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Research Recommendations – Examples and Writing Guide

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Research Recommendations

Definition:

Research recommendations refer to suggestions or advice given to someone who is looking to conduct research on a specific topic or area. These recommendations may include suggestions for research methods, data collection techniques, sources of information, and other factors that can help to ensure that the research is conducted in a rigorous and effective manner. Research recommendations may be provided by experts in the field, such as professors, researchers, or consultants, and are intended to help guide the researcher towards the most appropriate and effective approach to their research project.

Parts of Research Recommendations

Research recommendations can vary depending on the specific project or area of research, but typically they will include some or all of the following parts:

• Research question or objective : This is the overarching goal or purpose of the research project.
• Research methods : This includes the specific techniques and strategies that will be used to collect and analyze data. The methods will depend on the research question and the type of data being collected.
• Data collection: This refers to the process of gathering information or data that will be used to answer the research question. This can involve a range of different methods, including surveys, interviews, observations, or experiments.
• Data analysis : This involves the process of examining and interpreting the data that has been collected. This can involve statistical analysis, qualitative analysis, or a combination of both.
• Results and conclusions: This section summarizes the findings of the research and presents any conclusions or recommendations based on those findings.
• Limitations and future research: This section discusses any limitations of the study and suggests areas for future research that could build on the findings of the current project.

How to Write Research Recommendations

Writing research recommendations involves providing specific suggestions or advice to a researcher on how to conduct their study. Here are some steps to consider when writing research recommendations:

• Understand the research question: Before writing research recommendations, it is important to have a clear understanding of the research question and the objectives of the study. This will help to ensure that the recommendations are relevant and appropriate.
• Consider the research methods: Consider the most appropriate research methods that could be used to collect and analyze data that will address the research question. Identify the strengths and weaknesses of the different methods and how they might apply to the specific research question.
• Provide specific recommendations: Provide specific and actionable recommendations that the researcher can implement in their study. This can include recommendations related to sample size, data collection techniques, research instruments, data analysis methods, or other relevant factors.
• Justify recommendations : Justify why each recommendation is being made and how it will help to address the research question or objective. It is important to provide a clear rationale for each recommendation to help the researcher understand why it is important.
• Consider limitations and ethical considerations : Consider any limitations or potential ethical considerations that may arise in conducting the research. Provide recommendations for addressing these issues or mitigating their impact.
• Summarize recommendations: Provide a summary of the recommendations at the end of the report or document, highlighting the most important points and emphasizing how the recommendations will contribute to the overall success of the research project.

Example of Research Recommendations

Example of Research Recommendations sample for students:

• Further investigate the effects of X on Y by conducting a larger-scale randomized controlled trial with a diverse population.
• Explore the relationship between A and B by conducting qualitative interviews with individuals who have experience with both.
• Investigate the long-term effects of intervention C by conducting a follow-up study with participants one year after completion.
• Examine the effectiveness of intervention D in a real-world setting by conducting a field study in a naturalistic environment.
• Compare and contrast the results of this study with those of previous research on the same topic to identify any discrepancies or inconsistencies in the findings.
• Expand upon the limitations of this study by addressing potential confounding variables and conducting further analyses to control for them.
• Investigate the relationship between E and F by conducting a meta-analysis of existing literature on the topic.
• Explore the potential moderating effects of variable G on the relationship between H and I by conducting subgroup analyses.
• Identify potential areas for future research based on the gaps in current literature and the findings of this study.
• Conduct a replication study to validate the results of this study and further establish the generalizability of the findings.

Applications of Research Recommendations

Research recommendations are important as they provide guidance on how to improve or solve a problem. The applications of research recommendations are numerous and can be used in various fields. Some of the applications of research recommendations include:

• Policy-making: Research recommendations can be used to develop policies that address specific issues. For example, recommendations from research on climate change can be used to develop policies that reduce carbon emissions and promote sustainability.
• Program development: Research recommendations can guide the development of programs that address specific issues. For example, recommendations from research on education can be used to develop programs that improve student achievement.
• Product development : Research recommendations can guide the development of products that meet specific needs. For example, recommendations from research on consumer behavior can be used to develop products that appeal to consumers.
• Marketing strategies: Research recommendations can be used to develop effective marketing strategies. For example, recommendations from research on target audiences can be used to develop marketing strategies that effectively reach specific demographic groups.
• Medical practice : Research recommendations can guide medical practitioners in providing the best possible care to patients. For example, recommendations from research on treatments for specific conditions can be used to improve patient outcomes.
• Scientific research: Research recommendations can guide future research in a specific field. For example, recommendations from research on a specific disease can be used to guide future research on treatments and cures for that disease.

Purpose of Research Recommendations

The purpose of research recommendations is to provide guidance on how to improve or solve a problem based on the findings of research. Research recommendations are typically made at the end of a research study and are based on the conclusions drawn from the research data. The purpose of research recommendations is to provide actionable advice to individuals or organizations that can help them make informed decisions, develop effective strategies, or implement changes that address the issues identified in the research.

The main purpose of research recommendations is to facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings. Recommendations can help bridge the gap between research and practice by providing specific actions that can be taken based on the research results. By providing clear and actionable recommendations, researchers can help ensure that their findings are put into practice, leading to improvements in various fields, such as healthcare, education, business, and public policy.

Characteristics of Research Recommendations

Research recommendations are a key component of research studies and are intended to provide practical guidance on how to apply research findings to real-world problems. The following are some of the key characteristics of research recommendations:

• Actionable : Research recommendations should be specific and actionable, providing clear guidance on what actions should be taken to address the problem identified in the research.
• Evidence-based: Research recommendations should be based on the findings of the research study, supported by the data collected and analyzed.
• Contextual: Research recommendations should be tailored to the specific context in which they will be implemented, taking into account the unique circumstances and constraints of the situation.
• Feasible : Research recommendations should be realistic and feasible, taking into account the available resources, time constraints, and other factors that may impact their implementation.
• Prioritized: Research recommendations should be prioritized based on their potential impact and feasibility, with the most important recommendations given the highest priority.
• Communicated effectively: Research recommendations should be communicated clearly and effectively, using language that is understandable to the target audience.
• Evaluated : Research recommendations should be evaluated to determine their effectiveness in addressing the problem identified in the research, and to identify opportunities for improvement.

Advantages of Research Recommendations

Research recommendations have several advantages, including:

• Providing practical guidance: Research recommendations provide practical guidance on how to apply research findings to real-world problems, helping to bridge the gap between research and practice.
• Improving decision-making: Research recommendations help decision-makers make informed decisions based on the findings of research, leading to better outcomes and improved performance.
• Enhancing accountability : Research recommendations can help enhance accountability by providing clear guidance on what actions should be taken, and by providing a basis for evaluating progress and outcomes.
• Informing policy development : Research recommendations can inform the development of policies that are evidence-based and tailored to the specific needs of a given situation.
• Enhancing knowledge transfer: Research recommendations help facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings.
• Encouraging further research : Research recommendations can help identify gaps in knowledge and areas for further research, encouraging continued exploration and discovery.
• Promoting innovation: Research recommendations can help identify innovative solutions to complex problems, leading to new ideas and approaches.

Limitations of Research Recommendations

While research recommendations have several advantages, there are also some limitations to consider. These limitations include:

• Context-specific: Research recommendations may be context-specific and may not be applicable in all situations. Recommendations developed in one context may not be suitable for another context, requiring adaptation or modification.
• I mplementation challenges: Implementation of research recommendations may face challenges, such as lack of resources, resistance to change, or lack of buy-in from stakeholders.
• Limited scope: Research recommendations may be limited in scope, focusing only on a specific issue or aspect of a problem, while other important factors may be overlooked.
• Uncertainty : Research recommendations may be uncertain, particularly when the research findings are inconclusive or when the recommendations are based on limited data.
• Bias : Research recommendations may be influenced by researcher bias or conflicts of interest, leading to recommendations that are not in the best interests of stakeholders.
• Timing : Research recommendations may be time-sensitive, requiring timely action to be effective. Delayed action may result in missed opportunities or reduced effectiveness.
• Lack of evaluation: Research recommendations may not be evaluated to determine their effectiveness or impact, making it difficult to assess whether they are successful or not.

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Criteria for Good Qualitative Research: A Comprehensive Review

• Regular Article
• Open access
• Published: 18 September 2021
• Volume 31 , pages 679–689, ( 2022 )

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• Drishti Yadav   ORCID: orcid.org/0000-0002-2974-0323 1  

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This review aims to synthesize a published set of evaluative criteria for good qualitative research. The aim is to shed light on existing standards for assessing the rigor of qualitative research encompassing a range of epistemological and ontological standpoints. Using a systematic search strategy, published journal articles that deliberate criteria for rigorous research were identified. Then, references of relevant articles were surveyed to find noteworthy, distinct, and well-defined pointers to good qualitative research. This review presents an investigative assessment of the pivotal features in qualitative research that can permit the readers to pass judgment on its quality and to condemn it as good research when objectively and adequately utilized. Overall, this review underlines the crux of qualitative research and accentuates the necessity to evaluate such research by the very tenets of its being. It also offers some prospects and recommendations to improve the quality of qualitative research. Based on the findings of this review, it is concluded that quality criteria are the aftereffect of socio-institutional procedures and existing paradigmatic conducts. Owing to the paradigmatic diversity of qualitative research, a single and specific set of quality criteria is neither feasible nor anticipated. Since qualitative research is not a cohesive discipline, researchers need to educate and familiarize themselves with applicable norms and decisive factors to evaluate qualitative research from within its theoretical and methodological framework of origin.

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Good Qualitative Research: Opening up the Debate

Beyond qualitative/quantitative structuralism: the positivist qualitative research and the paradigmatic disclaimer.

What is Qualitative in Research

Avoid common mistakes on your manuscript.

Introduction

“… It is important to regularly dialogue about what makes for good qualitative research” (Tracy, 2010 , p. 837)

To decide what represents good qualitative research is highly debatable. There are numerous methods that are contained within qualitative research and that are established on diverse philosophical perspectives. Bryman et al., ( 2008 , p. 262) suggest that “It is widely assumed that whereas quality criteria for quantitative research are well‐known and widely agreed, this is not the case for qualitative research.” Hence, the question “how to evaluate the quality of qualitative research” has been continuously debated. There are many areas of science and technology wherein these debates on the assessment of qualitative research have taken place. Examples include various areas of psychology: general psychology (Madill et al., 2000 ); counseling psychology (Morrow, 2005 ); and clinical psychology (Barker & Pistrang, 2005 ), and other disciplines of social sciences: social policy (Bryman et al., 2008 ); health research (Sparkes, 2001 ); business and management research (Johnson et al., 2006 ); information systems (Klein & Myers, 1999 ); and environmental studies (Reid & Gough, 2000 ). In the literature, these debates are enthused by the impression that the blanket application of criteria for good qualitative research developed around the positivist paradigm is improper. Such debates are based on the wide range of philosophical backgrounds within which qualitative research is conducted (e.g., Sandberg, 2000 ; Schwandt, 1996 ). The existence of methodological diversity led to the formulation of different sets of criteria applicable to qualitative research.

Among qualitative researchers, the dilemma of governing the measures to assess the quality of research is not a new phenomenon, especially when the virtuous triad of objectivity, reliability, and validity (Spencer et al., 2004 ) are not adequate. Occasionally, the criteria of quantitative research are used to evaluate qualitative research (Cohen & Crabtree, 2008 ; Lather, 2004 ). Indeed, Howe ( 2004 ) claims that the prevailing paradigm in educational research is scientifically based experimental research. Hypotheses and conjectures about the preeminence of quantitative research can weaken the worth and usefulness of qualitative research by neglecting the prominence of harmonizing match for purpose on research paradigm, the epistemological stance of the researcher, and the choice of methodology. Researchers have been reprimanded concerning this in “paradigmatic controversies, contradictions, and emerging confluences” (Lincoln & Guba, 2000 ).

In general, qualitative research tends to come from a very different paradigmatic stance and intrinsically demands distinctive and out-of-the-ordinary criteria for evaluating good research and varieties of research contributions that can be made. This review attempts to present a series of evaluative criteria for qualitative researchers, arguing that their choice of criteria needs to be compatible with the unique nature of the research in question (its methodology, aims, and assumptions). This review aims to assist researchers in identifying some of the indispensable features or markers of high-quality qualitative research. In a nutshell, the purpose of this systematic literature review is to analyze the existing knowledge on high-quality qualitative research and to verify the existence of research studies dealing with the critical assessment of qualitative research based on the concept of diverse paradigmatic stances. Contrary to the existing reviews, this review also suggests some critical directions to follow to improve the quality of qualitative research in different epistemological and ontological perspectives. This review is also intended to provide guidelines for the acceleration of future developments and dialogues among qualitative researchers in the context of assessing the qualitative research.

The rest of this review article is structured in the following fashion: Sect.  Methods describes the method followed for performing this review. Section Criteria for Evaluating Qualitative Studies provides a comprehensive description of the criteria for evaluating qualitative studies. This section is followed by a summary of the strategies to improve the quality of qualitative research in Sect.  Improving Quality: Strategies . Section  How to Assess the Quality of the Research Findings? provides details on how to assess the quality of the research findings. After that, some of the quality checklists (as tools to evaluate quality) are discussed in Sect.  Quality Checklists: Tools for Assessing the Quality . At last, the review ends with the concluding remarks presented in Sect.  Conclusions, Future Directions and Outlook . Some prospects in qualitative research for enhancing its quality and usefulness in the social and techno-scientific research community are also presented in Sect.  Conclusions, Future Directions and Outlook .

For this review, a comprehensive literature search was performed from many databases using generic search terms such as Qualitative Research , Criteria , etc . The following databases were chosen for the literature search based on the high number of results: IEEE Explore, ScienceDirect, PubMed, Google Scholar, and Web of Science. The following keywords (and their combinations using Boolean connectives OR/AND) were adopted for the literature search: qualitative research, criteria, quality, assessment, and validity. The synonyms for these keywords were collected and arranged in a logical structure (see Table 1 ). All publications in journals and conference proceedings later than 1950 till 2021 were considered for the search. Other articles extracted from the references of the papers identified in the electronic search were also included. A large number of publications on qualitative research were retrieved during the initial screening. Hence, to include the searches with the main focus on criteria for good qualitative research, an inclusion criterion was utilized in the search string.

From the selected databases, the search retrieved a total of 765 publications. Then, the duplicate records were removed. After that, based on the title and abstract, the remaining 426 publications were screened for their relevance by using the following inclusion and exclusion criteria (see Table 2 ). Publications focusing on evaluation criteria for good qualitative research were included, whereas those works which delivered theoretical concepts on qualitative research were excluded. Based on the screening and eligibility, 45 research articles were identified that offered explicit criteria for evaluating the quality of qualitative research and were found to be relevant to this review.

Figure  1 illustrates the complete review process in the form of PRISMA flow diagram. PRISMA, i.e., “preferred reporting items for systematic reviews and meta-analyses” is employed in systematic reviews to refine the quality of reporting.

PRISMA flow diagram illustrating the search and inclusion process. N represents the number of records

Criteria for Evaluating Qualitative Studies

Fundamental criteria: general research quality.

Various researchers have put forward criteria for evaluating qualitative research, which have been summarized in Table 3 . Also, the criteria outlined in Table 4 effectively deliver the various approaches to evaluate and assess the quality of qualitative work. The entries in Table 4 are based on Tracy’s “Eight big‐tent criteria for excellent qualitative research” (Tracy, 2010 ). Tracy argues that high-quality qualitative work should formulate criteria focusing on the worthiness, relevance, timeliness, significance, morality, and practicality of the research topic, and the ethical stance of the research itself. Researchers have also suggested a series of questions as guiding principles to assess the quality of a qualitative study (Mays & Pope, 2020 ). Nassaji ( 2020 ) argues that good qualitative research should be robust, well informed, and thoroughly documented.

Qualitative Research: Interpretive Paradigms

All qualitative researchers follow highly abstract principles which bring together beliefs about ontology, epistemology, and methodology. These beliefs govern how the researcher perceives and acts. The net, which encompasses the researcher’s epistemological, ontological, and methodological premises, is referred to as a paradigm, or an interpretive structure, a “Basic set of beliefs that guides action” (Guba, 1990 ). Four major interpretive paradigms structure the qualitative research: positivist and postpositivist, constructivist interpretive, critical (Marxist, emancipatory), and feminist poststructural. The complexity of these four abstract paradigms increases at the level of concrete, specific interpretive communities. Table 5 presents these paradigms and their assumptions, including their criteria for evaluating research, and the typical form that an interpretive or theoretical statement assumes in each paradigm. Moreover, for evaluating qualitative research, quantitative conceptualizations of reliability and validity are proven to be incompatible (Horsburgh, 2003 ). In addition, a series of questions have been put forward in the literature to assist a reviewer (who is proficient in qualitative methods) for meticulous assessment and endorsement of qualitative research (Morse, 2003 ). Hammersley ( 2007 ) also suggests that guiding principles for qualitative research are advantageous, but methodological pluralism should not be simply acknowledged for all qualitative approaches. Seale ( 1999 ) also points out the significance of methodological cognizance in research studies.

Table 5 reflects that criteria for assessing the quality of qualitative research are the aftermath of socio-institutional practices and existing paradigmatic standpoints. Owing to the paradigmatic diversity of qualitative research, a single set of quality criteria is neither possible nor desirable. Hence, the researchers must be reflexive about the criteria they use in the various roles they play within their research community.

Improving Quality: Strategies

Another critical question is “How can the qualitative researchers ensure that the abovementioned quality criteria can be met?” Lincoln and Guba ( 1986 ) delineated several strategies to intensify each criteria of trustworthiness. Other researchers (Merriam & Tisdell, 2016 ; Shenton, 2004 ) also presented such strategies. A brief description of these strategies is shown in Table 6 .

It is worth mentioning that generalizability is also an integral part of qualitative research (Hays & McKibben, 2021 ). In general, the guiding principle pertaining to generalizability speaks about inducing and comprehending knowledge to synthesize interpretive components of an underlying context. Table 7 summarizes the main metasynthesis steps required to ascertain generalizability in qualitative research.

Figure  2 reflects the crucial components of a conceptual framework and their contribution to decisions regarding research design, implementation, and applications of results to future thinking, study, and practice (Johnson et al., 2020 ). The synergy and interrelationship of these components signifies their role to different stances of a qualitative research study.

Essential elements of a conceptual framework

In a nutshell, to assess the rationale of a study, its conceptual framework and research question(s), quality criteria must take account of the following: lucid context for the problem statement in the introduction; well-articulated research problems and questions; precise conceptual framework; distinct research purpose; and clear presentation and investigation of the paradigms. These criteria would expedite the quality of qualitative research.

How to Assess the Quality of the Research Findings?

The inclusion of quotes or similar research data enhances the confirmability in the write-up of the findings. The use of expressions (for instance, “80% of all respondents agreed that” or “only one of the interviewees mentioned that”) may also quantify qualitative findings (Stenfors et al., 2020 ). On the other hand, the persuasive reason for “why this may not help in intensifying the research” has also been provided (Monrouxe & Rees, 2020 ). Further, the Discussion and Conclusion sections of an article also prove robust markers of high-quality qualitative research, as elucidated in Table 8 .

Quality Checklists: Tools for Assessing the Quality

Numerous checklists are available to speed up the assessment of the quality of qualitative research. However, if used uncritically and recklessly concerning the research context, these checklists may be counterproductive. I recommend that such lists and guiding principles may assist in pinpointing the markers of high-quality qualitative research. However, considering enormous variations in the authors’ theoretical and philosophical contexts, I would emphasize that high dependability on such checklists may say little about whether the findings can be applied in your setting. A combination of such checklists might be appropriate for novice researchers. Some of these checklists are listed below:

The most commonly used framework is Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al., 2007 ). This framework is recommended by some journals to be followed by the authors during article submission.

Standards for Reporting Qualitative Research (SRQR) is another checklist that has been created particularly for medical education (O’Brien et al., 2014 ).

Also, Tracy ( 2010 ) and Critical Appraisal Skills Programme (CASP, 2021 ) offer criteria for qualitative research relevant across methods and approaches.

Further, researchers have also outlined different criteria as hallmarks of high-quality qualitative research. For instance, the “Road Trip Checklist” (Epp & Otnes, 2021 ) provides a quick reference to specific questions to address different elements of high-quality qualitative research.

Conclusions, Future Directions, and Outlook

This work presents a broad review of the criteria for good qualitative research. In addition, this article presents an exploratory analysis of the essential elements in qualitative research that can enable the readers of qualitative work to judge it as good research when objectively and adequately utilized. In this review, some of the essential markers that indicate high-quality qualitative research have been highlighted. I scope them narrowly to achieve rigor in qualitative research and note that they do not completely cover the broader considerations necessary for high-quality research. This review points out that a universal and versatile one-size-fits-all guideline for evaluating the quality of qualitative research does not exist. In other words, this review also emphasizes the non-existence of a set of common guidelines among qualitative researchers. In unison, this review reinforces that each qualitative approach should be treated uniquely on account of its own distinctive features for different epistemological and disciplinary positions. Owing to the sensitivity of the worth of qualitative research towards the specific context and the type of paradigmatic stance, researchers should themselves analyze what approaches can be and must be tailored to ensemble the distinct characteristics of the phenomenon under investigation. Although this article does not assert to put forward a magic bullet and to provide a one-stop solution for dealing with dilemmas about how, why, or whether to evaluate the “goodness” of qualitative research, it offers a platform to assist the researchers in improving their qualitative studies. This work provides an assembly of concerns to reflect on, a series of questions to ask, and multiple sets of criteria to look at, when attempting to determine the quality of qualitative research. Overall, this review underlines the crux of qualitative research and accentuates the need to evaluate such research by the very tenets of its being. Bringing together the vital arguments and delineating the requirements that good qualitative research should satisfy, this review strives to equip the researchers as well as reviewers to make well-versed judgment about the worth and significance of the qualitative research under scrutiny. In a nutshell, a comprehensive portrayal of the research process (from the context of research to the research objectives, research questions and design, speculative foundations, and from approaches of collecting data to analyzing the results, to deriving inferences) frequently proliferates the quality of a qualitative research.

Prospects : A Road Ahead for Qualitative Research

Irrefutably, qualitative research is a vivacious and evolving discipline wherein different epistemological and disciplinary positions have their own characteristics and importance. In addition, not surprisingly, owing to the sprouting and varied features of qualitative research, no consensus has been pulled off till date. Researchers have reflected various concerns and proposed several recommendations for editors and reviewers on conducting reviews of critical qualitative research (Levitt et al., 2021 ; McGinley et al., 2021 ). Following are some prospects and a few recommendations put forward towards the maturation of qualitative research and its quality evaluation:

In general, most of the manuscript and grant reviewers are not qualitative experts. Hence, it is more likely that they would prefer to adopt a broad set of criteria. However, researchers and reviewers need to keep in mind that it is inappropriate to utilize the same approaches and conducts among all qualitative research. Therefore, future work needs to focus on educating researchers and reviewers about the criteria to evaluate qualitative research from within the suitable theoretical and methodological context.

There is an urgent need to refurbish and augment critical assessment of some well-known and widely accepted tools (including checklists such as COREQ, SRQR) to interrogate their applicability on different aspects (along with their epistemological ramifications).

Efforts should be made towards creating more space for creativity, experimentation, and a dialogue between the diverse traditions of qualitative research. This would potentially help to avoid the enforcement of one's own set of quality criteria on the work carried out by others.

Moreover, journal reviewers need to be aware of various methodological practices and philosophical debates.

It is pivotal to highlight the expressions and considerations of qualitative researchers and bring them into a more open and transparent dialogue about assessing qualitative research in techno-scientific, academic, sociocultural, and political rooms.

Frequent debates on the use of evaluative criteria are required to solve some potentially resolved issues (including the applicability of a single set of criteria in multi-disciplinary aspects). Such debates would not only benefit the group of qualitative researchers themselves, but primarily assist in augmenting the well-being and vivacity of the entire discipline.

To conclude, I speculate that the criteria, and my perspective, may transfer to other methods, approaches, and contexts. I hope that they spark dialog and debate – about criteria for excellent qualitative research and the underpinnings of the discipline more broadly – and, therefore, help improve the quality of a qualitative study. Further, I anticipate that this review will assist the researchers to contemplate on the quality of their own research, to substantiate research design and help the reviewers to review qualitative research for journals. On a final note, I pinpoint the need to formulate a framework (encompassing the prerequisites of a qualitative study) by the cohesive efforts of qualitative researchers of different disciplines with different theoretic-paradigmatic origins. I believe that tailoring such a framework (of guiding principles) paves the way for qualitative researchers to consolidate the status of qualitative research in the wide-ranging open science debate. Dialogue on this issue across different approaches is crucial for the impending prospects of socio-techno-educational research.

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Yadav, D. Criteria for Good Qualitative Research: A Comprehensive Review. Asia-Pacific Edu Res 31 , 679–689 (2022). https://doi.org/10.1007/s40299-021-00619-0

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Research Recommendations – Guiding policy-makers for evidence-based decision making

Research recommendations play a crucial role in guiding scholars and researchers toward fruitful avenues of exploration. In an era marked by rapid technological advancements and an ever-expanding knowledge base, refining the process of generating research recommendations becomes imperative.

But, what is a research recommendation?

Research recommendations are suggestions or advice provided to researchers to guide their study on a specific topic . They are typically given by experts in the field. Research recommendations are more action-oriented and provide specific guidance for decision-makers, unlike implications that are broader and focus on the broader significance and consequences of the research findings. However, both are crucial components of a research study.

Difference Between Research Recommendations and Implication

Although research recommendations and implications are distinct components of a research study, they are closely related. The differences between them are as follows:

Types of Research Recommendations

Recommendations in research can take various forms, which are as follows:

These recommendations aim to assist researchers in navigating the vast landscape of academic knowledge.

Let us dive deeper to know about its key components and the steps to write an impactful research recommendation.

Key Components of Research Recommendations

The key components of research recommendations include defining the research question or objective, specifying research methods, outlining data collection and analysis processes, presenting results and conclusions, addressing limitations, and suggesting areas for future research. Here are some characteristics of research recommendations:

Research recommendations offer various advantages and play a crucial role in ensuring that research findings contribute to positive outcomes in various fields. However, they also have few limitations which highlights the significance of a well-crafted research recommendation in offering the promised advantages.

The importance of research recommendations ranges in various fields, influencing policy-making, program development, product development, marketing strategies, medical practice, and scientific research. Their purpose is to transfer knowledge from researchers to practitioners, policymakers, or stakeholders, facilitating informed decision-making and improving outcomes in different domains.

How to Write Research Recommendations?

Research recommendations can be generated through various means, including algorithmic approaches, expert opinions, or collaborative filtering techniques. Here is a step-wise guide to build your understanding on the development of research recommendations.

1. Understand the Research Question:

Understand the research question and objectives before writing recommendations. Also, ensure that your recommendations are relevant and directly address the goals of the study.

2. Review Existing Literature:

Familiarize yourself with relevant existing literature to help you identify gaps , and offer informed recommendations that contribute to the existing body of research.

3. Consider Research Methods:

Evaluate the appropriateness of different research methods in addressing the research question. Also, consider the nature of the data, the study design, and the specific objectives.

4. Identify Data Collection Techniques:

Gather dataset from diverse authentic sources. Include information such as keywords, abstracts, authors, publication dates, and citation metrics to provide a rich foundation for analysis.

5. Propose Data Analysis Methods:

Suggest appropriate data analysis methods based on the type of data collected. Consider whether statistical analysis, qualitative analysis, or a mixed-methods approach is most suitable.

6. Consider Limitations and Ethical Considerations:

Acknowledge any limitations and potential ethical considerations of the study. Furthermore, address these limitations or mitigate ethical concerns to ensure responsible research.

7. Justify Recommendations:

Explain how your recommendation contributes to addressing the research question or objective. Provide a strong rationale to help researchers understand the importance of following your suggestions.

8. Summarize Recommendations:

Provide a concise summary at the end of the report to emphasize how following these recommendations will contribute to the overall success of the research project.

By following these steps, you can create research recommendations that are actionable and contribute meaningfully to the success of the research project.

Download now to unlock some tips to improve your journey of writing research recommendations.

Example of a Research Recommendation

Here is an example of a research recommendation based on a hypothetical research to improve your understanding.

Research Recommendation: Enhancing Student Learning through Integrated Learning Platforms

Background:

The research study investigated the impact of an integrated learning platform on student learning outcomes in high school mathematics classes. The findings revealed a statistically significant improvement in student performance and engagement when compared to traditional teaching methods.

Recommendation:

In light of the research findings, it is recommended that educational institutions consider adopting and integrating the identified learning platform into their mathematics curriculum. The following specific recommendations are provided:

• Implementation of the Integrated Learning Platform:

Schools are encouraged to adopt the integrated learning platform in mathematics classrooms, ensuring proper training for teachers on its effective utilization.

• Professional Development for Educators:

Develop and implement professional programs to train educators in the effective use of the integrated learning platform to address any challenges teachers may face during the transition.

• Monitoring and Evaluation:

Establish a monitoring and evaluation system to track the impact of the integrated learning platform on student performance over time.

• Resource Allocation:

Allocate sufficient resources, both financial and technical, to support the widespread implementation of the integrated learning platform.

By implementing these recommendations, educational institutions can harness the potential of the integrated learning platform and enhance student learning experiences and academic achievements in mathematics.

This example covers the components of a research recommendation, providing specific actions based on the research findings, identifying the target audience, and outlining practical steps for implementation.

Using AI in Research Recommendation Writing

Enhancing research recommendations is an ongoing endeavor that requires the integration of cutting-edge technologies, collaborative efforts, and ethical considerations. By embracing data-driven approaches and leveraging advanced technologies, the research community can create more effective and personalized recommendation systems. However, it is accompanied by several limitations. Therefore, it is essential to approach the use of AI in research with a critical mindset, and complement its capabilities with human expertise and judgment.

Here are some limitations of integrating AI in writing research recommendation and some ways on how to counter them.

1. Data Bias

AI systems rely heavily on data for training. If the training data is biased or incomplete, the AI model may produce biased results or recommendations.

How to tackle: Audit regularly the model’s performance to identify any discrepancies and adjust the training data and algorithms accordingly.

2. Lack of Understanding of Context:

AI models may struggle to understand the nuanced context of a particular research problem. They may misinterpret information, leading to inaccurate recommendations.

How to tackle: Use AI to characterize research articles and topics. Employ them to extract features like keywords, authorship patterns and content-based details.

3. Ethical Considerations:

AI models might stereotype certain concepts or generate recommendations that could have negative consequences for certain individuals or groups.

How to tackle: Incorporate user feedback mechanisms to reduce redundancies. Establish an ethics review process for AI models in research recommendation writing.

4. Lack of Creativity and Intuition:

AI may struggle with tasks that require a deep understanding of the underlying principles or the ability to think outside the box.

How to tackle: Hybrid approaches can be employed by integrating AI in data analysis and identifying patterns for accelerating the data interpretation process.

5. Interpretability:

Many AI models, especially complex deep learning models, lack transparency on how the model arrived at a particular recommendation.

How to tackle: Implement models like decision trees or linear models. Provide clear explanation of the model architecture, training process, and decision-making criteria.

6. Dynamic Nature of Research:

Research fields are dynamic, and new information is constantly emerging. AI models may struggle to keep up with the rapidly changing landscape and may not be able to adapt to new developments.

How to tackle: Establish a feedback loop for continuous improvement. Regularly update the recommendation system based on user feedback and emerging research trends.

The integration of AI in research recommendation writing holds great promise for advancing knowledge and streamlining the research process. However, navigating these concerns is pivotal in ensuring the responsible deployment of these technologies. Researchers need to understand the use of responsible use of AI in research and must be aware of the ethical considerations.

Exploring research recommendations plays a critical role in shaping the trajectory of scientific inquiry. It serves as a compass, guiding researchers toward more robust methodologies, collaborative endeavors, and innovative approaches. Embracing these suggestions not only enhances the quality of individual studies but also contributes to the collective advancement of human understanding.

Frequently Asked Questions

The purpose of recommendations in research is to provide practical and actionable suggestions based on the study's findings, guiding future actions, policies, or interventions in a specific field or context. Recommendations bridges the gap between research outcomes and their real-world application.

To make a research recommendation, analyze your findings, identify key insights, and propose specific, evidence-based actions. Include the relevance of the recommendations to the study's objectives and provide practical steps for implementation.

Begin a recommendation by succinctly summarizing the key findings of the research. Clearly state the purpose of the recommendation and its intended impact. Use a direct and actionable language to convey the suggested course of action.

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• How to Write Recommendations in Research | Examples & Tips

How to Write Recommendations in Research | Examples & Tips

Published on 15 September 2022 by Tegan George .

Recommendations in research are a crucial component of your discussion section and the conclusion of your thesis , dissertation , or research paper .

As you conduct your research and analyse the data you collected , perhaps there are ideas or results that don’t quite fit the scope of your research topic . Or, maybe your results suggest that there are further implications of your results or the causal relationships between previously-studied variables than covered in extant research.

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What should recommendations look like, building your research recommendation, how should your recommendations be written, recommendation in research example, frequently asked questions about recommendations.

Recommendations for future research should be:

• Concrete and specific
• Supported with a clear rationale
• Directly connected to your research

Overall, strive to highlight ways other researchers can reproduce or replicate your results to draw further conclusions, and suggest different directions that future research can take, if applicable.

Relatedly, when making these recommendations, avoid:

• Undermining your own work, but rather offer suggestions on how future studies can build upon it
• Suggesting recommendations actually needed to complete your argument, but rather ensure that your research stands alone on its own merits
• Using recommendations as a place for self-criticism, but rather as a natural extension point for your work

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There are many different ways to frame recommendations, but the easiest is perhaps to follow the formula of research question   conclusion  recommendation. Here’s an example.

Conclusion An important condition for controlling many social skills is mastering language. If children have a better command of language, they can express themselves better and are better able to understand their peers. Opportunities to practice social skills are thus dependent on the development of language skills.

As a rule of thumb, try to limit yourself to only the most relevant future recommendations: ones that stem directly from your work. While you can have multiple recommendations for each research conclusion, it is also acceptable to have one recommendation that is connected to more than one conclusion.

These recommendations should be targeted at your audience, specifically toward peers or colleagues in your field that work on similar topics to yours. They can flow directly from any limitations you found while conducting your work, offering concrete and actionable possibilities for how future research can build on anything that your own work was unable to address at the time of your writing.

See below for a full research recommendation example that you can use as a template to write your own.

The current study can be interpreted as a first step in the research on COPD speech characteristics. However, the results of this study should be treated with caution due to the small sample size and the lack of details regarding the participants’ characteristics.

Future research could further examine the differences in speech characteristics between exacerbated COPD patients, stable COPD patients, and healthy controls. It could also contribute to a deeper understanding of the acoustic measurements suitable for e-health measurements.

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While it may be tempting to present new arguments or evidence in your thesis or disseration conclusion , especially if you have a particularly striking argument you’d like to finish your analysis with, you shouldn’t. Theses and dissertations follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the discussion section and results section .) The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

The conclusion of your thesis or dissertation should include the following:

• A restatement of your research question
• A summary of your key arguments and/or results
• A short discussion of the implications of your research

For a stronger dissertation conclusion , avoid including:

• Generic concluding phrases (e.g. “In conclusion…”)
• Weak statements that undermine your argument (e.g. “There are good points on both sides of this issue.”)

Your conclusion should leave the reader with a strong, decisive impression of your work.

In a thesis or dissertation, the discussion is an in-depth exploration of the results, going into detail about the meaning of your findings and citing relevant sources to put them in context.

The conclusion is more shorter and more general: it concisely answers your main research question and makes recommendations based on your overall findings.

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on June 22, 2023.

Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analyzing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, history, etc.

• How does social media shape body image in teenagers?
• How do children and adults interpret healthy eating in the UK?
• What factors influence employee retention in a large organization?
• How is anxiety experienced around the world?
• How can teachers integrate social issues into science curriculums?

Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, other interesting articles, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography , action research , phenomenological research, and narrative research. They share some similarities, but emphasize different aims and perspectives.

Note that qualitative research is at risk for certain research biases including the Hawthorne effect , observer bias , recall bias , and social desirability bias . While not always totally avoidable, awareness of potential biases as you collect and analyze your data can prevent them from impacting your work too much.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

• Observations: recording what you have seen, heard, or encountered in detailed field notes.
• Interviews:  personally asking people questions in one-on-one conversations.
• Focus groups: asking questions and generating discussion among a group of people.
• Surveys : distributing questionnaires with open-ended questions.
• Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
• You take field notes with observations and reflect on your own experiences of the company culture.
• You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
• You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves “instruments” in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analyzing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

• Prepare and organize your data. This may mean transcribing interviews or typing up fieldnotes.
• Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
• Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorize your data.
• Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
• Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analyzing qualitative data. Although these methods share similar processes, they emphasize different concepts.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

• Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

• Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

• Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

• Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

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

• Unreliability

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

• Subjectivity

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

• Limited generalizability

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

• Labor-intensive

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

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

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

Research bias

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

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

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

There are five common approaches to qualitative research :

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

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

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

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

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

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Implications or Recommendations in Research: What's the Difference?

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High-quality research articles that get many citations contain both implications and recommendations. Implications are the impact your research makes, whereas recommendations are specific actions that can then be taken based on your findings, such as for more research or for policymaking.

Updated on August 23, 2022

That seems clear enough, but the two are commonly confused.

This confusion is especially true if you come from a so-called high-context culture in which information is often implied based on the situation, as in many Asian cultures. High-context cultures are different from low-context cultures where information is more direct and explicit (as in North America and many European cultures).

Let's set these two straight in a low-context way; i.e., we'll be specific and direct! This is the best way to be in English academic writing because you're writing for the world.

Implications and recommendations in a research article

The standard format of STEM research articles is what's called IMRaD:

• Introduction
• Discussion/conclusions

Some journals call for a separate conclusions section, while others have the conclusions as the last part of the discussion. You'll write these four (or five) sections in the same sequence, though, no matter the journal.

The discussion section is typically where you restate your results and how well they confirmed your hypotheses. Give readers the answer to the questions for which they're looking to you for an answer.

At this point, many researchers assume their paper is finished. After all, aren't the results the most important part? As you might have guessed, no, you're not quite done yet.

The discussion/conclusions section is where to say what happened and what should now happen

The discussion/conclusions section of every good scientific article should contain the implications and recommendations.

The implications, first of all, are the impact your results have on your specific field. A high-impact, highly cited article will also broaden the scope here and provide implications to other fields. This is what makes research cross-disciplinary.

Recommendations, however, are suggestions to improve your field based on your results.

These two aspects help the reader understand your broader content: How and why your work is important to the world. They also tell the reader what can be changed in the future based on your results.

These aspects are what editors are looking for when selecting papers for peer review.

Implications and recommendations are, thus, written at the end of the discussion section, and before the concluding paragraph. They help to “wrap up” your paper. Once your reader understands what you found, the next logical step is what those results mean and what should come next.

Then they can take the baton, in the form of your work, and run with it. That gets you cited and extends your impact!

The order of implications and recommendations also matters. Both are written after you've summarized your main findings in the discussion section. Then, those results are interpreted based on ongoing work in the field. After this, the implications are stated, followed by the recommendations.

Writing an academic research paper is a bit like running a race. Finish strong, with your most important conclusion (recommendation) at the end. Leave readers with an understanding of your work's importance. Avoid generic, obvious phrases like "more research is needed to fully address this issue." Be specific.

The main differences between implications and recommendations (table)

Now let's dig a bit deeper into actually how to write these parts.

What are implications?

Research implications tell us how and why your results are important for the field at large. They help answer the question of “what does it mean?” Implications tell us how your work contributes to your field and what it adds to it. They're used when you want to tell your peers why your research is important for ongoing theory, practice, policymaking, and for future research.

Crucially, your implications must be evidence-based. This means they must be derived from the results in the paper.

Implications are written after you've summarized your main findings in the discussion section. They come before the recommendations and before the concluding paragraph. There is no specific section dedicated to implications. They must be integrated into your discussion so that the reader understands why the results are meaningful and what they add to the field.

A good strategy is to separate your implications into types. Implications can be social, political, technological, related to policies, or others, depending on your topic. The most frequently used types are theoretical and practical. Theoretical implications relate to how your findings connect to other theories or ideas in your field, while practical implications are related to what we can do with the results.

Key features of implications

• State the impact your research makes
• Helps us understand why your results are important
• Must be evidence-based
• Written in the discussion, before recommendations
• Can be theoretical, practical, or other (social, political, etc.)

Examples of implications

Let's take a look at some examples of research results below with their implications.

The result : one study found that learning items over time improves memory more than cramming material in a bunch of information at once .

The implications : This result suggests memory is better when studying is spread out over time, which could be due to memory consolidation processes.

The result : an intervention study found that mindfulness helps improve mental health if you have anxiety.

The implications : This result has implications for the role of executive functions on anxiety.

The result : a study found that musical learning helps language learning in children .

The implications : these findings suggest that language and music may work together to aid development.

What are recommendations?

As noted above, explaining how your results contribute to the real world is an important part of a successful article.

Likewise, stating how your findings can be used to improve something in future research is equally important. This brings us to the recommendations.

Research recommendations are suggestions and solutions you give for certain situations based on your results. Once the reader understands what your results mean with the implications, the next question they need to know is "what's next?"

Recommendations are calls to action on ways certain things in the field can be improved in the future based on your results. Recommendations are used when you want to convey that something different should be done based on what your analyses revealed.

Similar to implications, recommendations are also evidence-based. This means that your recommendations to the field must be drawn directly from your results.

The goal of the recommendations is to make clear, specific, and realistic suggestions to future researchers before they conduct a similar experiment. No matter what area your research is in, there will always be further research to do. Try to think about what would be helpful for other researchers to know before starting their work.

Recommendations are also written in the discussion section. They come after the implications and before the concluding paragraphs. Similar to the implications, there is usually no specific section dedicated to the recommendations. However, depending on how many solutions you want to suggest to the field, they may be written as a subsection.

Key features of recommendations

• Statements about what can be done differently in the field based on your findings
• Must be realistic and specific
• Written in the discussion, after implications and before conclusions
• Related to both your field and, preferably, a wider context to the research

Examples of recommendations

Here are some research results and their recommendations.

A meta-analysis found that actively recalling material from your memory is better than simply re-reading it .

• The recommendation: Based on these findings, teachers and other educators should encourage students to practice active recall strategies.

A medical intervention found that daily exercise helps prevent cardiovascular disease .

• The recommendation: Based on these results, physicians are recommended to encourage patients to exercise and walk regularly. Also recommended is to encourage more walking through public health offices in communities.

A study found that many research articles do not contain the sample sizes needed to statistically confirm their findings .

The recommendation: To improve the current state of the field, researchers should consider doing power analysis based on their experiment's design.

What else is important about implications and recommendations?

When writing recommendations and implications, be careful not to overstate the impact of your results. It can be tempting for researchers to inflate the importance of their findings and make grandiose statements about what their work means.

Remember that implications and recommendations must be coming directly from your results. Therefore, they must be straightforward, realistic, and plausible.

Another good thing to remember is to make sure the implications and recommendations are stated clearly and separately. Do not attach them to the endings of other paragraphs just to add them in. Use similar example phrases as those listed in the table when starting your sentences to clearly indicate when it's an implication and when it's a recommendation.

When your peers, or brand-new readers, read your paper, they shouldn't have to hunt through your discussion to find the implications and recommendations. They should be clear, visible, and understandable on their own.

That'll get you cited more, and you'll make a greater contribution to your area of science while extending the life and impact of your work.

The AJE Team

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Standards for Reporting Qualitative Research

A synthesis of recommendations.

O’Brien, Bridget C. PhD; Harris, Ilene B. PhD; Beckman, Thomas J. MD; Reed, Darcy A. MD, MPH; Cook, David A. MD, MHPE

Dr. O’Brien is assistant professor, Department of Medicine and Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.

Dr. Harris is professor and head, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois.

Dr. Beckman is professor of medicine and medical education, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.

Dr. Reed is associate professor of medicine and medical education, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.

Dr. Cook is associate director, Mayo Clinic Online Learning, research chair, Mayo Multidisciplinary Simulation Center, and professor of medicine and medical education, Mayo Clinic College of Medicine, Rochester, Minnesota.

Funding/Support: This study was funded in part by a research review grant from the Society for Directors of Research in Medical Education.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimer: The funding agency had no role in the study design, analysis, interpretation, writing of the manuscript, or decision to submit the manuscript for publication.

Supplemental digital content for this article is available at https://links.lww.com/ACADMED/A218 .

Correspondence should be addressed to Dr. O’Brien, Office of Research and Development in Medical Education, UCSF School of Medicine, Box 3202, 1855 Folsom St., Suite 200, San Francisco, CA 94143-3202; e-mail: [email protected] .

Purpose 

Standards for reporting exist for many types of quantitative research, but currently none exist for the broad spectrum of qualitative research. The purpose of the present study was to formulate and define standards for reporting qualitative research while preserving the requisite flexibility to accommodate various paradigms, approaches, and methods.

Method 

The authors identified guidelines, reporting standards, and critical appraisal criteria for qualitative research by searching PubMed, Web of Science, and Google through July 2013; reviewing the reference lists of retrieved sources; and contacting experts. Specifically, two authors reviewed a sample of sources to generate an initial set of items that were potentially important in reporting qualitative research. Through an iterative process of reviewing sources, modifying the set of items, and coding all sources for items, the authors prepared a near-final list of items and descriptions and sent this list to five external reviewers for feedback. The final items and descriptions included in the reporting standards reflect this feedback.

Results 

The Standards for Reporting Qualitative Research (SRQR) consists of 21 items. The authors define and explain key elements of each item and provide examples from recently published articles to illustrate ways in which the standards can be met.

Conclusions 

The SRQR aims to improve the transparency of all aspects of qualitative research by providing clear standards for reporting qualitative research. These standards will assist authors during manuscript preparation, editors and reviewers in evaluating a manuscript for potential publication, and readers when critically appraising, applying, and synthesizing study findings.

Qualitative research contributes to the literature in many disciplines by describing, interpreting, and generating theories about social interactions and individual experiences as they occur in natural, rather than experimental, situations. 1–3 Some recent examples include studies of professional dilemmas, 4 medical students’ early experiences of workplace learning, 5 patients’ experiences of disease and interventions, 6–8 and patients’ perspectives about incident disclosures. 9 The purpose of qualitative research is to understand the perspectives/experiences of individuals or groups and the contexts in which these perspectives or experiences are situated. 1 , 2 , 10

Qualitative research is increasingly common and valued in the medical and medical education literature. 1 , 10–13 However, the quality of such research can be difficult to evaluate because of incomplete reporting of key elements. 14 , 15 Quality is multifaceted and includes consideration of the importance of the research question, the rigor of the research methods, the appropriateness and salience of the inferences, and the clarity and completeness of reporting. 16 , 17 Although there is much debate about standards for methodological rigor in qualitative research, 13 , 14 , 18–20 there is widespread agreement about the need for clear and complete reporting. 14 , 21 , 22 Optimal reporting would enable editors, reviewers, other researchers, and practitioners to critically appraise qualitative studies and apply and synthesize the results. One important step in improving the quality of reporting is to formulate and define clear reporting standards.

Authors have proposed guidelines for the quality of qualitative research, including those in the fields of medical education, 23–25 clinical and health services research, 26–28 and general education research. 29 , 30 Yet in nearly all cases, the authors do not describe how the guidelines were created, and often fail to distinguish reporting quality from the other facets of quality (e.g., the research question or methods). Several authors suggest standards for reporting qualitative research, 15 , 20 , 29–33 but their articles focus on a subset of qualitative data collection methods (e.g., interviews), fail to explain how the authors developed the reporting criteria, narrowly construe qualitative research (e.g., thematic analysis) in ways that may exclude other approaches, and/or lack specific examples to help others see how the standards might be achieved. Thus, there remains a compelling need for defensible and broadly applicable standards for reporting qualitative research.

We designed and carried out the present study to formulate and define standards for reporting qualitative research through a rigorous synthesis of published articles and expert recommendations.

We formulated standards for reporting qualitative research by using a rigorous and systematic approach in which we reviewed previously proposed recommendations by experts in qualitative methods. Our research team consisted of two PhD researchers and one physician with formal training and experience in qualitative methods, and two physicians with experience, but no formal training, in qualitative methods.

We first identified previously proposed recommendations by searching PubMed, Web of Science, and Google using combinations of terms such as “qualitative methods,” “qualitative research,” “qualitative guidelines,” “qualitative standards,” and “critical appraisal” and by reviewing the reference lists of retrieved sources, reviewing the Equator Network, 22 and contacting experts. We conducted our first search in January 2007 and our last search in July 2013. Most recommendations were published in peer-reviewed journals, but some were available only on the Internet, and one was an interim draft from a national organization. We report the full set of the 40 sources reviewed in Supplemental Digital Appendix 1, found at https://links.lww.com/ACADMED/A218 .

Two of us (B.O., I.H.) reviewed an initial sample of sources to generate a comprehensive list of items that were potentially important in reporting qualitative research (Draft A). All of us then worked in pairs to review all sources and code the presence or absence of each item in a given source. From Draft A, we then distilled a shorter list (Draft B) by identifying core concepts and combining related items, taking into account the number of times each item appeared in these sources. We then compared the items in Draft B with material in the original sources to check for missing concepts, modify accordingly, and add explanatory definitions to create a prefinal list of items (Draft C).

We circulated Draft C to five experienced qualitative researchers (see the acknowledgments) for review. We asked them to note any omitted or redundant items and to suggest improvements to the wording to enhance clarity and relevance across a broad spectrum of qualitative inquiry. In response to their reviews, we consolidated some items and made minor revisions to the wording of labels and definitions to create the final set of reporting standards—the Standards for Reporting Qualitative Research (SRQR)—summarized in Table 1 .

To explicate how the final set of standards reflect the material in the original sources, two of us (B.O., D.A.C.) selected by consensus the 25 most complete sources of recommendations and identified which standards reflected the concepts found in each original source (see Table 2 ).

The SRQR is a list of 21 items that we consider essential for complete, transparent reporting of qualitative research (see Table 1 ). As explained above, we developed these items through a rigorous synthesis of prior recommendations and concepts from published sources (see Table 2 ; see also Supplemental Digital Appendix 1, found at https://links.lww.com/ACADMED/A218 ) and expert review. These 21 items provide a framework and recommendations for reporting qualitative studies. Given the wide range of qualitative approaches and methodologies, we attempted to select items with broad relevance.

The SRQR includes the article’s title and abstract (items 1 and 2); problem formulation and research question (items 3 and 4); research design and methods of data collection and analysis (items 5 through 15); results, interpretation, discussion, and integration (items 16 through 19); and other information (items 20 and 21). Supplemental Digital Appendix 2, found at https://links.lww.com/ACADMED/A218 , contains a detailed explanation of each item, along with examples from recently published qualitative studies. Below, we briefly describe the standards, with a particular focus on those unique to qualitative research.

Titles, abstracts, and introductory material. Reporting standards for titles, abstracts, and introductory material (problem formulation, research question) in qualitative research are very similar to those for quantitative research, except that the results reported in the abstract are narrative rather than numerical, and authors rarely present a specific hypothesis. 29 , 30

Research design and methods. Reporting on research design and methods of data collection and analysis highlights several distinctive features of qualitative research. Many of the criteria we reviewed focus not only on identifying and describing all aspects of the methods (e.g., approach, researcher characteristics and role, sampling strategy, context, data collection and analysis) but also on justifying each choice. 13 , 14 This ensures that authors make their assumptions and decisions transparent to readers. This standard is less commonly expected in quantitative research, perhaps because most quantitative researchers share positivist assumptions and generally agree about standards for rigor of various study designs and sampling techniques. 14 Just as quantitative reporting standards encourage authors to describe how they implemented methods such as randomization and measurement validity, several qualitative reporting criteria recommend that authors describe how they implemented a presumably familiar technique in their study rather than simply mentioning the technique. 10 , 14 , 32 For example, authors often state that data collection occurred until saturation, with no mention of how they defined and recognized saturation. Similarly, authors often mention an “iterative process,” with minimal description of the nature of the iterations. The SRQR emphasizes the importance of explaining and elaborating on these important processes. Nearly all of the original sources recommended describing the characteristics and role of the researcher (i.e., reflexivity). Members of the research team often form relationships with participants, and analytic processes are highly interpretive in most qualitative research. Therefore, reviewers and readers must understand how these relationships and the researchers’ perspectives and assumptions influenced data collection and interpretation. 15 , 23 , 26 , 34

Results. Reporting of qualitative research results should identify the main analytic findings. Often, these findings involve interpretation and contextualization, which represent a departure from the tradition in quantitative studies of objectively reporting results. The presentation of results often varies with the specific qualitative approach and methodology; thus, rigid rules for reporting qualitative findings are inappropriate. However, authors should provide evidence (e.g., examples, quotes, or text excerpts) to substantiate the main analytic findings. 20 , 29

Discussion. The discussion of qualitative results will generally include connections to existing literature and/or theoretical or conceptual frameworks, the scope and boundaries of the results (transferability), and study limitations. 10–12 , 28 In some qualitative traditions, the results and discussion may not have distinct boundaries; we recommend that authors include the substance of each item regardless of the section in which it appears.

The purpose of the SRQR is to improve the quality of reporting of qualitative research studies. We hope that these 21 recommended reporting standards will assist authors during manuscript preparation, editors and reviewers in evaluating a manuscript for potential publication, and readers when critically appraising, applying, and synthesizing study findings. As with other reporting guidelines, 35–37 we anticipate that the SRQR will evolve as it is applied and evaluated in practice. We welcome suggestions for refinement.

Qualitative studies explore “how?” and “why?” questions related to social or human problems or phenomena. 10 , 38 Purposes of qualitative studies include understanding meaning from participants’ perspectives (How do they interpret or make sense of an event, situation, or action?); understanding the nature and influence of the context surrounding events or actions; generating theories about new or poorly understood events, situations, or actions; and understanding the processes that led to a desired (or undesired) outcome. 38 Many different approaches (e.g., ethnography, phenomenology, discourse analysis, case study, grounded theory) and methodologies (e.g., interviews, focus groups, observation, analysis of documents) may be used in qualitative research, each with its own assumptions and traditions. 1 , 2 A strength of many qualitative approaches and methodologies is the opportunity for flexibility and adaptability throughout the data collection and analysis process. We endeavored to maintain that flexibility by intentionally defining items to avoid favoring one approach or method over others. As such, we trust that the SRQR will support all approaches and methods of qualitative research by making reports more explicit and transparent, while still allowing investigators the flexibility to use the study design and reporting format most appropriate to their study. It may be helpful, in the future, to develop approach-specific extensions of the SRQR, as has been done for guidelines in quantitative research (e.g., the CONSORT extensions). 37

Limitations, strengths, and boundaries

We deliberately avoided recommendations that define methodological rigor, and therefore it would be inappropriate to use the SRQR to judge the quality of research methods and findings. Many of the original sources from which we derived the SRQR were intended as criteria for methodological rigor or critical appraisal rather than reporting; for these, we inferred the information that would be needed to evaluate the criterion. Occasionally, we found conflicting recommendations in the literature (e.g., recommending specific techniques such as multiple coders or member checking to demonstrate trustworthiness); we resolved these conflicting recommendations through selection of the most frequent recommendations and by consensus among ourselves.

Some qualitative researchers have described the limitations of checklists as a means to improve methodological rigor. 13 We nonetheless believe that a checklist for reporting standards will help to enhance the transparency of qualitative research studies and thereby advance the field. 29 , 39

Strengths of this work include the grounding in previously published criteria, the diversity of experience and perspectives among us, and critical review by experts in three countries.

Implications and application

Similar to other reporting guidelines, 35–37 the SRQR may be viewed as a starting point for defining reporting standards in qualitative research. Although our personal experience lies in health professions education, the SRQR is based on sources originating in diverse health care and non-health-care fields. We intentionally crafted the SRQR to include various paradigms, approaches, and methodologies used in qualitative research. The elaborations offered in Supplemental Digital Appendix 2 (see https://links.lww.com/ACADMED/A218 ) should provide sufficient description and examples to enable both novice and experienced researchers to use these standards. Thus, the SRQR should apply broadly across disciplines, methodologies, topics, study participants, and users.

The SRQR items reflect information essential for inclusion in a qualitative research report, but should not be viewed as prescribing a rigid format or standardized content. Individual study needs, author preferences, and journal requirements may necessitate a different sequence or organization than that shown in Table 1 . Journal word restrictions may prevent a full exposition of each item, and the relative importance of a given item will vary by study. Thus, although all 21 standards would ideally be reflected in any given report, authors should prioritize attention to those items that are most relevant to the given study, findings, context, and readership.

Application of the SRQR need not be limited to the writing phase of a given study. These standards can assist researchers in planning qualitative studies and in the careful documentation of processes and decisions made throughout the study. By considering these recommendations early on, researchers may be more likely to identify the paradigm and approach most appropriate to their research, consider and use strategies for ensuring trustworthiness, and keep track of procedures and decisions.

Journal editors can facilitate the review process by providing the SRQR to reviewers and applying its standards, thus establishing more explicit expectations for qualitative studies. Although the recommendations do not address or advocate specific approaches, methods, or quality standards, they do help reviewers identify information that is missing from manuscripts.

As authors and editors apply the SRQR, readers will have more complete information about a given study, thus facilitating judgments about the trustworthiness, relevance, and transferability of findings to their own context and/or to related literature. Complete reporting will also facilitate meaningful synthesis of qualitative results across studies. 40 We anticipate that such transparency will, over time, help to identify previously unappreciated gaps in the rigor and relevance of research findings. Investigators, editors, and educators can then work to remedy these deficiencies and, thereby, enhance the overall quality of qualitative research.

Acknowledgments: The authors thank Margaret Bearman, PhD, Calvin Chou, MD, PhD, Karen Hauer, MD, Ayelet Kuper, MD, DPhil, Arianne Teherani, PhD, and participants in the UCSF weekly educational scholarship works-in-progress group (ESCape) for critically reviewing the Standards for Reporting Qualitative Research.

References Cited Only in Table 2

Supplemental digital content.

• ACADMED_89_9_2014_05_22_OBRIEN_1301196_SDC1.pdf; [PDF] (385 KB)
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Developing community-based physical activity interventions and recreational programming for children in rural and smaller urban centres: a qualitative exploration of service provider and parent experiences

• Emma Ostermeier 1 ,
• Jason Gilliland 2 , 3 , 4 , 5 , 6 , 7 ,
• Jennifer D. Irwin 7 ,
• Jamie A. Seabrook 3 , 4 , 5 , 6 , 8 &
• Patricia Tucker 5 , 6 , 9  

BMC Health Services Research volume  24 , Article number:  1017 ( 2024 ) Cite this article

Metrics details

Children’s physical inactivity is a persisting international public health concern. While there is a large body of literature examining physical activity interventions for children, the unique physical activity context of low-density communities in rural areas and smaller urban centres remains largely underexplored. With an influx of families migrating to rural communities and small towns, evaluations of health promotion efforts that support physical activity are needed to ensure they are meeting the needs of the growing populations in these settings. The aim of this community-based research was to explore service providers’ and parents’ perspectives on physical activity opportunities available in their community and recommendations toward the development and implementation of efficacious physical activity programming for children in rural communities and smaller urban centres.

Three in-person community forums with recreation service providers ( n  = 37 participants) and 1 online community forum with the parents of school-aged children ( n  = 9 participants) were hosted. An online survey and Mentimeter activity were conducted prior to the community forums to gather participants’ views on the barriers and facilitators to physical activities and suggestions for activity-promoting programs. The service provider and parent discussions were audio-recorded, transcribed verbatim, and analyzed following a deductive approach guided by Hseih and Shannon’s (2005) procedure for direct content analysis. A code list developed from the responses to the pre-forum survey and Mentimeter activity was used to guide the analysis and category development.

Seven distinct categories related to the existing physical activity opportunities and recommendations for programs in rural communities and smaller urban centres were identified during the analysis: (1) Recovery from Pandemic-Related Measures, (2) Knowledge and Access to Programs, (3) Availability, (4) Personnel Support, (5) Quality of Programs and Facilities, (6) Expenses and Subsidies, and (7) Inclusivity and Preferences.

To improve the health and well-being of children who reside in low-density areas, the results of this study highlight service provider and parent recommendations when developing and implementing community-based physical activity programs and interventions in rural and smaller urban settings, including skill development programs, non-competitive activity options, maximizing existing spaces for activities, and financial support.

Peer Review reports

Physical activity is an important behaviour for children’s development, health, and well-being [ 1 ]. The World Health Organization’s guidelines for physical activity and sedentary behaviour recommend that children 5–17 years of age accumulate an average of 60 min of daily moderate-to-vigorous physical activity to attain physical, mental, and cognitive health benefits, including improved quality of life [ 2 ]; however, most children are not meeting the recommendations [ 3 , 4 ]. The high rates of physical inactivity have been further exacerbated by the COVID-19 pandemic, with the literature reporting considerable declines in children’s physical activity during stay-at-home orders [ 5 ] and activity levels remaining low following the reopening of recreational facilities [ 6 ]. In Canada, only 28% of children aged 5 to 17 years met the recommended amount of physical activity during the early years of the pandemic [ 7 ], an 11% decrease from the reported activity levels prior to the pandemic [ 8 ]. This is particularly troubling as sedentary lifestyles during childhood can cultivate unhealthy habits that will continue as they transition into adolescence [ 9 ] and persist into adulthood [ 10 ]. To help engage children in more physical activity as the public health precautions were lifted, parents highlighted the need for a variety of accessible, affordable programs that offered children the opportunity to be active outside of school [ 11 , 12 ]. Therefore, tailored and feasible health promotion interventions and initiatives are essential in preventing the persistent rise in physical inactivity.

Although there has been increasing support for interventions to promote physical activity in children, low-density areas – including dispersed rural communities (i.e., rural areas with a low population density and low population size), villages (i.e., small, semi-dense, rural settlements with a small population size), and smaller urban centres (i.e., semi-dense areas with a moderate population size) – have been underexplored [ 13 , 14 , 15 ], even though thinly populated communities have higher rates of obesity, chronic conditions (e.g., asthma and developmental delays) and mortality among children [ 16 , 17 ]. Due to the lower densities of development in rural and smaller urban settings, children in these areas commonly experience issues related to limited local resources and program options, reduced access to health-related services, and greater need for vehicular transportation to activities [ 18 , 19 ]. With the recent rise in migration of Canadians to rural areas [ 20 ], finding ways to help children from smaller communities overcome the barriers to physical activity participation is valuable. As Canada has the fastest-growing rural communities of the G7 countries [ 20 ], it can serve as an ideal location for additional research on children’s physical activity in less densely populated settings.

The Grade 5 ACT-i-Pass Program is a community-based physical activity intervention originally developed for London, Ontario, Canada that offers children in grade 5 free organized and drop-in activities at participating recreational facilities for the school year [ 21 ]. As previous evaluations of the program have indicated that the pass improved children’s physical activity [ 22 ], expanding the program to additional communities may be a promising approach to address children’s low physical activity levels; therefore, plans for offering the program in the neighbouring rural and smaller urban areas are underway.

Despite community-based interventions having the potential to foster much-needed population-level changes in physical activity [ 23 ], the effective implementation and intended outputs of these programs are vulnerable to the context and can be hindered by a variety of complex individual, social, and environmental conditions [ 24 ]. Durlak and Dupre [ 25 ] suggest that understanding the factors that influence program uptake and adoption by a specific community can help close the gap between an evidence-based intervention plan and its effectiveness in a real-world context. Thus, prior to investing the funds necessary to scale-up this program to rural and smaller urban settings, the extent to which community members would find programs like the ACT-i-Pass suitable needs to be determined to ensure a tailored version of the program that is most likely to be used by the target population is offered.

As an initial step of the program development phase, a needs assessment provides context into the factors associated with children’s engagement in physical activity and service providers’ capacity to offer recreation programs [ 26 ]. Specifically, a multisector approach to physical activity promotion can improve the quality and implementation of interventions in real-world settings by allowing families and community organizations to advise on the development and design of interventions based on their experiences and knowledge of the area [ 27 ]. Gaining input from the target audience during the planning stages of interventions can be used to highlight strategies to address the various social and environmental factors that influence physical activity participation, help align components of interventions with the needs and preferences of the target audience, generate buy-in from the community, and incentivize organizations to promote and adopt programs [ 28 , 29 ]. Notably, studies have shown that multi-disciplinary collaborations that integrate partners during the design stage of interventions can lead to more effective and sustainable health promotion initiatives [ 29 , 30 , 31 ].

The aim of this study was to host discussions with service providers and parents in Oxford, Elgin and Middlesex Counties to understand their experiences with the physical activity opportunities available in rural communities and smaller urban centres and gather their recommendations toward the development and implementation of efficacious physical activity programming for children in dispersed, resource-limited areas. To achieve this aim, this study explored factors which positively or negatively influence children’s physical activity participation in rural communities and smaller urban centres. Moreover, this study gathered parents’ and service providers’ perspectives about the design and/or implementation of health promotion initiatives in their community, specifically, the ACT-i-Pass Program and physical activity interventions targeting children.

Study design

This naturally-unfolding experiment is part of a larger study exploring the adaptation, implementation, and evaluation of the Grade 5 ACT-i-Pass Program expansion. As a case study, this research focuses on a predominantly rural region in Southwestern Ontario, Canada. Oxford, Elgin, and Middlesex counties are made up of farmland, outdoor attractions including conservation areas and beaches, and a variety of smaller urban centres (i.e., towns and small cities) and rural settlements (i.e., villages and dispersed communities) with populations of 22,015, 17,030, and 83,160 children ages 0 to 14 years, respectively [ 32 , 33 , 34 ]. To achieve the aim of this study, we hosted community forums, a group information collection technique that empowers members of the target area to use their knowledge and lived experiences to identify community-level impacts of interventions and provide locally derived strategies that can support beneficial behaviour changes while minimizing potential harms [ 35 ]. This study protocol was approved by Western University’s Non-Medical Research Ethics Board (REB #103954).

Participants and recruitment

Service providers and parents were recruited to participate in this study. Service providers were identified through an online search of recreational facilities, which was reviewed for missing organizations with program partners at the two health units and the municipal governments that attend to the residents of Oxford, Elgin, and Middlesex Counties in an effort to produce a comprehensive list of potential participants. Identified service providers were contacted via email and phone and provided details about the community forum, including an overview of the study. Potential parent participants were identified via the ACT-i-Pass registration form. For year 1 of the expanded program, information was distributed earlier than previous program years, including early access to the registration form, as part of a promotional effort to inform families that the program was now available to children in the counties. An extended pre-program promotion timeline also offered the project team time to recruit parents for the community forums and integrate their feedback into the program design for the upcoming year. Of those who consented to be contacted about research activities, parents were emailed an invitation to participate in the community forum, which included a brief overview of the study and the pre-forum survey.

Service providers were defined as any business, organization or community group that works with children and their families in the counties. To be eligible to participate in this study, service providers had to: (1) offer programs related to physical activity or have mandates that aimed to improve the health and well-being of children (i.e., physical activity program providers, municipal recreation representatives, small business owners who offered activities for children, government employees from family service branches, health unit representatives, and not-for-profit organizations); (2) provide services for families in Oxford County, Elgin County (including the City of St. Thomas), or Middlesex County; (3) speak and understand English; and (4) provided written and oral consent to participate in the study and to be audio-recorded.

Parents were eligible to participate in a community forum if they were the parent or guardian of a grade 5 child(ren) in Oxford, Elgin or Middlesex County who enrolled their child in the ACT-i-Pass during the early registration stage and consented to participate in the research study.

Data collection

Pre-forum survey.

As part of the invitation email for the community forum, service providers and parents were asked to complete an online (via Qualtrics) pre-forum survey. The service provider survey gathered details about their organization, key barriers and facilitators to physical activity opportunities, and the extent to which community members would find the ACT-i-Pass program appropriate for children in their area. Parents were posed similar survey questions as service providers except the parent survey asked to provide socio-demographic information instead of organization details.

Mentimeter activity

Before the start of the community forum conversations, service providers and parents were asked to engage in a brainwriting activity using Mentimeter interactive presentation software ( https://www.mentimeter.com/ ). Brainwriting is a form of idea generation where participants silently and independently record their ideas [ 36 ]. As an alternative to collaborative group-sharing sessions, brainwriting can be an effective way to gain a greater variety of unique ideas by engaging more participants in an activity while minimizing group conflicts, social pressure to conform to the group, and dominance of a few participants’ perspectives [ 37 , 38 ]. Participants could provide an unlimited number of responses to two questions: (1) What are the factors that influence children’s physical activity participation?; and (2) What program components or strategies can lead to successful physical activity programs and interventions in your community? Service provider and parent responses to the Mentimeter activity and the pre-forum survey, including their frequency counts, were amalgamated into a single list.

Community forum discussions

In total, 4 community forums were hosted for service providers ( n  = 3 forums) and parents ( n  = 1 forum) in Spring 2023. Community forums were organized and hosted separately for parents and service providers to acquire the perspective of those trying to access the activities as well as those trying to develop and run programs. In-person community forums with service providers were hosted at local community centres and libraries. Separate community forums were offered in Oxford, Elgin, and Middlesex Counties to improve geographic accessibility. The agenda of the community forums was organized in two parts. The first hour of the forum served as a promotional event for the health units to educate and recruit organizations to the ACT-i-Pass Program. Following a short break, the second hour was a research effort conducted by the research team to gather perspectives from community stakeholders about the physical activity opportunities that exist in the area.

Parent community forums were planned to be in-person, but the research team experienced issues with geographic accessibility, scheduling conflicts, and commitments impacting attendance; consequently, parent community forums were hosted online via Microsoft Teams. Differing from the service provider agenda, the first half hour consisted of an overview of the ACT-i-Pass and a question and answer session, following an hour of discussion guided by the research team about the physical activity opportunities for children in their community. The perspectives of children were not collected for this study as their input will be most valuable after completing a year of the program. By collecting children’s perspectives once they have used the pass, they can offer the research team insight into their experiences and propose adaptations to the ACT-i-Pass design that can improve the quality of the program.

The discussions lasted between 50 and 75 min ( \(\bar x\) = 61 min). Two members of the research team attended each community forum. One member acted as the moderator for all community forum discussions to ensure consistency. The second member took notes to capture all key ideas and thoughts from the participants. Prior to the questions, participants were provided an overview of the topics being discussed and asked if they still consented to be recorded.

The community forum conversations followed a semi-structured interview guide (Additional Files 1 & 2) developed by the research team. The guides for service providers and parents consisted of 7 and 6 questions respectively and a series of prompts. The questions were related to the recreational spaces and activity options available in their community (i.e., What organizations in your community provide physical activity programming for children?), the characteristics of the community that positively or negatively influence physical activity participation (i.e., What characteristics of Oxford/Elgin/Middlesex would you describe as factors that positively or negatively influence children’s physical activity participation?), and the adoption of the community-based programs into their communities (i.e., Do you have any recommendations for the ACT-i-Pass as we begin offering activities in Oxford/Elgin/Middlesex?). Conversations with service providers and parents were audio-recorded and transcribed verbatim via Microsoft Streams. A member of the research team de-identified and reviewed the transcripts for accuracy.

Data analysis

All transcripts were imported into QSR NVivo 12 and analyzed following the steps outlined in Hseih and Shannon’s [ 39 ] procedure for direct content analysis. A deductive approach to the content analysis was deemed appropriate for this study as the responses generated during the pre-forum survey and Mentimeter activity offered a participant-directed list of codes related to children’s physical activity participation, recreation programs, and health promotion interventions in the 3 counties [ 40 ].

The analysis started with the preparation of the coding list by developing the initial coding categories. A list of 119 codes was derived from the service provider- and parent-generated responses in the pre-forum survey and Mentimeter activity. As similar words and terms were used to describe the same phenomena, the responses were refined into a universal term, resulting in 102 unique codes. Subsequently, the codes were grouped into initial categories based on key concepts and a definition for each category was generated. The initial categories were developed by members of the research team who attended the community forums as they had more in-depth knowledge of the data and the nuances associated with statements made by the participants [ 41 ]. An audit trail with a detailed record of the research process was developed to add trustworthiness to the findings [ 42 , 43 ]. The list of pre-determined categories and their definitions were reviewed by an auditor to increase their accuracy and relevance to the responses provided by community forum participants [ 39 ].

Two reviewers analyzed the transcripts independently and collaborated to identify the final categories. Using multiple reviewers during coding can add reliability to the findings and improve the quality of the analysis by introducing various perspectives and lived experiences that can produce a deep, thorough exploration of the data [ 44 ]. The researchers first reviewed the transcripts to familiarize themselves with the data and note any initial patterns or thoughts on the discussions. To isolate the nuances in the topics discussed during the service provider and parent discussions, the data were organized by adding attribute codes to each transcript to identify the study population (i.e., parents or service providers) and location (i.e., Oxford, Elgin, or Middlesex) [ 45 ]. The reviewers then went through the transcript a second time and coded categories using the pre-determined code list. As some factors could be perceived as beneficial or a hindrance in different circumstances, reviewers included a second code, when applicable, to identify if the quote referred to a positive or negative experience. Statements that did not fit into one of the pre-determined codes were highlighted and reviewed to see if a new data-driven code was required.

Recommendations presented by Elo et al. [ 46 ] and Smith et al. [ 47 ] were integrated into the methodology of the study to add trustworthiness (i.e., credibility, transferability, dependability, and confirmability [ 48 ]) and rigour to the findings [ 49 ]. Transferability was introduced to the study by gathering direct testimony from service providers and parents in the counties and providing descriptions of the community and participant characteristics, which allows the reader to make a judgement if the findings are applicable to their settings [ 49 , 50 ]. To establish dependability to the analysis, reviewers engaged in memoing throughout the analysis process, which involved recording thoughts of the transcripts or possible answers to the research question to improve the transparency of the findings [ 45 ]. This process included a critical analysis of the transcripts to identify the potential influence of the focus group facilitators on participants’ responses and to identify potential leading or vague questions [ 46 ]. The reviewers met at various points throughout the analysis to discuss coding and to share notes. Following the categories being finalized by the two reviewers, the research team engaged in the process of “critical friends” to add credibility and conformability to the findings [ 47 ]. As an alternative to inter-rater reliability where the aim is to reach a consensus, this is a reflexive activity that encourages in-depth discussions amongst the research team, where the reviewers offer their interpretations of the data and others present critical feedback that can challenge the reviewers’ biases, pre-conceived ideas and knowledge of the subject matter that may have influenced the findings [ 47 ].

Participants

In total, 94 physical activity service providers and community organizations from across the counties of Oxford, Elgin and Middlesex were contacted. From the invited organizations, 42 representatives from 38 organizations attended one of the community forums, with 37 representatives (39.36%) consenting to participate in the research study (with time constraints noted as the primary reason for not staying for the community forum group discussion). Additionally, 79 parents consented to be contacted about ACT-i-Pass research projects. Of those who consented, 9 parents participated in the community forum (11.39%). Participants were dispersed across the counties, with most parents characterizing themselves as white ( n  = 8; 88.89%) and female ( n  = 9; 100%). See participant characteristics for both the service provider and parent community forums in Table  1 .

Category development

The positive and negative factors related to children’s physical activity participation and physical activity programs identified by service providers and parents during the Mentimeter activity and the pre-forum survey are visually represented in Fig.  1 A and B respectively.

Positive and negative factors related to children’s physical activity in rural and smaller urban centres. Positive factors are represented in blue ( A ) and negative factors are represented in red ( B ). The words represent service provider and parent responses to the pre-forum survey and Mentimeter questions related to children’s barriers and facilitators to physical activity participation, the design and implementation of physical activity programs, and recommendations for physical activity programs in their community

The synthesis of the service provider and parent responses to the Mentimeter activity and pre-forum survey resulted in 10 initial coding categories. Following the analysis of the transcripts and discussion amongst the research team, 1 new category was added and 4 categories were integrated into other existing categories due to similarities in content. This resulted in 7 unique categories. Further details on the categories and their definitions can be found in Fig.  2 .

Categories developed and adapted from the pre-forum survey, Mentimeter activity and community forum discussions. Yellow codes represent ideas discussed during service provider community forums, blue codes represent the ideas from the parent community forum, and green codes represent the ideas discussed by both groups

Recovery from pandemic-related measures

Conversations in all the community forums highlighted the long-term impacts of the COVID-19 pandemic on children’s physical activity. Specifically, service providers and parents believed the public health protections introduced to reduce transmission of the virus were associated with lower physical activity levels that have yet to return to pre-pandemic levels.

Despite both groups describing the barriers and challenges created by the pandemic, the focus of the discussions differed between parents and service providers. The community forum discussions with parents were directed toward their child’s quality of life. During the early stages of the COVID-19 pandemic in 2020 and 2021, all the parents agreed that children lacked access to activities, resulting in, “two years or so of limited access to everything and they didn’t even do it for an entire summer”. Without their regular opportunities during the closure of recreational facilities and gyms, some parents expressed concerns about the physical activity-related skills their children may lack, with one parent explaining, “they [gyms] had to modify a lot longer than other places due to the fact that they were known as potential super spreader locations”. As a result, some parents felt that “it’s unfortunate for our kids now who didn’t get that opportunity that you didn’t realize at the time was such a big developmental stage that they were in”. Without the opportunity for children to try different activities and develop their physical activity-related skills, parents worried about the long-term influence the early years of the pandemic may have had on their children’s physical activity participation.

Alternatively, service providers were focused on the influence of the pandemic-related protocols on program attendance and the consequential changes to the current program offerings and schedules. Following the re-opening of gyms and recreational spaces after the removal of COVID-19 protocols, many service providers felt that enrollment rates had not returned to pre-pandemic numbers. As one service provider mentioned, “getting kids to sign up for anything is difficult. Getting them to register for anything is impossible”. Another service provider expanded on this topic, discussing their experience recruiting children after they re-opened: “Pre-pandemic, all our programs were full. We were bursting at the seams March 2020. We are just slowly trying to figure out what people want right now. Our membership base is really changed and we’re not seeing the kids in the drop-in programs like we used to”. As a result, service providers had to adapt their programming options and scheduling. This includes “I would say at 6 out of our 10 branches we’ve changed our hours” and “trying to figure out what works and we’re hoping in the next session [Summer] to add a few more programs”.

Knowledge and access to programs

Both service providers and parents noted the concept of accessibility of activities for children in their communities; specifically, discussions were focused on the knowledge of and ability to partake in physical activity programs. One of the primary topics explored during the community forums was the unique aspects of the rural environment that influence children’s ability to get to the recreational facilities or small businesses offering activities. In addition to physical accessibility, service providers and parents discussed families’ awareness of the local physical activity opportunities.

Rural environments were described as low-density and dispersed spaces that, “if you live in a rural community, there’s no option if you don’t have a car” (Service Provider). The dispersed organization of these communities limits children’s ability to get to activities by themselves. Service providers and parents both described safety concerns with children travelling to activities by themselves, referring to “they’re [recreation facilities] a distance away and it’s the time of the year that’s dark” (Parent), and “there’s no bike paths leading to here [our facility], so those are barriers for that age” (Service Provider). Public transportation is non-existent in rural areas, placing pressure on parents to get their children to activities. As described by one parent, “I think it’s just access is a really big one, so like physically getting into the program and getting to London isn’t going to work for a lot of the community because there’s no public transportation between here and there.” This is a particularly large issue in small rural communities that lack resource availability and require families to travel to other municipalities or towns to access services, as mentioned by one parent: “I live in a town where we piggyback off the other town, so I have to travel only because my town doesn’t offer sports”. One challenge service providers can encounter is families’ unwillingness to travel to activities. Rural communities can cover a large area and it can be difficult to come up with programs that are accessible to all families within the region. As one service provider explained, “when we do county-wide scavenger hunts or something like that, if they live in the Far East they’re not going to [go]. Absolutely not. They might go to St. Thomas, but they’re not going from one end [of the county] to the other”.

In addition, many parents highlighted having difficulties finding programs for children, describing that it requires time and research on multiple platforms: “I think there’s programs all over the place. Some are private. Some are public. Some are invite only. Some of them are on Facebook and some of them are word of mouth.” As a result, one parent believed that they needed to be self-reliant to find their child after school activities and “sometimes we have to seek the questions and ask ourselves and not wait for the information to come to us”. One parent noted that access to information also differs among different socio-demographic groups in their region, with those from “the lower income side … [they] don’t have a lot of access to the information that gets sent out and be educated on things so there’s certainly a barrier of almost classism.”

One of the obstacles for service providers is figuring out how to best promote programs. While deliberating about effective ways to get information to parents, service providers indicated that the ultimate difficulty is that “there’s so much information out there that everything just gets bogged down, right? Gets lost in Facebook walls or Instagram or whatever”. Some service providers attributed promotion challenges to the popularity of different media platforms, specifically highlighting previously used modes of promotion now have limited effectiveness. Some examples provided by service providers included, “a newsletter every quarter of what’s going on and the newsprint in our area, people don’t read it anymore”, “FM radio is there and that’s supposed to be our local news for all that and most people don’t listen”, and “internet out in the rural areas is not always easy”.

Recommendations

To alleviate the issues associated with the physical accessibility of programs, parents and service providers recommended that interventions take the environment into greater consideration when developing programs for rural and smaller urban centres. Service providers encouraged more efforts to be focused on smaller communities that lack local recreational facilities and programs, including boosting the community’s use of outdoor spaces.

To better support parents’ understanding of the recreational opportunities available to their children, several parents spoke of the need for an online repository where the information for all physical activity programs can be found in one location, as emphasized by one who said, “it would be nice if there was a central spot where all of that [recreation programs] could be held and not necessarily relying on Facebook to find all that… ”.

Availability

A large portion of the community forum conversations centred around the availability of physical activity opportunities related to the programs, facilities, and resources in the community that can be used by children. Primarily, service providers and parents focused on the variety of activity options available to children.

In the counties, the activity options offered by municipalities can vary between communities, with some places not having programs, services and/or spaces for children to play. As one parent described:

They have the space, but they don’t have necessarily the programs. I’ll give you an example. We have a tennis court, but there’s nobody to run a tennis program. We don’t have the trained athlete or adult to run the programs. There’s badminton areas and volleyball areas, but there’s no one to run the program in our area again.

When trying to enrol in programs, some parents mentioned having difficulties getting a space for their child, with one parent highlighting, “show up two minutes late [to register] and now they can’t get in [the program]. Yeah, it really feels like if you already know then you’re good, but if it’s something new you’re trying to try out, good luck”. By not being able to enrol their child in local physical activity opportunities, parents struggle to get their children active outside of school.

In response to parents’ concerns about activities not being available or programs having insufficient spaces, service providers explained that limited activity offerings may be a consequence of previous attendance rates. As one service provider explained, “it gives you that justification to run the program that the numbers [participants] are there and it[s] driving revenue into your pocket, then you could say yeah let’s drive it forward”. Attendance is especially important in smaller, rural communities that have limited recreation budgets as underscored by one service provider who said, “[our municipality] does have a community center, but I know that they have been struggling to get people, so that’s affecting their offerings”. Consequently, local private organizations and small businesses are critical resources for physical activity in non-urban areas.

In addition to the activities, service providers referred to the available spaces for physical activity in rural and smaller urban centres. Predominantly, service providers focused on dispersed rural communities as they do not have local indoor recreational facilities. One service provider detailed, “again, it comes down to amenities and facilities. There aren’t really any there. It’s the rural part. There’s no facilities so there’s no programs”. While there may be a lack of indoor facilities for physical activity, a variety of outdoor spaces do exist in the counties; however, children can encounter challenges when trying to use these spaces. For instance, the definitions linked to specific places can limit children’s use of outdoor recreational facilities. One service provider referred to the definition of a space in terms of the associated activity: “Yeah, so if you have a big open park that is a soccer field, you can’t do anything else there but soccer. You can’t go and run around or do stuff because then they think you get kicked off”. In addition, service providers believed demographics, particularly age, influenced the places children felt they were allowed to use to play. For example, one service provider discussed older children’s experiences playing on the local playgrounds:

The facilities seem to be claimed by another group. It’s like your sense of belonging, like ‘well, I can’t go there’, and I hear it quite regularly by youth that are in that transitional age that they don’t feel like they could even go to the playground facility because it’s for younger kids and they’re deemed troublemakers if they’re there… so the facility might be there, but they’re not welcomed there.

Parents requested additional spaces in organized recreation programs to help alleviate their current frustrations. Conversely, based on the conversations with service providers, capacity can vary across community types and resource availability, as one service provider described, “if you look at what the capacity of the City of London compared to the capacity of the county and the capacity of each municipality is very different”. Service providers suggested that the development of seasonal programming should be influenced by the available spaces in the community, prioritizing activities that they can offer consistently and sustainably.

For service providers, particularly municipal recreation departments, to maximize the available spaces in the community and increase their capacity for additional programming, non-traditional locations for physical activity programs were suggested. This includes offering activities in any large, open room that is available such as a church, school, or library. The discussions also highlighted the large number of outdoor spaces in their communities. However, some parents noted that outdoor spaces were being underutilized, “you’re not just going to meet a bunch of kids at the park for a few hours. It’s rare that we just find random kids on the street that they can go play with… Yeah, my kids don’t have the internal appetite to just go outside and play”. Thus, parents believed additional outdoor organized activities, particularly during the summer, would be an advantageous way to increase the number of physical activity options and encourage more children to be active. Service providers did note that children may perceive certain outdoor locations as unwelcoming and unavailable and emphasized the importance of educating and redefining the way children view the spaces in their community.

Personnel support

There are multiple levels of support required for children to engage in physical activity. Service providers and parents highlighted four groups: friends and peers, parents/guardians, schools, and governments and municipalities.

Both service providers and parents discussed the difficulties parents/guardians face when trying to engage their children in physical activity. The discussions with service providers indicated that many families in rural communities “have to travel… My town is close enough to bigger centers, but, and as I hate to say, behind the times so there’s nothing”. Consequently, it can be difficult for parents who live in rural communities who drive longer distances to work. As one parent mentioned, “parents that work outside of their community have to drive all the way home at the end of the workday to pick up their child, and then to drive an hour back into [the city] is a lot of hours in a car. That is a lot of time consumed that is difficult for families and gas”. An additional issue service providers mentioned about parents’ ability to support active lifestyles was their knowledge of physical activity expectations for children. Some service providers felt, “the parents that I talked to in training have very little idea of physical activity guidelines, but they have an idea of what their child looks like. There are a lot of barriers and to kind of make sense of what’s out there and how it applies to raising a child”. As a result, service providers believed that low registration rates were potentially attributed to inadequate physical activity literacy.

While peers were primarily described as a positive influence on children’s physical activity, peer pressure was recognized by parents. If friends exhibit dislike for, or remove themselves from, an activity, this may discourage a child from participating. As one parent noted, “depending on who’s in their class, my daughter would definitely choose to sit on the sideline with her friend than try dodgeball”.

Governments and municipality officials were also highlighted by service providers as a group that has hindered children’s ability to be physically active. As one service provider describes, “a lot of policies in these small towns… I know that’s an issue in a lot of small communities, the liability issues”. Specifically, the safety protocols that need to be enforced at their facilities have led to inequities in activity access. As one service provider mentioned, “A lot of street hockey going on right now and the powers that be shutting it down… Hard getting their kids out to let them do anything because there’s always somebody watching saying ‘no, no, no you can’t’”. Similarly, another service provider talked about their skating programs and the new helmet regulations:

It was felt really hard this year with the new board policy for skating at the arenas. The school board implemented a policy of CSA-approved helmets, so children that only had a bicycle helmet could no longer participate in the school field trip for skating unless their families could pay to get them a hockey helmet or ice hockey helmet. Very limiting policy for those children to be able to participate.

While the government’s efforts aim to create a safety measure that protects children, they have also led to greater inequities in physical activity participation.

Facilitators

Peers were characterized as key influencers in children’s lives, with parents and service providers describing how they can encourage each other to be active. For example, parents highlighted, “if you can bring a friend with you they’re more than likely to go with a buddy or two or a couple people instead of by themselves”, and “you both can kind of support each other on the [basketball] court and it’ll be great and they had a great time, but it was only because her friend was joining that she joined”. Some service providers have also seen the benefits of peers encouraging participation in recreation programs, explaining, “our badminton program almost didn’t run this past season because we had one kid signed up for the first month and then within probably a week or so of us cancelling the program, we had 15 kids sign up because one kid told his friends”. Overall, peers were viewed as an important driver of physical activity for children by acting as a key support system during activities.

Besides peers, parents and guardians have a pivotal role in their children’s health and are “key to their child’s physical activity” (Parent). Many parents felt that it was their responsibility to encourage their children to be active: “I guess it also at the grade 5 level, it’s really the parent that needs to push it [physical activity]. The parent is the one that has to drive them. The parent has to free time up in the afternoon, not to be cooking or cleaning or picking up from the week, but let’s pause and do physical activity”. Some of the service providers believed parents demonstrated they recognized the relationship between physical activity and their children’s health and well-being: “I have parents emailing me every day right now about stuff, so I think parents are starting to see what we are seeing, that their kids aren’t active enough”. Many parents described being happy to take their children to activities, stating, “it’s a choice, but you also see the joy in the kid, your kid’s eyes and you wanna keep going because they just love it so much”.

In addition, schools were described as key settings for physical activity, with staff playing an important role in physical activity promotion. Parents believed schools, specifically physical education classes, are responsible for introducing children to activities:

The other thing with sports is that you have to sign up for a period of time and we were just saying, if they’re not introduced to it in school, how would they know if they like it? And then why would a parent pay $300 for them to try something that they might absolutely hate? So, something like school can help introduce sports.

Similarly, many service providers viewed schools as advantageous places for physical activity, specifically for afterschool programs as “schools can provide space after hours and the kids are already there”. Schools were also labelled as a central location for program promotion, with one service provider stating, “schools are actually sending their papers home. They send their newsletter home once a week, electronically”. In terms of staff, teachers can be ambassadors and advocates for children’s participation in physical activity. As one parent explains, “if you get it to the right teachers, they interact with parents all the time. I know that they will send like a video or something”.

Based on the conversations with service providers and parents, creating partnerships is important for community-based interventions and recreation programs. Some service providers believed that talking with “established organizations that have the audience has been a driver of success for programs especially”. Teachers and administrative staff at schools were key collaborators identified during the community forums as they are constantly in contact with parents and can easily share information about recreation programs with their classes. Service providers have talked about the benefits of teacher advocates for physical activity interventions like the ACT-i-Pass Program, with one recommending, “put it in some of the teachers’ brains that ‘hey, guess what? We got this ACT-i-Pass thing’. They can physically talk to a parent instead of just a paper or something that gets missed”. Additionally, service providers recommended that parents be provided more education about the national movement guidelines to reinforce the amount of physical activity children should be acquiring.

Quality of programs and facilities

The quality of the physical activity offerings and facilities was discussed during the service provider community forums. By quality, service providers referred to the facilities being in good condition and programs being led by trained personnel who are skilled in the activity.

A few service providers noted changes to the composition of the counties over the last few years, including the growing population, changing demographics and redevelopment, as one of the underlying reasons for lower program quality. This has been particularly difficult in rural and smaller urban centres, with one service provider explaining, “everyone’s moving out of the city into the smaller towns so it makes sense to expand them now, establish them now, but [my community] hasn’t done anything”. As a result, service providers stressed that the internal migration “changes the dynamic of how you look at programming too because you could have a group you catered to for a while and then you have a line of families that are coming in from other places. They are expecting a lot of different standards of smaller areas which forces us to grow too”.

To offer a quality program, many service providers emphasized the demand for qualified staff that are knowledgeable about the activity and “skilled enough to be able to actually provide the program”. As mentioned by one of the service providers, “finding that instructor is definitely the hardest part when you’re trying to either start or restart a program, because if you don’t have that person to lead it or you don’t have the right person to lead it, your program doesn’t work no matter whether you had 1500 kids interested in that program if you don’t have someone excited and skilled to run it”. Due to the low population size of rural and smaller urban centres, finding community members who are proficient in an activity and willing to teach the skills to children is one of the service providers’ key obstacles in offering recreation programs.

When offering new programs, service providers stressed the time needed to gain community buy-in, as recreation programs are a “community service, it’s a service that you’re offering the community, so their interest is important”. The challenge highlighted by service providers is the time and effort required to gain awareness and secure regular enrollment in programs, which is necessary for their longevity:

It doesn’t happen overnight that people will come … It’s building the consistency, so families know that’s what’s gonna happen, whether they have 3 people show up for open basketball or whether there’s 20 people show up. If you don’t have the consistency, I think it’s really hard to be able to keep programming and families close within that area to participate in it.

To encourage community engagement, service providers have found that partnerships can help provide useful insight into the program models that work and the different approaches that have been unsuccessful. For instance, some service providers believed that sharing their experiences with other organizations can improve the quality of physical activity offerings across the community. One service provider referred to their experience meeting with the recreation programmers across their county:

I mentioned earlier how the municipalities who are in recreation are more than willing to talk to each other and share information with each other about what works and what doesn’t work. We started to try to open a membership option with some of our recreation programs and we reached out to a couple [of organizations], like, ‘hey, have you seen that this is a good thing or not?’

Consulting families was also viewed as vital for higher-quality programs. One service provider found that “a big piece, if you wanted to utilize those spaces, would be to engage with the youth to understand, like, if we open the gym or do we have a structured basketball tournament or badminton tournament or whatever that be”. By talking with potential users, this provides “validation that if they are going to pay staffing to be there and that people are going to show up”.

To account for the rising population, a service provider suggested that municipalities need to account for physical activity-related facilities and staffing during the development of rural communities and smaller urban centres: “we need to be able to provide the programs and amenities that come with that [the county growing], but until other things grow, whether it’s facilities or staffing or availability or whatever it is, you won’t grow with the population”. Service providers from rural communities also noted that it takes time to gain awareness among families when they introduce new program offerings, recommending that fellow program coordinators “… keep in mind with timing, it’ll take time. The population is lower, but we find things take longer and you have to build over time. Be patient”.

Expenses and subsidies

The expenses related to physical activity programming were a predominant topic among all community forums; however, the focus of expenses for parents was related to the cost of attending activities, while service providers were associated with the cost of managing programs.

For parents, the topic of expenses was related to the cost of their child attending and participating in activities. Ultimately, many parents felt that the price of organized physical activity is too high, with some describing sports as unfeasible opportunities for their children. As one parent described her son’s hockey season, “we’ll be in at $5000 by the time the season’s done and that’s just local league. That is cheap hockey. Now, if he wants to go competitive, some of my friends are saying they’re spending $7,000 to $10,000 for them to play competitive”. Families attributed the challenges associated with expenses to the cost of living “getting worse. We had a conversation at our dinner table about the cost of living. Everyone’s talking about it increasing”. Due to the high prices, parents felt that it can be difficult for children to try a variety of activities and find what they enjoy as one parent reported, “we’d be more than willing to sign our kids up for a bunch of programs if they had them, if we could… I can maybe pick one and then that’s all you can get this year because it’s all financially I can do”, meaning that “the cost of certain programs are just not attainable for some people… there’s a much larger cost to getting into the programs, so that negates it for some people”.

In addition to the registration fee, parents attributed transportation and unplanned expenses as challenging supplemental costs. Parents described the cost of gas accumulating quickly throughout the season, “now I’m driving him every day, not every day, but to his practices and his games. Well, that’s gas money, that’s another thousand dollars”. There are also team events that can lead to activities being more expensive than planned. For instance, one parent discussed the extra costs they noticed as their child engaged in more team sports:

It’s not only just the cost of equipment, but people go out for dinner after or they go out for ice cream. It’s all those things that if you can’t afford to bring your child, pay for it, the child might just decide ‘I don’t wanna be the one who’s going and I can’t go out for a meal after or get that ice cream cone with the group because I don’t have the $4’, so it’s a lot.

In contrast, service providers were focused on the expenses of managing physical activity programs. Service providers described having to limit the types of activities they can offer due to their available funds. Service providers supporting rural communities believed that it “might be easier for cities and towns to run them [recreation programs] because maybe they have that built into their budget that they can have money to give a program. We don’t, unfortunately”. Also, due to limited funds, they may not be able to offer some free and low-cost programs, with one service provider explaining, “there’s pickleball nets and they get so many people out of that but it’s free and that’s not something that I can do with our programs”.

Service providers also discussed the available resources in their communities. Due to budgets, service providers reported issues getting access to the necessary equipment and the need to borrow supplies from partners or schools. For those who have the equipment, service providers experienced time and cost challenges of transporting their equipment to facilities: “We have our equipment because we have our own space… we can bring it there [to the school] but we can’t store it there, which means there’s an extra amount of time and money that goes into that transportation every week for each day”.

Finally, a lack of funds influences the type of staff working at service providers. As one service provider expressed, “getting actual programmers for us, ‘cause we don’t have the Y budget that would provide a programmer to us, so that is a challenge”. In order to recruit the necessary staff, many service providers have to counter the extra costs by increasing the price of their activities: “So then you start paying that that main instructor that price needs to go up in order for us to continue”. Either the price goes up or you don’t run the program”.

To improve access to resources, one suggestion offered by service providers involved partnering with other publicly-funded organizations, such as community centres or libraries, to supply children with equipment that they can borrow and bring home: “Through the Y[MCA] or a program like that where you could come and get sports equipment or things so they can try a sport whether it be a hockey stick or a baseball glove or a soccer ball or a basketball. To have a sports lending library there”.

To help fund activities, a few service providers found that gaining sponsorships from organizations was a beneficial way to acquire additional funds. As described by one service provider, “maybe there would be another business that might be willing to provide funding so if a child wanted to sign up or to be able to help out businesses that are keen to help but maybe just can’t afford it financially”. External funding partners can also subsidize activity fees for children by acting as a “sponsor a dance class or a Taekwondo class or a something like that”. As offering free programming was deemed difficult or impractical for service providers, it was suggested that grants and subsidy programs be used to help improve families’ access to recreation programs. Funding support offerings can provide opportunities related to “their income level and if they were under a certain level then they received 50% funding for all the registration fees”, or “a necessity program so money is just for low-income families to help cover the cost of activities”.

Inclusion and preferences

Offering a variety of activity types and levels to make service providers more welcoming to all children was another frequently discussed topic during the community forums. As stated by one service provider, “inclusivity is crucial to youth right now, right? So, if you’re not inclusive you’re not being positive and allowing everyone to participate and then you’re not gonna be successful and kids aren’t gonna participate”. The discussions concentrated on service providers having a diverse number of activity types and levels within each activity to consider children’s abilities and preferences.

Some service providers and parents credited children’s low engagement in physical activity to the confidence or skillset to participate in a specific activity. As one service provider discussed, “I have noticed a huge confidence issue. Not picking things up that they aren’t fantastic at right off the bat… ‘I’m not good, I’m outta here, everyone’s better than me’”. A few parents reported seeing confidence issues in their children, with one parent describing, “it’s so tricky, especially when you think about that confidence. The ability to do sport, especially hitting that grade 7, that 13-year-old where you’re very self-conscious.” An explanation for confidence issues is the pressure they feel from their peers when they “size themselves up. It’s a natural thing people do. The ‘am I better than you? Are you better than me?’ mentality” (Parent). To help grow children’s confidence, children are looking for “proper skills and drills, it’s very popular” (Service Provider).

The appropriateness of the available activities may also be lacking with the current program options. Specifically, children have different needs and a greater variety of activities will help offer programs suitable to the different skill sets and ages of children. One characteristic highlighted throughout the conversations was the competitive spirit of children. Some of the parents attributed the lack of participation in organized programs to the absence of non-competitive options for sports. As one parent mentioned, “I find that there’s kind of a gap between like rec hockey players and just base recreation players… They don’t like high levels.” Parents felt that many activities were “the team sport atmosphere. My child’s not competitive, so knowing that she wants to learn, she wants to be better, but she has her own internal competitiveness, not external”. A problem many parents encountered was trying to find programs for their children to try and learn activities, as underscored by one parent while discussing an introductory hockey program in their community:

Now, one thing I don’t know is having those same kids on the ice at the same time as those who have been playing the sport for years because if that’s the case, that’s gonna fail immediately. They almost need their own ice time or their own space that they’re learning at their level.

In addition to the activity options for non-competitive children, the activities need to be age-appropriate. For instance, children can be embarrassed when “my child who is 10 is doing say beginner hockey, but then there’s also 5-year-olds in that group. Even if she’s at the same level as them, she is not going back. She’s like ‘I’m at the same level as a 5-year-old. No, thank you’” (Parent). The financial and personnel constraints service providers experience have also affected the program offerings by prompting more co-ed activities that combine both boys and girls; however, one parent said this has negatively impacted her daughter’s participation in team sports as, “at her age, they’re often both male and female combined, so co-ed. What I’m seeing as a parent is that the boys are becoming bigger and more aggressive as in they’re competitive and she is not, so therefore, she gets intimidated”.

Offering children activities they want to participate in and are passionate about was described as critical for continued physical activity participation. Ultimately, parents cannot force their child to want to take part in an activity. As one service provider highlighted, “you know we have parents bringing kids 3 or 4 years old to take martial arts. The parents are making them do something that doesn’t really draw [their] interest, but after 11 years old they seem to make their own choices”. As one parent noted, providing children with the opportunity to try various activities can be beneficial “if you want them to stay active in the long run, they need to find something they enjoy”.

Moving forward, it will be important to offer activities for various skill levels. As noted by one service provider, “building people’s confidence up, giving them an opportunity—a safe space to try a sport or try an activity with people with the same skill level as them”. In order to develop children’s self-efficacy and increase program uptake, there needs to be a variety of program offerings to account for “the diversity in who the kids are, the ages of the kids and interests” (Service Provider). This can also be done by offering flexible activities where the programs are “something more that evolves and keeps them interested” and they can be adapted by “asking them if they feel good and you’re teaching them to help structure play” (Service Provider). In addition, offering non-competitive and entry-level programs can encourage children to join activities where “everybody that joined it was just kind of trying it. Nothing serious and it made it easier to attend those things as opposed to going with a group of kids who have been playing that sport for 7 years and you’re trying it for the first time” (Parent).

One strategy to alleviate the issue of activity options for all children is offering non-traditional activities. For instance, service providers reported, “people get bogged down with the traditional programming like soccer and basketball. There’s so many other programs that are out there” and “dodgeball’s huge right now. Just those off the cuff programs that aren’t traditional… just doing something that they don’t have the opportunity to do and just being creative with that”. Similarly, service providers suggested that program offerings should integrate trending activities among youth: Working on some trends in certain sports. Like, who would’ve thought pickleball? Cornholes replaced horseshoes. You know what I mean? You gotta kind of recognize it’s replacing something in a more modernizing way.

Through a series of community forums with service providers and parents, this study aimed to explore the physical activity opportunities in rural communities and smaller urban centres and to understand how to develop and implement community-based physical activity programs for children in areas with low resource availability. The discussions with service providers and parents highlighted a variety of barriers and facilitators to physical activity participation. Some examples of barriers included the distance to activities, the expenses related to physical activity programs, and limited resources to meet the population growth. In contrast, flexible activities, promoting programs through schools, and outdoor spaces were described as facilitators. In addition, recommendations for the development and implementation of physical activity programs for children in low-density and minimally resourced areas were noted. Recommendations covered a range of topics such as developing physical activity-related skills, utilizing non-traditional physical activity spaces, and centring program offerings around equipment and personnel capacities.

When asked about the factors that influence children’s physical activity, service providers and parents believed that the loss of organized programs and the closure of recreational facilities due to the government-regulated COVID-19 public health protections had a negative effect on their child(ren)’s physical activity. Children’s preference for organized recreational opportunities and limited involvement in active play is consistent with the evaluations of Canadian children’s physical activity participation [ 7 , 8 ], For instance, Sharp et al. [ 52 ] found that most rural children were looking for structured after school or weekend activities and would enrol in a wide variety of organized programs, such as physical activities, music, clubs, and tutoring. However, children’s desire to engage in organized activities conflicts with the body of literature asserting that there is a lack of resources in non-urban communities [ 53 , 54 ]. In a comparison of rural and urban Canadians, participants from rural communities are more likely to report barriers to accessing recreational facilities [ 55 ]. Due to the interest in more structured activities, implementing community-wide programs and finding strategies to improve recreation offerings can be a beneficial way to promote physical activity participation in resource-limited communities.

Accessibility was noted as a common barrier throughout the community forums, consistent with the literature on rural physical activity [ 56 ]. Poor accessibility was associated with the community structure and resources varying between communities. For instance, Gilbert et al. [ 19 ] found smaller rural communities with a population size of less than 6,000 residents had fewer resources and less infrastructure than larger communities, which may require a tailored intervention plan. Due to the longer distances between home and program offerings, transportation is one of the main barriers to physical activity in rural and smaller urban centres. In non-urban communities, public transportation is non-existent or unreliable, and active transportation is not available to children as parents may be concerned about the lack of bicycle lanes and sidewalks, their children travelling on underutilized routes, and wild animals [ 57 ]. Consequently, children cannot attend programs without a parent or family member acting as a driver. As a result, researchers and program coordinators need to understand the unique characteristics of the different communities in their jurisdiction when developing community-based programs and create an implementation plan that best meets the needs of the whole target population.

Outdoor spaces were also identified as a beneficial method for improving children’s physical activity. Both parents and service providers highlighted the variety of outdoor spaces that are unused by children without organized activities. In addition to engaging children in more physical activity, outdoor spaces have been found to provide various other health-related benefits, including increased self-esteem, problem-solving abilities, social behaviours, and motor skills [ 58 ]. While outdoor spaces can provide additional recreational opportunities when programs and facilities are limited, they may target those who are sufficiently active. For instance, children from rural and remote communities who reported being involved in a higher number of organized activities also reported greater involvement in unstructured leisure activities; this refutes the ‘over-scheduling hypothesis’ that proposes those who participate in more organized activities face time constraints that inhibit participation in unstructured forms of physical activity such as outdoor play [ 52 ]. As the outdoors can provide an open space for imagination and creative activities, offering non-traditional activities in these settings can help engage children who are not interested in sport-focused activity offerings.

In addition, parents and service providers described select individual-level factors as barriers to physical activity participation. Consistent across evaluations of urban and non-urban communities, children are potentially not participating in any programs due to their lack of interest in physical activity options [ 59 ]. Parents and service providers presented conflicting accounts for why there are issues with the current program offerings. Consequently, it is difficult to conclude if service providers’ limited capacity or families’ low uptake has led to a reduced variety of activity options, but they both likely play a role in children’s physical activity opportunities. With the rising internal migration to rural communities on account of the transition to virtual and hybrid work options available during the COVID-19 pandemic [ 20 ], there is an increasing demand for resources and services in these areas. As there are difficulties associated with recruiting staff and the capacity for communities to build more recreational facilities, program offerings should prioritize the resources that currently exist in the community, including integrating the land use and development plans for the municipality to account for the growing population [ 60 ].

One finding highlighted in the current study by both service providers and parents was the cost of recreation programs. Due to the high cost of extracurricular activities, family income is an important factor in physical activity participation for children [ 61 ]. For example, Kellstedt and colleagues [ 62 ] found that children’s chances of partaking in sports were 4 times more likely when they lived in a higher-income household. This aligns with the idea that socioeconomic-based health inequalities increase across the life course because of the cumulative advantage or disadvantage associated with differential access to health-promoting resources, much of which is rooted in early life exposures [ 63 ]. While many recommendations for reducing the economic accessibility of physical activity surround affordable programs, one frequently reported barrier among rural populations is the shortage of free and low-cost physical activity opportunities [ 55 ]. The high cost of activities was also noted as a challenge for service providers. Local governments in smaller communities tend to face financial challenges with limited revenue, minimal financial capacity, and a high cost of living [ 15 ]. As a result, service providers have difficulties maintaining their facilities and creating environments that better support physical activity, which means regular free activity offerings are not a viable solution in many communities.

Recommendations for physical activity interventions and recreation programs

In response to the identified facilitators and barriers related to recreation programs, service providers and parents offered recommendations to integrate into the expansion of the ACT-i-Pass Program and future physical activity interventions. Recognizing that the number of physical activity providers declines as the ACT-i-Pass shifts from a densely-populated city to more dispersed, resource-limited settings, the recommendations provide valuable adaptations to the intervention’s design and implementation that can offer physical activity opportunities tailored to the needs of families in rural and smaller urban communities. For instance, due to the range of conditions that exist in non-urban areas (e.g., population size, resources), the unique characteristics of the different communities and available resources need to be incorporated into community-based programs to ensure activities are accessible to all children, particularly those in low-density rural areas [ 64 ]. For example, the transportation options in dispersed communities differ from urban environments; therefore, additional attention needs to be placed on creating more programs in a variety of neighbourhoods or reducing transportation barriers by offering busing from schools to service providers or encouraging carpooling with other families.

Primarily, creating additional structured activity options for children was deemed a beneficial strategy for engaging children in greater amounts of physical activity. One suggestion included utilizing the abundance of outdoor spaces available in the area. Encouraging outdoor play and creating more outdoor programs in a variety of communities can help children be more active [ 65 ]. In addition, increasing the program offerings to service a greater variety of activity preferences and skill levels can allow programs and interventions to have a greater impact on the health behaviours of children. Traditional activity offerings are not reaching all children, particularly those not interested in sports or competitive environments; therefore, providing unique and fluid programs may help gain their interest in activities and engage them in more physical activity. Program coordinators were encouraged to integrate trending activities (e.g., pickleball) and flexible programs into their offerings. Flexible programs, alternatively termed scaffold play, are child-directed activities that are guided by an adult [ 66 ]. The objective of these activities is to foster children’s development and creativity as they work towards a specified objective outlined by the adult [ 67 ]. While this strategy is primarily used in a preschool context [ 68 ], it may continue to have benefits among older children.

Additionally, partnerships were a key recommendation from service providers, reinforcing the importance of collaborations in successful community-based interventions [ 69 ]. Specifically, it was stressed that community organizations and families are valuable sources of information and support when creating programs for children. Community organizations, such as government agencies and businesses, can assist in the administration of programs and interventions by offering financial support via subsidies or grants that reduce the financial strain of registration fees for families or facility management costs for service providers [ 70 ]. Other partners, such as schools, can also improve awareness of programs and interventions by acting as promoters [ 71 ]. Alternatively, engaging with families can give greater context to the community and help set priorities for interventions based on the interests and the supports needed by the target population [ 72 ].

As COVID-19 continues to influence the physical activity context, there are additional recommendations that need to be integrated into health promotion efforts. For instance, children missed pivotal years of physical education due to the closure of schools and recreational facilities. Perceptions of athletic ability, self-efficacy, and motivation to be active are all factors that can have a significant influence on physical activity behaviours [ 73 ]. Thus, interventions should integrate programs with a greater focus directed toward building children’s physical activity confidence by teaching skill sets and movement competence [ 74 ]. In addition, with many small businesses closing during the pandemic, redefining what qualifies as a setting for physical activity is important. In rural communities, children do take advantage of existing afterschool program opportunities (e.g., church youth groups) when school athletics programs, sports leagues, and recreation activities are limited or unavailable [ 52 ]. As the findings indicate that children are hesitant to use spaces without the guidance of an adult, creating structured programs will make non-conventional physical activity spaces more accessible for children. A full list of the recommendations provided by service provider and parent community forum participants is provided in Fig.  3 .

Service provider and parent-derived recommendations for physical activity programs and interventions in rural and smaller urban centres

Limitations

While this study provides valuable insights into rural and smaller urban centres and physical activity programs, there are limitations that must be considered. The parent community forums exclusively involved responses from mothers. While it is common that parental perspectives on their children’s health behaviours tend to come from mothers [ 75 ], we are missing the paternal perspective that may offer different experiences with their child(ren)’s physical activity. Additionally, our study consisted of families and service providers from Elgin (including the City of St. Thomas), Oxford, and Middlesex Counties. Based on responses to the Census Profile, the populations of these three communities consist primarily of English speakers and non-immigrants and have a lack of racial and ethnic diversity [ 32 , 33 , 34 ]. Due to the similarities between participants, we are unable to make conclusions about the influence of demographic characteristics on the experiences of families from our study area. While efforts were made to produce a thorough list of service providers, the perspectives of some organizations may have been missed if they did not have an online presence or if our community partners were unaware of their existence. Finally, rural communities and smaller urban centres are contextually diverse based on population size and physical activity-specific resources [ 19 ]. There are multiple definitions used to differentiate between urban, suburban, and rural areas that vary based on one or more community characteristic(s), such as population density, population size, distance from an urban area or distance to an essential service [ 76 ]. As a result, the applicability of findings to other non-urban spaces can be challenging and may only relate to the experiences of service providers and families who reside in rural communities, villages and small urban centres that are within an hour’s drive of a large urban centre.

To counter the rise in physical inactivity associated with the COVID-19 pandemic, developing and implementing interventions that can encourage children to live more active lifestyles are critical. To improve the quality and effectiveness of community-based interventions, researchers and program developers should collaborate with community members and organizations to adapt interventions to meet the needs of their target community. This is particularly important for small, dispersed communities that have unique characteristics based on their population size, number of recreational facilities, and activity options. Service providers and parents emphasized the need for interventions and programs that offer accessible, diverse, high-quality program options that are inclusive and meet the needs of all children in the community. To account for the impacts of the COVID-19 pandemic, interventions need to integrate additional opportunities for children to develop their confidence and physical activity-related skills and find resources that can reduce the economic strain associated with recreation programs. While a variety of suggestions from parents and strategies used by service providers were noted, further studies are needed to evaluate the impact of the recommendations on the effectiveness of interventions and recreation programs in rural and smaller urban centres with a focus on fidelity, uptake, use and changes to physical activity levels.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to research ethics board requirements but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Southwestern Public Health for their support in administering and organizing the ACT-i-Pass community forums. We also thank program service providers and local school boards (the London District Catholic School Board, Thames Valley District School Board, Conseil Scolaire Viamonde and Conseil Scolaire Catholique Providence) for their continued support of the ACT-i-Pass Program. We also thank the parents and organization representatives who took the time to attend the community forum and participate in a community forum discussion. Finally, we thank our research assistant, Samantha Lotzkar, who reviewed the transcripts for accuracy and acted as a secondary analyst.

This research was funded by the Lawson Foundation Miggsie Fund’s Community Grants (GRT 2022-49).

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E.O., J.G., J.I., J.S. and P.T. conceptualized the study. E.O. and P.T. developed the community forum guides. E.O. recruited study participants, moderated the community forums, conducted the analysis, and wrote the original manuscript draft. J.G., J.I., J.S. and P.T. reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

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Ostermeier, E., Gilliland, J., Irwin, J.D. et al. Developing community-based physical activity interventions and recreational programming for children in rural and smaller urban centres: a qualitative exploration of service provider and parent experiences. BMC Health Serv Res 24 , 1017 (2024). https://doi.org/10.1186/s12913-024-11418-w

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Evans D, Coad J, Cottrell K, et al. Public involvement in research: assessing impact through a realist evaluation. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.36.)

Public involvement in research: assessing impact through a realist evaluation.

Chapter 9 conclusions and recommendations for future research.

• How well have we achieved our original aim and objectives?

The initially stated overarching aim of this research was to identify the contextual factors and mechanisms that are regularly associated with effective and cost-effective public involvement in research. While recognising the limitations of our analysis, we believe we have largely achieved this in our revised theory of public involvement in research set out in Chapter 8 . We have developed and tested this theory of public involvement in research in eight diverse case studies; this has highlighted important contextual factors, in particular PI leadership, which had not previously been prominent in the literature. We have identified how this critical contextual factor shapes key mechanisms of public involvement, including the identification of a senior lead for involvement, resource allocation for involvement and facilitation of research partners. These mechanisms then lead to specific outcomes in improving the quality of research, notably recruitment strategies and materials and data collection tools and methods. We have identified a ‘virtuous circle’ of feedback to research partners on their contribution leading to their improved confidence and motivation, which facilitates their continued contribution. Following feedback from the HS&DR Board on our original application we did not seek to assess the cost-effectiveness of different mechanisms of public involvement but we did cost the different types of public involvement as discussed in Chapter 7 . A key finding is that many research projects undercost public involvement.

In our original proposal we emphasised our desire to include case studies involving young people and families with children in the research process. We recruited two studies involving parents of young children aged under 5 years, and two projects involving ‘older’ young people in the 18- to 25-years age group. We recognise that in doing this we missed studies involving children and young people aged under 18 years; in principle we would have liked to have included studies involving such children and young people, but, given the resources at our disposal and the additional resource, ethical and governance issues this would have entailed, we regretfully concluded that this would not be feasible for our study. In terms of the four studies with parental and young persons’ involvement that we did include, we have not done a separate analysis of their data, but the themes emerging from those case studies were consistent with our other case studies and contributed to our overall analysis.

In terms of the initial objectives, we successfully recruited the sample of eight diverse case studies and collected and analysed data from them (objective 1). As intended, we identified the outcomes of involvement from multiple stakeholders‘ perspectives, although we did not get as many research partners‘ perspectives as we would have liked – see limitations below (objective 2). It was more difficult than expected to track the impact of public involvement from project inception through to completion (objective 3), as all of our projects turned out to have longer time scales than our own. Even to track involvement over a stage of a case study research project proved difficult, as the research usually did not fall into neatly staged time periods and one study had no involvement activity over the study period.

Nevertheless, we were able to track seven of the eight case studies prospectively and in real time over time periods of up to 9 months, giving us an unusual window on involvement processes that have previously mainly been observed retrospectively. We were successful in comparing the contextual factors, mechanisms and outcomes associated with public involvement from different stakeholders‘ perspectives and costing the different mechanisms for public involvement (objective 4). We only partly achieved our final objective of undertaking a consensus exercise among stakeholders to assess the merits of the realist evaluation approach and our approach to the measurement and valuation of economic costs of public involvement in research (objective 5). A final consensus event was held, where very useful discussion and amendment of our theory of public involvement took place, and the economic approach was discussed and helpfully critiqued by participants. However, as our earlier discussions developed more fully than expected, we decided to let them continue rather than interrupt them in order to run the final exercise to assess the merits of the realist evaluation approach. We did, however, test our analysis with all our case study participants by sending a draft of this final report for comment. We received a number of helpful comments and corrections but no disagreement with our overall analysis.

• What were the limitations of our study?

Realist evaluation is a relatively new approach and we recognise that there were a number of limitations to our study. We sought to follow the approach recommended by Pawson, but we acknowledge that we were not always able to do so. In particular, our theory of public involvement in research evolved over time and initially was not as tightly framed in terms of a testable hypothesis as Pawson recommends. In his latest book Pawson strongly recommends that outcomes should be measured with quantitative data, 17 but we did not do so; we were not aware of the existence of quantitative data or tools that would enable us to collect such data to answer our research questions. Even in terms of qualitative data, we did not capture as much information on outcomes as we initially envisaged. There were several reasons for this. The most important was that capturing outcomes in public involvement is easier the more operational the focus of involvement, and more difficult the more strategic the involvement. Thus, it was relatively easy to see the impact of a patient panel on the redesign of a recruitment leaflet but harder to capture the impact of research partners in a multidisciplinary team discussion of research design.

We also found it was sometimes more difficult to engage research partners as participants in our research than researchers or research managers. On reflection this is not surprising. Research partners are generally motivated to take part in research relevant to their lived experience of a health condition or situation, whereas our research was quite detached from their lived experience; in addition people had many constraints on their time, so getting involved in our research as well as their own was likely to be a burden too far for some. Researchers clearly also face significant time pressures but they had a more direct interest in our research, as they are obliged to engage with public involvement to satisfy research funders such as the NIHR. Moreover, researchers were being paid by their employers for their time during interviews with us, while research partners were not paid by us and usually not paid by their research teams. Whatever the reasons, we had less response from research partners than researchers or research managers, particularly for the third round of data collection; thus we have fewer data on outcomes from research partners‘ perspectives and we need to be aware of a possible selection bias towards more engaged research partners. Such a bias could have implications for our findings; for example payment might have been a more important motivating factor for less engaged advisory group members.

There were a number of practical difficulties we encountered. One challenge was when to recruit the case studies. We recruited four of our eight case studies prior to the full application, but this was more than 1 year before our project started and 15 months or more before data collection began. In this intervening period, we found that the time scales of some of the case studies were no longer ideal for our project and we faced the choice of whether to continue with them, although this timing was not ideal, or seek at a late moment to recruit alternative ones. One of our case studies ultimately undertook no involvement activity over the study period, so we obtained fewer data from it, and it contributed relatively little to our analysis. Similarly, one of the four case studies we recruited later experienced some delays itself in beginning and so we had a more limited period for data collection than initially envisaged. Research governance approvals took much longer than expected, particularly as we had to take three of our research partners, who were going to collect data within NHS projects, through the research passport process, which essentially truncated our data collection period from 1 year to 9 months. Even if we had had the full year initially envisaged for data collection, our conclusion with hindsight was that this was insufficiently long. To compare initial plans and intentions for involvement with the reality of what actually happened required a longer time period than a year for most of our case studies.

In the light of the importance we have placed on the commitment of PIs, there is an issue of potential selection bias in the recruitment of our sample. As our sampling strategy explicitly involved a networking approach to PIs of projects where we thought some significant public involvement was taking place, we were likely (as we did) to recruit enthusiasts and, at worst, those non-committed who were at least open to the potential value of public involvement. There were, unsurprisingly, no highly sceptical PIs in our sample. We have no data therefore on how public involvement may work in research where the PI is sceptical but may feel compelled to undertake involvement because of funder requirements or other factors.

• What would we do differently next time?

If we were to design this study again, there are a number of changes we would make. Most importantly we would go for a longer time period to be able to capture involvement through the whole research process from initial design through to dissemination. We would seek to recruit far more potential case studies in principle, so that we had greater choice of which to proceed with once our study began in earnest. We would include case studies from the application stage to capture the important early involvement of research partners in the initial design period. It might be preferable to research a smaller number of case studies, allowing a more in-depth ethnographic approach. Although challenging, it would be very informative to seek to sample sceptical PIs. This might require a brief screening exercise of a larger group of PIs on their attitudes to and experience of public involvement.

The economic evaluation was challenging in a number of ways, particularly in seeking to obtain completed resource logs from case study research partners. Having a 2-week data collection period was also problematic in a field such as public involvement, where activity may be very episodic and infrequent. Thus, collecting economic data alongside other case study data in a more integrated way, and particularly with interviews and more ethnographic observation of case study activities, might be advantageous. The new budgeting tool developed by INVOLVE and the MHRN may provide a useful resource for future economic evaluations. 23

We have learned much from the involvement of research partners in our research team and, although many aspects of our approach worked well, there are some things we would do differently in future. Even though we included substantial resources for research partner involvement in all aspects of our study, we underestimated how time-consuming such full involvement would be. We were perhaps overambitious in trying to ensure such full involvement with the number of research partners and the number and complexity of the case studies. We were also perhaps naive in expecting all the research partners to play the same role in the team; different research partners came with different experiences and skills, and, like most of our case studies, we might have been better to be less prescriptive and allow the roles to develop more organically within the project.

• Implications for research practice and funding

If one of the objectives of R&D policy is to increase the extent and effectiveness of public involvement in research, then a key implication of this research is the importance of influencing PIs to value public involvement in research or to delegate to other senior colleagues in leading on involvement in their research. Training is unlikely to be the key mechanism here; senior researchers are much more likely to be influenced by peers or by their personal experience of the benefits of public involvement. Early career researchers may be shaped by training but again peer learning and culture may be more influential. For those researchers sceptical or agnostic about public involvement, the requirement of funders is a key factor that is likely to make them engage with the involvement agenda. Therefore, funders need to scrutinise the track record of research teams on public involvement to ascertain whether there is any evidence of commitment or leadership on involvement.

One of the findings of the economic analysis was that PIs have consistently underestimated the costs of public involvement in their grant applications. Clearly the field will benefit from the guidance and budgeting tool recently disseminated by MHRN and INVOLVE. It was also notable that there was a degree of variation in the real costs of public involvement and that effective involvement is not necessarily costly. Different models of involvement incur different costs and researchers need to be made aware of the costs and benefits of these different options.

One methodological lesson we learned was the impact that conducting this research had on some participants’ reflection on the impact of public involvement. Particularly for research staff, the questions we asked sometimes made them reflect upon what they were doing and change aspects of their approach to involvement. Thus, the more the NIHR and other funders can build reporting, audit and other forms of evaluation on the impact of public involvement directly into their processes with PIs, the more likely such questioning might stimulate similar reflection.

• Recommendations for further research

There are a number of gaps in our knowledge around public involvement in research that follow from our findings, and would benefit from further research, including realist evaluation to extend and further test the theory we have developed here:

• In-depth exploration of how PIs become committed to public involvement and how to influence agnostic or sceptical PIs would be very helpful. Further research might compare, for example, training with peer-influencing strategies in engendering PI commitment. Research could explore the leadership role of other research team members, including research partners, and how collective leadership might support effective public involvement.
• More methodological work is needed on how to robustly capture the impact and outcomes of public involvement in research (building as well on the PiiAF work of Popay et al. 51 ), including further economic analysis and exploration of impact when research partners are integral to research teams.
• Research to develop approaches and carry out a full cost–benefit analysis of public involvement in research would be beneficial. Although methodologically challenging, it would be very useful to conduct some longer-term studies which sought to quantify the impact of public involvement on such key indicators as participant recruitment and retention in clinical trials.
• It would also be helpful to capture qualitatively the experiences and perspectives of research partners who have had mixed or negative experiences, since they may be less likely than enthusiasts to volunteer to participate in studies of involvement in research such as ours. Similarly, further research might explore the (relatively rare) experiences of marginalised and seldom-heard groups involved in research.
• Payment for public involvement in research remains a contested issue with strongly held positions for and against; it would be helpful to further explore the value research partners and researchers place on payment and its effectiveness for enhancing involvement in and impact on research.
• A final relatively narrow but important question that we identified after data collection had finished is: what is the impact of the long periods of relative non-involvement following initial periods of more intense involvement for research partners in some types of research, particularly clinical trials?

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