the system”. (IDI/LHE/IDO LGA).

“We announced to people through radio jingles, and phone calls telling them that vaccination is now available at the center and the mobilizer also goes around to inform people”. (IDI/RECORDER/IFELODUN LGA)

3.4.2 (ii) Health education

Participants expressed that, residents of the state across various communities, particularly those who visited the health facilities, such as the caregivers, were significantly educated on COVID-19 vaccination (including the significance, and potency, amongst others). The participants added that the residents were not only educated but were also provided with IEC materials, as this is evident in their statement:

“We had various IEC materials talking about the COVID-19 pandemic, how it can be contracted, and even talking about the vaccines, the potency, and the safety of the vaccines”. (IDI/State Immunization Officer/Ekiti State)

“Yes, like I have rightly said during our clinic sessions, we leverage these sessions to speak about the integration, then during any community meetings we speak about it, especially about the COVID-19 vaccination, and the integration of the two. Also, during one-on-one discussions, we discuss it with the people”. (IDI/LGA Health Education Officer/Ido LGA).

“In our facility, we carry out health education, we explain the benefits of immunization and how to take precautions such as no shaking of hands, and using of a nose mask, and we tell them about the things they should do and not engage in that can have a consequence on their health” (IDI/Recorder/Ijero LGA).

3.4.3 (iii) Vaccine accessibility

The healthcare workers interviewed for the study emphasized that the eligible populations had access to vaccines throughout the program implementation. Ease of access was ensured by operating fixed-post and mobile outreach teams. The fixed post teams are located in the facility where community residents could visit to get immunized or vaccinated. On the other hand, the outreach sessions involve healthcare workers moving around the communities where the facilities are situated to take immunizations and COVID-19 vaccinations to the communal residents’ doorsteps.

“The people around had access to the vaccine because we did fix post and outreach (sessions) in which case we went to their doorsteps to give them the vaccine. Thanks to the effort of the program organizers who funded the outreach. We were able to reach several people at their workplace, we met them at their various villages and settlements, where we administered the vaccine”. (IDI/LGA Health Education Officer/Ifelodun LGA).

“We took it to them, then some came, and we operated both outreach and fixed post (sessions)”. (IDI/Routine Immunization Focal Person/Emure LGA)

3.5 Health workforce

Subsequently, the study assessed the health workforce component of the health system to understand its contribution to strengthening the immunization health system of the Ekiti State Primary Healthcare Board. Additionally, this component sheds light on the health workforce’s contribution to the optimization of integrating COVID-19 vaccination into routine immunization. To this end, two key areas were discussed: Training the health workers, and temporary engagement of ad-hoc staff.

3.5.1 (i) Training

While the NPHCDA believed in the recommended integrated strategy for optimization of COVID-19 vaccination into routine immunization, this had not been implemented in any part of the country. Therefore, the intervention in Ekiti state was considered a “Proof of concept” for the strategy of integrating into RI, wherein the existing immunization guideline was adapted to include two vaccinators and two recorders, The study participants were able to call out that before the commencement of the integration strategy for the optimization of COVID-19 vaccination into routine immunization, health workers involved in the support were trained across all levels.

“We were trained on the integration of COVID-19 into RI. We went for training on how to do everything (hands-on) such that as we’re administering COVID-19 vaccines, we’re doing routine immunization. So, we were trained”. (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

“There was training, and there was also retraining as part of the program's success story. Health workers were trained before the commencement of the program. We were all trained at different levels, and they trained us equally. We also trained the mobilizers, so that the program could be sustained. So, they also have adequate knowledge of COVID–19 and RI services”. (IDI/LGA Immunization Officer/Ijero LGA).

“Yes, we had training. We went to National for training, after which we came down to the state to cascade the training. Afterward, we developed our micro plan that integrates all those services, and the training was conducted effectively at the state level and down to the local government level”. (IDI/M&E/ESPHCDA).

3.5.2 (ii) Ad-hoc staff recruitment

In the interview conducted, the study participants expressed that the shortage of manpower influenced the need for additional recruitment of ad-hoc staff to strengthen the workforce for the optimization of COVID-19 vaccination into routine immunization in Ekiti state. The engaged ad-hoc staff are usually residents or/and members of the communities who possess important skills in other areas, particularly technological skills, where the services were needed to optimize COVID-19 vaccination into routine immunization.

“Yes, there was recruitment, because not all those that supported outreach were health workers. At the facility, which is the fixed team, we ensured that, for the sake of the integration, only the RI officer and the recorder were allowed to work as part of the team for the fixed team. While for the outreach team, to complete the number of personnel needed for the team, we other members of the team aside from the vaccinators one of whom led the team” (IDI/Assistant Technical Adviser/Ekiti State).

“Yes, because presently in Ekiti State, we are all aware of staff shortage. As a result, our staff will not be enough to cover all the communities. So, we had to recruit some ad hoc staff, in which they were also trained along with our staff, to be able to carry out the activity”. (IDI/LGA Immunization Officer/Ifelodun LGA).

“Yes, we employed ad-hoc staff. The likes of the mobilizers and those who are conversant with the communities who know the in -and—out of the communities, people that were given to us to help us mobilize people” (IDI/Recorder/Ikere LGA).

“The likes of the mobilizers and those who are conversant with the communities who know the in and—out of the communities were available to help us mobilize people” (IDI/Recorder/Ikere LGA)

3.6 Commodities and vaccines

In discussing the measures taken to ensure the availability of commodities and vaccines for the seamless operation of the intervention geared towards the optimization of vaccination services in the state, participants emphasized that they structured their micro plan with an adequate standard, and adhered to the micro plan developed, as this aided management of commodities and vaccines across the state.

“We used what was developed in the micro plan to supply all the materials required. So, in that area, since they are given all the micro plans that are robust and cover every resource, then from that micro plan, that's where we supply. And then we ensured no area lacked all the required resources from our end. So, they give us what they have, and we compare it with the target population. Then we make available the supply through the cold store to ensure that those commodities; the syringe, the vaccine carrier, everything was provided”. (IDI/M&E/ESPHCDA).

“We have something we call bundling; it is like a package deal. When you get a vaccine dose, you get all other necessary supplies like syringes, needles, cards, and cotton wool. It ensures that everything needed for the vaccination is provided together. So, it's not only about counting the doses but also ensuring the availability of all the materials required for a smooth vaccination process”. (IDI/LGA Health Education Officer/Ido LGA).

“We had a plan that we used to provide everything that we would need for the program. There has never been a time we ran out of supplies of commodities. So, we monitor the supplies to know when they are running out. And most times it's LIO that gets it for us”. (IDI/RECORDER/GBONYIN LGA).

3.7 Health information system

Quality and reliable immunization data is the lifeline of sound and informed decision-making in healthcare interventions. A robust data reporting structure was set up to generate quality data from the integrated program. Subsequently, a trained and technologically inclined health worker was reporting at the facility level, while technologically skilled individuals, usually hired as ad-hoc staff were utilized for outreach teams, to ensure adequate electronic reporting. Their roles were to report and record data. Regular data validation and verification meetings were held at all levels of operation. Participants expressed the following:

3.7.1 (i) Data recording and reporting

“At the facility level, we have the recorder and the RIO. At the end of the month, they collate their reports. Vaccine utilization must be checked across the board to tally with the number of people that have been immunized for the month, while the RIO is reporting to the CCO and the LIO the recorder also reports to the M&E, and later the LGA level, at that LGA level the M&E, the LGA M&E, the LIO, and the CCO will now look at those data again before uploading to the DHIS but, when we also came on board we requested that they maintain the reporting structure and made some little improvements”. (IDI/Assistant Technical Adviser/Ekiti State).

“Yes, using Kobo Collect and all other platforms daily even immediately they are vaccinating, they are capturing all this data and sending it to the appropriate person, and the M&E for the LGA usually does the summary and sends it to the appropriate person”. (IDI/LGA Health Education Officer/Emure LGA).

“When the patient comes to the facility, I will take the paper record and request demographic information. Subsequently, I will enter similar information and others into my phone, and later tell the person to proceed with the vaccination. After vaccination, I will record on DHIS 2 stating if it is the first time or second time of vaccination. I will then collect all the data from both immunization and COVID-19 and record it on Kobo Collect one after the other” (IDI/Recorder/Ado LGA).

3.7.2 (ii) Data validation

“At the facility level, we have the recorder and the RI. At the end of the month, they collate their reports, both of them. RI officer and the recorder report to the M&E, the LGA M&E. The RIO reports to the CCO and the LIO. The LGA M&E, the LIO, and the CCO will now look at the data again before uploading to the DHIS”. (IDI/Assistant Technical Adviser/Ekiti State).

“They have an OPD register, tally sheet, and immunization register which they work on … immediately a child is brought to the facility and that child is being attended to, they record it immediately, and when they have collected all their data they bring it together and come for the validation meeting where they will look at what they have done, the M&E officer will be there, the CCO will be there too if the number of vaccines collected correspond with what they used”. (IDI/LIO/Gbonyin LGA).

“We ensure our work tallies, if our work does not tally, we won't be able to present quality data”. (IDI/Recorder/Ifelodun LGA)

3.8 PHC financing

Participants believe that the financial support offered to health workers was highly commendable, as that was a major agent of encouragement for health workers to remain dedicated and committed to their work. Additionally, participants emphasized that payments were made to all healthcare workers involved in the intervention across all levels to ensure the optimization of COVID-19 vaccination into routine immunization, yielding a subsequent seamless implementation and operation of the intervention. As such, participants stated that:

“They tried. I explained earlier that they motivated us— financial support is part of it. Because it helps to make transport convenient, and even minor things like getting water when you’re thirsty. So, this helped to keep us motivated” (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

“Sydani Group, as I’ve said, has done well because I can see that they are the ones that have sponsored and spent much on this integration. All the teams that have worked, both the facility and outreach teams and even at the LGA levels, received stipends at the end of the month, including the EMID and the Validators, as Sydani paid for their data and everything they used. So, this aids in the effectiveness of the program”. (IDI/LGA Health Education Officer/Emure LGA).

“Sydani supported them with some stipends and the stipend was based on target. There was a daily target for the teams, including the outreach and the fixed-post teams. The fixed-post team had a daily target of getting at least 7 people vaccinated before they could lay claim to the financial aspect of it for the day”. (IDI/Assistant Technical Adviser/Ekiti State).

3.9 Leadership and governance

Responses from the participants revealed the existence of a structured leadership system that was employed for accountability and transparency during the implementation of the intervention. In doing so, there were supervisory roles at different levels to ensure standard and adequate supervision of the provider of the immunization and vaccination services (i.e. the facility health workers). In other words, participants expressed that:

“Well with the planning, we had LGA, state, and National level supervisors. Based on that, national supervisors in the state were paired with state supervisors and distributed to different local governments for supervision. At the LGA level the MOH, LGA health secretaries, deputy program officers, and the M&E are all the supervisors. And then at the ward level, health management–chairman, and health management committee of that facilities are part of them. So, we distribute ourselves across the teams for supervision. Then we use the ODK app for supervision”. (IDI/M&E Officer/ESPHCDA).

“The LGA team tried because we were doing on-the-job supervision and training for them, they indeed went for training but we still guided them and corrected them with love,, we showed them how they ought to do it if need be and about data entry, we asked them “why have all these data not been entered?” and if she said “it’s because of the network”, as there are some communities with poor networks actually, we would encourage them that immediately they get to the town they should upload the data and we follow up if they have uploaded it”. (IDI/LGA Immunization Officer/EMURE LGA).

“My perception of the supervisory role is that they tried. Because there is a proverb that says that one who must catch a monkey must act like a monkey. We are not perfect people, but I’m grateful that our bosses played good leadership roles. When they see that we seem tired, they call us themselves and encourage us. So that leadership role they carried out, was good for us”. (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

3.10 Barriers to the integration of COVID-19 and routine immunization

This study assessed the barriers to integrating COVID-19 vaccination into routine immunization using the WHO Health System Building Blocks framework. Specifically, the study utilized the WHO framework to understand some of the challenges experienced during the implementation exercise in Ekiti state.

3.10.1 Service Delivery

Under the service delivery component, responses from the study participants indicated three key issues experienced during the program implementation. These include rumors, demand for palliatives, and complaints about adverse events following immunization.

3.10.2 (i) Rumors

Participants emphasized that a fundamental barrier they experienced among community residents was rumors about COVID-19 vaccination in the state. The study participants reported that the propagating rumors slightly influenced their coverage, believing their recorded coverage could have been higher without the pervading rumors among people at the grassroots level. However, efforts were made by the team to debunk some of these rumors.

“The major challenge that we faced at that time with the issue of service delivery was the issue of rumor. It affected our service delivery. Because some people have heard rumors about the vaccines, especially the COVID-19 vaccine, that those taking it, may be taking it to cause one problem or the other. Some even said that after two years, those who took the vaccine may die from it”. (IDI/LGA Immunization Officer/Ifelodun LGA).

“When we had almost finished the process, different rumors began to fly around, and people did not want to take the vaccine anymore. We had to explain the concept of the spaced doses to them and dispel the rumor to help people continue coming for their doses”. (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

3.10.3 (ii) Demand for Palliatives

Participants further shared their experiences with the caregivers and in some cases, reports from the outreach teams on the demand of community residents. According to the participants, community dwellers believed that health workers had received their share of the palliatives, while community dwellers were abandoned to their fates. This was evident from the following responses:

“We are just sacrificing our time and everything, when the VC/supervisor of health can be saying that, think of so many that will be happening in the field, many insulting words saying we did not give them palliatives that we and our families have finished the palliative, and we are now bringing vaccines to them” (IDI/LGA Immunization Officer/EMURE LGA).

“The caregiver always insults us saying we only give them injections, we don’t give them food and whenever we go for awareness, they always ask us if we will give them money, the people we want to give vaccines to help their health, they ask for money for food, these are the challenges we are facing”. (IDI/Recorder/Ikere LGA).

3.10.4 (iii) Adverse Events Following Immunization

The study participants also revealed that the complaint of Adverse Events Following Immunization (AEFI) either by a resident who had received one dose or by some of the community residents acted as a deterrent to other community residents. This affected the optimization of COVID-19 vaccination into routine immunization in the visited communities.

“The challenge we faced was that some patients refused to take the vaccine because of the adverse effect of the first dose and we enlightened them on the benefit of completing the dosage, some even said they wouldn’t take it because they had seen someone who got vaccinated and had a severe temperature and the likes, but we keep educating them and many end up taking the vaccine”.(IDI/Recorder/Ijero LGA).

“Some people said they don't want to be vaccinated because they heard rumors that the vaccine is affecting some people in the community, and they do not want to start complaining”. (IDI/Recorder/Ido LGA)

To address the challenges experienced under service delivery by the team the following activities were deployed:

Persuasion through the support of the community leaders, and

Health Education

Generally, participants emphasized that to address their challenges in service delivery, they had to persuade community members and educate them where necessary. Participants also added that in some cases, they worked with the community leaders who aided the persuasion given to the community residents before they could eventually go ahead to get them vaccinated or immunize their children.

“We then begin to persuade them and let them know that we did not benefit from any palliative needless to say to give people. We also let them know that even if they are being given palliatives, it will finish in days, and we encourage them to receive the vaccine that can enable them to live a healthy life. We educate them on how these vaccines can prevent some diseases from affecting their health”. (IDI/LGA Immunization Officer/EMURE LGA).

“We did immense work before we could convince our people. That was why I said we involved all the leaders in the community. They are the ones who assisted us in being able to talk to our people in this area. We successfully convinced them in the end, and they all took it. Most of them took the vaccine” (IDI/LGA Immunization Officer/IGbonyin LGA).

3.10.5 Health workforce

Participants in their interviews reported that the major barrier they experienced under the health workforce component was the shortage of health workers. According to the interviewees, the lack of manpower resulted in an increased workload burden amongst the available health workers in the facilities. This is evident in the following expressions by the health workers interviewed.

“We have a shortage of staff in all the health facilities. This is in all the health facilities across the LGAs in the state. For instance, normally, a trained health worker at a fixed post is expected to take delivery of a pregnant woman, there should be another staff responsible for COVID-19 vaccination, and there is usually a roaster for who will be there in the morning and for RI. However, we will be there in the morning and afternoon with no roaster because of the special assignment. We have to be there from morning till evening. Because you will have a lot of work to do, as there's no staff to fix those gaps” (IDI/LGA Immunization Officer/Oye LGA).

“When the process was on, the number of us available did the job well, but if we were more in number, it would have been more efficient. For example, fixed post people like us—a vaccinator and a recorder are at the fixed post, and you know there will be times that the work will be too much, and they’ve told us that our clients must not be kept waiting at the facility. If we had enough hands, we would attend to the clients faster. Although those available tried significantly. If the staff is increased, the work will be faster”. (IDI/Routine Immunization Focal Person/Ikole Ekiti LGA).

3.10.6 Health information system

Findings from the study interview revealed that, despite the electronically structured reporting system that was developed for them to utilize in reporting the data for COVID-19 vaccination into routine immunization, two major hindrances to this system were a lack of gadgets such as laptops and tablets, and poor network services on the part of the various service providers that operate in the state. The following are the findings from the study:

3.10.6.1 (i) Poor network

Participants emphasized that poor network services affected the reporting rate of the data they have acquired, which in some cases may affect their performance. Senior-level health officials highlighted that network issue sometimes results in health workers entering data inadequately on the expected platform(s).

“The network issue is fundamental. At times, at the state level, they will call us, expecting our report, but because of the network, we could not send it in time. We have undulated places, valleys, and other things within my local government that affect the network. That was the major challenge. Some work will be sent to the national or state level at midnight, which is not supposed to be like that”. (IDI/LGA Immunization Officer/Ijero LGA).

“Normally, we do evening review meetings. I collect and collate all the template data that was sent manually. But for us to get the EMID data downloaded, it is giving us a big problem because of the network challenge… In some areas with service, the network will not be okay. I know this because sometimes when they ask me to go to some LGA, to find out what is going on, I find that when I collect the Android phone they use, the data is stored in their local server with them. But for them to get the internal network to upload it to the national server, is a big problem”. (IDI/M&E Officer/ESPHCDA).

3.10.7 Leadership and governance

Participants were equally requested to discuss their challenges in line with the leadership and governance component of the intervention in line with the health building blocks. According to health workers at the supervisory level, bad roads, and lack of designated transportation were two main issues that the team experienced.

3.10.7.1 (i) Bad road networks

Health workers at the supervisory level expressed their worries over the nature of the existing road network in some local government areas across the state. These roads, according to them are not motorable, and evidence from the study is presented below.

“We have the challenge of mobility for example, if I want to go for supervision I cannot allow anyone to mount the bike with me because the roads are not motorable, especially during the rainy season, there was a day I was going for supervision in Alapoto (a remote area), I almost fell, and I had to hold on to a tree and I was later helped down, imagine if we were two (2) on the bike, we could have fallen into the water. So, the roads are bad, and some communities are very far away, I have been injured before when I fell from a bike”. (IDI/LGA Immunization Officer/Emure LGA).

“The only challenge is the poor road network to these health facilities. That is the only challenge we surely face”. (IDI/LGA Health Education Officer/Ikere LGA)

3.10.7.2 (ii) Lack of designated transportation for supervision

The participants also expressed their worries over not having a designated transportation system to aid their supervisory visits to the communities and LGAs across the states. Participants equally tied the unavailability of a transportation system to bad roads and the cost of transportation.

“There is no vehicle for supervision in Ekiti state. We don't have vehicles for supervision. If I'm going for supervision now, it's either I use my car or I go in public transport”. (IDI/ State Immunization Officer/ESPHCDA).

“The only challenge I can think of is that we do not have a transport system in place that can take us to the facilities because transportation is costly, and there are some places where we give COVID-19 vaccinations that are not motorable”. (IDI/Recorder/Oye LGA).

4 Discussion

Following our intervention in Ekiti State, with the support of the State Primary Healthcare Development Agency (ESPHCDA), our study explored the enablers and barriers to integrating COVID-19 vaccination into the routine immunization programme in Ekiti state, Nigeria. In assessing the enablers and barriers of the integration approach, the study adopted the six components of the WHO Health Building Blocks Framework.

Our study found that health workers at the facility, LGA, and state levels are well-acquainted with the idea of integrating COVID-19 vaccination into routine immunization as they shared similar definitions of the concept to mean the addition of COVID-19 vaccination into routine immunization. This corroborates the assertion of the World Health Organization [ 17 ] which defined integration as the “adoption (partial or full) of COVID-19 vaccination into national immunization program services, PHC, and any other relevant health services with the overall aim of improving program efficiency and sustainability, enhancing demand and improving user satisfaction, achieving and maintaining satisfactory coverage, and addressing inequities This could be hinged on the fact that health workers were trained extensively on the concept of integration and the implementation of such an approach in the optimization of COVID-19 vaccination into routine immunization in the state. Furthermore, this implies that the participants are actually in the know about the events unfolding around them and are equally up to the task.

All the categories of participants (at the facility, LGA, and state levels) interviewed believed that Ekiti State experienced improved COVID-19 vaccination, and routine immunization coverage upon the adoption of an integrated strategy. This particular notion held by health workers across the three levels might have been informed by the available data on COVID-19 vaccination and routine immunization (before and after adopting the strategy) in the state. This could also be informed by the experiences of health workers at the facility level who might have observed an increase in vaccine uptake among children and their caregivers.

Furthermore, participants agreed with the integration approach of leveraging caregivers’ visitation to the health facility with their child(ren) immunization which ensured the conviction of the former in receiving COVID-19 vaccination either for the first time or for their subsequent dosages. This assertion was influenced by the personal experiences of health workers at the facility, particularly based on their direct interactions with the caregivers. Additionally, participants from our study reported that the integrated efforts of the COVID-19 vaccination into routine immunization resulted in a decline in the prevalence of COVID-19 in the state and the mitigation of vaccine-preventable diseases amongst infant children such as measles.

Findings from the study revealed that to bring life-saving vaccines as close as possible to the people, three themes stood out: demand generation and social mobilization, health education, and vaccine accessibility. Participants from our study highlighted that a preliminary approach to ensuring demand generation was the involvement of key stakeholders such as traditional leaders, religious leaders, political leaders (LGA chairman), and other influential heads of various groups in the state. This is similar to the study [ 24 ], which reported that consistent high-level political advocacy and support were significantly critical to improving vaccination uptake in Nigeria. This adopted strategy of obtaining the buy-in of high-level stakeholders (particularly at the community level), by the health workers was informed by the past experiences the health workers have acquired over the years on program implementation.

Subsequently, community sensitizations were conducted, harmonizing various techniques including pre-recorded radio jingles that discussed the benefits and importance of vaccination, and media chats designed to address misconceptions and myths about COVID-19 vaccination. This corroborates a study [ 28 ], that employed community dialogue, and TV programs where state residents can call in to ask questions and seek clarifications on the vaccination exercise. The adoption of these strategies might have been influenced by lessons from implementing similar projects either locally or internationally. This could also be an outcome of the synergetic innovative strategies discussed by actors and partners in the state.

Health workers at the facility level leveraged clinic sessions at the various facilities to impart knowledge and foster positive attitudes among the caregivers towards COVID-19 vaccination and routine immunization. This was usually done by conducting health education sessions and sharing Information, Education, and communication (IEC) materials with the caregivers on the importance and benefits of COVID-19 vaccination uptake for the caregivers and the uptake of routine immunization by their wards or children. Our study findings underscore the recommendation [ 29 ], suggesting that the awareness of mothers/caregivers should be improved through the design of effective health education about COVID-19, and the distribution of IEC materials prepared in local languages during outreach sessions and at the health facilities. These steps were taken to improve the knowledge base of caregivers on vaccine uptake and address the myths and misconceptions they might hold about the COVID-19 vaccines.

Our study also found that health workers ensured the accessibility of COVID-19 vaccines and immunization antigens to the community residents far and near, through the adoption of a fixed-post vaccination section with health workers domiciled at the facilities to attend to clients, and outreach vaccination sections where health workers visit residents in hard-to-reach settlements. This strategy was employed to optimize the uptake of COVID-19 vaccination and routine immunization, and, to encourage community residents willing to accept the vaccines but are confronted with other challenges hindering them from visiting the health facilities.

Health workers reported that their involvement in organized training to develop their knowledge base on integrating COVID-19 vaccination into routine immunization helped improve their capacity and the quality of their service delivery. The training organized for health workers was likely premised on the need to develop the capacity of health workers for optimum performance, with the ultimate goal of achieving improved program efficiency on the part of the health workers. Our findings established the work of Subba et al., [ 30 ], that the capacity of the healthcare workforce must be built on specific public health emergency response for competencies. Additionally, the training of health workers will also act as a driver of the participation of these health workers in the implementation of the integrated approach strategy. As a way of addressing the shortage in manpower, the state government and local implementing partners engaged ad-hoc staff to strengthen the delivery of the outreach teams towards the optimization of COVID-19 vaccination into routine immunization in Ekiti state.

Highlights from our study findings also indicated that developing a micro plan before implementing the intervention fostered the consistent availability of material and vaccines for health workers in executing their activities for the integrated approach. This supports empirical study [ 24 , 31 , 32 ].

A Bottom-up data recording and reporting approach using a combination of paper and electronic tools. Our study found a concurrent reporting of COVID-19 vaccination into routine immunization data through a unified platform without data mixing. Additionally, findings from our study revealed that data verification and validation were drivers of timely and complete reporting of COVID and RI data among the teams in the state. This aligns with Tella-Lah et al. [ 33 ] who revealed that the EMID system optimization and integration of COVID-19 vaccination into routine immunization data into one system has significantly increased the number of vaccinations documented in Nigeria.

The participants significantly appreciated the financial support offered to them across all levels, as they considered it a form of motivation that spurred them to work more and push for the optimization of COVID-19 vaccination into routine immunization. This further asserts the study of Nyaboga and Muathe [ 34 ], whose findings ranked remuneration as having the major impact on performance among healthcare workers in Keyan’s public hospital. The approach of performance-based financing adopted by the partners for health workers at the grassroots level was significantly influential in the desire of health workers to get more people vaccinated, thereby translating to increased coverage.

Additionally, supervision was spread across three different levels to ensure accountability and transparency in the operationalization of integrating COVID-19 into RI. This structured level (federal, state, and LGA) of supervision adopted created a form of check and balance among key actors in the intervention implemented in Ekiti state supporting the recommendation of UNICEF, [ 35 ] that tier-based supervision is essential to immunization. Additionally, the supervision conducted at the facility level equally acted as a form of on-the-job training for health workers at the facility level.

Three key issues significantly affected the health workers in driving service delivery to optimize integrating the COVID-19 vaccination into routine immunization. These were rumors (myths and misconceptions), demand for palliatives, and adverse events following immunization. This corroborates the findings of Nabia et al., [ 36 ], who reported that vaccine hesitancy was usually due to misinformation and side effects, among others, in Sudan and the USA. The interviewees, especially at the facility level, also shared that, certain caregivers or community residents were deterred from taking the vaccine upon learning that a few caregivers experienced Adverse Events Following Immunization (AEFI). Health workers found this particularly challenging, as this confused caregivers with the existing rumors on COVID-19 vaccines in their communities. Despite these challenges, health workers managed to convince the caregivers of the value and importance of accepting the vaccination, particularly by leveraging on key stakeholders in the community.

Participants vehemently complained about the lack of skilled manpower. Although ad-hoc staff were engaged during the program implementation, they only possessed skills in areas other than health services and could only support outreach vaccination sessions. Therefore, the void still exists at the health facility level with a limited number of skilled health workers present in the facility to offer services other than vaccination or immunization resulting in work overburden. This alludes to the findings of Atobatele et al. [ 37 ] who reported the availability of manpower as one of two key enablers of integrating health interventions. This could potentially result in burnout syndrome among health workers in such a situation. Hence, the government must conduct a human resource for health (HRH) gap analysis to identify areas or specializations where health workers are needed more.

The study observed the need for improved network/internet services, and minimal data subscriptions for health workers as the mobile teams experienced few hiccups during the implementation of the vaccination strategy. Although study participants mentioned that they were motivated, well-renumerated, and incentivized, the reality is that the current economic situation of Nigeria has further depreciated the purchasing value of her currency. Hence, there is a need for future projects to improve the welfare or remuneration of health workers or outreach teams in similar studies. Our study found that bad road networks are imminent threats to the supervision of health workers at the grassroots level, particularly within the various hard-to-reach communities. This alludes to the fact that several rural road networks are not frequently maintained and are usually deteriorating over the years [ 38 , 39 ].

5 Conclusion

Our study assessed the enablers and barriers of integrating COVID-19 vaccination into routine immunization in primary healthcare facilities in Ekiti State. The findings underscored the positive impact of this integration on vaccination coverage, outbreak prevention, and the strengthening of the health system.

Adequate training and preparedness of the healthcare workers, demand generation activities, health education, vaccine availability, and accessibility significantly contributed to the success of the integration program. Early involvement of key stakeholders secured the required support, as the development of micro plans ensured efficient service delivery. The Bottom-up data recording approach and concurrent reporting on a unified platform showcased a robust health information system facilitating accurate data reporting. Challenges identified, include rumors, demand for palliatives, and adverse events after vaccination. The scarcity of skilled manpower, and poor network services, were identified as the barriers experienced in the program. Additionally, infrastructural and logistic challenges, such as bad road networks and lack of designated transport for supervision, were also highlighted.

Study Limitation.

One limitation experienced during this study was the unavailability of two eligible study participants at the state level during the interviews. These high-ranking officials could have provided more insights into the enablers and barriers of integrating COVID-19 vaccination into RI. Additionally, the study could not delve into understanding the nuances of the sustainability plan to be espoused in the state to maintain the integration of COVID-19 into RI and other PHC services in the state.

5.1 Recommendations

Recommendations emanating from this study include the government at the national and sub-national levels addressing manpower shortage through HRH gap analysis and recruitment of skilled staff. The provision of improved network services will enhance data reporting. The government should invest in transport systems for easy mobility to ensure sustained success and strengthen the integration strategy in the battle against COVID-19 and other vaccine-preventable diseases in Ekiti State. Consequently, the publication of a National handbook on integrating COVID-19 vaccination into routine immunization and other PHC services will equally optimize health service delivery in primary healthcare facilities, and other health facilities across the country.

Furthermore, subsequent studies on the integration of COVID-19 into routine immunization could feature clients (caregivers of children eligible for immunization and/or eligible adults for COVID-10 vaccination).

Data availability

The data supporting the findings will be available from the corresponding author upon request. Requests will be examined and considered on a case-by-case basis.

Abbreviations

Strategic Advisory Group Experts

World Health Organization

Low and Middle-Income Countries

Non Pharmaceutical Interventions

Routine Immunization

National Primary Healthcare Development Agency

State Primary Healthcare Development Agency

Ekiti State Primary Healthcare Development Agency

Local Government Area

Monitoring and Evaluation

Local (government area) Immunization Officer

Local (government area) Health Education Officer

State Immunization Officer

State Health Education Officer

Global Alliance for Vaccines and Immunization

Primary Health Care Facilities

The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (China CDC). The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly. 2020;2(8):113–22.

Article   Google Scholar  

Sorbello M, Greif R. COVID-19 pandemic: a multifaceted challenge for science and healthcare. Trends in Ana Crit Care. 2020;34:1–3. https://doi.org/10.1016/j.tacc.2020.08.009 .

WHO. WHO Director-general’s opening remarks at the media briefing on COVID-19 -March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Accessed 18 Sep 2023.

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio J. 2020;91(1):157–60. https://doi.org/10.23750/abm.v91i1.9397 .

Pley CM, McNaughton AL, Mathews PC, Lourenco J. The global impact of the COVID-19 pandemic on the prevention, diagnosis and treatment of hepatitis B virus (HBV) Infection. Br Med J Glob Health. 2021. https://doi.org/10.1136/bmjgh-2020-004275 .

Sacco PL, De Domenico M. Public health challenges and opportunities after COVID-19. Bull World Health Org. 2021;99(7):529–35. https://doi.org/10.2471/BLT.20.267757 .

Article   PubMed   PubMed Central   Google Scholar  

Aranda Z, Binde T, Tashman K, Tadikonda A, Mawindo B, Maweu D, Boley EJ, Mphande I, Dumbuya I, Montaño M, Clisbee M, Mvula MG, Ndayizigiye M, Jean-Baptiste CM, Varney PF, Anyango S, Grépin KA, Law MR, Mugunga JC, Hedt-Gauthier B, Fulcher IR. Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. Brit Med J Global Hlth. 2020. https://doi.org/10.1136/bmjgh-2021-007247 .

Okereke M, Ukor NA, Adebisi YA, Ogunklola IO, Iyagbaye EF, Owhor GA, Lucero-Prisno DE III. Impact of COVID-19 on access to healthcare in low- and middle-income countries: Current evidence and future recommendations. Int Hlth Plan Mgt. 2020;36(1):13–7. https://doi.org/10.1002/hpm.3067 .

Ihekweazu C. Lessons from Nigeria’s Adaptation of Global Health Initiatives during the COVID-19 Pandemic. Emerg Infect Dis. 2022;28(13):S299–301. https://doi.org/10.3201/eid2813.221175 .

Ota MOC, Badur S, Romano-Lazzoti L, Friedland LR. Impact of COVID-19 pandemic on routine immunization. Ann Medicine. 2021;53(1):2286–97. https://doi.org/10.1080/07853890.2021.2009128 .

Article   CAS   Google Scholar  

Sharma M, Singh SK, Sharma L, Dwiwedi MK, Agarwal D, Gupta GK, Dhiman R. Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries. J Fam Med Prim Care. 2021;11:3991–7. https://doi.org/10.4103/jfmpc.jfmpc_1102_21 .

Glass RI, Tate JE, Jiang B, Parashar U. The rotavirus vaccine story: from discovery to the eventual control of rotavirus disease. Inf Dis. 2021;224(4):331–42. https://doi.org/10.1093/infdis/jiaa598 .

Hora R, Ray A, Mehra R, Priya T, Koshal SS, Agrawal P, Kaur A, Quadri SF, Deb RA. Enablers and barriers to the scaling up of pneumococcal conjugate vaccine in india during the COVID-19 pandemic: a qualitative study. Hlth Serv Insights J. 2023. https://doi.org/10.1177/11786329231189407 .

do Carmo GMI, Yen C, Cortes J, Siqueira AA, de Oliveira WK, Cortez-Escalante JJ, Lopman B, Flamery B, de Oliveira LH, Carmo EH, Patel M. Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. Plos ONE. 2011. https://doi.org/10.1371/journal.pmed.1001024 .

WHO. At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF. 2020. https://www.who.int/news/item/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef . Accessed 20 Oct 2023.

Adamu AA, Jalo RI, Habonimana D, Wiysonge CS. COVID-19 and routine childhood immunization in Africa: leveraging systems thinking and implementation science to improve immunization system performance. Int J Inf Dis. 2020;98:161–5. https://doi.org/10.1016/j.ijid.2020.06.072 .

WHO/UNICEF. Considerations for integrating COVID-19 vaccination into immunization programs and primary health care for 2022 and beyond. 2020. https://iris.who.int/bitstream/handle/10665/366171/9789240064454-eng.pdf . Accessed 24 Oct 2023.

Hall S, Kaplow L, Sun YS, and Holt T. Z. (McKinsey and Company). None are safe until all are safe’: COVID-19 vaccine rollout in low and middle-income countries. 2021. https://www.mckinsey.com/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/none%20are%20safe%20until%20all%20are%20safe%20covid%2019%20vaccine%20rollout%20in%20low%20and%20middle%20income%20countries/none-are-safe-until-all-are-safe.pdf . Accessed 24 Oct 2023.

Omale UI, Iyare O, Ewah RL, Amuzie CI, Oka OU, Uduma VU, Adeke AS, Ikegwuonu CO, Nnachi OO, Ukpabi OO, Okeke IM, Nkwo GE, Nwali UI. COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants. BMJ Open. 2022;12(12): e061732. https://doi.org/10.1136/bmjopen-2022-061732 .

Article   PubMed   Google Scholar  

The Cable (2022). NPHCDA: 16-year-olds can receive COVID vaccine if required for educational purposes. https://www.thecable.ng/nphcda-16-year-olds-can-receive-covid-vaccine-if-required-for-educational-purposes/ . Accessed 30 April 2024.

Federal Ministry of Health/ (2015). National routine immunization strategy plan. https://www.nitag-resource.org/sites/default/files/2b302ead55915d61468ac747e2e437aee65871b1_1.pdf . Accessed 30 April 2024

Eze P, Agu UJ, Aniebo CL, Agu SA, Lawani LO, Acharya Y. Factors associated with incomplete immunisation in children aged 12–23 months at subnational level, Nigeria: a cross-sectional study. BMJ Open. 2021;11(6): e047445. https://doi.org/10.1136/bmjopen-2020-047445 .

Jean Baptiste AE, Wagai J, Luce R, Masresha B, Klinkenberg D, Veldhuijzen I, Oteri J, Dieng B, Ikeonu OC, Meleh S, Musa A, Braka F, Hahné S, Sanders EAM, Hak E. Measles outbreak in complex emergency: estimating vaccine effectiveness and evaluation of the vaccination campaign in Borno state, Nigeria, 2019. BMC Public Health. 2021;21(1):437. https://doi.org/10.1186/s12889-021-10436-1 .

Mirza I, Ameda IM, Ba AE, Traore C, Hagos MT, Gbaya AA, Schreiber B. COVID-19 Vaccination integration: efforts in 11 African countries to strengthen the primary health care system. Global Hlth Sci Prac J. 2024. https://doi.org/10.9745/GHSP-D-23-00251 .

Lava JB, Claro V, Quiñon MS, Labis R, Marcelo W, Lucero MA, Mendoza O, Stan L. Integrating COVID-19 vaccination in primary care service delivery: insights from implementation research in the Philippines. Glob Health Sci Pract. 2024;12(Suppl 1): e2300202. https://doi.org/10.9745/GHSP-D-23-00202 .

Bakare AA, Akinsola KO, King C, Sogbesan AA, Bakare OR, Fadahunsi OY, Salako J, Falade AG, Wees SH. Provider and community perspectives of integrated COVID-19 and routine childhood immunisation programs in Nigeria: a qualitative exploratory study. Hlth Serv Res. 2024. https://doi.org/10.21203/rs.3.rs-3952946/v1 .

Global Alliance for Vaccines and Immunization—GAVI. What are the health systems building blocks? 2013. https://hssfactsheets.weebly.com/uploads/4/8/1/1/48110245/gavi_cso_fact_sheet_no_5_building_blocks.pdf . Accessed 24 Oct 2023.

Leburu N, Shilumani C, Bhengu C, Matlala M, Maja P, Jimoh S, Mayet N. Risk communication and community engagement—unlocking the key to South Africa’s response to SARS-CoV-2. South Afr Med J. 2022;112(5b):371–4.

Miretu DG, Asfaw ZA, Addis SG. Impact of COVID-19 pandemic on vaccination coverage among children aged 15 to 23 months at dessie town, Northeast Ethiopia, 2020. J Hum Vaccines Immuno. 2021;17(8):2427–36. https://doi.org/10.1080/21645515.2021.1883387 .

Subba SH, Pradhan SK, Sahoo BK. Empowering primary healthcare institutions against COVID-19 pandemic: a health system-based approach. J Fam Med Pri Car. 2021;10(2):589–94. https://doi.org/10.4103/jfmpc.jfmpc_1416_20 .

Ngoshe IB, Mohammed B, Ayuba S, Idowu AM. Conduct of integrated health services in real hard-to-reach/underserved communities to address maternal/child health problems, 2016–2018 in Borno state Nigeria. Tex Int J Pub Health. 2022. https://doi.org/10.21522/TIJPH.2013.10.02.Art006 .

Hamisu M, Dieng B, Taiwo LJ, Baptiste AE, Bawa S, Wagai J, Ibizugbe S, Braka F, Nsubuga P, Shuaib F, Oteri J. Microplanning verification and 2017/2018 measles vaccination campaign in Nigeria: lessons learnt. Vaccine. 2021;17(39 Suppl 3):46–53. https://doi.org/10.1016/j.vaccine.2021.04.007 .

Tella-Lah T, Akinleye D, Aliyu AS, Falodun T, Okpere S, Akpan D, Orefunwa O, Metiboba L, Owoicho J, Okposen B, Nwabufo A. Achieving COVID-19 and routine immunization data systems integration on the electronic management of immunization data system in Nigeria. J Global Health Sci Pract. 2023. https://doi.org/10.9745/GHSP-D-23-00149 .

Nyaboga JM, Muathe SM. Employees motivation and health workers performance in public hospitals in Kenya. J Bus Mgt Sci. 2022;10(4):180–91. https://doi.org/10.12691/jbms-10-4-2 .

UNICEF. Effective supportive supervision in immunization: health system strengthening case study Madhya Pradesh, India. https://www.unicef.org/india/sites/unicef.org.india/files/2020-07/Effective%20Supportive%20Supervision%20in%20Immunization_0.pdf . Accessed 22 Jan 2024.

Nabia S, Womodi CB, Vilajeliu A, Sussman S, Olson K, Cooke R, Udayakumar K, Twose C, Ezeanya N, Adefarell AA, Lindstrand A. Experiences, enablers, and challenges in service delivery and integration of COVID-19 vaccines: a rapid systematic review. J MPDI Vaccines. 2023;11(974):1–28. https://doi.org/10.3390/vaccines11050974 .

Atobatele S, Sampson S, Jimoh AU, Isiaka SD, Ayodeji O, David JC, Daniel V, Dehinbo O. Integrating health intervention into existing program structure of the neglected tropical diseases: lessons learned from Yobe and Ebonyi states. Front in Pub Health J. 2024;11(1281091):1–9. https://doi.org/10.3389/fpubh.2023.1281091 .

Atubi AO. Road investment and traffic safety in Nigeria. Int J Scien Acad Res. 2021;1(8):7–14.

Google Scholar  

Enwereuzor AI, Umo IS, Charles-Akalonu CL. The conditions of infrastructure and the development of rural communities in Imo state. Nigeria Soc Sci. 2021;10(3):132–9. https://doi.org/10.11648/j.ss.20211003.18 .

Download references

Acknowledgements

We would like to acknowledge the United States Center for Disease Control (US-CDC) for providing the support and funding of the project intervention on the integration of COVID-19 vaccination into routine immunization in Ekiti State through our organization (Sydani Group, Nigeria). We also want to extend our appreciation to the National Primary Healthcare Development Board (NPHCDA) and the State Primary Healthcare Board of Ekiti State for their support during the project phases.

This study did not receive any external funding or grant from any funding agency in the public, commercial, or non-profit sectors.

Author information

Authors and affiliations.

Sydani Initiative for International Development, FCT, Plot 1422, Independence Avenue, Central Business District, Abuja, Nigeria

Akolade Uthman Jimoh, Oluwafisayo Azeez Ayodeji, Chukwudinma Okoh, Kehinde Adediran, Sunday Atobatele, Sidney Sampson & Tobiloba Tinuoye

Ekiti State Ministry of Health, Ekiti State Primary Health Care Development Agency, Ado-Ekiti, Ekiti State, Nigeria

Oyebanji Filani, Ayodele Seluwa, Nicholas Ojo & Sunday Omoya

School of Policy Studies, University of Bristol, Bristol, UK

Dapo Awobeku

Sydani Institute for Research and Innovation, Federal Capital Territory, Plot 1422, Independence Avenue, Central Business District, Abuja, Nigeria

Saheed Dipo Isiaka, Mahfus Dauda, Esther Opeyemi Adeshina, Olugbemisola Wuraola Samuel, Sunday Atobatele & Sidney Sampson

Bill and Melinda Gates Foundation, 45, Aguiyi Ironsi Street, Wuse, Nigeria

Segun Adekanmi Adenipekun

You can also search for this author in PubMed   Google Scholar

Contributions

The article was conceptualized by SDI, MD, EOA, and OAA. SDI, MD, and EOA conducted the qualitative analysis and drafted the manuscript. OWS reviewed the manuscript and made direct edits on the manuscript. SA and AUJ conducted a programmatic review of the paper to approve any program discussions from the paper. SS oversaw the intervention support provided to the two states. DA, SAA, KA, OF, TT, AS, SO, NO, and CO participated in project implementation in Ekiti state.

Corresponding author

Correspondence to Saheed Dipo Isiaka .

Ethics declarations

Ethics approval and consent to participate.

This research adhered to the principles outlined in the Helsinki Declaration. Prior to the commencement of the research, written informed consent was obtained from each participant. Additionally, the research protocols were reviewed and approved by the National Emergency Routine Immunization Coordinating Centre (NERICC), the Institutional (internal) Review Board of the National Primary Health Care Development Agency (NPHCDA) in Abuja, Nigeria.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reprints and permissions

About this article

Jimoh, A.U., Filani, O., Awobeku, D. et al. Qualitative assessment of the enablers and barriers of COVID-19 vaccination integration, into routine immunization Programme at primary health care facilities in Ekiti state, Nigeria. Discov Public Health 21 , 94 (2024). https://doi.org/10.1186/s12982-024-00217-7

Download citation

Received : 28 March 2024

Accepted : 12 September 2024

Published : 18 September 2024

DOI : https://doi.org/10.1186/s12982-024-00217-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Integration
• COVID-19 vaccination
• Routine immunization
• Primary health care facilities
• Find a journal
• Publish with us
• Track your research