qualitative and quantitative research questionnaire

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A Practical Guide to Writing Quantitative and Qualitative Research Questions and Hypotheses in Scholarly Articles

Edward barroga.

1 Department of General Education, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan.

Glafera Janet Matanguihan

2 Department of Biological Sciences, Messiah University, Mechanicsburg, PA, USA.

The development of research questions and the subsequent hypotheses are prerequisites to defining the main research purpose and specific objectives of a study. Consequently, these objectives determine the study design and research outcome. The development of research questions is a process based on knowledge of current trends, cutting-edge studies, and technological advances in the research field. Excellent research questions are focused and require a comprehensive literature search and in-depth understanding of the problem being investigated. Initially, research questions may be written as descriptive questions which could be developed into inferential questions. These questions must be specific and concise to provide a clear foundation for developing hypotheses. Hypotheses are more formal predictions about the research outcomes. These specify the possible results that may or may not be expected regarding the relationship between groups. Thus, research questions and hypotheses clarify the main purpose and specific objectives of the study, which in turn dictate the design of the study, its direction, and outcome. Studies developed from good research questions and hypotheses will have trustworthy outcomes with wide-ranging social and health implications.

INTRODUCTION

Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses. 1 , 2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results. 3 , 4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the inception of novel studies and the ethical testing of ideas. 5 , 6

It is crucial to have knowledge of both quantitative and qualitative research 2 as both types of research involve writing research questions and hypotheses. 7 However, these crucial elements of research are sometimes overlooked; if not overlooked, then framed without the forethought and meticulous attention it needs. Planning and careful consideration are needed when developing quantitative or qualitative research, particularly when conceptualizing research questions and hypotheses. 4

There is a continuing need to support researchers in the creation of innovative research questions and hypotheses, as well as for journal articles that carefully review these elements. 1 When research questions and hypotheses are not carefully thought of, unethical studies and poor outcomes usually ensue. Carefully formulated research questions and hypotheses define well-founded objectives, which in turn determine the appropriate design, course, and outcome of the study. This article then aims to discuss in detail the various aspects of crafting research questions and hypotheses, with the goal of guiding researchers as they develop their own. Examples from the authors and peer-reviewed scientific articles in the healthcare field are provided to illustrate key points.

DEFINITIONS AND RELATIONSHIP OF RESEARCH QUESTIONS AND HYPOTHESES

A research question is what a study aims to answer after data analysis and interpretation. The answer is written in length in the discussion section of the paper. Thus, the research question gives a preview of the different parts and variables of the study meant to address the problem posed in the research question. 1 An excellent research question clarifies the research writing while facilitating understanding of the research topic, objective, scope, and limitations of the study. 5

On the other hand, a research hypothesis is an educated statement of an expected outcome. This statement is based on background research and current knowledge. 8 , 9 The research hypothesis makes a specific prediction about a new phenomenon 10 or a formal statement on the expected relationship between an independent variable and a dependent variable. 3 , 11 It provides a tentative answer to the research question to be tested or explored. 4

Hypotheses employ reasoning to predict a theory-based outcome. 10 These can also be developed from theories by focusing on components of theories that have not yet been observed. 10 The validity of hypotheses is often based on the testability of the prediction made in a reproducible experiment. 8

Conversely, hypotheses can also be rephrased as research questions. Several hypotheses based on existing theories and knowledge may be needed to answer a research question. Developing ethical research questions and hypotheses creates a research design that has logical relationships among variables. These relationships serve as a solid foundation for the conduct of the study. 4 , 11 Haphazardly constructed research questions can result in poorly formulated hypotheses and improper study designs, leading to unreliable results. Thus, the formulations of relevant research questions and verifiable hypotheses are crucial when beginning research. 12

CHARACTERISTICS OF GOOD RESEARCH QUESTIONS AND HYPOTHESES

Excellent research questions are specific and focused. These integrate collective data and observations to confirm or refute the subsequent hypotheses. Well-constructed hypotheses are based on previous reports and verify the research context. These are realistic, in-depth, sufficiently complex, and reproducible. More importantly, these hypotheses can be addressed and tested. 13

There are several characteristics of well-developed hypotheses. Good hypotheses are 1) empirically testable 7 , 10 , 11 , 13 ; 2) backed by preliminary evidence 9 ; 3) testable by ethical research 7 , 9 ; 4) based on original ideas 9 ; 5) have evidenced-based logical reasoning 10 ; and 6) can be predicted. 11 Good hypotheses can infer ethical and positive implications, indicating the presence of a relationship or effect relevant to the research theme. 7 , 11 These are initially developed from a general theory and branch into specific hypotheses by deductive reasoning. In the absence of a theory to base the hypotheses, inductive reasoning based on specific observations or findings form more general hypotheses. 10

TYPES OF RESEARCH QUESTIONS AND HYPOTHESES

Research questions and hypotheses are developed according to the type of research, which can be broadly classified into quantitative and qualitative research. We provide a summary of the types of research questions and hypotheses under quantitative and qualitative research categories in Table 1 .

Research questions in quantitative research

In quantitative research, research questions inquire about the relationships among variables being investigated and are usually framed at the start of the study. These are precise and typically linked to the subject population, dependent and independent variables, and research design. 1 Research questions may also attempt to describe the behavior of a population in relation to one or more variables, or describe the characteristics of variables to be measured ( descriptive research questions ). 1 , 5 , 14 These questions may also aim to discover differences between groups within the context of an outcome variable ( comparative research questions ), 1 , 5 , 14 or elucidate trends and interactions among variables ( relationship research questions ). 1 , 5 We provide examples of descriptive, comparative, and relationship research questions in quantitative research in Table 2 .

Hypotheses in quantitative research

In quantitative research, hypotheses predict the expected relationships among variables. 15 Relationships among variables that can be predicted include 1) between a single dependent variable and a single independent variable ( simple hypothesis ) or 2) between two or more independent and dependent variables ( complex hypothesis ). 4 , 11 Hypotheses may also specify the expected direction to be followed and imply an intellectual commitment to a particular outcome ( directional hypothesis ) 4 . On the other hand, hypotheses may not predict the exact direction and are used in the absence of a theory, or when findings contradict previous studies ( non-directional hypothesis ). 4 In addition, hypotheses can 1) define interdependency between variables ( associative hypothesis ), 4 2) propose an effect on the dependent variable from manipulation of the independent variable ( causal hypothesis ), 4 3) state a negative relationship between two variables ( null hypothesis ), 4 , 11 , 15 4) replace the working hypothesis if rejected ( alternative hypothesis ), 15 explain the relationship of phenomena to possibly generate a theory ( working hypothesis ), 11 5) involve quantifiable variables that can be tested statistically ( statistical hypothesis ), 11 6) or express a relationship whose interlinks can be verified logically ( logical hypothesis ). 11 We provide examples of simple, complex, directional, non-directional, associative, causal, null, alternative, working, statistical, and logical hypotheses in quantitative research, as well as the definition of quantitative hypothesis-testing research in Table 3 .

Research questions in qualitative research

Unlike research questions in quantitative research, research questions in qualitative research are usually continuously reviewed and reformulated. The central question and associated subquestions are stated more than the hypotheses. 15 The central question broadly explores a complex set of factors surrounding the central phenomenon, aiming to present the varied perspectives of participants. 15

There are varied goals for which qualitative research questions are developed. These questions can function in several ways, such as to 1) identify and describe existing conditions ( contextual research question s); 2) describe a phenomenon ( descriptive research questions ); 3) assess the effectiveness of existing methods, protocols, theories, or procedures ( evaluation research questions ); 4) examine a phenomenon or analyze the reasons or relationships between subjects or phenomena ( explanatory research questions ); or 5) focus on unknown aspects of a particular topic ( exploratory research questions ). 5 In addition, some qualitative research questions provide new ideas for the development of theories and actions ( generative research questions ) or advance specific ideologies of a position ( ideological research questions ). 1 Other qualitative research questions may build on a body of existing literature and become working guidelines ( ethnographic research questions ). Research questions may also be broadly stated without specific reference to the existing literature or a typology of questions ( phenomenological research questions ), may be directed towards generating a theory of some process ( grounded theory questions ), or may address a description of the case and the emerging themes ( qualitative case study questions ). 15 We provide examples of contextual, descriptive, evaluation, explanatory, exploratory, generative, ideological, ethnographic, phenomenological, grounded theory, and qualitative case study research questions in qualitative research in Table 4 , and the definition of qualitative hypothesis-generating research in Table 5 .

Qualitative studies usually pose at least one central research question and several subquestions starting with How or What . These research questions use exploratory verbs such as explore or describe . These also focus on one central phenomenon of interest, and may mention the participants and research site. 15

Hypotheses in qualitative research

Hypotheses in qualitative research are stated in the form of a clear statement concerning the problem to be investigated. Unlike in quantitative research where hypotheses are usually developed to be tested, qualitative research can lead to both hypothesis-testing and hypothesis-generating outcomes. 2 When studies require both quantitative and qualitative research questions, this suggests an integrative process between both research methods wherein a single mixed-methods research question can be developed. 1

FRAMEWORKS FOR DEVELOPING RESEARCH QUESTIONS AND HYPOTHESES

Research questions followed by hypotheses should be developed before the start of the study. 1 , 12 , 14 It is crucial to develop feasible research questions on a topic that is interesting to both the researcher and the scientific community. This can be achieved by a meticulous review of previous and current studies to establish a novel topic. Specific areas are subsequently focused on to generate ethical research questions. The relevance of the research questions is evaluated in terms of clarity of the resulting data, specificity of the methodology, objectivity of the outcome, depth of the research, and impact of the study. 1 , 5 These aspects constitute the FINER criteria (i.e., Feasible, Interesting, Novel, Ethical, and Relevant). 1 Clarity and effectiveness are achieved if research questions meet the FINER criteria. In addition to the FINER criteria, Ratan et al. described focus, complexity, novelty, feasibility, and measurability for evaluating the effectiveness of research questions. 14

The PICOT and PEO frameworks are also used when developing research questions. 1 The following elements are addressed in these frameworks, PICOT: P-population/patients/problem, I-intervention or indicator being studied, C-comparison group, O-outcome of interest, and T-timeframe of the study; PEO: P-population being studied, E-exposure to preexisting conditions, and O-outcome of interest. 1 Research questions are also considered good if these meet the “FINERMAPS” framework: Feasible, Interesting, Novel, Ethical, Relevant, Manageable, Appropriate, Potential value/publishable, and Systematic. 14

As we indicated earlier, research questions and hypotheses that are not carefully formulated result in unethical studies or poor outcomes. To illustrate this, we provide some examples of ambiguous research question and hypotheses that result in unclear and weak research objectives in quantitative research ( Table 6 ) 16 and qualitative research ( Table 7 ) 17 , and how to transform these ambiguous research question(s) and hypothesis(es) into clear and good statements.

a These statements were composed for comparison and illustrative purposes only.

b These statements are direct quotes from Higashihara and Horiuchi. 16

a This statement is a direct quote from Shimoda et al. 17

The other statements were composed for comparison and illustrative purposes only.

CONSTRUCTING RESEARCH QUESTIONS AND HYPOTHESES

To construct effective research questions and hypotheses, it is very important to 1) clarify the background and 2) identify the research problem at the outset of the research, within a specific timeframe. 9 Then, 3) review or conduct preliminary research to collect all available knowledge about the possible research questions by studying theories and previous studies. 18 Afterwards, 4) construct research questions to investigate the research problem. Identify variables to be accessed from the research questions 4 and make operational definitions of constructs from the research problem and questions. Thereafter, 5) construct specific deductive or inductive predictions in the form of hypotheses. 4 Finally, 6) state the study aims . This general flow for constructing effective research questions and hypotheses prior to conducting research is shown in Fig. 1 .

Research questions are used more frequently in qualitative research than objectives or hypotheses. 3 These questions seek to discover, understand, explore or describe experiences by asking “What” or “How.” The questions are open-ended to elicit a description rather than to relate variables or compare groups. The questions are continually reviewed, reformulated, and changed during the qualitative study. 3 Research questions are also used more frequently in survey projects than hypotheses in experiments in quantitative research to compare variables and their relationships.

Hypotheses are constructed based on the variables identified and as an if-then statement, following the template, ‘If a specific action is taken, then a certain outcome is expected.’ At this stage, some ideas regarding expectations from the research to be conducted must be drawn. 18 Then, the variables to be manipulated (independent) and influenced (dependent) are defined. 4 Thereafter, the hypothesis is stated and refined, and reproducible data tailored to the hypothesis are identified, collected, and analyzed. 4 The hypotheses must be testable and specific, 18 and should describe the variables and their relationships, the specific group being studied, and the predicted research outcome. 18 Hypotheses construction involves a testable proposition to be deduced from theory, and independent and dependent variables to be separated and measured separately. 3 Therefore, good hypotheses must be based on good research questions constructed at the start of a study or trial. 12

In summary, research questions are constructed after establishing the background of the study. Hypotheses are then developed based on the research questions. Thus, it is crucial to have excellent research questions to generate superior hypotheses. In turn, these would determine the research objectives and the design of the study, and ultimately, the outcome of the research. 12 Algorithms for building research questions and hypotheses are shown in Fig. 2 for quantitative research and in Fig. 3 for qualitative research.

EXAMPLES OF RESEARCH QUESTIONS FROM PUBLISHED ARTICLES

• EXAMPLE 1. Descriptive research question (quantitative research)
• - Presents research variables to be assessed (distinct phenotypes and subphenotypes)
• “BACKGROUND: Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts.
• RESEARCH QUESTION: Does the clinical spectrum of patients with COVID-19 contain distinct phenotypes and subphenotypes? ” 19
• EXAMPLE 2. Relationship research question (quantitative research)
• - Shows interactions between dependent variable (static postural control) and independent variable (peripheral visual field loss)
• “Background: Integration of visual, vestibular, and proprioceptive sensations contributes to postural control. People with peripheral visual field loss have serious postural instability. However, the directional specificity of postural stability and sensory reweighting caused by gradual peripheral visual field loss remain unclear.
• Research question: What are the effects of peripheral visual field loss on static postural control ?” 20
• EXAMPLE 3. Comparative research question (quantitative research)
• - Clarifies the difference among groups with an outcome variable (patients enrolled in COMPERA with moderate PH or severe PH in COPD) and another group without the outcome variable (patients with idiopathic pulmonary arterial hypertension (IPAH))
• “BACKGROUND: Pulmonary hypertension (PH) in COPD is a poorly investigated clinical condition.
• RESEARCH QUESTION: Which factors determine the outcome of PH in COPD?
• STUDY DESIGN AND METHODS: We analyzed the characteristics and outcome of patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) with moderate or severe PH in COPD as defined during the 6th PH World Symposium who received medical therapy for PH and compared them with patients with idiopathic pulmonary arterial hypertension (IPAH) .” 21
• EXAMPLE 4. Exploratory research question (qualitative research)
• - Explores areas that have not been fully investigated (perspectives of families and children who receive care in clinic-based child obesity treatment) to have a deeper understanding of the research problem
• “Problem: Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment? This review aims to explore the scope of perspectives reported by families of children with obesity who have received individualized outpatient clinic-based obesity treatment.” 22
• EXAMPLE 5. Relationship research question (quantitative research)
• - Defines interactions between dependent variable (use of ankle strategies) and independent variable (changes in muscle tone)
• “Background: To maintain an upright standing posture against external disturbances, the human body mainly employs two types of postural control strategies: “ankle strategy” and “hip strategy.” While it has been reported that the magnitude of the disturbance alters the use of postural control strategies, it has not been elucidated how the level of muscle tone, one of the crucial parameters of bodily function, determines the use of each strategy. We have previously confirmed using forward dynamics simulations of human musculoskeletal models that an increased muscle tone promotes the use of ankle strategies. The objective of the present study was to experimentally evaluate a hypothesis: an increased muscle tone promotes the use of ankle strategies. Research question: Do changes in the muscle tone affect the use of ankle strategies ?” 23

EXAMPLES OF HYPOTHESES IN PUBLISHED ARTICLES

• EXAMPLE 1. Working hypothesis (quantitative research)
• - A hypothesis that is initially accepted for further research to produce a feasible theory
• “As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness .” 24
• “In conclusion, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response . The difference in perceived safety of these agents in COVID-19 illness could be related to the more potent efficacy to reduce fever with ibuprofen compared to acetaminophen. Compelling data on the benefit of fever warrant further research and review to determine when to treat or withhold ibuprofen for early stage fever for COVID-19 and other related viral illnesses .” 24
• EXAMPLE 2. Exploratory hypothesis (qualitative research)
• - Explores particular areas deeper to clarify subjective experience and develop a formal hypothesis potentially testable in a future quantitative approach
• “We hypothesized that when thinking about a past experience of help-seeking, a self distancing prompt would cause increased help-seeking intentions and more favorable help-seeking outcome expectations .” 25
• “Conclusion
• Although a priori hypotheses were not supported, further research is warranted as results indicate the potential for using self-distancing approaches to increasing help-seeking among some people with depressive symptomatology.” 25
• EXAMPLE 3. Hypothesis-generating research to establish a framework for hypothesis testing (qualitative research)
• “We hypothesize that compassionate care is beneficial for patients (better outcomes), healthcare systems and payers (lower costs), and healthcare providers (lower burnout). ” 26
• Compassionomics is the branch of knowledge and scientific study of the effects of compassionate healthcare. Our main hypotheses are that compassionate healthcare is beneficial for (1) patients, by improving clinical outcomes, (2) healthcare systems and payers, by supporting financial sustainability, and (3) HCPs, by lowering burnout and promoting resilience and well-being. The purpose of this paper is to establish a scientific framework for testing the hypotheses above . If these hypotheses are confirmed through rigorous research, compassionomics will belong in the science of evidence-based medicine, with major implications for all healthcare domains.” 26
• EXAMPLE 4. Statistical hypothesis (quantitative research)
• - An assumption is made about the relationship among several population characteristics ( gender differences in sociodemographic and clinical characteristics of adults with ADHD ). Validity is tested by statistical experiment or analysis ( chi-square test, Students t-test, and logistic regression analysis)
• “Our research investigated gender differences in sociodemographic and clinical characteristics of adults with ADHD in a Japanese clinical sample. Due to unique Japanese cultural ideals and expectations of women's behavior that are in opposition to ADHD symptoms, we hypothesized that women with ADHD experience more difficulties and present more dysfunctions than men . We tested the following hypotheses: first, women with ADHD have more comorbidities than men with ADHD; second, women with ADHD experience more social hardships than men, such as having less full-time employment and being more likely to be divorced.” 27
• “Statistical Analysis
• ( text omitted ) Between-gender comparisons were made using the chi-squared test for categorical variables and Students t-test for continuous variables…( text omitted ). A logistic regression analysis was performed for employment status, marital status, and comorbidity to evaluate the independent effects of gender on these dependent variables.” 27

EXAMPLES OF HYPOTHESIS AS WRITTEN IN PUBLISHED ARTICLES IN RELATION TO OTHER PARTS

• EXAMPLE 1. Background, hypotheses, and aims are provided
• “Pregnant women need skilled care during pregnancy and childbirth, but that skilled care is often delayed in some countries …( text omitted ). The focused antenatal care (FANC) model of WHO recommends that nurses provide information or counseling to all pregnant women …( text omitted ). Job aids are visual support materials that provide the right kind of information using graphics and words in a simple and yet effective manner. When nurses are not highly trained or have many work details to attend to, these job aids can serve as a content reminder for the nurses and can be used for educating their patients (Jennings, Yebadokpo, Affo, & Agbogbe, 2010) ( text omitted ). Importantly, additional evidence is needed to confirm how job aids can further improve the quality of ANC counseling by health workers in maternal care …( text omitted )” 28
• “ This has led us to hypothesize that the quality of ANC counseling would be better if supported by job aids. Consequently, a better quality of ANC counseling is expected to produce higher levels of awareness concerning the danger signs of pregnancy and a more favorable impression of the caring behavior of nurses .” 28
• “This study aimed to examine the differences in the responses of pregnant women to a job aid-supported intervention during ANC visit in terms of 1) their understanding of the danger signs of pregnancy and 2) their impression of the caring behaviors of nurses to pregnant women in rural Tanzania.” 28
• EXAMPLE 2. Background, hypotheses, and aims are provided
• “We conducted a two-arm randomized controlled trial (RCT) to evaluate and compare changes in salivary cortisol and oxytocin levels of first-time pregnant women between experimental and control groups. The women in the experimental group touched and held an infant for 30 min (experimental intervention protocol), whereas those in the control group watched a DVD movie of an infant (control intervention protocol). The primary outcome was salivary cortisol level and the secondary outcome was salivary oxytocin level.” 29
• “ We hypothesize that at 30 min after touching and holding an infant, the salivary cortisol level will significantly decrease and the salivary oxytocin level will increase in the experimental group compared with the control group .” 29
• EXAMPLE 3. Background, aim, and hypothesis are provided
• “In countries where the maternal mortality ratio remains high, antenatal education to increase Birth Preparedness and Complication Readiness (BPCR) is considered one of the top priorities [1]. BPCR includes birth plans during the antenatal period, such as the birthplace, birth attendant, transportation, health facility for complications, expenses, and birth materials, as well as family coordination to achieve such birth plans. In Tanzania, although increasing, only about half of all pregnant women attend an antenatal clinic more than four times [4]. Moreover, the information provided during antenatal care (ANC) is insufficient. In the resource-poor settings, antenatal group education is a potential approach because of the limited time for individual counseling at antenatal clinics.” 30
• “This study aimed to evaluate an antenatal group education program among pregnant women and their families with respect to birth-preparedness and maternal and infant outcomes in rural villages of Tanzania.” 30
• “ The study hypothesis was if Tanzanian pregnant women and their families received a family-oriented antenatal group education, they would (1) have a higher level of BPCR, (2) attend antenatal clinic four or more times, (3) give birth in a health facility, (4) have less complications of women at birth, and (5) have less complications and deaths of infants than those who did not receive the education .” 30

Research questions and hypotheses are crucial components to any type of research, whether quantitative or qualitative. These questions should be developed at the very beginning of the study. Excellent research questions lead to superior hypotheses, which, like a compass, set the direction of research, and can often determine the successful conduct of the study. Many research studies have floundered because the development of research questions and subsequent hypotheses was not given the thought and meticulous attention needed. The development of research questions and hypotheses is an iterative process based on extensive knowledge of the literature and insightful grasp of the knowledge gap. Focused, concise, and specific research questions provide a strong foundation for constructing hypotheses which serve as formal predictions about the research outcomes. Research questions and hypotheses are crucial elements of research that should not be overlooked. They should be carefully thought of and constructed when planning research. This avoids unethical studies and poor outcomes by defining well-founded objectives that determine the design, course, and outcome of the study.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

• Conceptualization: Barroga E, Matanguihan GJ.
• Methodology: Barroga E, Matanguihan GJ.
• Writing - original draft: Barroga E, Matanguihan GJ.
• Writing - review & editing: Barroga E, Matanguihan GJ.

Qualitative vs Quantitative Research Methods & Data Analysis

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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What is the difference between quantitative and qualitative?

The main difference between quantitative and qualitative research is the type of data they collect and analyze.

Quantitative research collects numerical data and analyzes it using statistical methods. The aim is to produce objective, empirical data that can be measured and expressed in numerical terms. Quantitative research is often used to test hypotheses, identify patterns, and make predictions.

Qualitative research , on the other hand, collects non-numerical data such as words, images, and sounds. The focus is on exploring subjective experiences, opinions, and attitudes, often through observation and interviews.

Qualitative research aims to produce rich and detailed descriptions of the phenomenon being studied, and to uncover new insights and meanings.

Quantitative data is information about quantities, and therefore numbers, and qualitative data is descriptive, and regards phenomenon which can be observed but not measured, such as language.

What Is Qualitative Research?

Qualitative research is the process of collecting, analyzing, and interpreting non-numerical data, such as language. Qualitative research can be used to understand how an individual subjectively perceives and gives meaning to their social reality.

Qualitative data is non-numerical data, such as text, video, photographs, or audio recordings. This type of data can be collected using diary accounts or in-depth interviews and analyzed using grounded theory or thematic analysis.

Qualitative research is multimethod in focus, involving an interpretive, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. Denzin and Lincoln (1994, p. 2)

Interest in qualitative data came about as the result of the dissatisfaction of some psychologists (e.g., Carl Rogers) with the scientific study of psychologists such as behaviorists (e.g., Skinner ).

Since psychologists study people, the traditional approach to science is not seen as an appropriate way of carrying out research since it fails to capture the totality of human experience and the essence of being human.  Exploring participants’ experiences is known as a phenomenological approach (re: Humanism ).

Qualitative research is primarily concerned with meaning, subjectivity, and lived experience. The goal is to understand the quality and texture of people’s experiences, how they make sense of them, and the implications for their lives.

Qualitative research aims to understand the social reality of individuals, groups, and cultures as nearly as possible as participants feel or live it. Thus, people and groups are studied in their natural setting.

Some examples of qualitative research questions are provided, such as what an experience feels like, how people talk about something, how they make sense of an experience, and how events unfold for people.

Research following a qualitative approach is exploratory and seeks to explain ‘how’ and ‘why’ a particular phenomenon, or behavior, operates as it does in a particular context. It can be used to generate hypotheses and theories from the data.

Qualitative Methods

There are different types of qualitative research methods, including diary accounts, in-depth interviews , documents, focus groups , case study research , and ethnography.

The results of qualitative methods provide a deep understanding of how people perceive their social realities and in consequence, how they act within the social world.

The researcher has several methods for collecting empirical materials, ranging from the interview to direct observation, to the analysis of artifacts, documents, and cultural records, to the use of visual materials or personal experience. Denzin and Lincoln (1994, p. 14)

Here are some examples of qualitative data:

Interview transcripts : Verbatim records of what participants said during an interview or focus group. They allow researchers to identify common themes and patterns, and draw conclusions based on the data. Interview transcripts can also be useful in providing direct quotes and examples to support research findings.

Observations : The researcher typically takes detailed notes on what they observe, including any contextual information, nonverbal cues, or other relevant details. The resulting observational data can be analyzed to gain insights into social phenomena, such as human behavior, social interactions, and cultural practices.

Unstructured interviews : generate qualitative data through the use of open questions.  This allows the respondent to talk in some depth, choosing their own words.  This helps the researcher develop a real sense of a person’s understanding of a situation.

Diaries or journals : Written accounts of personal experiences or reflections.

Notice that qualitative data could be much more than just words or text. Photographs, videos, sound recordings, and so on, can be considered qualitative data. Visual data can be used to understand behaviors, environments, and social interactions.

Qualitative Data Analysis

Qualitative research is endlessly creative and interpretive. The researcher does not just leave the field with mountains of empirical data and then easily write up his or her findings.

Qualitative interpretations are constructed, and various techniques can be used to make sense of the data, such as content analysis, grounded theory (Glaser & Strauss, 1967), thematic analysis (Braun & Clarke, 2006), or discourse analysis.

For example, thematic analysis is a qualitative approach that involves identifying implicit or explicit ideas within the data. Themes will often emerge once the data has been coded .

Key Features

• Events can be understood adequately only if they are seen in context. Therefore, a qualitative researcher immerses her/himself in the field, in natural surroundings. The contexts of inquiry are not contrived; they are natural. Nothing is predefined or taken for granted.
• Qualitative researchers want those who are studied to speak for themselves, to provide their perspectives in words and other actions. Therefore, qualitative research is an interactive process in which the persons studied teach the researcher about their lives.
• The qualitative researcher is an integral part of the data; without the active participation of the researcher, no data exists.
• The study’s design evolves during the research and can be adjusted or changed as it progresses. For the qualitative researcher, there is no single reality. It is subjective and exists only in reference to the observer.
• The theory is data-driven and emerges as part of the research process, evolving from the data as they are collected.

Limitations of Qualitative Research

• Because of the time and costs involved, qualitative designs do not generally draw samples from large-scale data sets.
• The problem of adequate validity or reliability is a major criticism. Because of the subjective nature of qualitative data and its origin in single contexts, it is difficult to apply conventional standards of reliability and validity. For example, because of the central role played by the researcher in the generation of data, it is not possible to replicate qualitative studies.
• Also, contexts, situations, events, conditions, and interactions cannot be replicated to any extent, nor can generalizations be made to a wider context than the one studied with confidence.
• The time required for data collection, analysis, and interpretation is lengthy. Analysis of qualitative data is difficult, and expert knowledge of an area is necessary to interpret qualitative data. Great care must be taken when doing so, for example, looking for mental illness symptoms.

Advantages of Qualitative Research

• Because of close researcher involvement, the researcher gains an insider’s view of the field. This allows the researcher to find issues that are often missed (such as subtleties and complexities) by the scientific, more positivistic inquiries.
• Qualitative descriptions can be important in suggesting possible relationships, causes, effects, and dynamic processes.
• Qualitative analysis allows for ambiguities/contradictions in the data, which reflect social reality (Denscombe, 2010).
• Qualitative research uses a descriptive, narrative style; this research might be of particular benefit to the practitioner as she or he could turn to qualitative reports to examine forms of knowledge that might otherwise be unavailable, thereby gaining new insight.

What Is Quantitative Research?

Quantitative research involves the process of objectively collecting and analyzing numerical data to describe, predict, or control variables of interest.

The goals of quantitative research are to test causal relationships between variables , make predictions, and generalize results to wider populations.

Quantitative researchers aim to establish general laws of behavior and phenomenon across different settings/contexts. Research is used to test a theory and ultimately support or reject it.

Quantitative Methods

Experiments typically yield quantitative data, as they are concerned with measuring things.  However, other research methods, such as controlled observations and questionnaires , can produce both quantitative information.

For example, a rating scale or closed questions on a questionnaire would generate quantitative data as these produce either numerical data or data that can be put into categories (e.g., “yes,” “no” answers).

Experimental methods limit how research participants react to and express appropriate social behavior.

Findings are, therefore, likely to be context-bound and simply a reflection of the assumptions that the researcher brings to the investigation.

There are numerous examples of quantitative data in psychological research, including mental health. Here are a few examples:

Another example is the Experience in Close Relationships Scale (ECR), a self-report questionnaire widely used to assess adult attachment styles .

The ECR provides quantitative data that can be used to assess attachment styles and predict relationship outcomes.

Neuroimaging data : Neuroimaging techniques, such as MRI and fMRI, provide quantitative data on brain structure and function.

This data can be analyzed to identify brain regions involved in specific mental processes or disorders.

For example, the Beck Depression Inventory (BDI) is a clinician-administered questionnaire widely used to assess the severity of depressive symptoms in individuals.

The BDI consists of 21 questions, each scored on a scale of 0 to 3, with higher scores indicating more severe depressive symptoms. 

Quantitative Data Analysis

Statistics help us turn quantitative data into useful information to help with decision-making. We can use statistics to summarize our data, describing patterns, relationships, and connections. Statistics can be descriptive or inferential.

Descriptive statistics help us to summarize our data. In contrast, inferential statistics are used to identify statistically significant differences between groups of data (such as intervention and control groups in a randomized control study).

• Quantitative researchers try to control extraneous variables by conducting their studies in the lab.
• The research aims for objectivity (i.e., without bias) and is separated from the data.
• The design of the study is determined before it begins.
• For the quantitative researcher, the reality is objective, exists separately from the researcher, and can be seen by anyone.
• Research is used to test a theory and ultimately support or reject it.

Limitations of Quantitative Research

• Context: Quantitative experiments do not take place in natural settings. In addition, they do not allow participants to explain their choices or the meaning of the questions they may have for those participants (Carr, 1994).
• Researcher expertise: Poor knowledge of the application of statistical analysis may negatively affect analysis and subsequent interpretation (Black, 1999).
• Variability of data quantity: Large sample sizes are needed for more accurate analysis. Small-scale quantitative studies may be less reliable because of the low quantity of data (Denscombe, 2010). This also affects the ability to generalize study findings to wider populations.
• Confirmation bias: The researcher might miss observing phenomena because of focus on theory or hypothesis testing rather than on the theory of hypothesis generation.

Advantages of Quantitative Research

• Scientific objectivity: Quantitative data can be interpreted with statistical analysis, and since statistics are based on the principles of mathematics, the quantitative approach is viewed as scientifically objective and rational (Carr, 1994; Denscombe, 2010).
• Useful for testing and validating already constructed theories.
• Rapid analysis: Sophisticated software removes much of the need for prolonged data analysis, especially with large volumes of data involved (Antonius, 2003).
• Replication: Quantitative data is based on measured values and can be checked by others because numerical data is less open to ambiguities of interpretation.
• Hypotheses can also be tested because of statistical analysis (Antonius, 2003).

Antonius, R. (2003). Interpreting quantitative data with SPSS . Sage.

Black, T. R. (1999). Doing quantitative research in the social sciences: An integrated approach to research design, measurement and statistics . Sage.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology . Qualitative Research in Psychology , 3, 77–101.

Carr, L. T. (1994). The strengths and weaknesses of quantitative and qualitative research : what method for nursing? Journal of advanced nursing, 20(4) , 716-721.

Denscombe, M. (2010). The Good Research Guide: for small-scale social research. McGraw Hill.

Denzin, N., & Lincoln. Y. (1994). Handbook of Qualitative Research. Thousand Oaks, CA, US: Sage Publications Inc.

Glaser, B. G., Strauss, A. L., & Strutzel, E. (1968). The discovery of grounded theory; strategies for qualitative research. Nursing research, 17(4) , 364.

Minichiello, V. (1990). In-Depth Interviewing: Researching People. Longman Cheshire.

Punch, K. (1998). Introduction to Social Research: Quantitative and Qualitative Approaches. London: Sage

Further Information

• Designing qualitative research
• Methods of data collection and analysis
• Introduction to quantitative and qualitative research
• Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?
• Qualitative research in health care: Analysing qualitative data
• Qualitative data analysis: the framework approach
• Using the framework method for the analysis of
• Qualitative data in multi-disciplinary health research
• Content Analysis
• Grounded Theory
• Thematic Analysis

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• Qualitative vs Quantitative Survey Questions

Quantitative vs Qualitative survey questions

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Research is developed using quantitative and qualitative research methods to gain a complete understanding of the target audience’s needs, challenges, wants, willingness to take action, and more. However, the right time to use either method (or use both together) can vary depending on your research goals and needs. 

Difference between Quantitative and Qualitative Research

Quantitative research is about collecting information that can be expressed numerically. Researchers often use it to correlate data about specific demographics, such as Gen Z being more likely to focus on their finances than Millennials . Quantitative research is usually conducted through surveys or web analytics, often including large volumes of people to ensure trends are statistically representative . 

Even when the survey audience is very large, quantitative research can be targeted towards a specific audience, usually determined by demographic information such as age, gender, geographic location.

Qualitative research focuses on personalized behavior, such as habits or motivations behind their decisions. This can be gathered through contextual inquiries or interviews to learn more about feelings, attitudes, and habits that are harder to quantify but offer important additional context to support statistical data.

When quantitative and qualitative research are paired, a complete set of data can be gathered about the target audience’s demographics, experience, attitudes, behaviors, wants and needs.

Benefits of Quantitative Survey Questions

Quantitative survey questions are an excellent starting point in market research, allowing a researcher to “take the temperature” of a population to ensure there is a want or need for a product or service before investing in expensive qualitative research.

Reaching bigger, broader audiences

Quantitative survey questions are best for gathering broad insights and developing basic profiles, validating assumptions about an unknown (or little known) audience. 

Mobile survey compatibility

Mobile survey environments are especially effective when closed-ended quantitative survey questions are used, as they allow for the optimal respondent experience . 

Statistical accuracy

Quantitative surveys are ideal when working with a control group or when there is a need for the statistical representation of a population. They can be deployed broadly and results weighted for statistical accuracy after the survey is complete.

Benefits of Qualitative Survey Questions

Qualitative survey questions aim to gather data that is not easily quantified such as attitudes, habits, and challenges. They are often used in an interview-style setting to observe behavioral cues that may help direct the questions.

Gaining context

Qualitative survey questions tend to be open-ended and aim to gather contextual information about particular sets of data, often focused on the “why” or “how” reasoning behind a respondent’s answer. 

Unexpected answers

The open-ended nature of qualitative survey questions opens up the possibility to discover solutions that may not have been presented in a traditional quantitative survey. Allowing respondents to express themselves freely may reveal new paths to explore further.

Examples of Quantitative Survey Questions

Quantitative survey questions are used to gain information about frequency, likelihood, ratings, pricing, and more. They often include Likert scales and other survey question types to engage respondents throughout the questionnaire. 

How many times did you use the pool at our hotel during your stay?

• 4 or more times

How likely are you to recommend this service to a friend?

• Very likely
• Somewhat likely
• Somewhat unlikely
• Very unlikely

Please select your answer to the following statement: “It’s important to contribute to a retirement plan.”

• Strongly agree
• Somewhat agree
• Somewhat disagree
• Strongly disagree

Examples of Qualitative Survey Questions

Qualitative survey questions aim to extract information that is not easily quantifiable such as feelings, behaviors, and motivations for making a choice. By asking open-ended questions, and following up with “why?”, respondents are given the freedom to express what led them to these decisions. A technique called the Five Whys is commonly used to determine cause-and-effect correlation. Some examples of qualitative survey questions are:

How would you improve your experience?

Describe the last time that you purchased an item online.

Why did you choose to take public transportation to the airport?

When you should use Quantitative and Qualitative Survey Questions

Whether or not you should use quantitative or qualitative survey questions depends on your research goals. Most often, both kinds are needed during different phases of a research project to create a complete picture of a market need, user-base, or persona.

When to use quantitative survey questions

• Initial research. Because quantitative research is typically less expensive or time-intensive than qualitative, it’s always best to begin with quantitative surveys. These can help ensure a research project is defined for the right target audience before investing in qualitative insights.
• Statistical data. Statistically accurate data, such as that which can be mapped to the census, can be collected through quantitative survey questions. This is ideal for ensuring an accurate sample in polling and national surveys.
• Broad insights. Quantitative survey questions are ideal for gaining a 10,000-foot view of a market to determine needs, wants, and desire for a product or service based on demographic data that will help shape product development or marketing campaigns.
• Quantifiable behaviors. Behavior such as how often a person visited a website page, how likely they are to purchase an item, or how much they are willing to pay for a product or service are all behavioral insights than can be gathered through quantitative survey questions.
• Mobile survey environments. Data quality can be impacted by the survey distribution method. Because mobile devices are hand-held and mobile audiences are on the go, quantitative survey questions that offer limited answer choices and quick responses tend to yield better data quality than open-ended responses that involve typing and more concentration.

When to use qualitative survey questions

• Gain context about quantifiable data. Research that begins with quantitative data might reveal an unexpected trend that requires further inquiry among a certain group.
• Understand hard-to-quantify behaviors. Thoughts, opinions, beliefs, motivations, challenges, and goals can be uncovered through qualitative research questions.
• Persona development. Personas are tools used by designers, marketers, and other disciplines to create and sell products to people based on specific motivations and interests. While these often include demographic information based on quantitative research, challenges and needs are uncovered through qualitative methods.
• Conversational environments. Focus groups and interviews are ideal places to conduct qualitative research. Disciplines like psychology and user experience research rely heavily on qualitative questions to uncover motivations and reasoning behind certain behaviors.

It is ideal to use a mix of both quantitative and qualitative methods to supplement gaps in data. These methods can be iterative and conducted at different points throughout a research project to follow up and verify different insights gathered from either method. Using both quantitative and qualitative survey questions is the best way to holistically understand audience segments.

Frequently asked questions

Are quantitative survey questions good for market research.

Quantitative survey questions are an excellent starting point in market research, allowing a researcher to determine if there is a want or need for a product or service before investing in expensive qualitative research.

What are quantitative survey questions?

What are qualitative survey questions.

Qualitative survey questions gather data that is not easily quantified such as attitudes, habits, and challenges. They are often used in an interview-style setting to observe behavioral cues that may help direct the questions.

How do qualitative and quantitative questions differ?

Quantitative survey questions are used in initial research, defining a research project for the right target audience. Qualitative questions are often open-ended and help answer "why” and gain context about quantifiable data and understand hard-to-quantify behaviors.

Can quantitative research be used towards a specific audience when the survey audience is large?

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Quantitative vs. Qualitative Research in Psychology

Anabelle Bernard Fournier is a researcher of sexual and reproductive health at the University of Victoria as well as a freelance writer on various health topics.

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

• Key Differences

Quantitative Research Methods

Qualitative research methods.

• How They Relate

In psychology and other social sciences, researchers are faced with an unresolved question: Can we measure concepts like love or racism the same way we can measure temperature or the weight of a star? Social phenomena⁠—things that happen because of and through human behavior⁠—are especially difficult to grasp with typical scientific models.

At a Glance

Psychologists rely on quantitative and quantitative research to better understand human thought and behavior.

• Qualitative research involves collecting and evaluating non-numerical data in order to understand concepts or subjective opinions.
• Quantitative research involves collecting and evaluating numerical data. 

This article discusses what qualitative and quantitative research are, how they are different, and how they are used in psychology research.

Qualitative Research vs. Quantitative Research

In order to understand qualitative and quantitative psychology research, it can be helpful to look at the methods that are used and when each type is most appropriate.

Psychologists rely on a few methods to measure behavior, attitudes, and feelings. These include:

• Self-reports , like surveys or questionnaires
• Observation (often used in experiments or fieldwork)
• Implicit attitude tests that measure timing in responding to prompts

Most of these are quantitative methods. The result is a number that can be used to assess differences between groups.

However, most of these methods are static, inflexible (you can't change a question because a participant doesn't understand it), and provide a "what" answer rather than a "why" answer.

Sometimes, researchers are more interested in the "why" and the "how." That's where qualitative methods come in.

Qualitative research is about speaking to people directly and hearing their words. It is grounded in the philosophy that the social world is ultimately unmeasurable, that no measure is truly ever "objective," and that how humans make meaning is just as important as how much they score on a standardized test.

Used to develop theories

Takes a broad, complex approach

Answers "why" and "how" questions

Explores patterns and themes

Used to test theories

Takes a narrow, specific approach

Answers "what" questions

Explores statistical relationships

Quantitative methods have existed ever since people have been able to count things. But it is only with the positivist philosophy of Auguste Comte (which maintains that factual knowledge obtained by observation is trustworthy) that it became a "scientific method."

The scientific method follows this general process. A researcher must:

• Generate a theory or hypothesis (i.e., predict what might happen in an experiment) and determine the variables needed to answer their question
• Develop instruments to measure the phenomenon (such as a survey, a thermometer, etc.)
• Develop experiments to manipulate the variables
• Collect empirical (measured) data
• Analyze data

Quantitative methods are about measuring phenomena, not explaining them.

Quantitative research compares two groups of people. There are all sorts of variables you could measure, and many kinds of experiments to run using quantitative methods.

These comparisons are generally explained using graphs, pie charts, and other visual representations that give the researcher a sense of how the various data points relate to one another.

Basic Assumptions

Quantitative methods assume:

• That the world is measurable
• That humans can observe objectively
• That we can know things for certain about the world from observation

In some fields, these assumptions hold true. Whether you measure the size of the sun 2000 years ago or now, it will always be the same. But when it comes to human behavior, it is not so simple.

As decades of cultural and social research have shown, people behave differently (and even think differently) based on historical context, cultural context, social context, and even identity-based contexts like gender , social class, or sexual orientation .

Therefore, quantitative methods applied to human behavior (as used in psychology and some areas of sociology) should always be rooted in their particular context. In other words: there are no, or very few, human universals.

Statistical information is the primary form of quantitative data used in human and social quantitative research. Statistics provide lots of information about tendencies across large groups of people, but they can never describe every case or every experience. In other words, there are always outliers.

Correlation and Causation

A basic principle of statistics is that correlation is not causation. Researchers can only claim a cause-and-effect relationship under certain conditions:

• The study was a true experiment.
• The independent variable can be manipulated (for example, researchers cannot manipulate gender, but they can change the primer a study subject sees, such as a picture of nature or of a building).
• The dependent variable can be measured through a ratio or a scale.

So when you read a report that "gender was linked to" something (like a behavior or an attitude), remember that gender is NOT a cause of the behavior or attitude. There is an apparent relationship, but the true cause of the difference is hidden.

Pitfalls of Quantitative Research

Quantitative methods are one way to approach the measurement and understanding of human and social phenomena. But what's missing from this picture?

As noted above, statistics do not tell us about personal, individual experiences and meanings. While surveys can give a general idea, respondents have to choose between only a few responses. This can make it difficult to understand the subtleties of different experiences.

Quantitative methods can be helpful when making objective comparisons between groups or when looking for relationships between variables. They can be analyzed statistically, which can be helpful when looking for patterns and relationships.

Qualitative data are not made out of numbers but rather of descriptions, metaphors, symbols, quotes, analysis, concepts, and characteristics. This approach uses interviews, written texts, art, photos, and other materials to make sense of human experiences and to understand what these experiences mean to people.

While quantitative methods ask "what" and "how much," qualitative methods ask "why" and "how."

Qualitative methods are about describing and analyzing phenomena from a human perspective. There are many different philosophical views on qualitative methods, but in general, they agree that some questions are too complex or impossible to answer with standardized instruments.

These methods also accept that it is impossible to be completely objective in observing phenomena. Researchers have their own thoughts, attitudes, experiences, and beliefs, and these always color how people interpret results.

Qualitative Approaches

There are many different approaches to qualitative research, with their own philosophical bases. Different approaches are best for different kinds of projects. For example:

• Case studies and narrative studies are best for single individuals. These involve studying every aspect of a person's life in great depth.
• Phenomenology aims to explain experiences. This type of work aims to describe and explore different events as they are consciously and subjectively experienced.
• Grounded theory develops models and describes processes. This approach allows researchers to construct a theory based on data that is collected, analyzed, and compared to reach new discoveries.
• Ethnography describes cultural groups. In this approach, researchers immerse themselves in a community or group in order to observe behavior.

Qualitative researchers must be aware of several different methods and know each thoroughly enough to produce valuable research.

Some researchers specialize in a single method, but others specialize in a topic or content area and use many different methods to explore the topic, providing different information and a variety of points of view.

There is not a single model or method that can be used for every qualitative project. Depending on the research question, the people participating, and the kind of information they want to produce, researchers will choose the appropriate approach.

Interpretation

Qualitative research does not look into causal relationships between variables, but rather into themes, values, interpretations, and meanings. As a rule, then, qualitative research is not generalizable (cannot be applied to people outside the research participants).

The insights gained from qualitative research can extend to other groups with proper attention to specific historical and social contexts.

Relationship Between Qualitative and Quantitative Research

It might sound like quantitative and qualitative research do not play well together. They have different philosophies, different data, and different outputs. However, this could not be further from the truth.

These two general methods complement each other. By using both, researchers can gain a fuller, more comprehensive understanding of a phenomenon.

For example, a psychologist wanting to develop a new survey instrument about sexuality might and ask a few dozen people questions about their sexual experiences (this is qualitative research). This gives the researcher some information to begin developing questions for their survey (which is a quantitative method).

After the survey, the same or other researchers might want to dig deeper into issues brought up by its data. Follow-up questions like "how does it feel when...?" or "what does this mean to you?" or "how did you experience this?" can only be answered by qualitative research.

By using both quantitative and qualitative data, researchers have a more holistic, well-rounded understanding of a particular topic or phenomenon.

Qualitative and quantitative methods both play an important role in psychology. Where quantitative methods can help answer questions about what is happening in a group and to what degree, qualitative methods can dig deeper into the reasons behind why it is happening. By using both strategies, psychology researchers can learn more about human thought and behavior.

Gough B, Madill A. Subjectivity in psychological science: From problem to prospect . Psychol Methods . 2012;17(3):374-384. doi:10.1037/a0029313

Pearce T. “Science organized”: Positivism and the metaphysical club, 1865–1875 . J Hist Ideas . 2015;76(3):441-465.

Adams G. Context in person, person in context: A cultural psychology approach to social-personality psychology . In: Deaux K, Snyder M, eds. The Oxford Handbook of Personality and Social Psychology . Oxford University Press; 2012:182-208.

Brady HE. Causation and explanation in social science . In: Goodin RE, ed. The Oxford Handbook of Political Science. Oxford University Press; 2011. doi:10.1093/oxfordhb/9780199604456.013.0049

Chun Tie Y, Birks M, Francis K. Grounded theory research: A design framework for novice researchers .  SAGE Open Med . 2019;7:2050312118822927. doi:10.1177/2050312118822927

Reeves S, Peller J, Goldman J, Kitto S. Ethnography in qualitative educational research: AMEE Guide No. 80 . Medical Teacher . 2013;35(8):e1365-e1379. doi:10.3109/0142159X.2013.804977

Salkind NJ, ed. Encyclopedia of Research Design . Sage Publishing.

Shaughnessy JJ, Zechmeister EB, Zechmeister JS.  Research Methods in Psychology . McGraw Hill Education.

By Anabelle Bernard Fournier Anabelle Bernard Fournier is a researcher of sexual and reproductive health at the University of Victoria as well as a freelance writer on various health topics.

Reference management. Clean and simple.

Qualitative vs. quantitative research - what’s the difference?

What is quantitative research?

What is quantitative research used for, how to collect data for quantitative research, what is qualitative research, what is qualitative research used for, how to collect data for qualitative research, when to use which approach, how to analyze qualitative and quantitative research, analyzing quantitative data, analyzing qualitative data, differences between qualitative and quantitative research, frequently asked questions about qualitative vs. quantitative research, related articles.

Both qualitative and quantitative research are valid and effective approaches to study a particular subject. However, it is important to know that these research approaches serve different purposes and provide different results. This guide will help illustrate quantitative and qualitative research, what they are used for, and the difference between them.

Quantitative research focuses on collecting numerical data and using it to measure variables. As such, quantitative research and data are typically expressed in numbers and graphs. Moreover, this type of research is structured and statistical and the returned results are objective.

The simplest way to describe quantitative research is that it answers the questions " what " or " how much ".

To illustrate what quantitative research is used for, let’s look at a simple example. Let’s assume you want to research the reading habits of a specific part of a population.

With this research, you would like to establish what they read. In other words, do they read fiction, non-fiction, magazines, blogs, and so on? Also, you want to establish what they read about. For example, if they read fiction, is it thrillers, romance novels, or period dramas?

With quantitative research, you can gather concrete data about these reading habits. Your research will then, for example, show that 40% of the audience reads fiction and, of that 40%, 60% prefer romance novels.

In other studies and research projects, quantitative research will work in much the same way. That is, you use it to quantify variables, opinions, behaviors, and more.

Now that we've seen what quantitative research is and what it's used for, let's look at how you'll collect data for it. Because quantitative research is structured and statistical, its data collection methods focus on collecting numerical data.

Some methods to collect this data include:

• Surveys . Surveys are one of the most popular and easiest ways to collect quantitative data. These can include anything from online surveys to paper surveys. It’s important to remember that, to collect quantitative data, you won’t be able to ask open-ended questions.
• Interviews . As is the case with qualitative data, you’ll be able to use interviews to collect quantitative data with the proviso that the data will not be based on open-ended questions.
• Observations . You’ll also be able to use observations to collect quantitative data. However, here you’ll need to make observations in an environment where variables can’t be controlled.
• Website interceptors . With website interceptors, you’ll be able to get real-time insights into a specific product, service, or subject. In most cases, these interceptors take the form of surveys displayed on websites or invitations on the website to complete the survey.
• Longitudinal studies . With these studies, you’ll gather data on the same variables over specified time periods. Longitudinal studies are often used in medical sciences and include, for instance, diet studies. It’s important to remember that, for the results to be reliable, you’ll have to collect data from the same subjects.
• Online polls . Similar to website interceptors, online polls allow you to gather data from websites or social media platforms. These polls are short with only a few options and can give you valuable insights into a very specific question or topic.
• Experiments . With experiments, you’ll manipulate some variables (your independent variables) and gather data on causal relationships between others (your dependent variables). You’ll then measure what effect the manipulation of the independent variables has on the dependent variables.

Qualitative research focuses on collecting and analyzing non-numerical data. As such, it's typically unstructured and non-statistical. The main aim of qualitative research is to get a better understanding and insights into concepts, topics, and subjects.

The easiest way to describe qualitative research is that it answers the question " why ".

Considering that qualitative research aims to provide more profound insights and understanding into specific subjects, we’ll use our example mentioned earlier to explain what qualitative research is used for.

Based on this example, you’ve now established that 40% of the population reads fiction. You’ve probably also discovered in what proportion the population consumes other reading materials.

Qualitative research will now enable you to learn the reasons for these reading habits. For example, it will show you why 40% of the readers prefer fiction, while, for instance, only 10% prefer thrillers. It thus gives you an understanding of your participants’ behaviors and actions.

We've now recapped what qualitative research is and what it's used for. Let's now consider some methods to collect data for this type of research.

Some of these data collection methods include:

• Interviews . These include one-on-one interviews with respondents where you ask open-ended questions. You’ll then record the answers from every respondent and analyze these answers later.
• Open-ended survey questions . Open-ended survey questions give you insights into why respondents feel the way they do about a particular aspect.
• Focus groups . Focus groups allow you to have conversations with small groups of people and record their opinions and views about a specific topic.
• Observations . Observations like ethnography require that you participate in a specific organization or group in order to record their routines and interactions. This will, for instance, be the case where you want to establish how customers use a product in real-life scenarios.
• Literature reviews . With literature reviews, you’ll analyze the published works of other authors to analyze the prevailing view regarding a specific subject.
• Diary studies . Diary studies allow you to collect data about peoples’ habits, activities, and experiences over time. This will, for example, show you how customers use a product, when they use it, and what motivates them.

Now, the immediate question is: When should you use qualitative research, and when should you use quantitative research? As mentioned earlier, in its simplest form:

• Quantitative research allows you to confirm or test a hypothesis or theory or quantify a specific problem or quality.
• Qualitative research allows you to understand concepts or experiences.

Let's look at how you'll use these approaches in a research project a bit closer:

• Formulating a hypothesis . As mentioned earlier, qualitative research gives you a deeper understanding of a topic. Apart from learning more profound insights about your research findings, you can also use it to formulate a hypothesis when you start your research.
• Confirming a hypothesis . Once you’ve formulated a hypothesis, you can test it with quantitative research. As mentioned, you can also use it to quantify trends and behavior.
• Finding general answers . Quantitative research can help you answer broad questions. This is because it uses a larger sample size and thus makes it easier to gather simple binary or numeric data on a specific subject.
• Getting a deeper understanding . Once you have the broad answers mentioned above, qualitative research will help you find reasons for these answers. In other words, quantitative research shows you the motives behind actions or behaviors.

Considering the above, why not consider a mixed approach ? You certainly can because these approaches are not mutually exclusive. In other words, using one does not necessarily exclude the other. Moreover, both these approaches are useful for different reasons.

This means you could use both approaches in one project to achieve different goals. For example, you could use qualitative to formulate a hypothesis. Once formulated, quantitative research will allow you to confirm the hypothesis.

So, to answer the initial question, the approach you use is up to you.  However, when deciding on the right approach, you should consider the specific research project, the data you'll gather, and what you want to achieve.

No matter what approach you choose, you should design your research in such a way that it delivers results that are objective, reliable, and valid.

Both these research approaches are based on data. Once you have this data, however, you need to analyze it to answer your research questions. The method to do this depends on the research approach you use.

To analyze quantitative data, you'll need to use mathematical or statistical analysis. This can involve anything from calculating simple averages to applying complex and advanced methods to calculate the statistical significance of the results. No matter what analysis methods you use, it will enable you to spot trends and patterns in your data.

Considering the above, you can use tools, applications, and programming languages like R to calculate:

• The average of a set of numbers . This could, for instance, be the case where you calculate the average scores students obtained in a test or the average time people spend on a website.
• The frequency of a specific response . This will be the case where you, for example, use open-ended survey questions during qualitative analysis. You could then calculate the frequency of a specific response for deeper insights.
• Any correlation between different variables . Through mathematical analysis, you can calculate whether two or more variables are directly or indirectly correlated. In turn, this could help you identify trends in the data.
• The statistical significance of your results . By analyzing the data and calculating the statistical significance of the results, you'll be able to see whether certain occurrences happen randomly or because of specific factors.

Analyzing qualitative data is more complex than quantitative data. This is simply because it's not based on numerical values but rather text, images, video, and the like. As such, you won't be able to use mathematical analysis to analyze and interpret your results.

Because of this, it relies on a more interpretive analysis style and a strict analytical framework to analyze data and extract insights from it.

Some of the most common ways to analyze qualitative data include:

• Qualitative content analysis . In a content analysis, you'll analyze the language used in a specific piece of text. This allows you to understand the intentions of the author, who the audience is, and find patterns and correlations in how different concepts are communicated. A major benefit of this approach is that it follows a systematic and transparent process that other researchers will be able to replicate. As such, your research will produce highly reliable results. Keep in mind, however, that content analysis can be time-intensive and difficult to automate. ➡️  Learn how to do a content analysis in the guide.
• Thematic analysis . In a thematic analysis, you'll analyze data with a view of extracting themes, topics, and patterns in the data. Although thematic analysis can encompass a range of diverse approaches, it's usually used to analyze a collection of texts like survey responses, focus group discussions, or transcriptions of interviews. One of the main benefits of thematic analysis is that it's flexible in its approach. However, in some cases, thematic analysis can be highly subjective, which, in turn, impacts the reliability of the results. ➡️  Learn how to do a thematic analysis in this guide.
• Discourse analysis . In a discourse analysis, you'll analyze written or spoken language to understand how language is used in real-life social situations. As such, you'll be able to determine how meaning is given to language in different contexts. This is an especially effective approach if you want to gain a deeper understanding of different social groups and how they communicate with each other. As such, it's commonly used in humanities and social science disciplines.

We’ve now given a broad overview of both qualitative and quantitative research. Based on this, we can summarize the differences between these two approaches as follows:

Qualitative research focuses on collecting and analyzing non-numerical data. As such, it's typically unstructured and non-statistical. The main aim of qualitative research is to get a better understanding and insights into concepts, topics, and subjects. Quantitative research focuses on collecting numerical data and using it to measure variables. As such, quantitative research and data are typically expressed in numbers and graphs. Moreover, this type of research is structured and statistical and the returned results are objective.

3 examples of qualitative research would be:

• Interviews . These include one-on-one interviews with respondents with open-ended questions. You’ll then record the answers and analyze them later.
• Observations . Observations require that you participate in a specific organization or group in order to record their routines and interactions.

3 examples of quantitative research include:

• Surveys . Surveys are one of the most popular and easiest ways to collect quantitative data. To collect quantitative data, you won’t be able to ask open-ended questions.
• Longitudinal studies . With these studies, you’ll gather data on the same variables over specified time periods. Longitudinal studies are often used in medical sciences.

The main purpose of qualitative research is to get a better understanding and insights into concepts, topics, and subjects. The easiest way to describe qualitative research is that it answers the question " why ".

The purpose of quantitative research is to collect numerical data and use it to measure variables. As such, quantitative research and data are typically expressed in numbers and graphs. The simplest way to describe quantitative research is that it answers the questions " what " or " how much ".

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• Qualitative vs Quantitative Research | Examples & Methods

Qualitative vs Quantitative Research | Examples & Methods

Published on 4 April 2022 by Raimo Streefkerk . Revised on 8 May 2023.

When collecting and analysing data, quantitative research deals with numbers and statistics, while qualitative research  deals with words and meanings. Both are important for gaining different kinds of knowledge.

Common quantitative methods include experiments, observations recorded as numbers, and surveys with closed-ended questions. Qualitative research Qualitative research is expressed in words . It is used to understand concepts, thoughts or experiences. This type of research enables you to gather in-depth insights on topics that are not well understood.

Table of contents

The differences between quantitative and qualitative research, data collection methods, when to use qualitative vs quantitative research, how to analyse qualitative and quantitative data, frequently asked questions about qualitative and quantitative research.

Quantitative and qualitative research use different research methods to collect and analyse data, and they allow you to answer different kinds of research questions.

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Quantitative and qualitative data can be collected using various methods. It is important to use a data collection method that will help answer your research question(s).

Many data collection methods can be either qualitative or quantitative. For example, in surveys, observations or case studies , your data can be represented as numbers (e.g. using rating scales or counting frequencies) or as words (e.g. with open-ended questions or descriptions of what you observe).

However, some methods are more commonly used in one type or the other.

Quantitative data collection methods

• Surveys :  List of closed or multiple choice questions that is distributed to a sample (online, in person, or over the phone).
• Experiments : Situation in which variables are controlled and manipulated to establish cause-and-effect relationships.
• Observations: Observing subjects in a natural environment where variables can’t be controlled.

Qualitative data collection methods

• Interviews : Asking open-ended questions verbally to respondents.
• Focus groups: Discussion among a group of people about a topic to gather opinions that can be used for further research.
• Ethnography : Participating in a community or organisation for an extended period of time to closely observe culture and behavior.
• Literature review : Survey of published works by other authors.

A rule of thumb for deciding whether to use qualitative or quantitative data is:

• Use quantitative research if you want to confirm or test something (a theory or hypothesis)
• Use qualitative research if you want to understand something (concepts, thoughts, experiences)

For most research topics you can choose a qualitative, quantitative or mixed methods approach . Which type you choose depends on, among other things, whether you’re taking an inductive vs deductive research approach ; your research question(s) ; whether you’re doing experimental , correlational , or descriptive research ; and practical considerations such as time, money, availability of data, and access to respondents.

Quantitative research approach

You survey 300 students at your university and ask them questions such as: ‘on a scale from 1-5, how satisfied are your with your professors?’

You can perform statistical analysis on the data and draw conclusions such as: ‘on average students rated their professors 4.4’.

Qualitative research approach

You conduct in-depth interviews with 15 students and ask them open-ended questions such as: ‘How satisfied are you with your studies?’, ‘What is the most positive aspect of your study program?’ and ‘What can be done to improve the study program?’

Based on the answers you get you can ask follow-up questions to clarify things. You transcribe all interviews using transcription software and try to find commonalities and patterns.

Mixed methods approach

You conduct interviews to find out how satisfied students are with their studies. Through open-ended questions you learn things you never thought about before and gain new insights. Later, you use a survey to test these insights on a larger scale.

It’s also possible to start with a survey to find out the overall trends, followed by interviews to better understand the reasons behind the trends.

Qualitative or quantitative data by itself can’t prove or demonstrate anything, but has to be analysed to show its meaning in relation to the research questions. The method of analysis differs for each type of data.

Analysing quantitative data

Quantitative data is based on numbers. Simple maths or more advanced statistical analysis is used to discover commonalities or patterns in the data. The results are often reported in graphs and tables.

Applications such as Excel, SPSS, or R can be used to calculate things like:

• Average scores
• The number of times a particular answer was given
• The correlation or causation between two or more variables
• The reliability and validity of the results

Analysing qualitative data

Qualitative data is more difficult to analyse than quantitative data. It consists of text, images or videos instead of numbers.

Some common approaches to analysing qualitative data include:

• Qualitative content analysis : Tracking the occurrence, position and meaning of words or phrases
• Thematic analysis : Closely examining the data to identify the main themes and patterns
• Discourse analysis : Studying how communication works in social contexts

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

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

In mixed methods research , you use both qualitative and quantitative data collection and analysis methods to answer your research question .

The research methods you use depend on the type of data you need to answer your research question .

• If you want to measure something or test a hypothesis , use quantitative methods . If you want to explore ideas, thoughts, and meanings, use qualitative methods .
• If you want to analyse a large amount of readily available data, use secondary data. If you want data specific to your purposes with control over how they are generated, collect primary data.
• If you want to establish cause-and-effect relationships between variables , use experimental methods. If you want to understand the characteristics of a research subject, use descriptive methods.

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 organisations.

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

• Prepare and organise 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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Qualitative vs quantitative research.

13 min read You’ll use both quantitative and qualitative research methods to gather data in your research projects. So what do qualitative and quantitative mean exactly, and how can you best use them to gain the most accurate insights?

What is qualitative research?

Qualitative research is all about language, expression, body language and other forms of human communication. That covers words, meanings and understanding. Qualitative research is used to describe WHY. Why do people feel the way they do, why do they act in a certain way, what opinions do they have and what motivates them?

Qualitative data is used to understand phenomena – things that happen, situations that exist, and most importantly the meanings associated with them. It can help add a ‘why’ element to factual, objective data.

Qualitative research gives breadth, depth and context to questions, although its linguistic subtleties and subjectivity can mean that results are trickier to analyze than quantitative data.

This qualitative data is called unstructured data by researchers. This is because it has not traditionally had the type of structure that can be processed by computers, until today. It has, until recently at least, been exclusively accessible to human brains. And although our brains are highly sophisticated, they have limited processing power. What can help analyze this structured data to assist computers and the human brain?

Free eBook: Quantitative and qualitative research design

What is quantitative research?

Quantitative data refers to numerical information. Quantitative research gathers information that can be counted, measured, or rated numerically – AKA quantitative data. Scores, measurements, financial records, temperature charts and receipts or ledgers are all examples of quantitative data.

Quantitative data is often structured data, because it follows a consistent, predictable pattern that computers and calculating devices are able to process with ease. Humans can process it too, although we are now able to pass it over to machines to process on our behalf. This is partly what has made quantitative data so important historically, and why quantitative data – sometimes called ‘hard data’ – has dominated over qualitative data in fields like business, finance and economics.

It’s easy to ‘crunch the numbers’ of quantitative data and produce results visually in graphs, tables and on data analysis dashboards. Thanks to today’s abundance and accessibility of processing power, combined with our ability to store huge amounts of information, quantitative data has fuelled the Big Data phenomenon, putting quantitative methods and vast amounts of quantitative data at our fingertips.

As we’ve indicated, quantitative and qualitative data are entirely different and mutually exclusive categories. Here are a few of the differences between them.

1. Data collection

Data collection methods for quantitative data and qualitative data vary, but there are also some places where they overlap.

2. Data analysis

Quantitative data suits statistical analysis techniques like linear regression, T-tests and ANOVA. These are quite easy to automate, and large quantities of quantitative data can be analyzed quickly.

Analyzing qualitative data needs a higher degree of human judgement, since unlike quantitative data, non numerical data of a subjective nature has certain characteristics that inferential statistics can’t perceive. Working at a human scale has historically meant that qualitative data is lower in volume – although it can be richer in insights.

3. Strengths and weaknesses

When weighing up qualitative vs quantitative research, it’s largely a matter of choosing the method appropriate to your research goals. If you’re in the position of having to choose one method over another, it’s worth knowing the strengths and limitations of each, so that you know what to expect from your results.

Qualitative vs quantitative – the role of research questions

How do you know whether you need qualitative or quantitative research techniques? By finding out what kind of data you’re going to be collecting.

You’ll do this as you develop your research question, one of the first steps to any research program. It’s a single sentence that sums up the purpose of your research, who you’re going to gather data from, and what results you’re looking for.

As you formulate your question, you’ll get a sense of the sort of answer you’re working towards, and whether it will be expressed in numerical data or qualitative data.

For example, your research question might be “How often does a poor customer experience cause shoppers to abandon their shopping carts?” – this is a quantitative topic, as you’re looking for numerical values.

Or it might be “What is the emotional impact of a poor customer experience on regular customers in our supermarket?” This is a qualitative topic, concerned with thoughts and feelings and answered in personal, subjective ways that vary between respondents.

Here’s how to evaluate your research question and decide which method to use:

• Qualitative research:

Use this if your goal is to understand something – experiences, problems, ideas.

For example, you may want to understand how poor experiences in a supermarket make your customers feel. You might carry out this research through focus groups or in depth interviews (IDI’s). For a larger scale research method you could start  by surveying supermarket loyalty card holders, asking open text questions, like “How would you describe your experience today?” or “What could be improved about your experience?” This research will provide context and understanding that quantitative research will not.

• Quantitative research:

Use this if your goal is to test or confirm a hypothesis, or to study cause and effect relationships. For example, you want to find out what percentage of your returning customers are happy with the customer experience at your store. You can collect data to answer this via a survey.

For example, you could recruit 1,000 loyalty card holders as participants, asking them, “On a scale of 1-5, how happy are you with our store?” You can then make simple mathematical calculations to find the average score. The larger sample size will help make sure your results aren’t skewed by anomalous data or outliers, so you can draw conclusions with confidence.

Qualitative and quantitative research combined?

Do you always have to choose between qualitative or quantitative data?

In some cases you can get the best of both worlds by combining both quantitative and qualitative data.You could use pre quantitative data to understand the landscape of your research. Here you can gain insights around a topic and propose a hypothesis. Then adopt a quantitative research method to test it out. Here you’ll discover where to focus your survey appropriately or to pre-test your survey, to ensure your questions are understood as you intended. Finally, using a round of qualitative research methods to bring your insights and story to life. This mixed methods approach is becoming increasingly popular with businesses who are looking for in depth insights.

For example, in the supermarket scenario we’ve described, you could start out with a qualitative data collection phase where you use focus groups and conduct interviews with customers. You might find suggestions in your qualitative data that customers would like to be able to buy children’s clothes in the store.

In response, the supermarket might pilot a children’s clothing range. Targeted quantitative research could then reveal whether or not those stores selling children’s clothes achieve higher customer satisfaction scores and a rise in profits for clothing.

Together, qualitative and quantitative data, combined with statistical analysis, have provided important insights about customer experience, and have proven the effectiveness of a solution to business problems.

Qualitative vs quantitative question types

As we’ve noted, surveys are one of the data collection methods suitable for both quantitative and qualitative research. Depending on the types of questions you choose to include, you can generate qualitative and quantitative data. Here we have summarized some of the survey question types you can use for each purpose.

Qualitative data survey questions

There are fewer survey question options for collecting qualitative data, since they all essentially do the same thing – provide the respondent with space to enter information in their own words. Qualitative research is not typically done with surveys alone, and researchers may use a mix of qualitative methods. As well as a survey, they might conduct in depth interviews, use observational studies or hold focus groups.

Open text ‘Other’ box (can be used with multiple choice questions)

Text box (space for short written answer)

Essay box (space for longer, more detailed written answers)

Quantitative data survey questions

These questions will yield quantitative data – i.e. a numerical value.

Net Promoter Score (NPS)

Likert Scale

Radio buttons (respondents choose just one option)

Check boxes (respondents can choose multiple options)

Sliding scale

Star rating

Analyzing data (quantitative or qualitative) using technology

We are currently at an exciting point in the history of qualitative analysis. Digital analysis and other methods that were formerly exclusively used for quantitative data are now used for interpreting non numerical data too.

A rtificial intelligence programs can now be used to analyze open text, and turn qualitative data into structured and semi structured quantitative data that relates to qualitative data topics such as emotion and sentiment, opinion and experience.

Research that in the past would have meant qualitative researchers conducting time-intensive studies using analysis methods like thematic analysis can now be done in a very short space of time. This not only saves time and money, but opens up qualitative data analysis to a much wider range of businesses and organizations.

The most advanced tools can even be used for real-time statistical analysis, forecasting and prediction, making them a powerful asset for businesses.

Qualitative or quantitative – which is better for data analysis?

Historically, quantitative data was much easier to analyze than qualitative data. But as we’ve seen, modern technology is helping qualitative analysis to catch up, making it quicker and less labor-intensive than before.

That means the choice between qualitative and quantitative studies no longer needs to factor in ease of analysis, provided you have the right tools at your disposal. With an integrated platform like Qualtrics, which incorporates data collection, data cleaning, data coding and a powerful suite of analysis tools for both qualitative and quantitative data, you have a wide range of options at your fingertips.

Related resources

Qualitative research questions 11 min read, qualitative research design 12 min read, primary vs secondary research 14 min read, business research methods 12 min read, qualitative research interviews 11 min read, market intelligence 10 min read, marketing insights 11 min read, request demo.

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When are surveys qualitative or quantitative research: Learn the difference!

• December 9, 2019

Are surveys qualitative or quantitative methods of data collection?

What is a qualitative survey, what types of survey questions are analyzed qualitatively, benefits of using a qualitative survey, types of a survey questionnaire in qualitative research, what is a quantitative survey, benefits of using a quantitative survey, an example of a survey with quantitative data, qualitative versus quantitative survey question examples, when to use qualitative versus quantitative research.

If you are new to the world of creating surveys, you might have a few questions about what a survey is and the different types. At SurveyPlanet, we give you the tools you need to create any survey. We also want to help you understand how to create better surveys that serve your distinct purposes.

Interested in finding out when a survey is a part of qualitative versus quantitative research?

What is a survey and how to know if it is qualitative or quantitative?

A survey is a method of gathering information from a select sample of people. Responses can be used to gain insights and data that enable drawing conclusions about a subject. The sample size of a survey represents a larger population and there are two different types of research: qualitative and quantitative. The type of research determines which kind of questions to ask.

A survey can be qualitative or quantitative. If you create a questionnaire with answer options using a scale then it is quantitative. If you have questions that require detailed responses then it is qualitative. Mixed-method surveys involve both.

A qualitative survey collects data in order to describe a topic. In other words, the survey is more interested in learning about opinions, views, and impressions than numerical data. Qualitative surveys are less structured and offer insights into the way people think, their motivations, and attitudes toward a topic. Such surveys are more difficult to analyze but can supply much-needed depth to research. Qualitative surveys give answers to “why” and “how.”

Many of the most powerful surveys are qualitative. They collect data that enables an understanding of people’s attitudes, motivations, and experiences. Qualitative surveys provide a deeper level of insight into consumer behavior and preferences than quantitative surveys.

Qualitative research survey questions examples

Qualitative questions are a useful research method when the goal is describing certain phenomena rather than getting an exact answer. Therefore, instead of sitting down one-on-one with participants, survey questions have a short-answer box that respondents can use to express themselves. Qualitative research questions are open-ended and are useful for market research and other data collection purposes.

Read our “ How to Analyze Survey Data: Learn What to Do With Survey Responses? “ to optimize data collection and analysis.

For the most part, qualitative surveys are completely exploratory. Their main purpose is to understand the way a targeted group thinks—its opinions and attitudes about a particular topic. During the analysis phase, every word written by respondents can be analyzed to form a hypothesis.

Although this type of survey is great for learning more about personal opinions, it’s best suited for a small sample size. Conclusions aren’t necessarily representative of the targeted group, and instead only a small portion of it.

Despite small sample sizes, qualitative surveys are essential for identifying weak points in business operations. Once identified, create related questions to include in a quantitative survey, which often are not carried out without doing qualitative research beforehand.

Examples of qualitative research surveys

There are many different ways to use qualitative research, with qualitative questions often used in interviews that collect data from one person about one topic. If the plan is to send a qualitative research survey to employees about job satisfaction or company culture, interviewing a few employees first is a good start. This way, you have an idea of what topics to bring up as well as possible follow-up questions. Think of qualitative surveys as a way to gain insight that will help in the creation of a comprehensive quantitative survey down the line.

Another example of qualitative research is a case study, which is like interviews in that they collect data from one source and are primarily focused on opinions. If you want to use a case study as a marketing tool to attract more customers, conduct a one-on-one interview and ask participants a series of questions about your business that can be showcased on your website.

Expert opinions are another example of qualitative research in which an expert weighs in on a topic. Again, this is a way to gather insights from a single source about a specific topic.

Yet another example of qualitative research is focus groups, where A small sample size is asked for opinions on a certain subject. Focus groups allow the reactions of individuals to be gauged in a free-flowing setting. This is a great way to test a new product or marketing strategy.

You can also collect the same type of information by conducting a qualitative survey.

A quantitative survey collects facts and numbers from respondents. It’s most commonly used to prove or disprove a hypothesis after completing qualitative research. The analysis phase looks at the statistical data to draw conclusions, such as proving or disproving a specific hypothesis. Choosing the right type of survey to distribute depends on the ultimate goal of the research.

There are several benefits to using quantitative surveys to collect data. For one, they allow the testing and substantiation of conclusions previously developed. The analysis phase is usually straightforward since it involves looking at numbers. Short, written answers do not need to be analyzed. There are no opinions or detailed answers involved.

On the flip side, quantitative surveys aren’t always ideal because a large sample size is required to come to a credible conclusion. For example, a survey sent to 100 people to sample the operations of a business with millions of customers is not credible. It’s safe to say that the answers of 100 participants won’t represent the entire customer base. Read about analyzing survey data correctly here .

Quantitative research can be conducted by carrying out one of two types of surveys. The first is a cross-sectional survey, which gives multiple variables to analyze during a particular time period. It’s most common in the health care, retail, and small to medium-sized enterprise (SME) industries.

The other type is a longitudinal survey. This type of survey is commonly conducted over a certain amount of time, anywhere from days to years. The purpose is to observe changes in behavior or thought processes over time. For example, the buying habits of a teenager can be tracked through their adult years. This type of survey is ideal for long-term feedback on services or products, or when a certain sequence of events is important.

To sum up and better illustrate the theme, we prepared a table with quantitative and qualitative survey question examples that will aid in the writing of an excellent survey.

So, when do you use a qualitative survey as opposed to a quantitative survey? Use qualitative research when the main objective is to understand respondents’ motivations and opinions or gather insights with which to create a hypothesis. Use quantitative research to measure findings from qualitative research. The data gathered from quantitative research will usually allow for a conclusion to be drawn, while qualitative research only allows for the development of a hypothesis.

If you’re ready to test out either qualitative or quantitative research, it’s time to create a survey and get started. SurveyPlanet has many different themes and pre-made surveys to help. Sign up for a free account today! If you want to gather more insights and further expand your research, our Pro plan gives access to even more features (such as question branching).

Photo by John Schnobrich on Unsplash

Questionnaires

Questionnaires can be classified as both, quantitative and qualitative method depending on the nature of questions. Specifically, answers obtained through closed-ended questions (also called restricted questions) with multiple choice answer options are analyzed using quantitative methods. Research findings in this case can be illustrated using tabulations, pie-charts, bar-charts and percentages.

Answers obtained to open-ended questionnaire questions (also known as unrestricted questions), on the other hand, are analyzed using qualitative methods. Primary data collected using open-ended questionnaires involve discussions and critical analyses without use of numbers and calculations.

There are following types of questionnaires:

Computer questionnaire . Respondents are asked to answer the questionnaire which is sent by mail. The advantages of the computer questionnaires include their inexpensive price, time-efficiency, and respondents do not feel pressured, therefore can answer when they have time, giving more accurate answers. However, the main shortcoming of the mail questionnaires is that sometimes respondents do not bother answering them and they can just ignore the questionnaire.

Telephone questionnaire .  Researcher may choose to call potential respondents with the aim of getting them to answer the questionnaire. The advantage of the telephone questionnaire is that, it can be completed during the short amount of time. The main disadvantage of the phone questionnaire is that it is expensive most of the time. Moreover, most people do not feel comfortable to answer many questions asked through the phone and it is difficult to get sample group to answer questionnaire over the phone.

In-house survey .  This type of questionnaire involves the researcher visiting respondents in their houses or workplaces. The advantage of in-house survey is that more focus towards the questions can be gained from respondents. However, in-house surveys also have a range of disadvantages which include being time consuming, more expensive and respondents may not wish to have the researcher in their houses or workplaces for various reasons.

Mail Questionnaire . This sort of questionnaires involve the researcher to send the questionnaire list to respondents through post, often attaching pre-paid envelope. Mail questionnaires have an advantage of providing more accurate answer, because respondents can answer the questionnaire in their spare time. The disadvantages associated with mail questionnaires include them being expensive, time consuming and sometimes they end up in the bin put by respondents.

Questionnaires can include the following types of questions:

Open question questionnaires . Open questions differ from other types of questions used in questionnaires in a way that open questions may produce unexpected results, which can make the research more original and valuable. However, it is difficult to analyze the results of the findings when the data is obtained through the questionnaire with open questions.

Multiple choice question s. Respondents are offered a set of answers they have to choose from. The downsize of questionnaire with multiple choice questions is that, if there are too many answers to choose from, it makes the questionnaire, confusing and boring, and discourages the respondent to answer the questionnaire.

Dichotomous Questions .  Thes type of questions gives two options to respondents – yes or no, to choose from. It is the easiest form of questionnaire for the respondent in terms of responding it.

Scaling Questions . Also referred to as ranking questions, they present an option for respondents to rank the available answers to questions on the scale of given range of values (for example from 1 to 10).

For a standard 15,000-20,000 word business dissertation including 25-40 questions in questionnaires will usually suffice. Questions need be formulated in an unambiguous and straightforward manner and they should be presented in a logical order.

Questionnaires as primary data collection method offer the following advantages:

• Uniformity: all respondents are asked exactly the same questions
• Cost-effectiveness
• Possibility to collect the primary data in shorter period of time
• Minimum or no bias from the researcher during the data collection process
• Usually enough time for respondents to think before answering questions, as opposed to interviews
• Possibility to reach respondents in distant areas through online questionnaire

At the same time, the use of questionnaires as primary data collection method is associated with the following shortcomings:

• Random answer choices by respondents without properly reading the question.
• In closed-ended questionnaires no possibility for respondents to express their additional thoughts about the matter due to the absence of a relevant question.
• Collecting incomplete or inaccurate information because respondents may not be able to understand questions correctly.
• High rate of non-response

Survey Monkey represents one of the most popular online platforms for facilitating data collection through questionnaires. Substantial benefits offered by Survey Monkey include its ease to use, presentation of questions in many different formats and advanced data analysis capabilities.

Survey Monkey as a popular platform for primary data collection

There are other alternatives to Survey Monkey you might want to consider to use as a platform for your survey. These include but not limited to Jotform, Google Forms, Lime Survey, Crowd Signal, Survey Gizmo, Zoho Survey and many others.

My  e-book,  The Ultimate Guide to Writing a Dissertation in Business Studies: a step by step approach  contains a detailed, yet simple explanation of quantitative methods. The e-book explains all stages of the research process starting from the selection of the research area to writing personal reflection. Important elements of dissertations such as research philosophy, research approach, research design, methods of data collection and data analysis are explained in simple words.

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Questionnaire – Definition, Types, and Examples

Table of Contents

Questionnaire

Definition:

A Questionnaire is a research tool or survey instrument that consists of a set of questions or prompts designed to gather information from individuals or groups of people.

It is a standardized way of collecting data from a large number of people by asking them a series of questions related to a specific topic or research objective. The questions may be open-ended or closed-ended, and the responses can be quantitative or qualitative. Questionnaires are widely used in research, marketing, social sciences, healthcare, and many other fields to collect data and insights from a target population.

History of Questionnaire

The history of questionnaires can be traced back to the ancient Greeks, who used questionnaires as a means of assessing public opinion. However, the modern history of questionnaires began in the late 19th century with the rise of social surveys.

The first social survey was conducted in the United States in 1874 by Francis A. Walker, who used a questionnaire to collect data on labor conditions. In the early 20th century, questionnaires became a popular tool for conducting social research, particularly in the fields of sociology and psychology.

One of the most influential figures in the development of the questionnaire was the psychologist Raymond Cattell, who in the 1940s and 1950s developed the personality questionnaire, a standardized instrument for measuring personality traits. Cattell’s work helped establish the questionnaire as a key tool in personality research.

In the 1960s and 1970s, the use of questionnaires expanded into other fields, including market research, public opinion polling, and health surveys. With the rise of computer technology, questionnaires became easier and more cost-effective to administer, leading to their widespread use in research and business settings.

Today, questionnaires are used in a wide range of settings, including academic research, business, healthcare, and government. They continue to evolve as a research tool, with advances in computer technology and data analysis techniques making it easier to collect and analyze data from large numbers of participants.

Types of Questionnaire

Types of Questionnaires are as follows:

Structured Questionnaire

This type of questionnaire has a fixed format with predetermined questions that the respondent must answer. The questions are usually closed-ended, which means that the respondent must select a response from a list of options.

Unstructured Questionnaire

An unstructured questionnaire does not have a fixed format or predetermined questions. Instead, the interviewer or researcher can ask open-ended questions to the respondent and let them provide their own answers.

Open-ended Questionnaire

An open-ended questionnaire allows the respondent to answer the question in their own words, without any pre-determined response options. The questions usually start with phrases like “how,” “why,” or “what,” and encourage the respondent to provide more detailed and personalized answers.

Close-ended Questionnaire

In a closed-ended questionnaire, the respondent is given a set of predetermined response options to choose from. This type of questionnaire is easier to analyze and summarize, but may not provide as much insight into the respondent’s opinions or attitudes.

Mixed Questionnaire

A mixed questionnaire is a combination of open-ended and closed-ended questions. This type of questionnaire allows for more flexibility in terms of the questions that can be asked, and can provide both quantitative and qualitative data.

Pictorial Questionnaire:

In a pictorial questionnaire, instead of using words to ask questions, the questions are presented in the form of pictures, diagrams or images. This can be particularly useful for respondents who have low literacy skills, or for situations where language barriers exist. Pictorial questionnaires can also be useful in cross-cultural research where respondents may come from different language backgrounds.

Types of Questions in Questionnaire

The types of Questions in Questionnaire are as follows:

Multiple Choice Questions

These questions have several options for participants to choose from. They are useful for getting quantitative data and can be used to collect demographic information.

• a. Red b . Blue c. Green d . Yellow

Rating Scale Questions

These questions ask participants to rate something on a scale (e.g. from 1 to 10). They are useful for measuring attitudes and opinions.

• On a scale of 1 to 10, how likely are you to recommend this product to a friend?

Open-Ended Questions

These questions allow participants to answer in their own words and provide more in-depth and detailed responses. They are useful for getting qualitative data.

• What do you think are the biggest challenges facing your community?

Likert Scale Questions

These questions ask participants to rate how much they agree or disagree with a statement. They are useful for measuring attitudes and opinions.

How strongly do you agree or disagree with the following statement:

“I enjoy exercising regularly.”

• a . Strongly Agree
• c . Neither Agree nor Disagree
• d . Disagree
• e . Strongly Disagree

Demographic Questions

These questions ask about the participant’s personal information such as age, gender, ethnicity, education level, etc. They are useful for segmenting the data and analyzing results by demographic groups.

• What is your age?

Yes/No Questions

These questions only have two options: Yes or No. They are useful for getting simple, straightforward answers to a specific question.

Have you ever traveled outside of your home country?

Ranking Questions

These questions ask participants to rank several items in order of preference or importance. They are useful for measuring priorities or preferences.

Please rank the following factors in order of importance when choosing a restaurant:

• a. Quality of Food
• c. Ambiance
• d. Location

Matrix Questions

These questions present a matrix or grid of options that participants can choose from. They are useful for getting data on multiple variables at once.

Dichotomous Questions

These questions present two options that are opposite or contradictory. They are useful for measuring binary or polarized attitudes.

Do you support the death penalty?

How to Make a Questionnaire

Step-by-Step Guide for Making a Questionnaire:

• Define your research objectives: Before you start creating questions, you need to define the purpose of your questionnaire and what you hope to achieve from the data you collect.
• Choose the appropriate question types: Based on your research objectives, choose the appropriate question types to collect the data you need. Refer to the types of questions mentioned earlier for guidance.
• Develop questions: Develop clear and concise questions that are easy for participants to understand. Avoid leading or biased questions that might influence the responses.
• Organize questions: Organize questions in a logical and coherent order, starting with demographic questions followed by general questions, and ending with specific or sensitive questions.
• Pilot the questionnaire : Test your questionnaire on a small group of participants to identify any flaws or issues with the questions or the format.
• Refine the questionnaire : Based on feedback from the pilot, refine and revise the questionnaire as necessary to ensure that it is valid and reliable.
• Distribute the questionnaire: Distribute the questionnaire to your target audience using a method that is appropriate for your research objectives, such as online surveys, email, or paper surveys.
• Collect and analyze data: Collect the completed questionnaires and analyze the data using appropriate statistical methods. Draw conclusions from the data and use them to inform decision-making or further research.
• Report findings: Present your findings in a clear and concise report, including a summary of the research objectives, methodology, key findings, and recommendations.

Questionnaire Administration Modes

There are several modes of questionnaire administration. The choice of mode depends on the research objectives, sample size, and available resources. Some common modes of administration include:

• Self-administered paper questionnaires: Participants complete the questionnaire on paper, either in person or by mail. This mode is relatively low cost and easy to administer, but it may result in lower response rates and greater potential for errors in data entry.
• Online questionnaires: Participants complete the questionnaire on a website or through email. This mode is convenient for both researchers and participants, as it allows for fast and easy data collection. However, it may be subject to issues such as low response rates, lack of internet access, and potential for fraudulent responses.
• Telephone surveys: Trained interviewers administer the questionnaire over the phone. This mode allows for a large sample size and can result in higher response rates, but it is also more expensive and time-consuming than other modes.
• Face-to-face interviews : Trained interviewers administer the questionnaire in person. This mode allows for a high degree of control over the survey environment and can result in higher response rates, but it is also more expensive and time-consuming than other modes.
• Mixed-mode surveys: Researchers use a combination of two or more modes to administer the questionnaire, such as using online questionnaires for initial screening and following up with telephone interviews for more detailed information. This mode can help overcome some of the limitations of individual modes, but it requires careful planning and coordination.

Example of Questionnaire

Title of the Survey: Customer Satisfaction Survey

Introduction:

We appreciate your business and would like to ensure that we are meeting your needs. Please take a few minutes to complete this survey so that we can better understand your experience with our products and services. Your feedback is important to us and will help us improve our offerings.

Instructions:

Please read each question carefully and select the response that best reflects your experience. If you have any additional comments or suggestions, please feel free to include them in the space provided at the end of the survey.

1. How satisfied are you with our product quality?

• Very satisfied
• Somewhat satisfied
• Somewhat dissatisfied
• Very dissatisfied

2. How satisfied are you with our customer service?

3. How satisfied are you with the price of our products?

4. How likely are you to recommend our products to others?

• Very likely
• Somewhat likely
• Somewhat unlikely
• Very unlikely

5. How easy was it to find the information you were looking for on our website?

• Somewhat easy
• Somewhat difficult
• Very difficult

6. How satisfied are you with the overall experience of using our products and services?

7. Is there anything that you would like to see us improve upon or change in the future?

…………………………………………………………………………………………………………………………..

Conclusion:

Thank you for taking the time to complete this survey. Your feedback is valuable to us and will help us improve our products and services. If you have any further comments or concerns, please do not hesitate to contact us.

Applications of Questionnaire

Some common applications of questionnaires include:

• Research : Questionnaires are commonly used in research to gather information from participants about their attitudes, opinions, behaviors, and experiences. This information can then be analyzed and used to draw conclusions and make inferences.
• Healthcare : In healthcare, questionnaires can be used to gather information about patients’ medical history, symptoms, and lifestyle habits. This information can help healthcare professionals diagnose and treat medical conditions more effectively.
• Marketing : Questionnaires are commonly used in marketing to gather information about consumers’ preferences, buying habits, and opinions on products and services. This information can help businesses develop and market products more effectively.
• Human Resources: Questionnaires are used in human resources to gather information from job applicants, employees, and managers about job satisfaction, performance, and workplace culture. This information can help organizations improve their hiring practices, employee retention, and organizational culture.
• Education : Questionnaires are used in education to gather information from students, teachers, and parents about their perceptions of the educational experience. This information can help educators identify areas for improvement and develop more effective teaching strategies.

Purpose of Questionnaire

Some common purposes of questionnaires include:

• To collect information on attitudes, opinions, and beliefs: Questionnaires can be used to gather information on people’s attitudes, opinions, and beliefs on a particular topic. For example, a questionnaire can be used to gather information on people’s opinions about a particular political issue.
• To collect demographic information: Questionnaires can be used to collect demographic information such as age, gender, income, education level, and occupation. This information can be used to analyze trends and patterns in the data.
• To measure behaviors or experiences: Questionnaires can be used to gather information on behaviors or experiences such as health-related behaviors or experiences, job satisfaction, or customer satisfaction.
• To evaluate programs or interventions: Questionnaires can be used to evaluate the effectiveness of programs or interventions by gathering information on participants’ experiences, opinions, and behaviors.
• To gather information for research: Questionnaires can be used to gather data for research purposes on a variety of topics.

When to use Questionnaire

Here are some situations when questionnaires might be used:

• When you want to collect data from a large number of people: Questionnaires are useful when you want to collect data from a large number of people. They can be distributed to a wide audience and can be completed at the respondent’s convenience.
• When you want to collect data on specific topics: Questionnaires are useful when you want to collect data on specific topics or research questions. They can be designed to ask specific questions and can be used to gather quantitative data that can be analyzed statistically.
• When you want to compare responses across groups: Questionnaires are useful when you want to compare responses across different groups of people. For example, you might want to compare responses from men and women, or from people of different ages or educational backgrounds.
• When you want to collect data anonymously: Questionnaires can be useful when you want to collect data anonymously. Respondents can complete the questionnaire without fear of judgment or repercussions, which can lead to more honest and accurate responses.
• When you want to save time and resources: Questionnaires can be more efficient and cost-effective than other methods of data collection such as interviews or focus groups. They can be completed quickly and easily, and can be analyzed using software to save time and resources.

Characteristics of Questionnaire

Here are some of the characteristics of questionnaires:

• Standardization : Questionnaires are standardized tools that ask the same questions in the same order to all respondents. This ensures that all respondents are answering the same questions and that the responses can be compared and analyzed.
• Objectivity : Questionnaires are designed to be objective, meaning that they do not contain leading questions or bias that could influence the respondent’s answers.
• Predefined responses: Questionnaires typically provide predefined response options for the respondents to choose from, which helps to standardize the responses and make them easier to analyze.
• Quantitative data: Questionnaires are designed to collect quantitative data, meaning that they provide numerical or categorical data that can be analyzed using statistical methods.
• Convenience : Questionnaires are convenient for both the researcher and the respondents. They can be distributed and completed at the respondent’s convenience and can be easily administered to a large number of people.
• Anonymity : Questionnaires can be anonymous, which can encourage respondents to answer more honestly and provide more accurate data.
• Reliability : Questionnaires are designed to be reliable, meaning that they produce consistent results when administered multiple times to the same group of people.
• Validity : Questionnaires are designed to be valid, meaning that they measure what they are intended to measure and are not influenced by other factors.

Advantage of Questionnaire

Some Advantage of Questionnaire are as follows:

• Standardization: Questionnaires allow researchers to ask the same questions to all participants in a standardized manner. This helps ensure consistency in the data collected and eliminates potential bias that might arise if questions were asked differently to different participants.
• Efficiency: Questionnaires can be administered to a large number of people at once, making them an efficient way to collect data from a large sample.
• Anonymity: Participants can remain anonymous when completing a questionnaire, which may make them more likely to answer honestly and openly.
• Cost-effective: Questionnaires can be relatively inexpensive to administer compared to other research methods, such as interviews or focus groups.
• Objectivity: Because questionnaires are typically designed to collect quantitative data, they can be analyzed objectively without the influence of the researcher’s subjective interpretation.
• Flexibility: Questionnaires can be adapted to a wide range of research questions and can be used in various settings, including online surveys, mail surveys, or in-person interviews.

Limitations of Questionnaire

Limitations of Questionnaire are as follows:

• Limited depth: Questionnaires are typically designed to collect quantitative data, which may not provide a complete understanding of the topic being studied. Questionnaires may miss important details and nuances that could be captured through other research methods, such as interviews or observations.
• R esponse bias: Participants may not always answer questions truthfully or accurately, either because they do not remember or because they want to present themselves in a particular way. This can lead to response bias, which can affect the validity and reliability of the data collected.
• Limited flexibility: While questionnaires can be adapted to a wide range of research questions, they may not be suitable for all types of research. For example, they may not be appropriate for studying complex phenomena or for exploring participants’ experiences and perceptions in-depth.
• Limited context: Questionnaires typically do not provide a rich contextual understanding of the topic being studied. They may not capture the broader social, cultural, or historical factors that may influence participants’ responses.
• Limited control : Researchers may not have control over how participants complete the questionnaire, which can lead to variations in response quality or consistency.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Understanding Research Questions: Quantitative vs Qualitative

By Divya Bhansali

Columbia University; Biomedical Engineering PhD candidate

3 minute read

Research is like being a detective, trying to uncover the mysteries of the world. In the world of research, one of the first and most crucial decisions you'll make is whether to ask quantitative or qualitative method questions. But what's the difference between quantitative and qualitative research, and why does it matter? Let's dive in and find out!

Quantitative Research Questions

Quantitative research involves numbers, statistics, and hard data. It's like counting beans in a jar. Quantitative research questions aim to answer "how much," "how many," or "to what extent" questions. When understanding how to write research paper , quantitative research questions can provide clear, measurable data to support your findings.

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Examples of Quantitative Research Questions

1. How many high school students use smartphones for over four hours a day?

This research question can be answered with precise numbers - a certain percentage of students may fall into this category.

2. What is the average GPA of students in our school?

You'll get a specific number, like 3.5, as an answer to this question.

3. How much has the average temperature increased over the last decade?

In this case, you're looking for a specific temperature change in degrees Celsius or Fahrenheit.

Considerations for Quantitative Research

Data Collection Methods : To answer quantitative research questions, you'll often use structured surveys, experiments, or observations with predefined variables. These methods help you collect precise, quantifiable data.

Data Analysis : Quantitative research involves statistical analysis, where you'll use mathematical tools to identify patterns and relationships in the data. Understanding how to write a research paper outline can help you organize these methods effectively.

Generalizability : Quantitative research often aims for generalizability, meaning you can draw conclusions that apply to a larger population.

Qualitative Research Questions

On the other hand, the qualitative research method is more about words, descriptions, and understanding the "whys" and "hows" of a phenomenon. It's like exploring the stories behind the beans in the jar. Qualitative analysis questions aim to answer questions about experiences, feelings, and behaviors.

Examples of Qualitative Research Questions

How do high school students feel about using smartphones for extended periods of time?

This question invites students to share their thoughts, emotions, and personal experiences.

2. What are the main challenges that students face when it comes to maintaining a high GPA?

This question prompts students to talk about their struggles, motivations, and strategies.

3. In what ways has climate change affected the daily lives of people in our community?

This question encourages people to share their stories about how they've been impacted.

Considerations for Qualitative Research

Data Collection Methods : Qualitative research methods often involve open-ended interviews, observations, or content analysis. These methods allow you to collect rich, descriptive data. 

Data Analysis : Qualitative research method requires a more interpretive approach. You'll analyze text or visual data to identify themes, patterns, and any unique insight.

In-Depth Understanding : Qualitative research delves deep into the experiences and perceptions of individuals, providing a nuanced understanding of a specific topic.

Knowing how to write an introduction for a research paper can be particularly important when presenting qualitative research. A compelling introduction sets the stage for the rich, descriptive data that follows.

If your study involves STEM subjects, having a solid stem research paper outline will be beneficial. Additionally, knowing how to write a thesis statement for a research paper is crucial for establishing a clear argument or hypothesis.

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Which One to Choose?

The choice between qualitative and quantitative research questions depends on what you want to discover and the nature of your study. Here are some key factors to consider:

Nature of the Research : Is your research more about numbers and statistical analysis, or is it about having a deeper understanding the human experience? Choose the approach that aligns with your research goals.

Data Collection : Think about how you'll gather information. Surveys and experiments often lead to quantitative data, while interviews and observations typically provide qualitative data.

Time and Resources : Consider the time and resources you have. Quantitative research can often be quicker and require fewer resources than in-depth qualitative studies.

Research Participants : The preferences and characteristics of your research participants matter. Some may prefer answering surveys with numeric options, while others may enjoy sharing their stories.

When you are ready to start your study, make sure to also understand how to write a research paper abstract for summarizing your work effectively.

Whether you choose to ask quantitative or qualitative survey questions, remember that both approaches are valuable and have their unique strengths. The key is to match your research goals with the right approach, ensuring that you gather the most relevant and meaningful data.

So, high school detectives, the choice is yours: will you count the beans or explore the stories behind them? Happy researching!

10+ Qualitative Survey Questions to Collect Deep Insights

Just like great ingredients are the basis for preparing an amazing meal, a great survey needs to have amazing questions. And unless you know the recipe by heart, choosing effective survey questions can be difficult. One of the most common choices you can make are qualitative survey questions.

They let you uncover deep insights with qualitative research, but they do come with some challenges. In this article, we’ll show you how to write great qualitative questions, what makes them good (and bad) choices for your qualitative surveys, as well as some examples to get you inspired.

Qualitative vs. quantitative questions

Before we go any further, we need to make a distinction between qualitative and quantitative survey questions .

Qualitative questions help you get qualitative data. These are the questions that get behind the why, what, and how of a particular subject through qualitative research of your focus groups. An example of a qualitative question would be: Please describe your recent experience with our customer support.

Use qualitative research questions when you need customers to explain their experience in their own words and provide you with deeper insights. 

Quantitative questions help you collect quantitative, numerical data. They help you put a numerical value on your customers’ feedback. An example of a quantitative question would be: “On a scale from 1 to 10, please rate your satisfaction with your recent experience with our customer support?”

‍ Use quantitative research questions when you need data that is easy to analyze and quantify so that you can make an important decision based on data.

Both question types have their pros and cons, and depending on your needs, you’ll want to use one or the other or a combination of both research methods on your target audience.

How to write good qualitative survey questions

Qualitative survey questions can unearth impressive data. However, you need to be very careful about how you write them to get the best feedback from your focus groups. Here are some quick tips to get started.

Make the qualitative research questions specific

The first rule is very simple. A qualitative question leaves your audience with a space to write anything they want. And the truth is, they will literally write anything if you don’t point them in the right direction.

If your survey questions are too broad, they will result in broad answers and feedback that is not particularly useful. For example, asking “How do you like our dashboard?” is going to give you a wide range of answers.

Instead, ask something along the lines of “What do you think of the different visualization styles in our reporting dashboard?”

The more specific the survey questions, the better the feedback. 

Have a clear purpose

Why are you asking a certain question? In the case of quantitative surveys, you don’t always need a specific reason, e.g. checking up on your NPS score .

However, qualitative questions demand lengthier answers and you need to motivate your target audience to provide that answer. The best way to do so? Just let them know why you’re asking.

For example, you could say that you’re asking about the checkout process in order to make it quicker to purchase and easier to choose a preferred payment method. The stronger the benefit for the customer, the more reasons for stating the purpose of the survey.

Focus on quality, not numbers

You won’t get the same number of answers with qualitative questions compared to quantitative ones such as CSAT surveys . Put simply, writing out an answer takes more time than selecting a number on a scale.

You may be tempted to simplify your survey questions to get more answers from your survey participants. However, try and resist the temptation.

Your aim is to get amazing feedback so don’t shy away from asking the survey questions that really interest you. Five good answers are much better than 50 superficial ones you can’t use.

Add subquestions when necessary

Sometimes, you can’t get all the info you need from one answer. If you want to ensure you get all the feedback you need, asking a subquestion makes sense.

For example, you could ask customers about their thoughts on a new feature you launched. A subquestion could be one where you ask the customers what would make them use that feature more.

You can actually ask this question in a matter of seconds by using this survey template:

Your customers are willing to provide feedback to help you out, but you sometimes need to nudge them in the right direction.

Pros and cons of using qualitative questions for surveys

Qualitative survey questions can yield amazing results. However, they have their good and bad sides, and you need to be aware of both before creating your next survey.

Advantages of using qualitative questions in surveys

Let’s start with the good stuff.

They help you get in-depth data

A quantitative question tells you how likely someone is to recommend you on a scale. While a number is a good piece of info, a few sentences describing why and how they would recommend you will provide the context. If you want in-depth data where customers describe how they feel about you in more detail, you need qualitative research questions.

They are more flexible by nature

The typical quantitative question has a standard form. Survey types such as CSAT, NPS, and CES have question formats that don’t vary much. On the other hand, the sky is the limit with qualitative research questions. You can phrase them in any way you want, using specific expressions to narrow down the type of feedback you want to get.

They encourage discussion

There is little that can happen once an NPS survey is complete. You get the results, analyze them (in minutes, thanks to Survicate’s dashboard ), and the conversation is over. Qualitative research questions encourage your customers to speak their minds and share how they feel.

Disadvantages of using qualitative survey questions

There are some downsides to keep in mind with this question type.

The sample size

Qualitative data is amazing when it comes to the insights that you get. But on the flip side, it requires detailed analysis, and you have to manually go through all the survey responses to find the gold nuggets in your feedback. As a result, the sample is usually much smaller than in quantitative surveys, and you have to use focus groups with limited respondent numbers.

Sample bias

With the smaller size sample usually comes the sample bias . This means that you’ll tend to pick customers who are similar in some way, including demographics, use cases, location, and your data might be skewed. 

Lack of privacy

Lots of data is always a great thing for businesses, but there may be some concerns from the customers’ end. 

If they give you detailed answers, you can accurately pinpoint the identity of the customer who supplied the answer. You can solve a part of the problem by making the survey anonymous , but bear in mind that some customers will be concerned about privacy issues regardless.

Difficulty with statistical analysis

Imagine 500 respondents filled in your NPS survey. You could get your NPS score within seconds using survey software like Survicate. On the other hand, getting qualitative research results from a focus group with 500 people could take weeks. Be prepared to set aside some time to go through the responses to your qualitative surveys manually.

Qualitative question examples

Here are some amazing qualitative question examples to get you inspired. You can adapt these to a specific use case depending on your industry and niche.

Exploratory questions

The most common of the qualitative research questions, the exploratory question aims to just… explore. You ask your survey participants about a particular topic so you can learn more about their thoughts, experiences, and attitudes.

• Describe the last interaction you had with our product.
• Does our product meet your overall expectations?
• What is the most valuable feature in our product?
• Why did you choose to use our product compared to the competitors?
• What is the one aspect of our product that you never use?
• What is your biggest objection to our checkout process and why?

Predictive questions

Predictive survey questions put survey participants in a certain situation. Based on past events, you ask them to predict what would happen in a hypothetical situation. If you phrase the questions correctly, they can provide a wealth of feedback about the respondents’ pain points and your product.

• If we added free returns on all orders above $50, would you shop more with us?
• If you could add one more feature to our product, what would that feature be and why?
• If we had a Zapier integration for our app, how often would you use it?
• If you were in charge of our customer support for a day, what would you change and why?
• Would you be more likely to buy our product if it was endorsed by a large company such as Microsoft?

Get ready for deep insights with qualitative questions in your surveys

Not everyone is born a great writer or a qualitative research expert. But nowadays, you don’t have to be either of those things to write amazing qualitative questions and have great qualitative surveys.

Survey software has come a long way and nowadays, it does more than just provide a platform for creating and distributing online surveys. Survicate comes with 125+ survey templates out of the box, packed with quantitative and qualitative questions, ready to use.

Kickstart your qualitative research today by choosing the right tool for the job. Try Survicate and see why online surveys are the future of conducting qualitative research.

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What’s in a Qualitative Research Question?

Qualitative research questions are driven by the need for the study. Ideally, research questions are formulated as a result of the problem and purpose, which leads to the identification of the methodology. When a qualitative methodology is chosen, research questions should be exploratory and focused on the actual phenomenon under study.

From the Dissertation Center, Chapter 1: Research Question Overview , there are several considerations when forming a qualitative research question. Qualitative research questions should

Below is an example of a qualitative phenomenological design. Note the use of the term “lived experience” in the central research question. This aligns with phenomenological design.

RQ1: “ What are the lived experiences of followers of mid-level managers in the financial services sector regarding their well-being on the job?”

If the researcher wants to focus on aspects of the theory used to support the study or dive deeper into aspects of the central RQ, sub-questions might be used. The following sub-questions could be formulated to seek further insight:

RQ1a.   “How do followers perceive the quality and adequacy of the leader-follower exchanges between themselves and their novice leaders?”

RQ1b.  “Under what conditions do leader-member exchanges affect a follower’s own level of well-being?”

Qualitative research questions also display the desire to explore or describe phenomena. Qualitative research seeks the lived experience, the personal experiences, the understandings, the meanings, and the stories associated with the concepts present in our studies.

We want to ensure our research questions are answerable and that we are not making assumptions about our sample. View the questions below:

How do healthcare providers perceive income inequality when providing care to poor patients?

In Example A, we see that there is no specificity of location or geographic areas. This could lead to findings that are varied, and the researcher may not find a clear pattern. Additionally, the question implies the focus is on “income inequality” when the actual focus is on the provision of care. The term “poor patients” can also be offensive, and most providers will not want to seem insensitive and may perceive income inequality as a challenge (of course!).

How do primary care nurses in outreach clinics describe providing quality care to residents of low-income urban neighborhoods?

In Example B, we see that there is greater specificity in the type of care provider. There is also a shift in language so that the focus is on how the individuals describe what they think about, experience, and navigate providing quality care.

Other Qualitative Research Question Examples

Vague : What are the strategies used by healthcare personnel to assist injured patients?

Try this : What is the experience of emergency room personnel in treating patients with a self-inflicted household injury?

The first question is general and vague. While in the same topic area, the second question is more precise and gives the reader a specific target population and a focus on the phenomenon they would have experienced. This question could be in line with a phenomenological study as we are seeking their experience or a case study as the ER personnel are a bounded entity.

Unclear : How do students experience progressing to college?

Try this : How do first-generation community members describe the aspects of their culture that promote aspiration to postsecondary education?

The first question does not have a focus on what progress is or what students are the focus. The second question provides a specific target population and provides the description to be provided by the participants. This question could be in line with a descriptive study.

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Combining Online and Offline Methods in Qualitative Research

The power of a hybrid approach.

F or qualitative researchers, there are many tools available online today. Online surveys, video interviews, online qual platform,  social media monitoring among others.

However, traditional offline approaches such as face-to-face interviews, focus groups, and ethnographic observations remain indispensable.

Rather than choosing one approach over the other, combining online and offline qualitative methods can yield richer, more comprehensive insights . This hybrid model addresses the limitations inherent in exclusive use of either method while amplifying their respective strengths.

The Digital Advantage: Harnessing Online Methods

Online qualitative methods offer several key benefits:

Broad Reach and Accessibility

Amongst the greatest advantages of online methods is their ability to reach widely dispersed participants in different geographical areas . It enables researchers to connect hard-to-accessed segments using unconventional barriers of location as well as mobility.

As Caitlin Roberson, CEO of market research firm In Resources, notes:

“Online methods have democratized qualitative research, giving us unprecedented access to diverse perspectives that were once difficult or cost-prohibitive to obtain.”

Efficiency and Cost Savings

Conducting studies online saves costs of travel, venue rentals during personal data collection, among other logistical expenses. This results in significant cost savings and faster project turnaround times for clients .

Utilizing Digital Tools

Recent technological advances have led to the development of powerful online qualitative tools:

• Online surveys: Platforms like SurveyMonkey and Qualtrics allow researchers to administer multimedia-rich interactive surveys.
• Video interviews : Tools like Zoom facilitate seamless virtual interviews with participants worldwide.
• Social media monitoring : Analyzing conversations on platforms like Twitter and Reddit provides valuable insights into public sentiment and behavior. 
• Online Qual Platform: Online qual platform is a digital research method that enables researchers to conduct various types of qualitative research remotely and online. This allows them to engage with participants in real time through features such as live chats, focus groups, video interviews, and/or mobile ethnography or diary studies.

The Human Connection: Strengths of Offline Methods

While online methods offer undeniable advantages, offline qualitative research remains essential for capturing nuanced, contextual data . Key strengths include:

In-Depth Interaction

Face-to-face interviews and focus groups foster a deeper level of engagement and rapport-building between researchers and participants . This can lead to more open and authentic dialogue, uncovering insights that may be missed in online settings.

Observing Context

Conducting research in participants’ natural environments through methods like ethnography and contextual inquiry allows researchers to observe non-verbal cues, behaviors, and environmental factors that influence experiences and decision-making .

Authentic Responses

While online methods can introduce biases like social desirability and response fatigue, in-person settings may encourage more genuine, thoughtful responses from participants .

Strategies for Integration: Getting the Best of Both Worlds

Combining online and offline methods can be achieved through various strategies, depending on research goals and resources:

Sequential Integration

One approach is to start with online methods like surveys to gather initial data , then follow up with offline methods like in-depth interviews to dive deeper into key findings . This can be an effective way to identify areas for further exploration while leveraging the efficiency of online tools.

Concurrent Use

Another strategy is to employ both online and offline methods simultaneously , using each to triangulate and cross-verify data from multiple sources. This approach can enhance the validity and reliability of findings.

Adaptive Approaches

Researchers can also adopt a flexible, adaptive approach , shifting between online and offline methods as needed throughout the research process. This allows them to take advantage of each method’s strengths at different stages while adjusting to emerging insights or logistical constraints.

Seeing the Hybrid Approach in Action

Healthcare research: improving patient experiences.

In a study focused on enhancing patient experiences in a hospital setting, researchers employed a hybrid approach:

• Online surveys were used to gather initial feedback from a large, geographically dispersed patient population.
• In-person focus groups and interviews were then conducted with a subset of participants to delve deeper into their responses and observe non-verbal cues.
• Ethnographic observations in hospital waiting rooms and patient rooms provided additional contextual insights.

This combination of techniques enabled researchers to identify significant areas of concern and develop a thorough understanding of the physical, emotional, and social factors influencing patient experiences.

Market Research: Understanding Consumer Behavior

One major consumer electronics company wanted to understand how different consumer segments purchase their products. They preferred a mixed approach:

• The online surveys provided quantitative data on purchasing habits, brand perceptions, and demographic characteristics for a large number of consumers.
• In-home Interviews and observations where the subjects interacted with various electronic devices within their natural environments.

Thus, by employing a blend of these approaches, the organization could not only understand what drives customer purchases, but also why and how they make these decisions, informing product development and marketing strategies.

Challenges and Considerations

However, there are certain issues that should be considered when combining Internet and offline methods:

• Technological Barriers: Ensure that online methods are accessible to participants who may have different levels of digital literacy or access to technology.
• Participant engagement: Implement strategies to maintain high levels of involvement in both online and offline settings, thereby reducing drop-off rates and non-response bias
• Data integration: Establish robust processes for merging and reconciling data from multiple sources to ensure consistency and reliability in analysis and interpretation.

Here is a comparison table outlining the key strengths and considerations of online and offline qualitative methods:

Best Practices for Successful Hybrid Qualitative Research

These best practices should be adhered to by researchers in order to maximize the benefits realized from combining online with offline approaches:

• Conduct ethical standards: Place emphasized the importance on informed consent, data protection as well as ethics rules while gathering information through both e-channels and non-electronic conduits.
• Build multidisciplinary skills: Develop multidisciplinary skills: Invest in training researchers proficient in both digital qualitative tools and traditional face-to-face methods.
• Engage in continuous evaluation and adaptation: Evaluate often the suitability of chosen techniques so that they may be adjusted where necessary in order for them to stay relevant.

Frequently Asked Questions (FAQs)

1. what is mixed method research in qualitative research.

Mixed methods research in qualitative research does not refer to combining qualitative and quantitative methods within the same study. Qualitative research employs purely qualitative methods like interviews, focus groups, observations, etc. Mixed methods research combines qualitative and quantitative components across the entire research program or series of related studies.

2. What is the process of combining both qualitative and quantitative research methodologies called?

The process of combining both qualitative and quantitative research methodologies is called mixed methods research.

3. Why is mixed methods research good?

Mixed methods research is beneficial for several reasons:

A. It allows researchers to offset the weaknesses of one method with the strengths of the other method, providing a more comprehensive understanding.

B. Using multiple methods to study the same phenomenon increases validity and credibility through triangulation of findings.

C. The combination can reveal new paradoxes, contradictions or fresh perspectives that may be missed with a single method.

D. One method can inform the development or refinement of the other method (e.g. qualitative informing quantitative instruments).

E. It allows addressing different aspects of the research problem for a holistic view.

F. Quantitative data provides generalizability while qualitative data offers depth and contextual meaning.

The Future of Qualitative Research: Embracing the Hybrid Model

The evolving technology is becoming increasingly confusing in the distinction between online and offline qualitative research. Hybrid research approaches are likely to be advanced by new technologies such as virtual reality simulations, online qual platform, biometric data collection and AI-powered sentiment analysis.

By combining online and offline methods, practitioners can future-proof their practices while revealing deeper insights into human experiences, behavior, and decision-making processes.

To enhance your qualitative research, adopt a hybrid approach that draws on the strengths of both online and offline modes. To know how we can develop a customized hybrid strategy that fits your specific research objectives you may wish to contact our team of experts in the field.

The post Combining Online and Offline Methods in Qualitative Research appeared first on Mom and More .

This paper is in the following e-collection/theme issue:

Published on 5.6.2024 in Vol 11 (2024)

The Influence of Incentive-Based Mobile Fitness Apps on Users’ Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study

Authors of this article:

Original Paper

• Aaya Faizah, SKom   ; 
• Alifah Fatimah Azzahra Hardian, SKom   ; 
• Rania Devina Nandini, SKom   ; 
• Putu Wuri Handayani, Prof Dr   ; 
• Nabila Cyldea Harahap, Dr  

Faculty of Computer Science, University of Indonesia, Depok, Indonesia

Corresponding Author:

Putu Wuri Handayani, Prof Dr

Faculty of Computer Science, University of Indonesia

Depok, 16424

Phone: 62 217863419

Email: [email protected]

Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people’s sports activities. However, public interest in using these apps for any length of time is still relatively low.

Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users’ continuance usage intention.

Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita.

Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards.

Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers.

Introduction

According to the World Health Organization [ 1 ], regular physical activity (PA) is a key factor in the prevention and management of noncommunicable diseases. The Global Status Report on Physical Activity [ 2 ] reported that 1.4 billion individuals aged >18 years do not meet the levels of PA recommended to promote and protect health. In 2016, it was reported that, globally, 23% of all men and 32% of all women aged ≥18 years were not sufficiently physically active to stay healthy [ 1 ]. This means that approximately 1 in 3 women and 1 in 4 men are not sufficiently active and do not meet the global recommendation of at least 150 minutes of moderate-intensity PA or 75 minutes of high-intensity PA per week [ 3 ]. In August 2022, McKinsey & Company released the results of a survey conducted with 1041 Indonesian respondents in which 26% of the respondents stated that they had started to engage actively in personal training, 32% reported that they had been playing sports regularly, and 9% indicated that they had increased the intensity of their sports or fitness activities [ 4 ]. These data indicate that the level of Indonesians’ interest in, and awareness of, sports, fitness, and personal training is significantly higher than the global average. This conclusion is supported by the increased use of mobile fitness apps (MFAs) in Indonesia, with 29 million users in 2022 [ 5 ].

MFAs use several types of incentives, which include self-incentives, peer incentives, and platform incentives [ 6 - 9 ]. In the MFA context, self-incentives involve a self-monitoring (SM) system in which users monitor and track their own behavior [ 10 , 11 ]. Peer incentives are focused on social support (SS), which includes informational, emotional, and material support or the protection provided by fellow users of the app [ 12 ]. In the context of MFAs, platform incentives usually take the form of rewards or awards resulting from gamification features [ 13 ]. Users who collect a large number of rewards are usually considered to have a higher status on the MFA and feel more satisfied with their use of the app [ 14 , 15 ].

According to Zhu et al [ 16 ], very few studies have examined the role played by gender differences in the use of health and fitness apps. Yin et al [ 17 ] stated that achievements in sports motivate men more, while social relationships motivate women more. Previous research on MFAs has explored their design [ 18 ] and evaluation [ 19 - 22 ], as well as user adoption intentions [ 23 ]. In addition, several studies have discussed continuity in the use of MFAs [ 24 - 27 ]. Chiu et al [ 25 ] integrated the expectation-confirmation theory (ECT) with the investment model to analyze the continuous use of MFAs. However, research investigating the various types of MFA incentives has been shown to have several limitations [ 17 , 26 ] because the effects of each incentive have mostly been explored separately [ 28 - 30 ]. Per McKinsey & Company’s 2022 survey among Indonesian citizens [ 4 ], 87% of the respondents intended to continue using their personal training and fitness apps. The market analysis and demographics of this study apply only to MFA users in Indonesia.

Research Question

This research adopted the self-determination theory (SDT) and the ECT. The SDT, as postulated by Ryan and Deci [ 31 ], states that there are 3 main psychological needs that drive human behavior: autonomy, relatedness, and competency. If these psychological needs are met, intrinsic motivation will increase and make it easier to maintain certain behaviors [ 31 ]. Teixeira et al [ 32 ] show that the SDT can be applied to behavioral interventions that relate to exercise or PA. While the SDT has the ability to predict the intensity of a behavior based on the influence of incentive factors [ 17 ], the ECT is generally used to predict the continuity of a behavior [ 25 ]. The combination of the SDT and the ECT was chosen to analyze the relationship between the incentive factors that affect the use of MFAs and continuity in using them. Thus, the research question is “How do the incentives promoted by MFAs influence users’ continuance usage intention (CUI)?” This research can provide guidance for MFA developers by helping them to evaluate their apps.

Research Model

The model used for this research is based on 2 theories and 1 moderating effect, namely, the SDT and the ECT, with the moderating effect of gender. Significant studies reporting on the use of these 2 theories include those by Yin et al [ 17 ], Huang and Ren [ 26 ], Chiu et al [ 25 ], and Li et al [ 33 ]. Yin et al [ 17 ] found that incentives are compatible with the SDT in motivating users’ PA behaviors. The SDT approach described by Yin et al [ 17 ] is the theoretical basis for this research because it analyzes incentives offered by MFAs collectively and uses gender as a moderating variable. The relationship between perceived usefulness (PU) and incentives was also analyzed by Huang and Ren [ 26 ]. This research suggests that technology functions in MFAs, such as SM, self-regulation, and goal attainment, have an indirect effect on CUI through PU; for instance, Chiu et al [ 25 ] and Li et al [ 33 ] found that users’ CUI was significantly predicted by ECT. Our research model, which includes 9 variables and 13 hypotheses (described in the following subsections), is presented in Figure 1 .

The Influence of SM on PU

SM, which is classified as one of the self-incentives in MFAs, includes managing and tracking one’s own behavior [ 17 ]. These actions enable users to observe their own progress and evaluate their performance against previously set goals [ 34 ]. PU refers to the extent to which a person feels that technology can improve their performance of certain tasks [ 35 ]. In this study, the task was identified as increasing the user’s PA, while, for MFA users, PU implies that using the MFA will enhance their personal training intensity [ 36 , 37 ]. Bhattacherjee [ 38 ] argues that when users confirm their initial expectations of the main functionality of a mobile app, they will begin to perceive the app as useful for improving their task performance and thus continue to use it. Huang and Ren [ 26 ] measured PU relating to the effectiveness and performance of PA through the use of 4 technological functions of the MFA, one of which is SM. Therefore, we examine the following hypothesis:

• H1: SM has an influence on PU.

The Influence of SS on PU

SS is classified as one of the peer incentives in MFAs [ 17 ]. Web-based SS is seen as an important factor affecting the physical and mental health of individuals, such as sports activity and increased well-being [ 12 , 39 ]. Humans have a tendency to behave in ways that are consistent with people in their own social networks, and this can be exploited in the context of mobile health (mHealth) [ 29 ]. Chen and Pu [ 40 ] conducted research on social incentives by developing the HealthyTogether mobile game, which allows users to participate in PA together and send messages to one another. The authors showed that users significantly increased their PA when using HealthyTogether compared to when they were exercising alone [ 40 ]. Edney et al [ 6 ] built the Active Team app, which is an MFA with social and gamification functions. The primary outcome of their study was a change in the total daily minutes of moderate to vigorous PA at 3 months, as measured objectively using an accelerometer [ 6 ]. Therefore, we propose the following hypothesis:

• H2: SS has an influence on PU.

The Influence of Platform Rewards on PU

The platform rewards include gamification elements, such as badges, points, and leaderboards [ 17 ]. The gamification element in MFAs can provide two types of information: (1) the user’s PA progress and (2) a comparison of the user’s PA with that of other users [ 41 ]. From this information, MFA users can observe their progress and experience greater satisfaction as they recognize their own personal training achievements. This leads to higher user competency satisfaction and increased behavioral motivation [ 13 , 42 ]. Yin et al [ 17 ] found that platform rewards have a positive relationship with users’ PA. This finding is supported by Plangger et al [ 13 ] and Huang and Ren [ 26 ], who analyzed the effect of the goal-attainment technology function of MFAs, in which users can set their own goals, which are then achieved by undertaking PA. These achievements are then categorized as platform rewards. Huang and Ren [ 26 ] also found that this technology function had a positive effect on PU. Therefore, we propose the following hypothesis:

• H3: Platform rewards have a positive influence on PU.

The Influence of External Influence on PU

External influence (EI) is one of the extrinsic motivations identified in the SDT, which means that behavior is motivated through influences that do not depend on internal factors [ 43 ]. Huang [ 28 ] proposed this variable to explain how PA can be promoted through external factors. One example is companies providing incentives to MFA users as part of their corporate social responsibility initiatives [ 28 ]. Several studies discuss EI and PA. One example of EI referred to in this study is the name or image of a sponsor of an activity [ 44 ]. Low and Pyun [ 45 ] explain that sponsorship that gives a good impression to customers or users will produce behavior that tends to be positive. In the context of sporting activities, Huang [ 28 ] explains that sponsor characteristics play an important role in participation in a sporting activity. Therefore, because an MFA is a tool that can measure a person’s PA, we intend to explore the following hypothesis:

• H4: EI has an influence on PU.

The Influence of Gender on SM and PU

According to Mao et al [ 7 ], MFA incentives are not always equally effective for women and men. This is because women and men have different ways of thinking [ 17 ]. Yin et al [ 17 ] conducted research that assumed that gender would influence the effectiveness of SM incentives, making them more effective for men than for women. This assumption was based on the belief that men generally pay more attention to their own achievements than women [ 46 ]. Surprisingly, Yin et al [ 17 ] show that gender does not affect the effectiveness of SM in MFAs. This finding relates to the concept of self-regulation, which is strongly driven by self-efficacy [ 47 ]. Individuals who decide to use MFAs are generally believed to have high self-efficacy in carrying out PA [ 17 ]. Therefore, we plan to test the following hypothesis:

• H5: Gender influences the relationship between SM and PU in MFA users.

The Influence of Gender on SS and PU

With regard to SS, Yin et al [ 17 ] explain that SS is one of the factors that most helps to fulfill the relatedness needs described in the SDT. According to Wang et al [ 9 ], social ties and commitment are more important for women than for men in shaping their attitudes toward the sharing of information. In considering gender, Yin et al [ 17 ] found that women tend to be more influenced by their relatedness needs than men. Women are also believed to be driven more by collective goals, such as pleasure or interpersonal harmony [ 48 , 49 ]. In the context of health apps, Kimbrough et al [ 50 ] found that women are usually more affected by environmental conditions and social relationships than men. Thus, we propose the following hypothesis:

• H6: Gender influences the relationship between SS and PU among MFA users.

The Influence of Gender on Platform Rewards and PU

Men tend to focus more on themselves and tend to be more independent than women [ 46 , 51 ]. Men also tend to focus more on completing or achieving individual goals that demonstrate their performance and abilities [ 46 , 51 ]. Relatedly, Vilela and Nelson [ 52 ] showed that men tend to be more motivated by their own achievements than women when using information system products. This is due to the general behavioral characteristics of men, who are generally more aggressive, pragmatic, and self-oriented in their behavior compared to women [ 52 ]. When specifically applied to incentives and CUI, Yin et al [ 17 ] also found an influence between gender and the effectiveness of platform reward incentives. The authors assumed that this is caused by the behavioral characteristics of men, who generally make decisions more rationally and pay greater attention to their own behavior. Thus, we propose the following hypothesis:

• H7: Gender influences the relationship between platform rewards and PU among MFA users.

The Influence of Gender on EI and PU

Sun and Zhang [ 53 ] state that women have a higher awareness of the environment than men. Leong et al [ 54 ] and Li et al [ 33 ] also found that men tend to be less easily influenced by external advice or support. Similarly, Venkatesh et al [ 55 ] concluded that women tend to be more influenced by EI, while men are usually less affected by external facilitation in their use of technology. This was confirmed by Weman Josefsson et al [ 56 ], who showed that men participate in challenges organized by the community to compete, while women participate for social and autonomy reasons. Hence, we propose the following hypothesis:

• H8: Gender influences the relationship between EI and PU among MFA users.

The Influence of Confirmation of Expectations on PU

Confirmation of expectations refers to the perceived level of conformity between the information system product or service expectation and actual performance [ 38 ]. Bhattacherjee [ 38 ] explains that PU refers to the individual’s perception of the anticipated benefits from the use of IT products or services. The ECT implies that the confirmation of a user’s expectations has a positive effect on their perception of the PU of an IT product or service [ 25 , 57 - 59 ]. According to the cognitive dissonance theory [ 60 ], IT users may experience psychological conflict if their initial expectations are not confirmed by their actual use experience [ 61 ]. Conversely, if users’ initial expectations are confirmed or met, they may display higher investment behavior and reduce their preference for alternative apps [ 25 ]. Hsu and Lin [ 62 ] state that confirmation of expectations is positively related to the perceived quality of the IT product or service used, with the result that users tend to ignore quality alternatives. Therefore, we propose the following hypothesis:

• H9: Confirmation of expectations has an influence on PU.

The Influence of Confirmation of Expectations on Satisfaction

Chiu et al [ 25 ] proposed that confirmation of user expectations affects satisfaction with the app as well as its PU. Satisfaction can be interpreted as an individual’s evaluation of their initial experience with a product or service [ 38 ]. Chiu et al [ 25 ] explain that before downloading an app, users generally have expectations of it, based on detailed information received from the app provider and on ratings and reviews from other users. After using the app, the user gains experience and evaluates the performance of the app based on previously established expectations. In line with the expectation-confirmation model, Chiu et al [ 25 ] assume that users’ perceptions of postuse benefits and the confirmation of previous expectations determine their satisfaction in using IT products and services. Therefore, we propose the following hypothesis:

• H10: Confirmation of expectations has an influence on satisfaction.

The Influence of PU on CUI

PU refers to the user’s perception of the benefits expected from using an IT product or service [ 61 , 63 ]. According to Bhattacherjee [ 38 ], expectations based on the user’s direct experience have an important role in forming their IT CUI. Chiu et al [ 25 ] state that many studies conducted in various contexts [ 59 , 64 , 65 ] empirically support a positive relationship between PU and CUI. Wu et al [ 66 ] show that when users find the mHealth app useful, they show a higher level of satisfaction and tend to use it continuously. Thus, we define the following hypothesis:

• H11a: PU has an influence on CUI.

The Influence of PU on Satisfaction

According to Chiu et al [ 25 ], PU also has a strong and positive impact on satisfaction. The authors state that the more benefits users receive from health and fitness apps, the greater their satisfaction [ 25 ]. When a user has used an app for an extended period of time, the user will evaluate its performance and form either a confirmation or a disconfirmation of judgment with regard to their expectations [ 62 ]. Disconfirmation of expectations affects user satisfaction and creates negative perceptions of the usefulness of MFAs. Conversely, users’ positive perceptions of usefulness increase their satisfaction with an app. Therefore, we propose the following hypothesis:

• H11b: PU has an influence on satisfaction.

The Influence of Satisfaction on CUI

Satisfaction can be identified as a significant factor influencing consumer behavior [ 25 ]. Bhattacherjee [ 61 ] strengthens this definition by explaining that user satisfaction is an important determinant of postadoption behavior relating to IT products and services. In other words, users with higher levels of satisfaction will exhibit greater levels of use of IT products and services than those who are less satisfied [ 25 ]. Wu et al [ 66 ] confirm that satisfied users are more likely to continue using an app because dissatisfied users can easily switch to other technologies at no additional cost. The relationship between satisfaction and CUI has been identified as one of the strongest relationships in the expectation-confirmation model [ 63 ]. Therefore, we propose the following hypothesis:

• H12: Satisfaction has an influence on the CUI of MFA users.

Research Procedure

This study used a mixed methods approach that integrated a quantitative approach, based on a questionnaire, with a qualitative approach, using interviews. The only inclusion criterion for respondents in this study was that they used MFAs. We modified a questionnaire that has been established in previous studies [ 12 , 15 , 16 , 24 , 25 , 28 , 33 , 66 - 70 ]. Before distributing the questionnaire, a readability test was conducted to validate how easily the questionnaire could be understood by respondents. The readability test was carried out both face-to-face and internet-based, using Google Meet, with 8 people who met the research criterion (ie, they all used MFAs). This readability test was carried out between February 5 and 10, 2023. We then used the results of the readability test to refine the questionnaire.

Once the questionnaire had been refined, we conducted a pilot study from February 20 to 25, 2023, aiming to measure the validity and reliability of the questionnaire by distributing it to 31 selected research respondents. The results of the pilot study were used to check the value of Cronbach α, which, in this pilot study, was 0.832, well over the required value of >0.7.

Research Instruments

The instruments used in this study were a web-based questionnaire and semistructured interview questions. The questionnaire first asked questions regarding the demographics of the respondents, and it then presented statements regarding the research model being tested. Each of the 8 variables exclude the gender variable in the study was assessed by 3 or 4 measurement items, and each indicator was represented by a statement to which participants responded on a Likert scale ranging from 1= strongly disagree to 5= strongly agree . The questionnaire used in this study is available in Multimedia Appendix 1 , and a list of the interview questions is available in Multimedia Appendix 1 .

Ethical Considerations

This research was approved by Faculty of Computer Science (approval number S-7/UN2.F11.D1.5/PPM.00.00/2024).

Participant Demographics

We distributed the research questionnaire on the web through various social media platforms such as WhatsApp, Line, Twitter, Instagram, and Telegram. These social media platforms are widely used by Indonesians. The questionnaire distribution was carried out between February 27 and March 20, 2023. Table 1 provides a demographic summary of the respondents. Of the respondents, 75.5% (286/379) were aged between 17 and 25 years, 72.3% (274/379) were women, 25.1% (95/379) were privately employed, and 51.5% (195/379) lived in Greater Jakarta.

After collecting both the quantitative and qualitative data, we processed the quantitative data using covariance-based structural equation modeling. Using covariance-based structural equation modeling, data processing is carried out in several stages: specification and identification of the research model, estimation of the research model, testing the feasibility of the research model, modification of the research model, and hypothesis testing.

To validate the quantitative data results, we also collected qualitative data by conducting semistructured interviews with 30 respondents. The interviews were conducted both offline and on the web and took 30 to 45 minutes each. The qualitative data analysis was carried out thematically on the basis of the defined hypotheses.

Measurement Model

The factor loading values of all variables and indicators met the Cronbach α standard of >0.7 [ 71 ]; thus, the model feasibility test could be carried out. This study yielded average variance extracted values >0.5 as well as Cronbach α and composite reliability values >0.7 [ 71 ] ( Table 2 ).

Structural Model

Next, we tested the structural model with the goodness-of-fit criteria, which included the relative chi-square index, goodness-of-fit index, root-mean-square error of approximation, root mean square residual, normal fit index, comparative fit index, and the Tucker-Lewis Index [ 71 ]. The goodness-of-fit values are presented in Table 3 , and the R 2 values are shown in Table 4 .

Hypotheses Testing

This study used a 2-tailed significance test; thus, the condition for accepting the hypothesis was P <.05 [ 71 ]. Table 5 presents the results of hypotheses 1 to 4 and 9 to 12, only one of which (H2) was rejected.

a SM: self-monitoring.

b PU: perceived usefulness.

c SS: social support.

d PR: platform rewards.

e EI: external influence.

f COE: confirmation of expectations.

g CUI: continuance usage intention.

According to Awang [ 72 ], the test for moderation is not significant when the difference in chi-square values between the constrained model and the unconstrained model is <3.84. Table 6 presents a summary of the results of the hypothesis testing using the moderating effect of gender. On the basis of the difference in the chi-square values between the constrained model and the unconstrained model, it can be concluded that all difference values were >3.84 and therefore meet the requirements for calculating the significance of the moderating effect, meaning that H5, H6, H7, and H8 were all accepted.

Qualitative Interviews and Validity of the Hypotheses

This research shows that the incentives offered in MFAs in the form of SM (eg, distance walked or run, number of calories expended, time taken, and heart rate) influence users’ motivation to undertake PA. The acceptance of H1 is thus in accordance with the findings of Yin et al [ 17 ] and Stragier et al [ 73 ]. Yin et al [ 17 ] state that the user’s PA level correlates positively with the amount of SM they do. The majority of interviewees felt that the SM feature provided encouragement for their PA:

So I feel happy because I have exercised, more enthusiasm. [Interviewee 6]

In addition, the interviewees believed that MFAs documented or tracked their progress in PA, which helped them to maintain or even improve their exercise consistency:

So that I can compare with previous progress and so that in the future I can look back at my history. Like pace, I also remember what date I did sport. [Interviewee 9]

An example of a feature that can be implemented is one that displays a summary of the user’s performance while exercising, together with visualizations in the form of trends and graphs. Some apps also display comments that describe the user’s sports activity performance, based on their activity level. Users can take advantage of these insights to increase their PA levels in their next sports activity.

However, H2 was rejected in this study. H2’s rejection aligns with the findings of Sun and Jiang [ 74 ] and Kim et al [ 75 ]. According to Kim et al [ 75 ], social comparison and the user’s level of PA are not directly connected. Social comparison here is defined as the relationship between the level of PA and the variable self-efficacy, or a person’s belief in their own capabilities [ 75 ]. The rejection of H2 indicates that the community or social ecosystem around MFA users does not have a significant impact on motivating the users to exercise. On the basis of the interviews, the SS feature in the app does not have an important effect on PA levels because users do not feel compelled to exercise when using the SS feature:

There is no motivation from the engagement side, more from tracking my own progress. [Interviewee 9]

In addition, nearly one-third of the interviewees (9/30, 30%) admitted that they used the SS feature only to document sports activities that had already been completed.

H3 was accepted in this study. The acceptance of H3 aligns with the studies by Bojd et al [ 41 ], Payne et al [ 42 ], Plangger et al [ 13 ], Goes et al [ 76 ], and Hamari and Koivisto [ 77 ]. Bojd et al [ 41 ] found that the gamification element in MFAs can provide two types of information: (1) the user’s PA progress and (2) a comparison of the user’s PA with that of other users. Furthermore, when MFA users are able to observe their progress, they feel more satisfied and recognize their own PA competency, which will drive higher user competency satisfaction and behavioral motivation [ 13 , 42 ]. Goes et al [ 76 ] and Hamari and Koivisto [ 77 ] also highlight the gamification element in MFA, which tracks the user’s effort, progress, and achievement of personal goals. According to Goes et al [ 76 ], the public nature of user-acquired gamification elements, such as levels, badges, or leaderboards, can generate users’ social status on the MFA platform, which encourages social comparison and competitive motivation among users. On the basis of the interviews, MFA users want to take part in challenges (an example of implementing gamification) on the app because they want to obtain limited edition rewards and measure their own capabilities in sports activities:

Gamification keeps me motivated and helps me see my activities historically during physical activity based on the badge I have earned. [Interviewee 21]

Furthermore, the interviewees acknowledged that the rewards they obtain can be used as a benchmark of their capacity in the sports activity against which to build new achievements:

I feel happy when I get an achievement because it shows an improvement in my sport. Even though I don’t I have specifically targeted certain achievements, but if I can surpass the previous achievements, it means that my sport has improved. The goals that I have set are higher than before. [Interviewee 17]

Therefore, it would be better if the MFA included challenges that were personalized as well as recommendations that were based on the user’s type of sports activity, the user’s sports activity goals, and the user’s own sports activity history. An example of such a feature could be that, based on the user’s history, if they have only managed to run a distance of 3 km, then, to improve their performance, other MFA users could recommend a 4-km challenge.

Huang [ 28 ] found that sponsor characteristics play an important role in triggering user behavior. Sponsorship referred to circumstances where the use of a sponsor’s product occurred naturally as part of a sponsored event [ 78 ]; for example, with an MFA whose function is to promote PA, sponsorship of athletic apparel would be perceived as highly congruent, whereas sponsorship of a cold remedy would reflect low congruence. The H4 finding is in line with the study by Yang et al [ 79 ], who stated that the level of involvement of a brand produces a positive association with the brand and strengthens the positive effect of an evaluation impacting one’s behavioral intention toward an app. From the interviews, it was found that interviewees were encouraged to take part in a challenge or activity if the activity was associated with the party (public figure, company, etc) that organized it:

For a club other than Strava, I think it’s cool if you participate, for example, it’s like unique. There’s definitely a challenge made by Strava every month, so it’s not as special as other clubs. The limited edition is more about Heart Month, New Year, and others. I want to take part because it would be a shame if I didn’t follow. [Interviewee 9]

We found that not many interviewees took advantage of EI incentives, but those who did participate focused more on the challenges than on the organizers or the external community. If a user felt capable of taking part in a challenge, they would try to do so:

Actually, I see from the challenge, if I feel capable, then I want to join. [Interviewee 7]

Thus, we argue that it would be better if MFA developers or providers developed challenges for their apps that are created by communities, organizations, and figures with high functional congruence.

With regard to H5, H6, H7, and H8, the results show that, in every case, gender has a moderating effect on the relationship between the variables investigated. This study showed that gender influences the relationship between SM and PU (H5). These results are supported by the studies by Gabriel and Gardner [ 46 ] and Sun et al [ 51 ], who found that men tend to make decisions based on rationality, while women tend to be more perceptual. According to Gabriel and Gardner [ 46 ] and Sun et al [ 51 ], men are generally more focused on personal goals that demonstrate their individual performance and abilities, while women are usually less conscious of their own goals and performance. This finding is supported by van Elburg et al [ 80 ], who state that men focus more on practical goals and achieving goals when using an mHealth app. We found that our female interviewees usually used the metrics in MFAs for tracking their PA only as monitoring information:

I only look at the pulse. [Interviewee 1]

However, the men usually used these metrics as targets for self-development:

To find out whether in sports we have reached the desired target or not. On the other hand, if our sports performance is good, this can also be seen through the information displayed on Apple Watch. Thus, the Apple Watch can be a helpful tool in determining whether our performance has reached the expected level or not. [Interviewee 12]

Moreover, this study found that gender influenced the extent to which SS incentives affected users’ PU (H6). The results of the interviews showed that most female respondents felt more motivated by their social community or by the SS feature provided in the MFA they used. By contrast, the male users used the SS feature, such as sharing their sports activity progress, for personal documentation purposes:

Just so you know. Only for review, not to share with other friends. [Interviewee 28]

Other male respondents stated that this was the case simply because the app posted their activity automatically :

Because it has to be posted on the Strava application. [Interviewee 8]

Many male respondents had never used this feature, indicating their lack of interest in the SS feature:

I have never tried it. [Interviewee 18]

However, the female respondents all expressed interest in the SS feature available in MFAs and felt more motivated to exercise due to this feature:

I also become motivated to exercise when I see my friends after posting their sports results. [Interviewee 11]

Some of the female respondents commented that the SS feature of MFAs motivated them to exercise by creating a sense of competition:

If I just wake up in the morning and get a notification that my friend has finished exercising, I feel left behind because I just woke up but he has finished exercising. Section it motivates, really. [Interviewee 9]

Relatedly, Li et al [ 33 ] found that women pay greater attention to social relations and are more willing to accept support from those around them. By contrast, Leong et al [ 54 ] found that men usually ignore external advice or support due to their sense of independence. These findings are supported by Yin et al [ 17 ], who found that SS had a more positive effect on PA in women than in men.

This study also showed that gender influences the relationship between platform rewards and PU (H7). The interviews showed that male respondents were generally more motivated by the challenges, badges, and awards offered by the MFA they were using:

Makes me more enthusiastic for the next run, and I use it to keep track of whether I should improve or maintain, for example, I can rank third so I feel I have to improve my performance. [Interviewee 16]

However, the female respondents usually followed or used this feature only for their own satisfaction and without specific targets or motivations:

There is no specific goal to get rewards, but I feel happy and proud of myself if I get them. [Interviewee 13]

According to Yin et al [ 17 ], in the context of PA, men usually pay more attention to meeting their needs for autonomy and competence, such as badges, awards, and so on. This was also demonstrated by Vilela and Nelson [ 52 ], who stated that men tend to be more aggressive, pragmatic, and self-oriented. Therefore, they are motivated by the need for achievement when using information system products [ 52 ]. Similar findings were identified by Forman et al [ 81 ], who showed that the gamification element has a more positive effect on men than on women by arousing their competitive and achievement-oriented motivation. Brandts et al [ 82 ] also support this finding and explain that task-based goal setting increases task completion and performance only for men.

This study also showed that gender affected the impact of EI on the user’s PU of MFAs (H8). The results of the interviews confirmed that there are 2 main reasons a person will participate in PA supported by the MFA: the match between the organizer of the activity and the user and the match between the user’s capabilities and the activity or challenge created. Comparing these 2 reasons, we found that the women were more likely to do something because of a match with the organizers, in contrast to the men, who usually focused more on their own ability to participate in an activity:

If Strava doesn’t have motivation, if it’s a club other than in my opinion, Strava is cool if you join, it’s like unique. What Strava makes is there every month, so it’s not as special as other clubs to participate on Strava. [Interviewee 29]

According to Huang [ 28 ] and Yang et al [ 79 ], the reason female MFA users participate in sports activities is that they experience a special feeling because these sports activities are created by a special club. Huang [ 28 ] and Yang et al [ 79 ] explain that the sponsorship characteristics of a sports activity and high brand involvement play important roles in triggering the behavioral intention of MFA users and their behavior in general. H8 is also supported by the findings of Weman Josefsson et al [ 56 ], who explain that men tend to be more influenced by winning rewards than women, who tend to participate more for autonomous and social reasons.

Furthermore, H9 was confirmed in this study. The acceptance of H9 is in accordance with previous research conducted by Bhattacherjee [ 38 ], Huang et al [ 15 ], Chiu et al [ 25 ], Wang et al [ 9 ], Cai et al [ 83 ], and Wu et al [ 66 ]. Wu et al [ 66 ] found that PU and user satisfaction are directly influenced by confirmation of expectations, namely, the realization of the expected benefits of using mHealth. This result is supported by Chiu et al [ 25 ], who state that PU of the MFA is reflected in the user’s enhanced exercise capacity and satisfaction, as evidenced by their increased enjoyment of exercising. Thus, it is to be expected that, after the initial experience, the confirmation level of the user’s expectations will have a positive effect on their PU [ 9 , 15 , 38 , 83 ]. One of the expectations of a respondent who used an MFA was that they would experience changes and improvements in their PA or exercise, and these expectations were indeed successfully confirmed:

Because when I want to download Strava I want to be diligent in exercising, and it is proven that I exercise more often because I can track my sports progress. [Interviewee 23]

H10 was also accepted by this study, and this result is in accordance with the studies by Bhattacherjee [ 38 ], Huang et al [ 15 ], Chiu et al [ 25 ], Wang et al [ 9 ], Cai et al [ 83 ], and Wu et al [ 66 ]. Wang et al [ 9 ] found that confirmation of expectations positively affects user satisfaction with IT products and services. The results of the interviews confirmed that interviewees felt satisfaction when using MFAs:

From a user point of view, everything has been fulfilled in my opinion. What I need so far has been achieved. [Interviewee 24]

In my opinion, the features are quite complete, because that’s all I really need. The application also provides a reminder if you have passed one day without exercising and automatically arranges for the workout that can be fulfilled the next day to be even tougher. [Interviewee 10]

This study also showed that PU influences CUI. Acceptance of H11a is in accordance with the studies by Bhattacherjee [ 38 ], Huang et al [ 15 ], Chiu et al [ 25 ], Huang and Ren [ 26 ], Wang et al [ 9 ], Cai et al [ 83 ], Wu et al [ 66 ], and Cho et al [ 24 ]. Cho et al [ 24 ] reported that, in the context of MFAs, perceived benefits were associated with managing health-related information. The interviews confirmed that interviewees would continue using the MFAs if they helped them to be more active in their exercising, and they could track their sports activity progress effectively:

I will continue to use it because in my opinion it is also effective and looks simple. [Interviewee 10]

As long as device is connected to the Apple Watch, will still use it. The ability to track different types of exercise separately is one of the advantages of the Apple Watch. This makes me still choose to use the Apple Watch in the future, as long as it meets my sporting needs. [Interviewee 12]

The study’s acceptance of H11b is in accordance with the studies by Bhattacherjee [ 38 ], Huang et al [ 15 ], Chiu et al [ 25 ], Wang et al [ 9 ], Cai et al [ 83 ], and Wu et al [ 66 ]. Cai et al [ 83 ] explain that PU is reflected in user satisfaction when exercising using an MFA. The more benefits users obtain from the MFA, the greater their satisfaction [ 25 ]. Wang et al [ 9 ] also found that satisfaction was a partial mediator between CUI and PU. We found that the level of user satisfaction with an MFA was based not only on its meeting users’ sports activity expectations but also on the convenience and effectiveness of the features, the user interface, and the user experience that supported the user’s sports activities:

I will continue to use Strava, because I am comfortable with Strava. [Interviewee 14]

I will continue to use it, because in my opinion it is also effective and the appearance is not a hassle. [Interviewee 10]

What makes me satisfied is the user interface, which is easy to use, and the user experience is simple. [Interviewee 19]

Finally, the effect of satisfaction on CUI was confirmed in this study. The acceptance of H12 is in accordance with the studies by Bhattacherjee [ 38 ], Huang et al [ 15 ], Chiu et al [ 25 ], Wang et al [ 9 ], Cai et al [ 83 ], and Wu et al [ 66 ]. Wu et al [ 66 ] found that satisfied users are more likely to continue using an app because dissatisfied users can easily switch to other mHealth technologies. User satisfaction is an important determinant of the postadoption behavior of users of IT products and services [ 38 ]. This is supported by Chiu et al [ 25 ], who state that user satisfaction with the use of IT products and services is very important for fostering long-term use of IT. The main reason for user satisfaction with an MFA is that the features are complete and meet user needs, with the result that they come to depend on the MFA for their exercise routines:

Because I really like it and I have become very dependent on this application for sports. I don’t want to exercise if there is no access to this application. [Interviewee 9]

This application has fulfilled my daily needs. [Interviewee 15]

Principal Findings

The findings from this study extend previous research by examining the incentive system in MFAs [ 17 , 26 ] and the use of the ECT in the context of mHealth [ 25 , 33 , 38 , 62 , 66 ]. It also expands the understanding of the moderating effect of gender on incentive-based systems [ 68 ]. We found that MFAs and the incentives they offer have a strong influence on users’ sports activity behaviors and on their intention to continue using the app. The results of this study indicate that the most influential feature of an MFA is the SM incentive feature. MFA users often do not feel like exercising or engaging in PA if the activity is not being tracked by their app. The SM feature was also found to have a greater impact on male users than on female users. This finding regarding gender differs from the results of a study by Yin et al [ 17 ], who stated that no gender trend was evident in the effectiveness of the SM feature. Furthermore, in contrast to the study by Yin et al [ 17 ], we found that SS had little effect on the PA of MFA users. The results of the qualitative interviews indicate that this is because the social circle of Indonesian MFA users is relatively small, and this small social circle affects the effectiveness of the SS feature.

MFA service providers should evaluate how different app features impact users of different genders to effectively motivate users to keep using their app in the long term. In addition, users feel more satisfied when their expectations regarding the use of an app are met. App developers can increase the PU of their MFA by using the users’ social communities (eg, by creating social profile features, group exercises, sporting events organized by recognized organizations or communities, and personalized challenges or awards based on the user’s sports activity history). App developers can improve the accuracy of the tracking feature, whether through a smartphone or a smartwatch, with the goal of providing users with more in-depth statistics and data. For user convenience, app providers should also develop tracking features that start automatically.

Limitations

The respondents to both the quantitative and qualitative studies were predominantly aged 17 to 25 years and female; thus, other moderating variables could be considered in a future study. The weak effect size for PU in Table 4 indicates that the differences or relationships between some variables were not significant. This suggests that there are other variables that might influence PU, which were not considered in this study. In future research, another variable that could be considered is PA. This could serve as a metric to determine whether using MFAs with specific incentives increases users’ PA [ 17 ].

Conclusions

The results of the study show that SM, platform rewards, and EI can all influence the PU of MFAs. However, no relationship was found between SS and the PU of MFAs. Indonesians generally consider MFAs to be useful because these apps allow them to track their sports activities and also offer rewards and awards. The confirmation of a user’s initial expectations also affects their perceptions of the usefulness of MFAs. PU and confirmation of expectations also affect user satisfaction with MFAs, which in turn influences the user’s desire to continue using the MFA. In addition, gender was shown to influence user behavior when using MFAs. In future research, the scope of EI incentives could be expanded by considering financial reasons for exercising, other people’s recommendations, and job demands, among other factors. We suggest considering tangible benefits as additional incentives to determine whether quantifiable benefits, such as assets or money, can increase a person’s motivation to exercise.

Acknowledgments

This research was supported by a 2024 internal funding from the Faculty of Computer Science, Universitas Indonesia.

Data Availability

The data sets generated and analyzed during this study are not publicly available due to a lack of authorization to share these data.

Conflicts of Interest

None declared.

Study questionnaire and interview questions.

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Abbreviations

Edited by K Adapa; submitted 18.07.23; peer-reviewed by M Mardiana, H Namba; comments to author 27.01.24; revised version received 05.02.24; accepted 29.04.24; published 05.06.24.

©Aaya Faizah, Alifah Fatimah Azzahra Hardian, Rania Devina Nandini, Putu Wuri Handayani, Nabila Cyldea Harahap. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 05.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included.

• Open access
• Published: 27 May 2024

Understanding patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, Uganda, a qualitative study

• Priscilla Namaganda 1 ,
• Patience Nantume 2 ,
• Kelvin Roland Mubiru 3 ,
• Adelliine Twimukye 2 &
• Christine Sekaggya Wiltshire 2  

BMC Health Services Research volume  24 , Article number:  666 ( 2024 ) Cite this article

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In 2016, Uganda added Hydroxyurea (HU) to the list of essential drugs to treat sickle cell disease SCD. However, Hydroxyurea utilization has been low for several countries in sub-Saharan Africa. This study examined patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, in Uganda.

To understand the patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease, we conducted a parallel convergent mixed methods study at outpatient departments of two national referral hospitals in Uganda from October 2022 to January 2023. The cross-sectional mixed-methods study employed both quantitative and qualitative methods. We collected survey data from a systematic sample of 259 participants and conducted individual interviews with a purposive sample of 40 participants (20 adolescents or their caregivers and 20 adult patients with SCD) and interviewed them individually on their knowledge, perceptions, barriers, and facilitators of HU utilization. Descriptive data were analyzed using Stata 16, whereas qualitative data were analyzed thematically using an inductive approach supported by NVivo 12 software. We triangulated data to determine the concordance of qualitative and quantitative data.

The study enrolled 40 participants for qualitative interviews and 259 patients for quantitative, with an average age of 16, over half being female, 46% having secondary education, and 96% unmarried. The prevalence of HU use was 78%. The study identified three themes as follows: Patient barriers at the individual including Inadequate knowledge about HU, Persistent pain, Poor adherence to HU, Poor communication with health care workers, and Psychosocial and emotional challenges. At the facility level, long queues and poor quality of care, drug-related side effects that affect HU, and drug stock-outs were reported. Myths, rumors, and misconceptions about HU, and gender-related barriers were reported to affect HU utilization at a community level. Facilitators for the use of HU and recommendations for improvement. Facilitators included perceived benefits, long duration on HU, information sharing by healthcare workers, availability of complementary drugs, confirmation of diagnosis, and availability of medication at public health facilities or private pharmacies. Patients suggested continuous adherence support, encouragement from healthcare workers, sensitization about benefits and risks, a peer-to-peer approach, and financial support for adolescents and women to start businesses to resolve financial problems.

Implementing the use of HU has been challenging in Uganda and needs improvement. Facilitators to hydroxyurea use have been highlighted, though Patient-identified barriers at individual, facility, and community levels that need to be resolved. The experiences and insights shared by our participants provide invaluable guidance for increasing the uptake of HU. Further studies are needed to establish validated instruments to assess patients’ pain communication and adherence to the HU regimen.

Peer Review reports

In Africa, sickle cell disease (SCD) contributes substantially to mortality in children younger than 5 years. The global burden has been quantified, with SCD accounting for 6.4% of the under-5 mortality across all of Africa [ 1 ]. However, in countries with greater sickle allele frequencies and lower childhood mortality rates, such as Uganda, SCD may account for up to 15% of under-5 mortality [ 2 ]. The mortality rate in adult patients with SCD is not known presumably because of a lack of accurate data but is thought to be high as more children with SCD survive into adolescence and adulthood, they are faced with poor access to comprehensive sickle cell care with a continuing risk of complications or death [ 2 ].

Hydroxyurea is one of the approved drugs for treating sickle cell disease [ 3 ]. The mechanism by which hydroxyurea works is rather unknown although its efficacy in the treatment of SCD is generally attributed to its ability to boost the levels of fetal hemoglobin (Hb F, α 2 γ 2 ) hence lowering the concentration of HbS. HbF is protective against clinical severity, and low-percentage HbF is associated with a higher risk of developing Vaso-occlusive complications, organ damage, and early death. Systemic review studies have documented the efficacy of hydroxyurea in adult patients with SCD [ 3 ]. In Uganda, the NOHARM and REACH studies reported a reduction in SCD-related complications with the use of hydroxyurea and appeared to be safe for children with SCD without increased severe malaria, infections, or adverse events [ 4 , 5 ].

Hydroxyurea was added to the list of essential drugs in Uganda in 2016 but it is not readily available [ 6 ].

The number of patients with SCD currently taking hydroxyurea is about 33%; this is undocumented data from patient charts. This low percentage of use could be due to limited access and availability of drugs, practitioners’ low knowledge of HU use, and patients’ fear of drug toxicities. Therefore, this study sought to assess barriers to HU treatment among this cohort of patients and document them. This study focused on knowledge, perceptions, barriers, and facilitators of adolescent and adult patients with sickle cell disease regarding HU because there is minimal data and even the data that is available focuses on children, not adults. Reasons reported by authors in studies done included fear of cancer and other side effects, not wanting to take a medication, not wanting to have required laboratory monitoring, or not thinking the medication would work [ 7 ]. The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve [ 8 ]. Not only do patients benefit, but providers and healthcare systems benefit as well, through (a) Improved satisfaction among patients and their families, (b) Enhanced reputation of providers among healthcare consumers, (c) Better morale and productivity among clinicians and ancillary staff, (d) Improved resource allocation, (e) Reduced expenses and increased financial margins throughout the continuum of care [ 8 ].

With greater use of HU for eligible patients, it is expected that fewer patients will be hospitalized for complications of SCD, resulting in a net reduction of national healthcare costs for patients with SCD [ 9 ]. In addition, the broader appropriate use of HU in patients with SCD should improve their quality of life and productivity [ 9 ]. With this information, we can lobby the government and/or donors to avail recourses for continued supply of HU and other resources like laboratory capacity that aid us in giving comprehensive care to patients with SCD. Therefore, we conducted a mixed methods study to identify the knowledge, perceptions, barriers, and facilitators of adolescent and adult patients with sickle cell disease regarding HU and suggest interventions to facilitate HU uptake in Uganda. We hypothesized that there was a relationship between patient-related barriers and hydroxyurea use among patients with SCD.

Study design

From October 2022 to January 2023, we conducted a cross-sectional mixed-methods study (parallel convergent) with qualitative components using a phenomenological approach.

Study setting

The study was conducted at the Sickle cell clinic in Mulago Hospital sickle cell clinic and Kiruddu Hospital, hematology. The Sickle Cell Clinic is an innovation for treating children with SCA with acute pain and other medical complications as outpatients. The Mulago sickle cell clinic attends to children, adolescents, and adult patients with SCD. The Kiruddu clinic attends to adolescent and adult patients with SCD in addition to other hematological conditions. Both Mulago and Kiruddu are national referral hospitals in Uganda and are teaching hospitals for Makerere University, College of Health Sciences. The Mulago SCD clinic cares for more than 300 patients with SCD. The hematology clinic at Kiruddu Hospital cares for 100 to 150 patients with SCD.

Sample size estimation

We purposively selected 40 participants to participate in the qualitative interviews. The actual sample size (40) was determined by how many participants were required to explore all the research questions and to achieve thematic saturation. It was difficult to determine the ideal sample size for achieving these objectives at the early stage of the research. Therefore, the process of participant selection was iterative, involving several rounds of selection and interviews as will be necessary to achieve thematic saturation. Data was collected until no new themes or patterns emerged from participants interviewed participants selected from each study site. 20 individual interviews were carried out in each selected site, making a total of 40 Individual interviews from two study sites. Patients were interviewed to identify the barriers to the use of hydroxyurea through In-depth interviews using an in-depth interview form developed for the study with 20 purposively selected patients per site. The criteria for the selection of patients for in-depth interviews were 10 adults (5 males and 5 females), and 10 adolescents (5 males and 5 females) who have ever missed appointments or drugs from each clinic. Also, their understanding, experiences, and what they had heard regarding using Hydroxyurea were assessed. All the interviews were conducted from the hospital premises and in a language preferred by the participants and audio recorded. All adolescents were interviewed with their caretakers and each caretaker signed a parent-guardian consent form in addition to the adolescent signing an assent form.

Eligibility for HU use was (a) Three or more sickle cell-associated moderate to severe pain crises in 12 months, requiring hospitalization or management at a health facility, (b) Sickle cell-associated pain that interferes with daily activities and quality of life, (c) History of severe and/or recurrent acute chest syndrome, (d) Severe symptomatic chronic anemia that interferes with daily activities or quality of life(severe symptomatic anemia criteria was assessed based on the need for blood transfusion). if participants responded yes to any of the above criteria, they were eligible for HU use. Patients with other sickle cell syndromes – e.g., Hb SC disease, S/ß thalassemia, pregnant, severely ill study, and declined to participate in the study were excluded.

The sample size for quantitative was estimated using Leslie Kish’s (1964) formula for sample size calculation. With a prevalence of HU use at 33.7% as reported by a study done in Oman [ 10 ] and at a 0.05 level of significance, the sample was estimated at 260 participants. The sickle cell clinic at Mulago Hospital runs daily and that at Kiruddu on Thursday of every week. Patients with SCD who came for assessment were screened using a questionnaire developed for the study and each one of them was informed about the study with the help of a research assistant. Patients who are taking HU or have taken HU were recorded. Patients who are not taking HU were assessed to determine if they fit the criteria for starting HU as described above. If participants responded to any of the above criteria, they were enrolled in the study after obtaining informed consent from research assistants. Patients enrolled were asked to fill out a standardized questionnaire with the help of research assistants. Information obtained included (a) demographic i.e. age, gender, address, level of education, religion, and occupation, (b) time when patient joined the clinic, past and current medications, history of SCD-associated complications and history of admissions, (c) status of HU use and reasons for not initiating HU and possible solutions to these challenges.

Study variables

Independent variables.

We collected data on; age, gender, address, level of education, religion, occupation, commonest complications of SCD experienced, indications for HU use, and the common medications used.

Dependent variables

Our outcomes were willingness to use HU, perceptions about HU use, reasons for not initiating HU and possible solutions to these challenges.

Procedures for data collection and instruments

Quantitative data.

We used a systematic sampling method for the survey. For the quantitative objective, all patients with SCD were screened and those who met the inclusion criteria were enrolled in the study. We therefore included every 4th participant in the survey beginning with the 4th adult until the sample size was attained. We used maximum variation purposive sampling to select the participants for the in-depth interviews. For the survey, we used an interviewer-administered semi-structured questionnaire to collect data on the 259 participants using a questionnaire administered by a research assistant. For the 40 individual interviews, we used an interview guide which was used to collect perceptions on HU. Interviews lasted approximately 10–20 min. Data collection occurred over three months and transcription began as data collection was ongoing.

Data quality control

The questionnaire was pre-tested on 5 participants from the same community to ensure that the questions were clear and understandable to participants. The Questionnaires and Interview guide were translated into the local language and then back-translated to English as part of standard operating procedures such that they have retained their meaning. The research assistants were adequately trained for 7 days and routinely supervised while in the field and the data they were collecting by the principal investigator to ensure the correct use of data collection tools and adherence to ethical principles.

To ensure reliability, we set clear research questions to expand on responses. Qualitative data was collected separately from quantitative data (parallel convergence). Codes and qualitative findings were crosschecked to improve reliability. Consensus between two or more observers was done to establish reliability. We used NVivo version 12 software to manage narrative data.

To ensure validity, all transcripts were checked for accuracy and completeness by the interviewers to enhance data validity. Feedback from research participants (member check) after analysis and interpretation was obtained in an organized results dissemination workshop. Documentation of member checks and interpretations that were changed because of member feedback was done. Triangulation combined quantitative (survey) and qualitative data collection methods (in-depth interviews) in this single study. Triangulation of various data collection methods was used. These included questionnaires, Topic guides (In-depth interviews), transcripts, field notes, and Literature review. This was aimed at verifying information, or facts obtained from using other methods.

Data management and analysis

Quantitative data collected were double-entered into the computer using EPI-DATA (version 3.1) software to minimize data entry errors. Data was exported to STATA version 15 for data cleaning and analysis. Data was then backed up and archived using codes to ensure confidentiality. The descriptive characteristics were presented using frequencies and percentages or proportions in tables. Numerical data was summarized using means and standard deviations for normally distributed continuous data or medians and interquartile ranges for continuous but skewed variables. The prevalence of hydroxyurea use among adult patients was calculated as a proportion of adult patients with SCD who have ever used hydroxyurea out of the total number of participants who are eligible for HU use with its 95% confidence intervals.

The Qualitative study was guided by the ethical principles of the Association of Social Anthropologists. These principles included protecting research participants, anticipating harm, avoiding undue intrusion, rights to confidentiality and anonymity, intellectual property rights, and participant involvement in research. Recording and storing participants’ information was done in a manner that facilitated greater confidentiality and anonymity, including the use of pseudonyms to describe participants during interviews, separation of participants’ ID information from their transcripts, storage of participant information in secured locations and password-protected hard drives, removal of participants names in all research dissemination outputs. Research assistants obtained informed consent prior to start of individual interviews. The Individual interviews were conducted in one-to-one and face-to-face format to provide greater privacy and assure participants of confidentiality. We conducted an inductive thematic analysis collected from individual interviews with different respondent categories such as (20 adolescents or their caregivers and 20 adult patients with SCD). The analysis examined meanings, themes, and patterns that manifested texts from the interviews regarding HU use in two hospitals in Uganda. All audio recordings from open-ended questions based on interview guides were transcribed verbatim. Two coders Individually read each transcript line by line and identified key concepts to develop a coding framework. A coding framework based on eight transcripts that were manually reviewed and coded to generate the initial set of codes that were crosschecked iteratively between two coders (AT & PN) for consensus and to improve reliability. All transcripts were imported into NVivo version 12 software for open coding and management of data. An initial codebook was developed, and the revised codes were grouped into categories and identified themes. Illustrative quotations for each emergent theme were selected for the results narration.

283 participants were assessed and 259 were enrolled in the study as shown in the flow chart, Fig.  1 .

Flow chart showing enrolment profile

Characteristics of adults and adolescents

The total sample size was 259, 221 participants were recruited from the Mulago Hospital sickle cell clinic and 38 from Kiruddu Hospital. At the Mulago sickle cell clinic, the average age was 16 years, with 58.5% being female, and 46% having an education level of secondary. At Kiruddu Hospital, the median age was 24, with 71.1% being female, and 48.1% having an education level of secondary. The average cost of transport to and from the hospital was 11,000 Ugx. The average duration of HU use was 24 months. All this is summarized in Table  1 .

Eligibility for HU use

259 participants met the criteria for HU, 202(78.0%) were taking HU, and 57 participants met the criteria for HU use but were not taking HU. Of those that use HU, 92.1% were current users and 7.9% were past users. HU use among eligible patients is shown in Table  2 .

Patient-related barriers to HU use

Painful crisis was the most common indication for HU use reported in 94.6% of participants, followed by chest syndrome (28%), anemia, 19.4%, and avascular necrosis, 24.7%. indication for HU use is summarized in Table  3 above.

Indications for initiating HU use

The study identified three themes as follows: Patient barriers at the individual, facility, and community level as shown in Tables  4 , 5 and 6 , and 7 . Facilitators for the use of HU and recommendations for improvement as displayed in Table  8 .

Individual barriers

Financial constraints.

The most common reason for stopping HU use was lack of affordability reported by 81.2% of participants. This information is summarised in Table  5 below. The major challenge among 19 (48%) participants from qualitative interviews was financial constraints to buy medication, and food and meet the transport costs to access care.

“There are times when I skipped my medicine doses… Sometimes it was due to money; if I didn’t have the money to buy the tablets. Because we are supposed to buy the tablets—sometimes you go to the pharmacy, and they are expensive, yet you don’t have money. You use the little money you must buy some tablets and they get finished, and I have no money to buy more. So, I first miss some days, and a few times I depend on Panadol and Ibuprofen for emergencies. I take it in case I don’t have the medicine not daily—they told me I could take it occasionally if I am constrained financially and unable to buy the medicine”.

-- IDI, 18, female, adult, Mulago.

Most adults and adolescents were not able to pay for prescribed sickle cell drugs and other ailments because they were expensive.

“… There was no money to buy it because a packet is shs.15,000; just one packet… yet buying it is expensive and I have no money. Now I no longer stay with my father; my mother stays home; she does not work. If my father goes to work and takes a long time there, my mother is suffering to buy the medicine. She buys it for shs. 15,000 but it gets finished in a week, so she must look for more shs. 15,000 to buy another dose”. -- IDI, 19, Male, adolescent, Mulago.

Most of the adolescents said they were unemployed and were mainly dependent on their parent’s support, which was sometimes limited:

“If there is transport because I am always at home. Ever since they fired me from my job, I have been at home”. -- IDI, 3 1, female, adolescent, Mulago.

Inadequate knowledge

Inadequate knowledge about HU among adolescents and adults by few participants. Generally, most individual participants from qualitative (27, 68%) and quantitative (231 (88.2%) across all age categories had a high level of awareness about hydroxyurea and its related benefits as shown in Table  5 below. For the few adult participants who lacked awareness about Hydroxyurea, it was because health workers did not inform them about it, and some had never started on it.

Because I didn’t know about it [Hydroxyurea]; they had never told me about it. So, the doctors asked me, “Have you ever used hydroxyurea?” and I told them, “I don’t know about it . -- IDI, 22, male, adult, Mulago.

Among adolescents, there was low knowledge about HU due to limited sensitization as they did not receive enough health education. Moreover, they reported rumors, myths, and misconceptions about sickle cell in the community.

“Most times what scares them, they say, “Once you start taking the drug and then stop you die”, it scares them as well—okay, the rumors are so many”. -- IDI, 11, Male, youth, Mulago.

Some participants said there was a lack of awareness about Hydroxyurea in the community because they were not sensitized and had not come across people who swallowed it:

“Community people have not been well oriented about Hydroxyurea benefits by the doctors… they have not heard anyone on it so far”. -- IDI, 16_ adult, Mulago.

Persistent pain affected the use of HU

Nearly half (38%) of the participants who participated in individual interviews reported persistent pain despite taking painkillers as a major challenge that hindered proper adherence.

They used to administer painkillers to me since I had a lot of pain! And if the pain comes, it is so strong; it is severe because at school there is a health facility they would do their best with the painkillers but they had no effect. So, they would bring me here” . -- IDI, 28, female, youth, Mulago.

Some participants said they could hardly walk to the health facility due to severe pain, hence missed appointments and picking drugs.

I missed my appointment because I was sick and bedridden, admitted to the hospital. Huh! I feel pain. There are times I could hardly walk…. -- IDI, 10, female, adult, Mulago.

Poor adherence to HU

43% (17, 43%), mainly adolescents from qualitative interviews reported Poor treatment adherence. They missed taking sickle cell medication on time or stopped it for a month or more. The major reasons for missing drugs were pain, running out of drugs, missed appointments to pick drug refills, and lack of funds to buy drugs when they ran out:

“So, when I swallow it in the morning, it takes like 30 minutes, then I go back to normal. But sometimes I miss doses because the medicine is finished before the people at home bring for me more, because I am not near home. They bring it within one week because they also must look for the money to buy it. -- IDI, 28, female, adolescent, Mulago.

Another reason for poor adherence to sick cell medication was forgetfulness. Some participants said they came back from school tired and slept off while others could be distracted by television:

“We leave preps at around 9 pm and I must wash my uniform, I must do this or that. So after, you are exhausted and you just fall on the bed; maybe you say, “Let me read this and swallow the medicine, then I sleep” but before you realize it, they are ringing the bell to wake students up. So that is when I have forgotten and then I remember”. --IDI, 28, female, adolescent, Mulago.

One participant said they had poor access to medication when traveling due to the loss of a loved one and suffered too much pain. They also missed appointments due to illness and admission.”

“I had lost someone. Sometimes, I would be ill and have a lot of pain. I felt too much pain. I missed a dose… Still, I have ever missed taking a dose that was because of my illness. I was admitted”. --IDI, 9, male, adult, Mulago.

Some participants missed drugs due to academic reasons. They could not leave school during the exam period to pick treatment refills.

“There is a time I missed some appointments that in turn made me miss drugs…I am in boarding school and my appointment was due during my examination period, so I was unable to come”. -- IDI, 19, Male, adolescent, Mulago).

One caretaker said adolescent was tired of swallowing several tablets daily hence missed taking drugs on some days.

“Talking about being fed up with the medicine; sometimes I say[caregiver], “I will give you shs.500 if you[adolescent] swallow the medicine”. So personally, when I noticed that on the weekend, she swallows 2000 mg, I said, “Okay, let us leave Monday” and we went against the doctor’s instructions. So honestly, we gave Monday a break; we don’t swallow medicine because she swallowed 2 tablets on Sunday and 2 tablets on Saturday, so we rested on Monday. We resume swallowing it on Tuesday till Sunday, then we rest on Monday. But eh! She totally didn’t like it! So, we discussed and came to that agreement, so that is how we do it”. -- IDI, 30, female, caregiver, Mulago.

Missed routine clinic visits or appointments affected adherence.

Most participants [ 11 ] missed routine clinic visits or appointments mainly because they lacked money for transport to the health facility. The cost of transport for some participants was Ugx 20,000.

“I have never missed a clinic appointment and you said yes…I missed because my mother did not have money for transport, yet she had debts—she had to work so that she could pay the debt she had”. --IDI, 21, female, adolescent, Mulago.

Missed appointments hindered participant’s access to medical care and routine sickle cell monitoring.

“Ever since we started this medication, they told us not to miss any appointments because she must come back and monitor her progress ever since she started hydroxyurea. I believe we won’t miss it again. Previously, we could buy our own medicine but this time round, we won’t miss clinic appointments again”. -- IDI, 14, caregiver, female, Mulago.

Transport constraints were the major reasons for missed appointments. Some participants said they lived at far-off distances from health facilities.

“Since sometimes I live far away and sometimes there is no money for the transport fare… Because there are times when I am suffering symptoms of the illness and I have no transport to bring me to the health Centre for instance now, I just borrowed the money to bring me here. So, I fall sick and swallow the medicine, then I feel better”. -- IDI, 31, female, adult, Mulago.

Only one participant reported that a busy work schedule hindered appointment-keeping.

“I miss appointments because sometimes I am weak, or sometimes I might be busy. I am healthy, but the work I am doing keeps me busy. That is what usually happens”. -- IDI, 22, male, adult, Mulago.

Psychosocial, and emotional challenges

Some participants said they lacked a positive outlook on life. They emphasized they lacked motivation, zeal, and interest to continue taking HU drugs because they had lost hope for a complete cure for sickle cell:

“Sometimes, we lack the zeal to come since we do not have the hope to get completely cured but if the doctor tells you to keep coming and follows you up and encourages you” --IDI, 10, female, adult, Mulago.

Some participants (n = 11, 28%) were anxious and worried to take drugs for life without stopping as they worried could cause undesirable side effects:

“For us that have used it, we experience the benefits, but also worry about the risks like kidney, failure because those are the crucial body organs! So, we worry about all that” --. IDI, 30, female, adult, Mulago.

Some participants (38%) from individual interviews suffered stress due to severe pain especially when they missed medication. They felt bad when missed sickle cell drugs because it would result in painful episodes.

“What I know is that it [hydroxyurea] prevents the painful episodes or controls it but now if you don’t swallow it, the pain returns and this time it is severe. That is what I’m scared of”. --IDI, 20, male, youth, Mulago.

Perceived drug-related side effects affected

Some participants [ 10 ] experienced drug-related side effects that affected adherence to HU, such as headache, dizziness, Painful erections at night, frequent urination, and eyes turned yellow.

“I would have headaches every single day without a break. So, there was a health worker we asked while I was admitted, and he said this drug does not cause headaches and we ignored the issue. But it was a severe headache; they first stopped me from taking it for some time… And they [doctors] told her to stop taking it for 2 weeks and that’s what she did”. --IDI, 24, female, adolescent, and caregiver, Mulago.

Some participants were anxious and worried about taking drugs for life without stopping as they worried could cause undesirable side effects:

“For us that have used it, we experience the benefits, but also worry about the risks like kidney, failure because those are the crucial body organs! So, we worry about all that”. --. IDI, 30, female, adult, Mulago.

Facility-related barriers

Long queues.

Long queues that led to poor quality of care were also reported in the hospital. Some participants were concerned about doctors who left without attending to them, yet they were in severe pain.

“ Anha! Sometimes you go and they tell you, “The time is up; the doctor is leaving, the patients’ queue was long”, sometimes you go and there is no medicine”. -- IDI, 5, female, adult, Mulago.

Some participants said there was no counseling support at the health facility regarding sickle cell at the health facility:

“Uh, they [doctors] did not support me when I missed my appointment. When I came, I was registered and given treatment. They did not do anything else or give me any form of counseling”. --IDI, 9, male, adult, Mulago .

Drug stock-outs

Drug stock-outs were mainly reported by adults. lack of sickle cell medication and other drugs in public health facilities leads patients to run out of drugs. They were told to buy the prescribed drugs from other private pharmacies to resolve issues of drug stock-outs, yet they could not afford them.

“About a month. Initially, they would give us three or six sachets of medicine. They can give you medicine for a two months or three months dose. Then, I buy the rest in the pharmacy. The challenge is some pharmacies do not have it in stock”. -- IDI, 10, female, adult, Mulago.

Some participants reported a lack of free medication in public hospitals.

“…Because even if you find someone and say, “Please help me with shs. 30,000 to buy medicine” they tell you, “Go to Mulago, medicine is there free of charge!” But they don’t know the problem is you will get there and fail to get it”. -- IDI, 5, female, adult, Mulago.

Poor communication with health providers

One participant said they did not report drug-related side effects they experienced to healthcare workers due to forgetfulness.

“I forgot to tell the health workers about the side effects I suffered. Sometimes I simply forget all about it and ignore it and say, “As long as it [side effect] is over, I continue swallowing…Now these health workers initiated me into that medicine and told me to swallow it. I would never skip a dose. They told me to swallow it from Monday to Friday, then I take a different dose for the weekend, and then it is the same for the following week”. -- IDI, 19, Male, Youth, Mulago.

Community-based barriers

Some participants reported that rumors, myths, and misconceptions were the major concerns about sickle cell in the community.

“Most times what scares them, they say, “Once you start taking the drug and then stop you die”, it scares them as well—okay, the rumors are so many” -- IDI, 11, Male, youth, Mulago.

Some participants said there was limited access to sickle cell medication in their nearby community health facilities:

“One time my leg was in severe pain; I had not yet seen the doctor. So, if the health facility was nearby—at that time I would go to Nakaseke, and they work on me. But now, there are no health workers who handle sickle cell cases in Namuwogga”. -- IDI, 27, female, adult Mulago.

Family disagreements or conflict arises from lack of financial provision by man for woman to take child to hospital:

“Sometimes we get challenges, and it affects the family. We even get disagreements between the mother and father; sometimes you are supposed to take the child and he says, “I have no money! If you can go, then go. If you are unable to go, you will go some other time” yet the appointment date is due. So, those are some of the challenges we experience” -- IDI, 26, female, caregiver Mulago.

Facilitators for the use of HU

Facilitators reported by participants were mainly at the Individual and facility level as displayed in Table  7 .

Individual level

Positive perception of HU among adolescents and adults facilitated its utilization. Hydroxyurea use was described as effective pain relief, symptom control, and good and helpful treatment among most of the qualitative participants (n = 28, 70%). This was because it mainly relieved and prevented painful sickle cell episodes, stroke, and malaria. One participant said she received pain relief having taken hydroxyurea, she also read via a Google search about weight gain benefits related to hydroxyurea’s use.

“I suffered severe pain before you started taking it [Hydroxyurea]. The pain was severe! It was so strong that sometimes I could faint because the pain was overwhelming…So far, it is not a bad medicine; it has helped us to decrease the pain so that it is not severe”. -- IDI, 3, female, adolescent, Kiruddu.

Patients reported that Hydroxyurea use improves quality of life as it reduces opportunistic infection and frequenting of hospitals by patients.

“The medicine can make you not go to the hospital every day because the day I began taking the medicine, I stopped going to the hospital. I stopped having infections. The medicine can protect you from getting sick in the cold. You can do anything even when you do not put on a sweater. You feel better. Even if you feel pain, it is not so much”- . - IDI, 15, adult male, Mulago.

Some participants illustrated the ability to do daily activities or tasks very well after using hydroxyurea. They said they had the energy to wash, cook, and perform house chores. Hydroxyurea uses enhanced mobility as one participant said could travel on long journeys having taken it.

“Initially, my back would hurt whenever I would walk a distance such as from this place to home which is no longer the case. I am better. I can perform my tasks very well. I wash, cook, and do everything very well”. --IDI, 9, male, adult, Mulago.

Participants said hydroxyurea use regulated the blood levels and reduced the level of the disease in the body or the blood.

“It seems when we had just gotten initiated onto hydroxyurea, the body was not yet used to it, so the blood levels were a bit unstable. Because when we initiated her onto hydroxyurea, they first checked her blood levels and all that. When we had just initiated her, her blood levels went down, and they initiated her back onto the drug around 2018 in December. And ever since that time, we have not had challenges with her blood levels, expect just eating lots of avocado to supplement”. -- IDI, 30, female, caregiver, Mulago.

Patients reported that Hydroxyurea use prevents a child from anemia, stroke, and other complications.

“Those [patients in waiting area] I have heard them say that it has worked for them; those I have heard especially while we are seated. They say it was effective for them; if the child had many pain episodes, they reduced. Or if the blood levels were reduced—even my brother; he used to have anemia and the pain was severe but when he started swallowing it, it started to reduce”. --IDI, 24, female, caregiver, Mulago.

Long duration on HU, enhanced patient confidence. Most of the participants were aware of hydroxyurea because they had experienced taking it for more than a year which enhanced their confidence. Duration on medication among most participants was between one to eleven years, few took it for less than a year.

“I started hydroxyurea this year in January; we came for a check-up after I went to school because I’m in boarding. Now usually when you take hydroxyurea—remember it is daily, every day I must— “ . --IDI, 28, female, adolescent, Mulago.

Facility level

Information shared by healthcare workers about HU enhanced its uptake. Health providers prescribed hydroxyurea and shared information about it through health education and seminars. They taught about the benefits and risks, the importance of hydroxyurea, and the need for patients to alert doctors in case they experienced unusual Side effects.

“…for us, we got to learn about the side effects from the doctors. But while we were at the seminar, they taught us that it is under the supervision of the doctors, who check frequently. But when we gather as women, those who know and those who don’t know, they say, “It burns the liver and the kidneys”, others say, “It is expensive”. But since you have some knowledge about it, you are firm and whatever you notice about it, you inform the doctor, “Doctor, I notice my fingers are turning” and they counsel you. Because even if we are taking it, as parents we are worried”. -- IDI, 30, female, adult, Mulago.

Healthcare workers performed testing to confirm the diagnosis of sickle cell before treatment initiation that enhanced treatment prescription. There was only one participant who said was started on treatment after symptom identification such as joint and leg swelling.

“I was then diagnosed with sickle cells. So, they asked them, “What signs have you noticed?” Then they said that they saw my joints and legs swelling. So, they got to understand and prescribe medication”. -- IDI, 10, female, adult, Mulago.

The availability of HU drugs enhanced its uptake. Some participants said they bought sickle cell medication from private pharmacies or clinics whenever drugs were not available at public health facilities.

“They [doctors from public facility] gave me the prescription and told me to buy it. So, I bought and took it from the private pharmacy, it was finished. So, after a while, I bought more medicine, but they told us we had to swallow it every day”. -- IDI, 5, female, adult, Mulago.

Recommendations from participants on how to alleviate barriers to SCD care

The major recommendation to patients was for patients to receive continuous advice and encouragement from healthcare workers. They particularly desired health workers to remind them about perfectly adhering to Hydroxyurea because it reduced the constant attacks and kept them healthy. They could advise them to set up reminders such as alarms for perfect adherence.

“We need to receive advice from the health workers. Sometimes, we lack the zeal to come since we do not have the hope to get completely cured but if the doctor tells you to keep coming and follows you up and encourages you” --IDI, 10, female, adult, Mulago.

Patients need to be told about the benefits of hydroxyurea, so that they may accept its early initiation and follow the doctor’s instructions.

“In order to accept the drug; we must tell them about the advantages of hydroxyurea. And I think we should also give them examples; I don’t know if you the health workers see that—personally, my child; I know that when she started taking hydroxyurea, her health condition became better. I regretted why they didn’t tell me earlier, but I feared it because I heard them say, “Once she gets initiated onto it, she takes it for life” and I would say, “Argh!” I was quite afraid of it. But I realized that in this life, many people are taking medicine daily and it helps them. [Hmmm] Maybe Musawo, the question I want to ask you today is, if the person grows up and gets to the child-bearing age, does she stop taking hydroxyurea”. -- IDI, 26, female, caretaker, Mulago.

Continuous sensitization about the benefits and risks of hydroxyurea, to create awareness.

“Other people need more teaching about the thing, and telling them, “If the child takes it, it will reduce the number of times you come here due to the child’s severe health condition” -. - IDI, 28, female, Youth, Mulago.

Counseling hydroxyurea should be done as well as counseling patients to value life.

“A way of encouraging people is to educate them about how important their health is; he shouldn’t be discouraged because he is neither the first nor last because there are many people out there who are ill, but everyone must believe in themselves so that they are healthy. So, if my parent cares, I also must care for myself to make sure I am healthy for the sake of my parent, instead of saying, “I don’t want to swallow medicine” one must sacrifice! --IDI, 18, female, adult, Mulago.

A peer-to-peer approach using experienced patients encourages patients to support each other and testify about the benefits of adhering to sickle cell treatment.

“…there is a school with children who suffer from sickle cell who are about 10. So, they asked me for advice, “Should we swallow hydroxyurea?” because I have spent 7 years. And I told them, “You swallow it, I also swallow it” I don’t discourage them because I have grown up without hydroxyurea. But I said the young ones know that it is helpful to them, so I cannot tell them about the fingernails turning black. Because I see their fingernails; they are not as black as I teach them different vocational skills in their school and they ask me, “Do you also swallow this medicine?” and I tell them I swallow it. But I do notice them. -- IDI, 27, female, adult Mulago.

Need financial support to start up a business as a source of income for medication to meet transport, food, and other needs.

“I was thinking, since she has finished Senior 6, maybe I could start up a small business for her so that she earns some money. Even if she gets shs. 2000, she saves it for clinic appointments and buying medicine” --IDI, 24, female, youth, Mulago.

Urge patients to drink plenty of water and mind their diet and clothing.

“They [patients] should be cautious of the cold weather by wearing a scarf. You should take water instead of Soda, minute maid [ soft drink] because that is not recommended. You would rather buy passion fruits and make your juice since the other drinks contain acids that are not good. I would rather drink water instead of drinking those other drinks. [Okay! ] You must wear a sweater when it is cold and desist from drinking cold water in the cold weather. You must mix it with hot water to become warm”. -- IDI, 17, female, Mulago.

Health facility based

Healthcare workers should address the fears and rumors about sick cell disease and treatment.

“You should address their fears and the rumors because personally, that is what made me afraid at first” -- IDI, 4, male, adult, Mulago.

Healthcare workers should advise/encourage patients to adhere to sickle cell medication:

“You must encourage the patient just like you would say, “You have to swallow folic acid because it increases the blood in the body, if you miss, then the blood levels reduce yet these cells need blood”. So even for that medicine, he/she must swallow it—so one must swallow it daily just as one did for folic acid” –. - IDI, 22, male, adult, Mulago.

There should be free drugs availed at the health facilities:

“Another thing is medicine is expensive! So, what will encourage us to come is, we should get free medicine if it is there. But the one we used to take was easy to access; if they bring us that medicine and at least we get it, find it here, then I am certain that we won’t miss any clinic appointment. Because when you come, you expect to go back with medicine, all you must do is invest in the transport”. -- IDI, 14, female, caretaker, Mulago.

Healthcare managers should ensure a consistent and sufficient drug supply.

Doctors should do follow-ups of patients and set up reminder mechanisms to adhere to treatment and keep routine clinic visits.

“Now there is a certain lady, they gave it to her and after it got finished, she stopped there claiming, “I thought you must give it to us. It is expensive in the pharmacies, and I thought I had to get it from here. Why would I buy it?” She was like, “Who is buying the medicine? Me? It is expensive! If you are giving it to us, give it to us consistently”. Other people need more teaching about the thing, and telling them, “If the child takes it, it will reduce the number of times you come here due to the child’s severe health condition” -- IDI, 28, female, Youth, Mulago.

Healthcare facilities should plan to offer transport refunds to sickle cell patients, “Support us by giving us money for the transport fare. Sometimes we are unable to afford it”.

“Apart from the government supplying the medicine; maybe about the transport as well. If they can, they could organize for us some transport when we are bringing them here because these children—sometimes we get challenges, and it affects the family. We even get disagreements between the mother and father; sometimes you are supposed to take the child and he says, “I have no money! If you can go, then go. If you are unable to go, you will go some other time” yet the appointment date is due. So, those are some of the challenges we experience”. -- IDI, 26, female, youth, Mulago.

Health facilities should allow credit options for patients who lack funds to buy drugs.

“What I think—okay, is it possible to give the people the drugs today and they pay for it another time; you record it down. I want them [doctors] to give us patients] the medicine on credit then they pay later”. --IDI, 20, male, youth, Mulago.

Financial empowerment for women to support sickle cell children at the family level should be done. Work opportunities or Income generation activity (IGA) for caregivers or sickle cell patients should be identified.

“So, we [women] must hustle even more than men—sometimes we come and there is no medicine completely! …for our children, we should be assisted in that regard, train us in income generation activities to support our children’’ -.

-- IDI, 30, female, adult, Mulago.

Community-based

Extension of sickle cell health services to the communities and local districts should be done to resolve the issue of transport.

“We need health facilities in every district because sickle cell patients are quite a number. In my village I was the only one and the whole world knew that I had the ‘virus’ as they used to call it. [Hmmm] and it hindered the boy who almost married me; they told him, “Don’t bother! That one is going to die”. But now… we need those health facilities”. -- IDI, 27, female, adult Mulago. “…they could put up health facilities in communities with health workers who handle sickle cells because you leave the place in severe pain—one time my leg was in severe pain; I had not yet seen the doctor. So, if the health facility was nearby—at that time I would go to Nakaseke, and they work on me. But now, there are no health workers who handle sickle cell cases in Namuwogga” -. -IDI, 27, female, adult Mulago.

Sensitization of patients and community people about Hydroxyurea should be done.

“Patients should be intensively sensitized about it [hydroxyurea] so that they can understand it very well. They should sensitize them so that they understand very well how effective it is”. -- IDI, 32, female, adult, Mulago.

Government should reduce the price of sickle cell medicine to enhance access for all patients.

“If it is possible—because most times the drugs are not in stock here, so they should reduce on the price or cost of the medicine…reduce the cost of that medicine. Some people cannot even start taking it; they live far away, from where they get the medicine, yet it is also expensive. So, it would hinder him or her from accessing it”. -- IDI, 11, Male, youth, Mulago.

The government should put up sickle cell health facilities in rural areas:

“Government should supply the medicine to the health facilities in the rural areas. Supply the medicine for sickle cell disease because even in the government health facilities; if you want medicine, they tell you it is out of stock because I have ever gone there when my drugs were over”. -- IDI, 13, female, youth, Mulago.

The government could support patients by providing more drugs in the health facility or in our clinic here:

“Government should supply the medicine to the health facilities in the rural areas. Supply the medicine for sickle cell disease because even in the government health facilities; if you want medicine, they tell you it is out of stock because I have ever gone there when my drugs were over” -- IDI, 13, female, youth, Mulago.

There is a need for a collaborative partnership with international or non-governmental organizations to support sickle cell patients:

Now, the government; because I have ever been NTV, talking about this issue. Just like they support our friends with HIV, they should also find international organizations to support us as well. Because HIV is serious, these patients are difficult! At least they could get for us only the capsules. -- IDI, 24, female, youth, Mulago.

The overall prevalence of HU use among participants who qualify for its use was high at 78%. This is the first study in Uganda to document the prevalence of HU use among patients with SCD. A literature search didn’t yield any studies documenting the prevalence of HU use among eligible patients. A Nigerian study that assessed Hydroxyurea utilization as a lesson in Public Health found that 65% of patients assessed were eligible for HU use and zero were using it, 5% of patients had been informed of or were aware of hydroxyurea as a treatment option for sickle cell disease [ 12 ]. In our study, though 88.2% of patients knew HU as treatment for SCD.

The high prevalence use of HU found in our study is unlike what other studies found in Africa, this is not uncommon given the high prevalence of SCD in these regions of the world. The high prevalence of use is explained by policies that encourage treatment of SCD e.g., HU is listed on the essential medicine list informed by the high prevalence of SCD hence it is procured and made available up to national referral hospitals. Patients are reviewed by healthcare workers in national referral hospitals who are experts in their field, and such are up to date with the latest management protocols for SCD, this is a key driver in the high prescription rate of HU.

In this study, patient-related barriers to HU use included financial constraints, poor adherence to sickle cell medication, missed routine clinic visits or appointments, psychosocial and emotional challenges, poor communication with health providers, and drug-related side effects (headaches, dizziness, frequent urination and yellowing of eyes).

To the best of our knowledge, this is the first study to document patient-related barriers to HU use among patients with SCD in Uganda. These barriers are like those reported by a cross-sectional survey done in Nigeria. Among patients and caregivers, barriers included lack of knowledge; perceived side effects; cost; religious beliefs of disease causation; and lack of pediatric formulation [ 13 ]. Another study done in Chicago, USA, looked at barriers to hydroxyurea adherence and health-related quality of life in adolescents and young adults with sickle cell disease, they found participants reported negative beliefs/motivational barriers (32%), recall barriers/forgetfulness (44%), and access barriers/paying for hydroxyurea and/or getting refills on time (32%) [ 14 ]. Another study looked at barriers to the use of hydroxyurea in the management of sickle cell disease in Nigeria, reported side effects profiles as the commonest barrier, reported concern for infertility (52.0%), and safety profile of HU in pregnancy and lactation (48.2%) [ 15 ]. A U.S. regional collaborative report on barriers to hydroxyurea use from the perspectives of providers, individuals with sickle cell disease, and families found providers and patient/caregiver reports about hydroxyurea use were inconsistent with one another; adults 26 years and older were least likely to be on hydroxyurea; and the likelihood of being on hydroxyurea decreased with one or more barriers, they also found that, even for patients on hydroxyurea, challenges to taking the medicine at the right time and forgetting were crucial unintentional barriers to adherence. Intentional barriers such as worry about side effects and “tried and it did not work” were important barriers for young adults and adults [ 16 ].

These barriers are not uncommon or unique since SCD is a chronic disease that requires daily medication. Similar challenges are experienced by other patients with chronic conditions [ 17 ]. Patients are bound to get treatment fatigued leading to poor adherence and missed appointments, get depressed, and sometimes suicidal. SCD is prevalent in the black population most of whom are residing in resource-limited settings like sub-Saharan Africa where finances are a major factor in accessing health care. Even in the US, SCD is prevalent among the black population [ 14 ] and most of these populations experience socioeconomic inequalities in developed countries.

These challenges are correlated in that financial constraints coupled with treatment fatigue led to poor adherence to treatment missed appointments, and psychosocial and emotional intrigue.

Other barriers reported were categorized as facility and these included drug stockouts, poor quality of care (referred as few health personnel to attend to them, and lack of counseling services). Community barriers included knowledge gaps and poor access to sickle cell medication in nearby health centers.

These barriers have been reported by other studies, in Nigeria, among clinicians, barriers included limited knowledge of the drug, as well as low self-efficacy to prescribe among physicians and to counsel among nurses; perceived side effects; perceived patient preference for traditional medicine; cost for patient and expense of accompanying laboratory monitoring; and limited availability of the drug and equipment for laboratory monitoring [ 18 ]. Another study in Nigeria reported barriers to hydroxyurea utilization identified by practitioners included safety and toxicity profile (100%), patient compliance (100%), effective follow-up (100%), drug availability (100%), affordability (100%) and specifically concern for reactivation of latent tuberculosis (50%) and carcinogenesis (100%) and teratogenicity (100%) [ 12 ].

In Africa, drug stockouts are a commonality, it is especially more pronounced if the medicine is used for chronic care like HU for SCD as opposed to an acute illness. Government programs support access to life-saving medications for human immunodeficiency virus (HIV), Tuberculosis (TB), and malaria; however, this is not the case for SCD. Advocacy efforts to sustain the continued availability of HU in the SCD treatment program are necessary.

Suggested recommendations by participants included; continuous advice and encouragement from health care workers, continuous sensitization about the benefits and risks of hydroxyurea to create awareness, peer to peer approach using experienced patients to support each other, the need for financial support to start up a business as a source of income for medication to meet transport, food, and other needs, self-motivation and self-love is needed among patients and urge patients to drink plenty of water and mind their diet and clothing.

These recommendations have been suggested by other studies i.e., prospective evaluation of patient’s perceptions of SCD and hydroxyurea in relation to adherence, HRQOL domains, and clinical outcomes is warranted [ 11 ].

Training of sickle cell care providers to attain and maintain competence in the use of hydroxyurea for the treatment of SCD was recommended by the researchers of the study on the level of utilization and provider-related barriers to hydroxyurea use in the treatment of SCD in Jos, Nigeria [ 19 ]. Researchers from an Irish study on the Irish SCD population reported that the smartphone app was expressed by the majority, with daily medication reminders being the most popular feature [ 11 ].

The suggested recommendations by participants are like interventions already in play in other public health programs such as comprehensive HIV treatment and care programs [ 20 ]. Such programs include social economic empowerment activities that equip them with skills for independent income generating for the sustenance of basic care. This allows patients to afford complementary medication, and nutrition and facilitates adherence to clinic appointments [ 21 ]. Such can be adapted into the SCD management program to offset challenges related to finances. With financial empowerment, all the other correlated challenges will be lessened.

Patients recognize the importance of medical information in advancing compliance with treatment. Programs geared towards increasing healthcare knowledge on novel SCD treatments like HU should be promoted. This will trickle down to more quality medication counseling provided to patients which will then lead to medication compliance. Expert patients could be trained to be peer influencers, by equipping them with information, educational, and communication material necessary to empower fellow patients psychosocially. This strategy has been successfully implemented in other public health challenges e.g., HIV and TB [ 22 ].

Other recommendations were health facility-based and these included; Healthcare workers should advise and encourage patients to adhere to sickle cell medication, There should be free drugs availed at the health facilities, Health managers should ensure consistent and sufficient drug supply, Health care workers should create awareness to patients about benefits of sickle cell treatment, Health care workers should offer continuous advice, health education to patients, Health care facilitates should plan to offer transport refund to sickle cell patients, Health facilities should allow credit options for patients who lack funds to buy drugs.

Community-based recommendations included the extension of sickle cell health services to the communities and local districts should be done to resolve the issue of transport, and Sensitization of patients and community people about Hydroxyurea.

Task shifting in terms of personnel and medication is necessary for grassroots accessibility. Such models have been implemented to improve life-saving therapy like ART for HIV-infected patients and disseminated drug delivery models [ 23 ].

National-based recommendations included the government reducing the price of sickle cell medicine to enhance access for all patients, the Government putting up sickle cell health facilities in rural areas, and there is need for a collaborative partnership with international or non-governmental organizations to support sickle cell patients.

Study limitations

This study was carried out at national referral hospitals which have a better supply of medicines and health care experts in the management of SCD, this created selective bias because the quality of care is not generalizable to other health centers in the country. Future research directions should include national surveys to understand the magnitude of the barriers to better government planning in the allocation of resources.

Because of the Cross-sectional nature, of the quantitative section, we were not able to determine causation but could only determine the association between HU use and patient-related barriers to HU use.

Study strengths

The study was conducted at two national referral hospitals that are in the central region of Uganda. This region has one of the highest prevalence of SCD The central region of Uganda is metropolitan with individuals coming in from different parts of Uganda so the SCD population may be representative. The findings of this study are therefore representative of the sickle cell population in Kampala which is the capital city of Uganda.

This is a mixed-method study, so the qualitative aspects of the study helped to explain the results of the quantitative findings. For example, in this study, we now know that lack of affordability is the reason why most patients have never been on HU even if it is indicated or stop using it when they need it.

Implementing the use of HU has been challenging in Uganda and needs improvement. Facilitators to hydroxyurea use have been highlighted, though Patient-identified barriers at individual, facility, and community levels that need to be resolved. The experiences and insights shared by our participants provide invaluable guidance for increasing the uptake of HU. Further studies are needed to establish validated instruments to assess patients’ pain communication and adherence to the HU regimen. The prevalence of HU use among eligible patients is high at 78%.

Data availability

The datasets used and/or analyzed during the current study are available at https://github.com/PNamaganda/Sickle-cell-Data-in-Uganda. Deidentified data and analyzed data for this manuscript are available from the corresponding author upon request.

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Acknowledgements

We acknowledge the patients of Mulago Hospital SCD clinic and Kiruddu Hospital who gave us consent to obtain this information.

This study was funded with funds from Novartis Pharmaceuticals. The funding project had no role in the design of the study and collection, analysis, and interpretation of data and no role in writing the manuscript.

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Priscilla Namaganda

Infectious Disease Institute, Makerere University, Kampala, Uganda

Patience Nantume, Adelliine Twimukye & Christine Sekaggya Wiltshire

Uganda Cancer Institute, Kampala, Uganda

Kelvin Roland Mubiru

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PN– conception, design of work, acquisition, analysis, interpretation of data, drafted and substantively revised the manuscript, PN– data collection, data entry, data cleaning KM – Quantitative data analysis. AT– Qualitative data analysis, CS- design of work, acquisition, analysis, interpretation of data, drafted and substantively revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Priscilla Namaganda .

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Written informed consent/ assent was obtained from all participants or their parent/guardian or legally authorized representative to participate in the study. Ethical approval was obtained from the Infectious Disease Institute Research Ethic Committee, IDIREC REF 037/2021. All methods and procedures were carried out in accordance with relevant guidelines and regulations.

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All data collection methods and analysis were carried out in accordance with relevant Good clinical care practice (GCP) guidelines and regulations.

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Namaganda, P., Nantume, P., Mubiru, K.R. et al. Understanding patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, Uganda, a qualitative study. BMC Health Serv Res 24 , 666 (2024). https://doi.org/10.1186/s12913-024-11125-6

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Received : 24 November 2023

Accepted : 20 May 2024

Published : 27 May 2024

DOI : https://doi.org/10.1186/s12913-024-11125-6

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