Qualitative Research

Original Editors - Scott Buxton

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Definition

It can be hard to give just one clear definition of what qualitative research is because of its broad, in-depth nature and the breadth and variety of what it is trying to achieve. Here are several definitions which will provide different perspectives.

Qualitative researchers are interested in understanding the meaning people have constructed, that is, how people make sense of their world and the experiences they have in the world. Qualitative research is research using methods such as participant observation or case studies which result in a narrative, descriptive account of a setting or practice. Sociologists using these methods typically reject positivism and adopt a form of interpretive sociology.

Qualitative research is a situated activity that locates the observer in the world. It consists of a set of interpretive, material practices that makes the world visible. These practices transform the world. They turn the world into a series of representations, including field notes, interviews, conversations, photographs, recordings, and memos to the self. At this level, qualitative research involves an interpretive, naturalistic approach to the world. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them.

“Qualitative research involves any research that uses data that do not indicate ordinal values.

For some qualitative research can be seen as a simple data collection method but for others can be a complex, deep and meaningful insight into the world.

Differences Between Qualitative and Quantitative

If you unfamiliar with qualitative research then the table below shows a simplistic comparison with quantitative research. 

Comparison of Quantitative and Qualitative Methods

	Quantitative	Qualitative
Philosophical Foundation	Deductive, reductionalist	Inductive, holistic
Aim	To test pre-set hypothesis	To explore complex human issues
Study Plan	Step-wise, predetermined	Iterative, flexible
Position of researcher	Aims to be detached and objective	Integral part of the research process
Assessing quality of outcomes	Direct tests of validity, reliability using statistics	Indirect quality assurance methods of trustworthiness
Measures of utility of results	Generalizability	Transferability

Basic Approaches 

Qualitative research can appear to be a complex topic which may push many prospective researchers towards the comforts of a quantitative approach, however, the outcomes of performing qualitative research can have equally important ramifications. After all patients are more than a disease or just 'another number' on a waiting list, they are people and are the reason many people are in the healthcare profession; their experience is vitally important. Ultimately qualitative research attempts to bridge between scientific findings and clinical practice with patient interaction. The table below gives a brief overview of the central identity and themes of qualitative research and data collection methods:

Research Approaches and Implications for Data Collection

Types of Approach	Defining Features	Data Collection Implications
Phenomenology	Focuses on individual experiences, beliefs and perceptions Test used as a proxy for human experience	Questions and observations are aimed at drawing out individual experiences and perceptions In focus groups, group exeriences and normative perceptions are typically sought out In-depth interviews and focus groups are ideal methods for collecting phenomenological data.
Ethnography	Oriented toward studying shared meanings and practices Emphasizes the emic perspective  Can have a historical or contemporary focus	Questions and observations are generally related to social and cultural processes and shared meanings within a given group Traditionally associated with long-term fieldwork Participation observation is well suited to ethnographic inquiry
Inductive Thematic Analysis	Draws on inductive analytic methods  Involves identifying and coding emergent themes within data Most common analytic approach used in qualitative inquiry	ITA requires free-flowing data In-depth interviews and focus groups are the most common data collection techniques associated with ITA Notes from participant observation activites can be analysed using ITA but interview/group data is better
Grounded Theory	Inductive data collection and analytic methods Uses systematic and exhaustive comparison of text-segments to build thematic structure and theory from a body of text Common analytic approach in qualitative studies	In-depth interviews and focus groups are the most common data collection techniques Sample sizes for grounded theory are more limited than for ITA because analytic process is more intensive and time consuming ITA and grounded theory are not the same
Case Study	Analysis of one to several cases that are unique with respect to the research topic Analysis primarily focused on exploring the unique quality	Case studies are selected based on a unique and sometimes rare quality Questions and observations should focus on the unique feature
Discourse/Conversation Analysis	Study of naturally occuring discoure - can range from conversation, public events, documents.	These linguistically focused methods often use existing documentation  Conversations between individuals that spontaneously emerge within group interviews or focus groups may be studies Participant observation is conductive to discourse analysis if narratives from public events can be recorded
Narrative Analysis	Narratives used as data source Can be from several sources i.e interviews, literature, letters	If generating narratives, then questions need to be aimed at eliciting stories and the importance those stories hold for participants as well as the larger culture
Mixed Methods	Defined as integrating qualitative and quantitative research methods in a single study Two most common methods are concurrent and sequential	Collection of qualitative data in a mixed methods study can be informed from a wide range of theoretical perspectives and analytic approaches Researches must specify upfront and in details how, when and why qualitative and quantitative data will be integrated.

Elements of Qualitative Research

Research Question

Creating a research question can be a difficult process and one which may not be perfect the first, second or even third time you try. Creating a succinct and thought provoking question which is precise in its aim provides the researcher with explicit aims and targets to work towards. With a non-specific and vague question research can lose its focus and confuse readers and be of no benefit to the scientific community. To make the difficult task easier specific step-by-step have been created such as the following.

The Spider

The SPIDER technique is to qualitative research, what PICO is to qualitative research; it is an acronym to aid the budding researcher to develop a concise and direct research question with clear aims and direction. The official definition is:

The SPIDER tool may assist public health professionals in effectively searching for qualitative and mixed-methods research. The SPIDER tool can be used as a structure for the literature search strategy in synthesizing research evidence on the  experiences of individuals and communities on an issue, together with quantitative research on intervention effectiveness, to understand how a public health intervention may be received and accessed in your community.

The letters standing for:

1. Sample
2. Phenomena of Interest
3. Design
4. Evaluation
5. Research Tool

The tool has been evaluated in two systematic reviews and by comparing the search results between PICO and SPIDER in terms of yield and relevance. The results were promising with a more manageable number of results yield by SPIDER however some discrepancies were seen in the search results. SPIDER missed two articles PICO discovered however SPIDER found one additional to PICO, clearly there are benefits to both. 

Ethics

As with quantitative research there are ethical standards which need to be upheld when performing qualitative research. The starting point of ethical concerns are the 4 principles of Beauchamp and Childress: 

1. Autonomy; respecting the rights of the individual i.e allowing the right to withdraw, full disclosure on the aims and involvement of the research and anonymity, consent and confidentiality
2. Beneficence; doing good from the results of the research
3. Non-maleficence; not doing harm to the patients be it physical, psychological or emotional
4. Justice; being equal, fair and responsible

Example of non-ethical studies are the 'Little Albert Study', the Milgram study about obedience, Harlow's monkey experiment and Zimbardo's prison experiment.

It is important to consider that asking a person about their thoughts and feelings about an experience may be traumatic or emotionally distressing and care needs to be taken when asking these questions. It may require a talking-therapy aftercare service to be in place to address these concerns. It is also important to remember that the emotions or stress may arise after the research has finished. 

With qualitative research it is vital to consider confidentiality you could potentially have thousands of words typed from a conversation you have had with a participant, potentially containing sensitive information so password protecting document and keeping them under lock-and-key is essential.

Prior to conducting research ethical approval will need to be granted by a Local Research Ethical Committee (LREC). This may contain 8-12 individuals from a wide range of professions, ages and experience who are separate from, and not involved in, the study in question. Universities and research centres will have their own research committees. If a study involves any of the following ethical approval will be needed.

1. The collection of personal information
2. Video or audio recording
3. Observation of individuals or groups
4. Collections of tissue of any kind
5. Deception
6. invasive procedures
7. Children
8. Anyone not able to provide consent
9. Any procedure which may cause distress (including inadvertently)
10. Any other ethical issue

Sampling

Sampling in qualitative research is integrally different to quantitative research sampling. This is explained in the following subheadings.

Size

Quantitative research is focused on generalizability and so large numbers of participants are required. This may be 1000's of participants to 100,000's.

However in qualitative research all that is needed is enough participants to answer the research question. More participants may be recruited half-way through the study or until common themes or answers reoccur (Data Saturation), this may only take 20 participants. Another consideration is the sheer amount of time and effort required to thoroughly analysis and manage qualitative data, so this factor may be limiting to the scope of the study.

Sampling Strategies

Convenience sample is the least rigorous technique in qualitative research, essentially it is involving the most accessible subjects. Although being the least rigurous it is most cost effective financially and in terms of effort and time demands. It may lack credibility so a more thoughtful and thorough method is needed

Judgement/Purposeful sampling is the most common sampling technique. The researcher seeks out participants who will answer the research question the most effectively.  It may be beneficial to include a narrow or broad sample based on intellect, geographical location, gender, age, experience or beliefs.Participants may also be able to suggest other participants who have had similar experiences which further the sample size, this is known as snowball sampling.

Theoretical Sampling necessitates building interpretative theories from the emerging data and selecting a new sample to elaborate on the new theories may be needed. This sample is ever changing until the research questions are answered.

Data Collection Methods

There are several different ways of collecting qualitative research data. The below subheadings contain the most common methods and will provide an overview into each.

In-depth Interviews

There are a number of different interview methods. 

Group Interviews

Group interviews have been around since the early 20th century and can be seen in a study performed by Bogardus in 1926. The method is used in a wide range of study types from mass communication, health, spirituality and education.Sometimes it can be difficult to choose between one-to-one interviews and grup interviews, as seen above they are both versatile and have many uses however group interviews can take the data to the next level. Blummer explains this:

A small number of individuals, brought together as a discussion or resource group, is more valuable many times over than any representative sample. Such a group, discussing collectively their sphere of life and probing into it as they meet one another's disagreements, will do more to lift the veils covering the sphere of life than any other device I know of.

This is true, a group interview is seen as more 'naturalistic' than its more structured cousin and lots of data may be uncovered. The group environment may encourage others to take part as it may feel more natural than a 1:1 interview setting. A reflective thought may be provoked in some individuals further enhancing the data. These are all justifiable methodological considerations for choosing a group interview, Frey & Fontana explain these considerations like this:

• Exploratory - Here group interviews are often being used in the initial stages of a research project when the researcher is unfamiliar or new to the social constext
• Pretest - Group interviews can be used to test questionnaire items, with respondents being asked to comment on readability, comprehension, wording etc. These are often very structured group interviews aiming to meet very specific outcomes.
• Triangulation - Frequently group interviews are used to offer additional data, lending methodological rigour to, for example, one-to-one interviews or questionnaire data.
• Phenomenological - When applied with this purpose in mind, group interviews are not used to generate provisional data. Rather, the data collected may be the only source of information, potentially providing details insight about specific phenomena and experiences.
  

There are a number of different types of group interview that are suitable for different research questions or methodological approach, these include brainstorming, nominal group techniques and focus groups. These could each have their own page on Physiopedia and maybe one day they will, however for now further research will be needed by the reader. 

In a sub-section about sampling was discussed, now different considerations need to be considered with group interviews. If there are too many participants then it may be difficult to control the discussion, too small and the discussion will not be insightful enough, therefore 6-10 participants is advised,

Observations

Another way to gather information is by observing people or events in their natural environment. It is important to understand the implications of watching people and ethics may play its part depending on whether the observations are overt (subjects know they are being observed) or covert (it is done without knowledge or consent). The three main types of observation are:

• Participant Observation - In this type of observation the researcher is part of the group and becomes an active participant in the research process. In order for this to be successful and produce accurate data it is important that the researcher is accepted by the group being observed.

• Direct Observation - The researcher is not a direct part of the group but is present in the process and needs to be present in such a way that they do not interfere with the process, eliminating any bias. The use of equipment such as cameras, video or audio can assist in gathering information.

• Indirect Observation - Requires observing and processing behavioural data as the result of an interaction or process.

Action Research

Action research is a reflective process that requires an individual to work with a team to not only find solutions to problems but also to improve the way the team works to solve problems..

Reports and Other Methods

There are many other alternatives to the above mentioned methods of data collection. These may include juries, on-line interviews over an instant messaging service, survey/questionnaire online or a physical hard copy or it may include email. A lot of these online methods can be called 'Remote Interviewing'.

Data Analysis

With all of the data, words and recording you would have amassed after doing  an interview the analysis can seem as the most challenging part of performing the research. You may have 10,000 words from each individual interview, or 50,000 from a group interview to try and decipher ideas from. There are a number of different ways of analysing the data, there can be a thematic, descriptie or in-depth approach, as well as others. However thematic analysis is usually sufficient. 

Before you get to the stage of finding new ideas and answers from your collected data you need to decide what you are going to do with it, are you going to fully or partially transcribe it. Once you find your preferred method of transcribing it is important to be consistent throughout your work. You can go down the route of typing out verbal information only with whole words or you can go for all of the verbal and non-verbal information including body language and pauses/timings as well. The more information you can gather, the more patterns emerge giving you rich and thick description which is integral to and the focal point of qualitative research. 

Some conventions of transcribing are as follows:

• (?) talk too obscure to transcribe.
• Hhhhh audible out-breath
• .hhh in-breath
• [ overlapping talk begins
• ] overlapping talk ends
• (.) silence, less than half a second
• (..) silence, less than one second
• (2.8) silence measured in 10ths of a second

lengthening of a sound

• Becau- cut off, interruption of a sound
• he says. Emphasis
• = no silence at all between sounds
• LOUD sounds
• ? rising intonation
• (left hand on neck) body conduct
• [notes, comments]
• Non-verbal cues can be written as (stretches arms wide) 
• tone of voice may also be (ironic tone)

 

Over the past decade or so, as qualitative research has gained support transcribing has become a prominent area of discussion, particularly in relation to the quality of transcription and errors which can arise. Inaccurate transcription can have a very detrimental effect on a research piece. If information is lost or misrepresented then the credibility of the work disappears. King & Horroks explain that, although not an exhaustive list, there are 3 main threats to good quality transcription; recording quality, missing context and tidying up transcribed information.

Recording quality is something which should be a relatively simple area basic improvement can be made. Making sure the recorder is of high quality, microphones being suitable places, voice is clear and loud and the pace of speech is at a measured pace. Remember you can always, if something is deemed important, ask the participant to repeat is clearer and louder. It is also good practice to record salient information at the start f the recording such as time, date and who the participant is so it is easily identifiable. 

Missing context is something that is a little more troublesome to overcome. Essentially this is an area which will become a problem if you are using simple verbatim transcription techniques. If you area just typing up what is being said and not the facial expression or tone of speech then information can be misconstrued. If for example you were talking to someone about their new job and they said "its great, great, I love it" you would assume they were having a great time. However if you included (sarcastic tone) and (facial grimace) then a completely different message is construed. It is therefore important to include these when necessary. 

Tidying up transcripts is something easy to accidentally do. Spoken English is very different to the written form. It is always messier, broken and the pace looks odd when written down. It is always tempting to correct mistakes when transcribing the information however it is not the job of a transcript to do this. Perhaps phrases such as (inaudible - perhaps "time of day") or (unclear, a name) would be more accurate and suitable for transcription purposes. Technical terms are also challenging and abbreviations should be avoided. Ensure the participants avoid them, or if they do, be sure to ask what they mean. If they are unavoidable a glossary of terms would be appropriate. 

Thematic Analysis - The Stages

Thematic analysis reviews all of the data to identify common ideas which reoccur and identify these as themes that summarise the collected views of participants. Based on the work of King & Horrocks.

Stage 1 - Descriptive Coding

The idea of this stage is to begin to identify the parts of the transcripts which will most likely help to answer your research question. It is always a good idea to read through the transcript several times to familiarise yourself with the work so as not to lose context when referring back in the future and to understand the whole meaning. Next highlight anything you feel will help you understand the views, opinions and beliefs of the participants and add comments next to them to explore the findings further. A colour scheme or numbering may be beneficial to connect ideas together and make it easier to find them.  Double spacing the transcripts may help de-clutter the page and allow room for notes or using an annotation software package. Once you have lots of comments and highlighted text, you may find codes emerging from the comments. Make sure they are close to the data and avoid speculation. Try not to incorporate every single piece of text or comment but only the salient points and use short phrases or abbreviations for your themes such as:(A-Level Chemistry) or (Self-confidence building). You can merge comments and codes if they are reoccurring or if they overlap considerably. This process is then repeated with the next transcript, adding the interview extracts, comments and themes to your already collected data. When moving from transcript to transcript you may have to return and edit your earlier themes or comments because of new emerging data. This is good practice and demonstrates free-flowing idea development and adaptation.

Stage 2 - Interpretive Coding 

The goal of stage 2 is to take the common codes found from stage 1 and focus on your interpretation of them. You can achieve this by grouping together the codes that share a similar concept or meaning and create a single code which captures it. Try not to make the new codes too blinkered by applying/putting them in to match a particular theory or framework but make sure they are broad and diverse enough to encapsulate what the participants are trying to say. If you are a psychologist you would at this stage be fitting the codes into areas of cognitive behavioural therapy (CBT) or psychological thinking by for example recognising troubling thoughts or ideas. The idea is to move on from descriptive findings to what they appear to mean just below the surface. This too should be a process which will need to be repeated again and again until you have reached the point at which new ideas are not emerging.

Stage 3 - Defining Overarching Themes At the final stage the goal is to create overarching themes that characterise the key concepts found. These should be built on the interpretive ideas formed and should delve deeper and be more abstract. They can include theories or applied concepts that underlie the reason you chose the research question in the first place, as long as you can support the ideas/concepts in the analysis. Try and restrict the number of themes to 2-5, otherwise your findings will become diluted and lack clarity. It may be useful to create a diagram or tree showing how you came to your conclusions, this is also good practice for an audit trail and for readers to discover when your ideas came from.

Results and Write up

The end product of qualitative research will achieve the same as a quantitative piece, it may just look different. The presentation may be different as well, with a lack of tables and graphs seeming foreign to some. Instead quotes, themes and new ideas emerge as a result of the analysis instead of percentages or numbers however qualitative data can be converted to numerical with the use of tallies or frequency of specific phrases being the focus.

The most common and arguably simplistic way to report on thematic analytical findings is to discuss each theme in turn referring to examples, quotes and characterising them to the reader. It is not necessary to include each quote in the report, only those which most strongly illustrate and describe the findings and answer your research question. 

Critiquing Qualitative Research

Critiquing research is integral to providing the best possible interventions in healthcare. Qualitative research has its own terminology and requirements to be seen as a rigorous and credible piece of work. The table below is an introduction to some of these concepts.

Criteria for Evaluating Qualitative Research. Lincoln & Guba 1985

Criteria	Definition	Assumptions	Strategies
Credibility	Authentic representations of experience	Multiple realities Causes not distinguishable from effects Empathetic researcher Researher as an instrument Emphasis of the research endeavour	Pruposeful sampling Disciplined subjectivity/bracketing Prolonged engagement Persistent observation Triangulation Peer debriefing Negative case analysis Referential adequacy Member checking
Transferability	Fit within contexts outside the study situation	Time and context-bound experiences Not responsibility of 'sending' researcher Provision of information for 'recieving' researcher	Purposeful sampling Thick and rich description
Dependability	Minimization of idiosyncrasies in interpretation, variability tracked to identifiable sources	Researcher as instrument Consistency in interpretation Multiple realities Idiosyncrasy of behaviour and context	Low-inference descriptors, mechanically recorded data Multiple researchers Participant researchers Peer examination Triangulation Inquiry audit
Confirmability	Extent to which biases, motivations, interests or perspectives of the inquirer influence interpretations	Biases, motivations, interests or perspectives of inquirer can influence interpretation Focus on investigator and interpretations	Audit trail products Thich description of the auid process Autobiography Journal/notebook

Glossary

Phenomenology - Phenomenology is the study of structures of consciousness as experienced from the first-person point of view. The central structure of an experience is its intentionality, its being directed toward something, as it is an experience of or about some object. An experience is directed toward an object by virtue of its content or meaning (which represents the object) together with appropriate enabling conditions.

Ethnography - this term traditionally refers to a practice in which researchers spend long periods living within a culture in order to study it. The term has been adopted within qualitative market research to describe occasions where researchers spend time - hours, days or weeks - observing and/or interacting with participants in areas of their everyday lives. This contrasts with interview-based research in which interaction with respondents is limited to a conventional interview or group discussion format, is more limited in time, and often takes place outside the participant's own environment

Inductive Theme Analysis - .Thematic analysis is used in qualitative research and focuses on examining themes within data.[3] This method emphasizes organization and rich description of the data set. Thematic analysis goes beyond simply counting phrases or words in a text and moves on to identifying implicit and explicit ideas within the data Grounded Theory - All research is "grounded" in data, but few studies produce a "grounded theory." Grounded Theory is an inductive methodology. Although many call Grounded Theory a qualitative method, it is not. It is a general method. It is the systematic generation of theory from systematic research. It is a set of rigorous research procedures leading to the emergence of conceptual categories. These concepts/categories are related to each other as a theoretical explanation of the action(s) that continually resolves the main concern of the participants in a substantive area. Grounded Theory can be used with either qualitative or quantitative data.

Discourse Analysis - Discourse analysis (DA), or discourse studies, is a general term for a number of approaches to analyze written, vocal, or sign language use or any significant semiotic event.

Narrative Analysis - 

Holistic - Characterized by the belief that the parts of something are intimately interconnected and explicable only by reference to the whole

Qualitative - Qualitative Research is primarily exploratory research. It is used to gain an understanding of underlying reasons, opinions, and motivations. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. Qualitative Research is also used to uncover trends in thought and opinions, and dive deeper into the problem. Qualitative data collection methods vary using unstructured or semi-structured techniques. Some common methods include focus groups (group discussions), individual interviews, and participation/observations. The sample size is typically small, and respondents are selected to fulfill a given quota.

Quantitative - Quantitative Research is used to quantify the problem by way of generating numerical data or data that can be transformed into useable statistics. It is used to quantify attitudes, opinions, behaviors, and other defined variables – and generalize results from a larger sample population. Quantitative Research uses measurable data to formulate facts and uncover patterns in research. Quantitative data collection methods are much more structured than Qualitative data collection methods. Quantitative data collection methods include various forms of surveys – online surveys, paper surveys, mobile surveys and kiosk surveys, face-to-face interviews, telephone interviews, longitudinal studies, website interceptors, online polls, and systematic observations.

Triangulation - In the social sciences, triangulation is often used to indicate that two (or more) methods are used in a study in order to check the results. "The concept of triangulation is borrowed from navigational and land surveying techniques that determine a single point in space with the convergence of measurements taken from two other distinct points." The idea is that one can be more confident with a result if different methods lead to the same result.

Credibility - Confidence in the 'truth' of the findings. Is it what the participants actually said or has the meaning been lost.

Transferability - Showing that the findings have applicability in other contexts. The qualitative form of generalizability.

Dependability - Showing that the findings are consistent and could be repeated if the same questions or environment were identical.

Confirmability - A degree of neutraility or the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest