research design for qualitative studies

Chapter 2. Research Design

Getting started.

When I teach undergraduates qualitative research methods, the final product of the course is a “research proposal” that incorporates all they have learned and enlists the knowledge they have learned about qualitative research methods in an original design that addresses a particular research question. I highly recommend you think about designing your own research study as you progress through this textbook. Even if you don’t have a study in mind yet, it can be a helpful exercise as you progress through the course. But how to start? How can one design a research study before they even know what research looks like? This chapter will serve as a brief overview of the research design process to orient you to what will be coming in later chapters. Think of it as a “skeleton” of what you will read in more detail in later chapters. Ideally, you will read this chapter both now (in sequence) and later during your reading of the remainder of the text. Do not worry if you have questions the first time you read this chapter. Many things will become clearer as the text advances and as you gain a deeper understanding of all the components of good qualitative research. This is just a preliminary map to get you on the right road.

Research Design Steps

Before you even get started, you will need to have a broad topic of interest in mind. [1] . In my experience, students can confuse this broad topic with the actual research question, so it is important to clearly distinguish the two. And the place to start is the broad topic. It might be, as was the case with me, working-class college students. But what about working-class college students? What’s it like to be one? Why are there so few compared to others? How do colleges assist (or fail to assist) them? What interested me was something I could barely articulate at first and went something like this: “Why was it so difficult and lonely to be me?” And by extension, “Did others share this experience?”

Once you have a general topic, reflect on why this is important to you. Sometimes we connect with a topic and we don’t really know why. Even if you are not willing to share the real underlying reason you are interested in a topic, it is important that you know the deeper reasons that motivate you. Otherwise, it is quite possible that at some point during the research, you will find yourself turned around facing the wrong direction. I have seen it happen many times. The reason is that the research question is not the same thing as the general topic of interest, and if you don’t know the reasons for your interest, you are likely to design a study answering a research question that is beside the point—to you, at least. And this means you will be much less motivated to carry your research to completion.

Researcher Note

Why do you employ qualitative research methods in your area of study? What are the advantages of qualitative research methods for studying mentorship?

Qualitative research methods are a huge opportunity to increase access, equity, inclusion, and social justice. Qualitative research allows us to engage and examine the uniquenesses/nuances within minoritized and dominant identities and our experiences with these identities. Qualitative research allows us to explore a specific topic, and through that exploration, we can link history to experiences and look for patterns or offer up a unique phenomenon. There’s such beauty in being able to tell a particular story, and qualitative research is a great mode for that! For our work, we examined the relationships we typically use the term mentorship for but didn’t feel that was quite the right word. Qualitative research allowed us to pick apart what we did and how we engaged in our relationships, which then allowed us to more accurately describe what was unique about our mentorship relationships, which we ultimately named liberationships ( McAloney and Long 2021) . Qualitative research gave us the means to explore, process, and name our experiences; what a powerful tool!

How do you come up with ideas for what to study (and how to study it)? Where did you get the idea for studying mentorship?

Coming up with ideas for research, for me, is kind of like Googling a question I have, not finding enough information, and then deciding to dig a little deeper to get the answer. The idea to study mentorship actually came up in conversation with my mentorship triad. We were talking in one of our meetings about our relationship—kind of meta, huh? We discussed how we felt that mentorship was not quite the right term for the relationships we had built. One of us asked what was different about our relationships and mentorship. This all happened when I was taking an ethnography course. During the next session of class, we were discussing auto- and duoethnography, and it hit me—let’s explore our version of mentorship, which we later went on to name liberationships ( McAloney and Long 2021 ). The idea and questions came out of being curious and wanting to find an answer. As I continue to research, I see opportunities in questions I have about my work or during conversations that, in our search for answers, end up exposing gaps in the literature. If I can’t find the answer already out there, I can study it.

—Kim McAloney, PhD, College Student Services Administration Ecampus coordinator and instructor

When you have a better idea of why you are interested in what it is that interests you, you may be surprised to learn that the obvious approaches to the topic are not the only ones. For example, let’s say you think you are interested in preserving coastal wildlife. And as a social scientist, you are interested in policies and practices that affect the long-term viability of coastal wildlife, especially around fishing communities. It would be natural then to consider designing a research study around fishing communities and how they manage their ecosystems. But when you really think about it, you realize that what interests you the most is how people whose livelihoods depend on a particular resource act in ways that deplete that resource. Or, even deeper, you contemplate the puzzle, “How do people justify actions that damage their surroundings?” Now, there are many ways to design a study that gets at that broader question, and not all of them are about fishing communities, although that is certainly one way to go. Maybe you could design an interview-based study that includes and compares loggers, fishers, and desert golfers (those who golf in arid lands that require a great deal of wasteful irrigation). Or design a case study around one particular example where resources were completely used up by a community. Without knowing what it is you are really interested in, what motivates your interest in a surface phenomenon, you are unlikely to come up with the appropriate research design.

These first stages of research design are often the most difficult, but have patience . Taking the time to consider why you are going to go through a lot of trouble to get answers will prevent a lot of wasted energy in the future.

There are distinct reasons for pursuing particular research questions, and it is helpful to distinguish between them.  First, you may be personally motivated.  This is probably the most important and the most often overlooked.   What is it about the social world that sparks your curiosity? What bothers you? What answers do you need in order to keep living? For me, I knew I needed to get a handle on what higher education was for before I kept going at it. I needed to understand why I felt so different from my peers and whether this whole “higher education” thing was “for the likes of me” before I could complete my degree. That is the personal motivation question. Your personal motivation might also be political in nature, in that you want to change the world in a particular way. It’s all right to acknowledge this. In fact, it is better to acknowledge it than to hide it.

There are also academic and professional motivations for a particular study.  If you are an absolute beginner, these may be difficult to find. We’ll talk more about this when we discuss reviewing the literature. Simply put, you are probably not the only person in the world to have thought about this question or issue and those related to it. So how does your interest area fit into what others have studied? Perhaps there is a good study out there of fishing communities, but no one has quite asked the “justification” question. You are motivated to address this to “fill the gap” in our collective knowledge. And maybe you are really not at all sure of what interests you, but you do know that [insert your topic] interests a lot of people, so you would like to work in this area too. You want to be involved in the academic conversation. That is a professional motivation and a very important one to articulate.

Practical and strategic motivations are a third kind. Perhaps you want to encourage people to take better care of the natural resources around them. If this is also part of your motivation, you will want to design your research project in a way that might have an impact on how people behave in the future. There are many ways to do this, one of which is using qualitative research methods rather than quantitative research methods, as the findings of qualitative research are often easier to communicate to a broader audience than the results of quantitative research. You might even be able to engage the community you are studying in the collecting and analyzing of data, something taboo in quantitative research but actively embraced and encouraged by qualitative researchers. But there are other practical reasons, such as getting “done” with your research in a certain amount of time or having access (or no access) to certain information. There is nothing wrong with considering constraints and opportunities when designing your study. Or maybe one of the practical or strategic goals is about learning competence in this area so that you can demonstrate the ability to conduct interviews and focus groups with future employers. Keeping that in mind will help shape your study and prevent you from getting sidetracked using a technique that you are less invested in learning about.

STOP HERE for a moment

I recommend you write a paragraph (at least) explaining your aims and goals. Include a sentence about each of the following: personal/political goals, practical or professional/academic goals, and practical/strategic goals. Think through how all of the goals are related and can be achieved by this particular research study . If they can’t, have a rethink. Perhaps this is not the best way to go about it.

You will also want to be clear about the purpose of your study. “Wait, didn’t we just do this?” you might ask. No! Your goals are not the same as the purpose of the study, although they are related. You can think about purpose lying on a continuum from “ theory ” to “action” (figure 2.1). Sometimes you are doing research to discover new knowledge about the world, while other times you are doing a study because you want to measure an impact or make a difference in the world.

Basic research involves research that is done for the sake of “pure” knowledge—that is, knowledge that, at least at this moment in time, may not have any apparent use or application. Often, and this is very important, knowledge of this kind is later found to be extremely helpful in solving problems. So one way of thinking about basic research is that it is knowledge for which no use is yet known but will probably one day prove to be extremely useful. If you are doing basic research, you do not need to argue its usefulness, as the whole point is that we just don’t know yet what this might be.

Researchers engaged in basic research want to understand how the world operates. They are interested in investigating a phenomenon to get at the nature of reality with regard to that phenomenon. The basic researcher’s purpose is to understand and explain ( Patton 2002:215 ).

Basic research is interested in generating and testing hypotheses about how the world works. Grounded Theory is one approach to qualitative research methods that exemplifies basic research (see chapter 4). Most academic journal articles publish basic research findings. If you are working in academia (e.g., writing your dissertation), the default expectation is that you are conducting basic research.

Applied research in the social sciences is research that addresses human and social problems. Unlike basic research, the researcher has expectations that the research will help contribute to resolving a problem, if only by identifying its contours, history, or context. From my experience, most students have this as their baseline assumption about research. Why do a study if not to make things better? But this is a common mistake. Students and their committee members are often working with default assumptions here—the former thinking about applied research as their purpose, the latter thinking about basic research: “The purpose of applied research is to contribute knowledge that will help people to understand the nature of a problem in order to intervene, thereby allowing human beings to more effectively control their environment. While in basic research the source of questions is the tradition within a scholarly discipline, in applied research the source of questions is in the problems and concerns experienced by people and by policymakers” ( Patton 2002:217 ).

Applied research is less geared toward theory in two ways. First, its questions do not derive from previous literature. For this reason, applied research studies have much more limited literature reviews than those found in basic research (although they make up for this by having much more “background” about the problem). Second, it does not generate theory in the same way as basic research does. The findings of an applied research project may not be generalizable beyond the boundaries of this particular problem or context. The findings are more limited. They are useful now but may be less useful later. This is why basic research remains the default “gold standard” of academic research.

Evaluation research is research that is designed to evaluate or test the effectiveness of specific solutions and programs addressing specific social problems. We already know the problems, and someone has already come up with solutions. There might be a program, say, for first-generation college students on your campus. Does this program work? Are first-generation students who participate in the program more likely to graduate than those who do not? These are the types of questions addressed by evaluation research. There are two types of research within this broader frame; however, one more action-oriented than the next. In summative evaluation , an overall judgment about the effectiveness of a program or policy is made. Should we continue our first-gen program? Is it a good model for other campuses? Because the purpose of such summative evaluation is to measure success and to determine whether this success is scalable (capable of being generalized beyond the specific case), quantitative data is more often used than qualitative data. In our example, we might have “outcomes” data for thousands of students, and we might run various tests to determine if the better outcomes of those in the program are statistically significant so that we can generalize the findings and recommend similar programs elsewhere. Qualitative data in the form of focus groups or interviews can then be used for illustrative purposes, providing more depth to the quantitative analyses. In contrast, formative evaluation attempts to improve a program or policy (to help “form” or shape its effectiveness). Formative evaluations rely more heavily on qualitative data—case studies, interviews, focus groups. The findings are meant not to generalize beyond the particular but to improve this program. If you are a student seeking to improve your qualitative research skills and you do not care about generating basic research, formative evaluation studies might be an attractive option for you to pursue, as there are always local programs that need evaluation and suggestions for improvement. Again, be very clear about your purpose when talking through your research proposal with your committee.

Action research takes a further step beyond evaluation, even formative evaluation, to being part of the solution itself. This is about as far from basic research as one could get and definitely falls beyond the scope of “science,” as conventionally defined. The distinction between action and research is blurry, the research methods are often in constant flux, and the only “findings” are specific to the problem or case at hand and often are findings about the process of intervention itself. Rather than evaluate a program as a whole, action research often seeks to change and improve some particular aspect that may not be working—maybe there is not enough diversity in an organization or maybe women’s voices are muted during meetings and the organization wonders why and would like to change this. In a further step, participatory action research , those women would become part of the research team, attempting to amplify their voices in the organization through participation in the action research. As action research employs methods that involve people in the process, focus groups are quite common.

If you are working on a thesis or dissertation, chances are your committee will expect you to be contributing to fundamental knowledge and theory ( basic research ). If your interests lie more toward the action end of the continuum, however, it is helpful to talk to your committee about this before you get started. Knowing your purpose in advance will help avoid misunderstandings during the later stages of the research process!

The Research Question

Once you have written your paragraph and clarified your purpose and truly know that this study is the best study for you to be doing right now , you are ready to write and refine your actual research question. Know that research questions are often moving targets in qualitative research, that they can be refined up to the very end of data collection and analysis. But you do have to have a working research question at all stages. This is your “anchor” when you get lost in the data. What are you addressing? What are you looking at and why? Your research question guides you through the thicket. It is common to have a whole host of questions about a phenomenon or case, both at the outset and throughout the study, but you should be able to pare it down to no more than two or three sentences when asked. These sentences should both clarify the intent of the research and explain why this is an important question to answer. More on refining your research question can be found in chapter 4.

Chances are, you will have already done some prior reading before coming up with your interest and your questions, but you may not have conducted a systematic literature review. This is the next crucial stage to be completed before venturing further. You don’t want to start collecting data and then realize that someone has already beaten you to the punch. A review of the literature that is already out there will let you know (1) if others have already done the study you are envisioning; (2) if others have done similar studies, which can help you out; and (3) what ideas or concepts are out there that can help you frame your study and make sense of your findings. More on literature reviews can be found in chapter 9.

In addition to reviewing the literature for similar studies to what you are proposing, it can be extremely helpful to find a study that inspires you. This may have absolutely nothing to do with the topic you are interested in but is written so beautifully or organized so interestingly or otherwise speaks to you in such a way that you want to post it somewhere to remind you of what you want to be doing. You might not understand this in the early stages—why would you find a study that has nothing to do with the one you are doing helpful? But trust me, when you are deep into analysis and writing, having an inspirational model in view can help you push through. If you are motivated to do something that might change the world, you probably have read something somewhere that inspired you. Go back to that original inspiration and read it carefully and see how they managed to convey the passion that you so appreciate.

At this stage, you are still just getting started. There are a lot of things to do before setting forth to collect data! You’ll want to consider and choose a research tradition and a set of data-collection techniques that both help you answer your research question and match all your aims and goals. For example, if you really want to help migrant workers speak for themselves, you might draw on feminist theory and participatory action research models. Chapters 3 and 4 will provide you with more information on epistemologies and approaches.

Next, you have to clarify your “units of analysis.” What is the level at which you are focusing your study? Often, the unit in qualitative research methods is individual people, or “human subjects.” But your units of analysis could just as well be organizations (colleges, hospitals) or programs or even whole nations. Think about what it is you want to be saying at the end of your study—are the insights you are hoping to make about people or about organizations or about something else entirely? A unit of analysis can even be a historical period! Every unit of analysis will call for a different kind of data collection and analysis and will produce different kinds of “findings” at the conclusion of your study. [2]

Regardless of what unit of analysis you select, you will probably have to consider the “human subjects” involved in your research. [3] Who are they? What interactions will you have with them—that is, what kind of data will you be collecting? Before answering these questions, define your population of interest and your research setting. Use your research question to help guide you.

Let’s use an example from a real study. In Geographies of Campus Inequality , Benson and Lee ( 2020 ) list three related research questions: “(1) What are the different ways that first-generation students organize their social, extracurricular, and academic activities at selective and highly selective colleges? (2) how do first-generation students sort themselves and get sorted into these different types of campus lives; and (3) how do these different patterns of campus engagement prepare first-generation students for their post-college lives?” (3).

Note that we are jumping into this a bit late, after Benson and Lee have described previous studies (the literature review) and what is known about first-generation college students and what is not known. They want to know about differences within this group, and they are interested in ones attending certain kinds of colleges because those colleges will be sites where academic and extracurricular pressures compete. That is the context for their three related research questions. What is the population of interest here? First-generation college students . What is the research setting? Selective and highly selective colleges . But a host of questions remain. Which students in the real world, which colleges? What about gender, race, and other identity markers? Will the students be asked questions? Are the students still in college, or will they be asked about what college was like for them? Will they be observed? Will they be shadowed? Will they be surveyed? Will they be asked to keep diaries of their time in college? How many students? How many colleges? For how long will they be observed?

Recommendation

Take a moment and write down suggestions for Benson and Lee before continuing on to what they actually did.

Have you written down your own suggestions? Good. Now let’s compare those with what they actually did. Benson and Lee drew on two sources of data: in-depth interviews with sixty-four first-generation students and survey data from a preexisting national survey of students at twenty-eight selective colleges. Let’s ignore the survey for our purposes here and focus on those interviews. The interviews were conducted between 2014 and 2016 at a single selective college, “Hilltop” (a pseudonym ). They employed a “purposive” sampling strategy to ensure an equal number of male-identifying and female-identifying students as well as equal numbers of White, Black, and Latinx students. Each student was interviewed once. Hilltop is a selective liberal arts college in the northeast that enrolls about three thousand students.

How did your suggestions match up to those actually used by the researchers in this study? It is possible your suggestions were too ambitious? Beginning qualitative researchers can often make that mistake. You want a research design that is both effective (it matches your question and goals) and doable. You will never be able to collect data from your entire population of interest (unless your research question is really so narrow to be relevant to very few people!), so you will need to come up with a good sample. Define the criteria for this sample, as Benson and Lee did when deciding to interview an equal number of students by gender and race categories. Define the criteria for your sample setting too. Hilltop is typical for selective colleges. That was a research choice made by Benson and Lee. For more on sampling and sampling choices, see chapter 5.

Benson and Lee chose to employ interviews. If you also would like to include interviews, you have to think about what will be asked in them. Most interview-based research involves an interview guide, a set of questions or question areas that will be asked of each participant. The research question helps you create a relevant interview guide. You want to ask questions whose answers will provide insight into your research question. Again, your research question is the anchor you will continually come back to as you plan for and conduct your study. It may be that once you begin interviewing, you find that people are telling you something totally unexpected, and this makes you rethink your research question. That is fine. Then you have a new anchor. But you always have an anchor. More on interviewing can be found in chapter 11.

Let’s imagine Benson and Lee also observed college students as they went about doing the things college students do, both in the classroom and in the clubs and social activities in which they participate. They would have needed a plan for this. Would they sit in on classes? Which ones and how many? Would they attend club meetings and sports events? Which ones and how many? Would they participate themselves? How would they record their observations? More on observation techniques can be found in both chapters 13 and 14.

At this point, the design is almost complete. You know why you are doing this study, you have a clear research question to guide you, you have identified your population of interest and research setting, and you have a reasonable sample of each. You also have put together a plan for data collection, which might include drafting an interview guide or making plans for observations. And so you know exactly what you will be doing for the next several months (or years!). To put the project into action, there are a few more things necessary before actually going into the field.

First, you will need to make sure you have any necessary supplies, including recording technology. These days, many researchers use their phones to record interviews. Second, you will need to draft a few documents for your participants. These include informed consent forms and recruiting materials, such as posters or email texts, that explain what this study is in clear language. Third, you will draft a research protocol to submit to your institutional review board (IRB) ; this research protocol will include the interview guide (if you are using one), the consent form template, and all examples of recruiting material. Depending on your institution and the details of your study design, it may take weeks or even, in some unfortunate cases, months before you secure IRB approval. Make sure you plan on this time in your project timeline. While you wait, you can continue to review the literature and possibly begin drafting a section on the literature review for your eventual presentation/publication. More on IRB procedures can be found in chapter 8 and more general ethical considerations in chapter 7.

Once you have approval, you can begin!

Research Design Checklist

Before data collection begins, do the following:

• Write a paragraph explaining your aims and goals (personal/political, practical/strategic, professional/academic).
• Define your research question; write two to three sentences that clarify the intent of the research and why this is an important question to answer.
• Review the literature for similar studies that address your research question or similar research questions; think laterally about some literature that might be helpful or illuminating but is not exactly about the same topic.
• Find a written study that inspires you—it may or may not be on the research question you have chosen.
• Consider and choose a research tradition and set of data-collection techniques that (1) help answer your research question and (2) match your aims and goals.
• Define your population of interest and your research setting.
• Define the criteria for your sample (How many? Why these? How will you find them, gain access, and acquire consent?).
• If you are conducting interviews, draft an interview guide.
•  If you are making observations, create a plan for observations (sites, times, recording, access).
• Acquire any necessary technology (recording devices/software).
• Draft consent forms that clearly identify the research focus and selection process.
• Create recruiting materials (posters, email, texts).
• Apply for IRB approval (proposal plus consent form plus recruiting materials).
• Block out time for collecting data.
• At the end of the chapter, you will find a " Research Design Checklist " that summarizes the main recommendations made here ↵
• For example, if your focus is society and culture , you might collect data through observation or a case study. If your focus is individual lived experience , you are probably going to be interviewing some people. And if your focus is language and communication , you will probably be analyzing text (written or visual). ( Marshall and Rossman 2016:16 ). ↵
• You may not have any "live" human subjects. There are qualitative research methods that do not require interactions with live human beings - see chapter 16 , "Archival and Historical Sources." But for the most part, you are probably reading this textbook because you are interested in doing research with people. The rest of the chapter will assume this is the case. ↵

One of the primary methodological traditions of inquiry in qualitative research, ethnography is the study of a group or group culture, largely through observational fieldwork supplemented by interviews. It is a form of fieldwork that may include participant-observation data collection. See chapter 14 for a discussion of deep ethnography. 

A methodological tradition of inquiry and research design that focuses on an individual case (e.g., setting, institution, or sometimes an individual) in order to explore its complexity, history, and interactive parts.  As an approach, it is particularly useful for obtaining a deep appreciation of an issue, event, or phenomenon of interest in its particular context.

The controlling force in research; can be understood as lying on a continuum from basic research (knowledge production) to action research (effecting change).

In its most basic sense, a theory is a story we tell about how the world works that can be tested with empirical evidence.  In qualitative research, we use the term in a variety of ways, many of which are different from how they are used by quantitative researchers.  Although some qualitative research can be described as “testing theory,” it is more common to “build theory” from the data using inductive reasoning , as done in Grounded Theory .  There are so-called “grand theories” that seek to integrate a whole series of findings and stories into an overarching paradigm about how the world works, and much smaller theories or concepts about particular processes and relationships.  Theory can even be used to explain particular methodological perspectives or approaches, as in Institutional Ethnography , which is both a way of doing research and a theory about how the world works.

Research that is interested in generating and testing hypotheses about how the world works.

A methodological tradition of inquiry and approach to analyzing qualitative data in which theories emerge from a rigorous and systematic process of induction.  This approach was pioneered by the sociologists Glaser and Strauss (1967).  The elements of theory generated from comparative analysis of data are, first, conceptual categories and their properties and, second, hypotheses or generalized relations among the categories and their properties – “The constant comparing of many groups draws the [researcher’s] attention to their many similarities and differences.  Considering these leads [the researcher] to generate abstract categories and their properties, which, since they emerge from the data, will clearly be important to a theory explaining the kind of behavior under observation.” (36).

An approach to research that is “multimethod in focus, involving an interpretative, 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.  Qualitative research involves the studied use and collection of a variety of empirical materials – case study, personal experience, introspective, life story, interview, observational, historical, interactional, and visual texts – that describe routine and problematic moments and meanings in individuals’ lives." ( Denzin and Lincoln 2005:2 ). Contrast with quantitative research .

Research that contributes knowledge that will help people to understand the nature of a problem in order to intervene, thereby allowing human beings to more effectively control their environment.

Research that is designed to evaluate or test the effectiveness of specific solutions and programs addressing specific social problems.  There are two kinds: summative and formative .

Research in which an overall judgment about the effectiveness of a program or policy is made, often for the purpose of generalizing to other cases or programs.  Generally uses qualitative research as a supplement to primary quantitative data analyses.  Contrast formative evaluation research .

Research designed to improve a program or policy (to help “form” or shape its effectiveness); relies heavily on qualitative research methods.  Contrast summative evaluation research

Research carried out at a particular organizational or community site with the intention of affecting change; often involves research subjects as participants of the study.  See also participatory action research .

Research in which both researchers and participants work together to understand a problematic situation and change it for the better.

The level of the focus of analysis (e.g., individual people, organizations, programs, neighborhoods).

The large group of interest to the researcher.  Although it will likely be impossible to design a study that incorporates or reaches all members of the population of interest, this should be clearly defined at the outset of a study so that a reasonable sample of the population can be taken.  For example, if one is studying working-class college students, the sample may include twenty such students attending a particular college, while the population is “working-class college students.”  In quantitative research, clearly defining the general population of interest is a necessary step in generalizing results from a sample.  In qualitative research, defining the population is conceptually important for clarity.

A fictional name assigned to give anonymity to a person, group, or place.  Pseudonyms are important ways of protecting the identity of research participants while still providing a “human element” in the presentation of qualitative data.  There are ethical considerations to be made in selecting pseudonyms; some researchers allow research participants to choose their own.

A requirement for research involving human participants; the documentation of informed consent.  In some cases, oral consent or assent may be sufficient, but the default standard is a single-page easy-to-understand form that both the researcher and the participant sign and date.   Under federal guidelines, all researchers "shall seek such consent only under circumstances that provide the prospective subject or the representative sufficient opportunity to consider whether or not to participate and that minimize the possibility of coercion or undue influence. The information that is given to the subject or the representative shall be in language understandable to the subject or the representative.  No informed consent, whether oral or written, may include any exculpatory language through which the subject or the representative is made to waive or appear to waive any of the subject's rights or releases or appears to release the investigator, the sponsor, the institution, or its agents from liability for negligence" (21 CFR 50.20).  Your IRB office will be able to provide a template for use in your study .

An administrative body established to protect the rights and welfare of human research subjects recruited to participate in research activities conducted under the auspices of the institution with which it is affiliated. The IRB is charged with the responsibility of reviewing all research involving human participants. The IRB is concerned with protecting the welfare, rights, and privacy of human subjects. The IRB has the authority to approve, disapprove, monitor, and require modifications in all research activities that fall within its jurisdiction as specified by both the federal regulations and institutional policy.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Methodology

Research Design | Step-by-Step Guide with Examples

Published on 5 May 2022 by Shona McCombes . Revised on 20 March 2023.

A research design is a strategy for answering your research question  using empirical data. Creating a research design means making decisions about:

• Your overall aims and approach
• The type of research design you’ll use
• Your sampling methods or criteria for selecting subjects
• Your data collection methods
• The procedures you’ll follow to collect data
• Your data analysis methods

A well-planned research design helps ensure that your methods match your research aims and that you use the right kind of analysis for your data.

Table of contents

Step 1: consider your aims and approach, step 2: choose a type of research design, step 3: identify your population and sampling method, step 4: choose your data collection methods, step 5: plan your data collection procedures, step 6: decide on your data analysis strategies, frequently asked questions.

• Introduction

Before you can start designing your research, you should already have a clear idea of the research question you want to investigate.

There are many different ways you could go about answering this question. Your research design choices should be driven by your aims and priorities – start by thinking carefully about what you want to achieve.

The first choice you need to make is whether you’ll take a qualitative or quantitative approach.

Qualitative research designs tend to be more flexible and inductive , allowing you to adjust your approach based on what you find throughout the research process.

Quantitative research designs tend to be more fixed and deductive , with variables and hypotheses clearly defined in advance of data collection.

It’s also possible to use a mixed methods design that integrates aspects of both approaches. By combining qualitative and quantitative insights, you can gain a more complete picture of the problem you’re studying and strengthen the credibility of your conclusions.

Practical and ethical considerations when designing research

As well as scientific considerations, you need to think practically when designing your research. If your research involves people or animals, you also need to consider research ethics .

• How much time do you have to collect data and write up the research?
• Will you be able to gain access to the data you need (e.g., by travelling to a specific location or contacting specific people)?
• Do you have the necessary research skills (e.g., statistical analysis or interview techniques)?
• Will you need ethical approval ?

At each stage of the research design process, make sure that your choices are practically feasible.

Prevent plagiarism, run a free check.

Within both qualitative and quantitative approaches, there are several types of research design to choose from. Each type provides a framework for the overall shape of your research.

Types of quantitative research designs

Quantitative designs can be split into four main types. Experimental and   quasi-experimental designs allow you to test cause-and-effect relationships, while descriptive and correlational designs allow you to measure variables and describe relationships between them.

With descriptive and correlational designs, you can get a clear picture of characteristics, trends, and relationships as they exist in the real world. However, you can’t draw conclusions about cause and effect (because correlation doesn’t imply causation ).

Experiments are the strongest way to test cause-and-effect relationships without the risk of other variables influencing the results. However, their controlled conditions may not always reflect how things work in the real world. They’re often also more difficult and expensive to implement.

Types of qualitative research designs

Qualitative designs are less strictly defined. This approach is about gaining a rich, detailed understanding of a specific context or phenomenon, and you can often be more creative and flexible in designing your research.

The table below shows some common types of qualitative design. They often have similar approaches in terms of data collection, but focus on different aspects when analysing the data.

Your research design should clearly define who or what your research will focus on, and how you’ll go about choosing your participants or subjects.

In research, a population is the entire group that you want to draw conclusions about, while a sample is the smaller group of individuals you’ll actually collect data from.

Defining the population

A population can be made up of anything you want to study – plants, animals, organisations, texts, countries, etc. In the social sciences, it most often refers to a group of people.

For example, will you focus on people from a specific demographic, region, or background? Are you interested in people with a certain job or medical condition, or users of a particular product?

The more precisely you define your population, the easier it will be to gather a representative sample.

Sampling methods

Even with a narrowly defined population, it’s rarely possible to collect data from every individual. Instead, you’ll collect data from a sample.

To select a sample, there are two main approaches: probability sampling and non-probability sampling . The sampling method you use affects how confidently you can generalise your results to the population as a whole.

Probability sampling is the most statistically valid option, but it’s often difficult to achieve unless you’re dealing with a very small and accessible population.

For practical reasons, many studies use non-probability sampling, but it’s important to be aware of the limitations and carefully consider potential biases. You should always make an effort to gather a sample that’s as representative as possible of the population.

Case selection in qualitative research

In some types of qualitative designs, sampling may not be relevant.

For example, in an ethnography or a case study, your aim is to deeply understand a specific context, not to generalise to a population. Instead of sampling, you may simply aim to collect as much data as possible about the context you are studying.

In these types of design, you still have to carefully consider your choice of case or community. You should have a clear rationale for why this particular case is suitable for answering your research question.

For example, you might choose a case study that reveals an unusual or neglected aspect of your research problem, or you might choose several very similar or very different cases in order to compare them.

Data collection methods are ways of directly measuring variables and gathering information. They allow you to gain first-hand knowledge and original insights into your research problem.

You can choose just one data collection method, or use several methods in the same study.

Survey methods

Surveys allow you to collect data about opinions, behaviours, experiences, and characteristics by asking people directly. There are two main survey methods to choose from: questionnaires and interviews.

Observation methods

Observations allow you to collect data unobtrusively, observing characteristics, behaviours, or social interactions without relying on self-reporting.

Observations may be conducted in real time, taking notes as you observe, or you might make audiovisual recordings for later analysis. They can be qualitative or quantitative.

Other methods of data collection

There are many other ways you might collect data depending on your field and topic.

If you’re not sure which methods will work best for your research design, try reading some papers in your field to see what data collection methods they used.

Secondary data

If you don’t have the time or resources to collect data from the population you’re interested in, you can also choose to use secondary data that other researchers already collected – for example, datasets from government surveys or previous studies on your topic.

With this raw data, you can do your own analysis to answer new research questions that weren’t addressed by the original study.

Using secondary data can expand the scope of your research, as you may be able to access much larger and more varied samples than you could collect yourself.

However, it also means you don’t have any control over which variables to measure or how to measure them, so the conclusions you can draw may be limited.

As well as deciding on your methods, you need to plan exactly how you’ll use these methods to collect data that’s consistent, accurate, and unbiased.

Planning systematic procedures is especially important in quantitative research, where you need to precisely define your variables and ensure your measurements are reliable and valid.

Operationalisation

Some variables, like height or age, are easily measured. But often you’ll be dealing with more abstract concepts, like satisfaction, anxiety, or competence. Operationalisation means turning these fuzzy ideas into measurable indicators.

If you’re using observations , which events or actions will you count?

If you’re using surveys , which questions will you ask and what range of responses will be offered?

You may also choose to use or adapt existing materials designed to measure the concept you’re interested in – for example, questionnaires or inventories whose reliability and validity has already been established.

Reliability and validity

Reliability means your results can be consistently reproduced , while validity means that you’re actually measuring the concept you’re interested in.

For valid and reliable results, your measurement materials should be thoroughly researched and carefully designed. Plan your procedures to make sure you carry out the same steps in the same way for each participant.

If you’re developing a new questionnaire or other instrument to measure a specific concept, running a pilot study allows you to check its validity and reliability in advance.

Sampling procedures

As well as choosing an appropriate sampling method, you need a concrete plan for how you’ll actually contact and recruit your selected sample.

That means making decisions about things like:

• How many participants do you need for an adequate sample size?
• What inclusion and exclusion criteria will you use to identify eligible participants?
• How will you contact your sample – by mail, online, by phone, or in person?

If you’re using a probability sampling method, it’s important that everyone who is randomly selected actually participates in the study. How will you ensure a high response rate?

If you’re using a non-probability method, how will you avoid bias and ensure a representative sample?

Data management

It’s also important to create a data management plan for organising and storing your data.

Will you need to transcribe interviews or perform data entry for observations? You should anonymise and safeguard any sensitive data, and make sure it’s backed up regularly.

Keeping your data well organised will save time when it comes to analysing them. It can also help other researchers validate and add to your findings.

On their own, raw data can’t answer your research question. The last step of designing your research is planning how you’ll analyse the data.

Quantitative data analysis

In quantitative research, you’ll most likely use some form of statistical analysis . With statistics, you can summarise your sample data, make estimates, and test hypotheses.

Using descriptive statistics , you can summarise your sample data in terms of:

• The distribution of the data (e.g., the frequency of each score on a test)
• The central tendency of the data (e.g., the mean to describe the average score)
• The variability of the data (e.g., the standard deviation to describe how spread out the scores are)

The specific calculations you can do depend on the level of measurement of your variables.

Using inferential statistics , you can:

• Make estimates about the population based on your sample data.
• Test hypotheses about a relationship between variables.

Regression and correlation tests look for associations between two or more variables, while comparison tests (such as t tests and ANOVAs ) look for differences in the outcomes of different groups.

Your choice of statistical test depends on various aspects of your research design, including the types of variables you’re dealing with and the distribution of your data.

Qualitative data analysis

In qualitative research, your data will usually be very dense with information and ideas. Instead of summing it up in numbers, you’ll need to comb through the data in detail, interpret its meanings, identify patterns, and extract the parts that are most relevant to your research question.

Two of the most common approaches to doing this are thematic analysis and discourse analysis .

There are many other ways of analysing qualitative data depending on the aims of your research. To get a sense of potential approaches, try reading some qualitative research papers in your field.

A sample is a subset of individuals from a larger population. Sampling means selecting the group that you will actually collect data from in your research.

For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.

Statistical sampling allows you to test a hypothesis about the characteristics of a population. There are various sampling methods you can use to ensure that your sample is representative of the population as a whole.

Operationalisation means turning abstract conceptual ideas into measurable observations.

For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioural avoidance of crowded places, or physical anxiety symptoms in social situations.

Before collecting data , it’s important to consider how you will operationalise the variables that you want to measure.

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.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, March 20). Research Design | Step-by-Step Guide with Examples. Scribbr. Retrieved 27 May 2024, from https://www.scribbr.co.uk/research-methods/research-design/

Is this article helpful?

Shona McCombes

Qualitative study design: Qualitative study design

• Qualitative study design
• Phenomenology
• Grounded theory
• Ethnography
• Narrative inquiry
• Action research
• Case Studies
• Field research
• Focus groups
• Observation
• Surveys & questionnaires
• Study Designs Home

Email your Librarians

Related guides

• Study Design Basics
• Quantitative Study Designs

Introduction

The effective evaluation of research involves assessing the way a study has been designed and conducted, and whether the method used was the most appropriate for answering the aims of the study. In contrast to quantitative studies, which are about breadth, qualitative research focuses on depth. 

Whereas quantitative research aims to develop objective theories by generating quantifiable numerical data, qualitative research aims to understand meaning. This might be the meanings that people attribute to their work, their behaviours or beliefs, or their attitudes or perceptions. Qualitative research is often based on methods of observation and enquiry; qualitative research “explores the meaning of human experiences and creates the possibilities of change through raised awareness and purposeful action” ( Taylor & Francis, 2013 ). Qualitative research focuses on life experiences; they are more about the “why” and “how” rather than the “how many”, or “how often”. 

Qualitative study designs might be chosen for any number of reasons. In health, you might be interested in finding out how nurses feel or experience care in the ICU; or you might want to find out how people engaged in heavy substance use found the experience of connecting with a support agency. Qualitative study designs are beneficial for certain types of research questions such as those looking to provide unique insights into specific contexts or social situations. However, they are not as strong when wanting to find direct cause and effect links or where a statistically significant result is required ( Taylor et al., 2006 ). 

Attribution and acknowledgement

Crediting creators and attributing content is a core part of both academic integrity and of being a digital citizen more broadly. This guide was created by Deakin Library.

The text and layout of Qualitative study design is © Deakin University 2023 and licensed under a CC BY NC 4.0

• Next: Methodologies >>
• Last Updated: Apr 8, 2024 11:12 AM
• URL: https://deakin.libguides.com/qualitative-study-designs

Research Design 101

Everything You Need To Get Started (With Examples)

By: Derek Jansen (MBA) | Reviewers: Eunice Rautenbach (DTech) & Kerryn Warren (PhD) | April 2023

Navigating the world of research can be daunting, especially if you’re a first-time researcher. One concept you’re bound to run into fairly early in your research journey is that of “ research design ”. Here, we’ll guide you through the basics using practical examples , so that you can approach your research with confidence.

Overview: Research Design 101

What is research design.

• Research design types for quantitative studies
• Video explainer : quantitative research design
• Research design types for qualitative studies
• Video explainer : qualitative research design
• How to choose a research design
• Key takeaways

Research design refers to the overall plan, structure or strategy that guides a research project , from its conception to the final data analysis. A good research design serves as the blueprint for how you, as the researcher, will collect and analyse data while ensuring consistency, reliability and validity throughout your study.

Understanding different types of research designs is essential as helps ensure that your approach is suitable  given your research aims, objectives and questions , as well as the resources you have available to you. Without a clear big-picture view of how you’ll design your research, you run the risk of potentially making misaligned choices in terms of your methodology – especially your sampling , data collection and data analysis decisions.

The problem with defining research design…

One of the reasons students struggle with a clear definition of research design is because the term is used very loosely across the internet, and even within academia.

Some sources claim that the three research design types are qualitative, quantitative and mixed methods , which isn’t quite accurate (these just refer to the type of data that you’ll collect and analyse). Other sources state that research design refers to the sum of all your design choices, suggesting it’s more like a research methodology . Others run off on other less common tangents. No wonder there’s confusion!

In this article, we’ll clear up the confusion. We’ll explain the most common research design types for both qualitative and quantitative research projects, whether that is for a full dissertation or thesis, or a smaller research paper or article.

Research Design: Quantitative Studies

Quantitative research involves collecting and analysing data in a numerical form. Broadly speaking, there are four types of quantitative research designs: descriptive , correlational , experimental , and quasi-experimental . 

Descriptive Research Design

As the name suggests, descriptive research design focuses on describing existing conditions, behaviours, or characteristics by systematically gathering information without manipulating any variables. In other words, there is no intervention on the researcher’s part – only data collection.

For example, if you’re studying smartphone addiction among adolescents in your community, you could deploy a survey to a sample of teens asking them to rate their agreement with certain statements that relate to smartphone addiction. The collected data would then provide insight regarding how widespread the issue may be – in other words, it would describe the situation.

The key defining attribute of this type of research design is that it purely describes the situation . In other words, descriptive research design does not explore potential relationships between different variables or the causes that may underlie those relationships. Therefore, descriptive research is useful for generating insight into a research problem by describing its characteristics . By doing so, it can provide valuable insights and is often used as a precursor to other research design types.

Correlational Research Design

Correlational design is a popular choice for researchers aiming to identify and measure the relationship between two or more variables without manipulating them . In other words, this type of research design is useful when you want to know whether a change in one thing tends to be accompanied by a change in another thing.

For example, if you wanted to explore the relationship between exercise frequency and overall health, you could use a correlational design to help you achieve this. In this case, you might gather data on participants’ exercise habits, as well as records of their health indicators like blood pressure, heart rate, or body mass index. Thereafter, you’d use a statistical test to assess whether there’s a relationship between the two variables (exercise frequency and health).

As you can see, correlational research design is useful when you want to explore potential relationships between variables that cannot be manipulated or controlled for ethical, practical, or logistical reasons. It is particularly helpful in terms of developing predictions , and given that it doesn’t involve the manipulation of variables, it can be implemented at a large scale more easily than experimental designs (which will look at next).

That said, it’s important to keep in mind that correlational research design has limitations – most notably that it cannot be used to establish causality . In other words, correlation does not equal causation . To establish causality, you’ll need to move into the realm of experimental design, coming up next…

Need a helping hand?

Experimental Research Design

Experimental research design is used to determine if there is a causal relationship between two or more variables . With this type of research design, you, as the researcher, manipulate one variable (the independent variable) while controlling others (dependent variables). Doing so allows you to observe the effect of the former on the latter and draw conclusions about potential causality.

For example, if you wanted to measure if/how different types of fertiliser affect plant growth, you could set up several groups of plants, with each group receiving a different type of fertiliser, as well as one with no fertiliser at all. You could then measure how much each plant group grew (on average) over time and compare the results from the different groups to see which fertiliser was most effective.

Overall, experimental research design provides researchers with a powerful way to identify and measure causal relationships (and the direction of causality) between variables. However, developing a rigorous experimental design can be challenging as it’s not always easy to control all the variables in a study. This often results in smaller sample sizes , which can reduce the statistical power and generalisability of the results.

Moreover, experimental research design requires random assignment . This means that the researcher needs to assign participants to different groups or conditions in a way that each participant has an equal chance of being assigned to any group (note that this is not the same as random sampling ). Doing so helps reduce the potential for bias and confounding variables . This need for random assignment can lead to ethics-related issues . For example, withholding a potentially beneficial medical treatment from a control group may be considered unethical in certain situations.

Quasi-Experimental Research Design

Quasi-experimental research design is used when the research aims involve identifying causal relations , but one cannot (or doesn’t want to) randomly assign participants to different groups (for practical or ethical reasons). Instead, with a quasi-experimental research design, the researcher relies on existing groups or pre-existing conditions to form groups for comparison.

For example, if you were studying the effects of a new teaching method on student achievement in a particular school district, you may be unable to randomly assign students to either group and instead have to choose classes or schools that already use different teaching methods. This way, you still achieve separate groups, without having to assign participants to specific groups yourself.

Naturally, quasi-experimental research designs have limitations when compared to experimental designs. Given that participant assignment is not random, it’s more difficult to confidently establish causality between variables, and, as a researcher, you have less control over other variables that may impact findings.

All that said, quasi-experimental designs can still be valuable in research contexts where random assignment is not possible and can often be undertaken on a much larger scale than experimental research, thus increasing the statistical power of the results. What’s important is that you, as the researcher, understand the limitations of the design and conduct your quasi-experiment as rigorously as possible, paying careful attention to any potential confounding variables .

Research Design: Qualitative Studies

There are many different research design types when it comes to qualitative studies, but here we’ll narrow our focus to explore the “Big 4”. Specifically, we’ll look at phenomenological design, grounded theory design, ethnographic design, and case study design.

Phenomenological Research Design

Phenomenological design involves exploring the meaning of lived experiences and how they are perceived by individuals. This type of research design seeks to understand people’s perspectives , emotions, and behaviours in specific situations. Here, the aim for researchers is to uncover the essence of human experience without making any assumptions or imposing preconceived ideas on their subjects.

For example, you could adopt a phenomenological design to study why cancer survivors have such varied perceptions of their lives after overcoming their disease. This could be achieved by interviewing survivors and then analysing the data using a qualitative analysis method such as thematic analysis to identify commonalities and differences.

Phenomenological research design typically involves in-depth interviews or open-ended questionnaires to collect rich, detailed data about participants’ subjective experiences. This richness is one of the key strengths of phenomenological research design but, naturally, it also has limitations. These include potential biases in data collection and interpretation and the lack of generalisability of findings to broader populations.

Grounded Theory Research Design

Grounded theory (also referred to as “GT”) aims to develop theories by continuously and iteratively analysing and comparing data collected from a relatively large number of participants in a study. It takes an inductive (bottom-up) approach, with a focus on letting the data “speak for itself”, without being influenced by preexisting theories or the researcher’s preconceptions.

As an example, let’s assume your research aims involved understanding how people cope with chronic pain from a specific medical condition, with a view to developing a theory around this. In this case, grounded theory design would allow you to explore this concept thoroughly without preconceptions about what coping mechanisms might exist. You may find that some patients prefer cognitive-behavioural therapy (CBT) while others prefer to rely on herbal remedies. Based on multiple, iterative rounds of analysis, you could then develop a theory in this regard, derived directly from the data (as opposed to other preexisting theories and models).

Grounded theory typically involves collecting data through interviews or observations and then analysing it to identify patterns and themes that emerge from the data. These emerging ideas are then validated by collecting more data until a saturation point is reached (i.e., no new information can be squeezed from the data). From that base, a theory can then be developed .

As you can see, grounded theory is ideally suited to studies where the research aims involve theory generation , especially in under-researched areas. Keep in mind though that this type of research design can be quite time-intensive , given the need for multiple rounds of data collection and analysis.

Ethnographic Research Design

Ethnographic design involves observing and studying a culture-sharing group of people in their natural setting to gain insight into their behaviours, beliefs, and values. The focus here is on observing participants in their natural environment (as opposed to a controlled environment). This typically involves the researcher spending an extended period of time with the participants in their environment, carefully observing and taking field notes .

All of this is not to say that ethnographic research design relies purely on observation. On the contrary, this design typically also involves in-depth interviews to explore participants’ views, beliefs, etc. However, unobtrusive observation is a core component of the ethnographic approach.

As an example, an ethnographer may study how different communities celebrate traditional festivals or how individuals from different generations interact with technology differently. This may involve a lengthy period of observation, combined with in-depth interviews to further explore specific areas of interest that emerge as a result of the observations that the researcher has made.

As you can probably imagine, ethnographic research design has the ability to provide rich, contextually embedded insights into the socio-cultural dynamics of human behaviour within a natural, uncontrived setting. Naturally, however, it does come with its own set of challenges, including researcher bias (since the researcher can become quite immersed in the group), participant confidentiality and, predictably, ethical complexities . All of these need to be carefully managed if you choose to adopt this type of research design.

Case Study Design

With case study research design, you, as the researcher, investigate a single individual (or a single group of individuals) to gain an in-depth understanding of their experiences, behaviours or outcomes. Unlike other research designs that are aimed at larger sample sizes, case studies offer a deep dive into the specific circumstances surrounding a person, group of people, event or phenomenon, generally within a bounded setting or context .

As an example, a case study design could be used to explore the factors influencing the success of a specific small business. This would involve diving deeply into the organisation to explore and understand what makes it tick – from marketing to HR to finance. In terms of data collection, this could include interviews with staff and management, review of policy documents and financial statements, surveying customers, etc.

While the above example is focused squarely on one organisation, it’s worth noting that case study research designs can have different variation s, including single-case, multiple-case and longitudinal designs. As you can see in the example, a single-case design involves intensely examining a single entity to understand its unique characteristics and complexities. Conversely, in a multiple-case design , multiple cases are compared and contrasted to identify patterns and commonalities. Lastly, in a longitudinal case design , a single case or multiple cases are studied over an extended period of time to understand how factors develop over time.

As you can see, a case study research design is particularly useful where a deep and contextualised understanding of a specific phenomenon or issue is desired. However, this strength is also its weakness. In other words, you can’t generalise the findings from a case study to the broader population. So, keep this in mind if you’re considering going the case study route.

How To Choose A Research Design

Having worked through all of these potential research designs, you’d be forgiven for feeling a little overwhelmed and wondering, “ But how do I decide which research design to use? ”. While we could write an entire post covering that alone, here are a few factors to consider that will help you choose a suitable research design for your study.

Data type: The first determining factor is naturally the type of data you plan to be collecting – i.e., qualitative or quantitative. This may sound obvious, but we have to be clear about this – don’t try to use a quantitative research design on qualitative data (or vice versa)!

Research aim(s) and question(s): As with all methodological decisions, your research aim and research questions will heavily influence your research design. For example, if your research aims involve developing a theory from qualitative data, grounded theory would be a strong option. Similarly, if your research aims involve identifying and measuring relationships between variables, one of the experimental designs would likely be a better option.

Time: It’s essential that you consider any time constraints you have, as this will impact the type of research design you can choose. For example, if you’ve only got a month to complete your project, a lengthy design such as ethnography wouldn’t be a good fit.

Resources: Take into account the resources realistically available to you, as these need to factor into your research design choice. For example, if you require highly specialised lab equipment to execute an experimental design, you need to be sure that you’ll have access to that before you make a decision.

Keep in mind that when it comes to research, it’s important to manage your risks and play as conservatively as possible. If your entire project relies on you achieving a huge sample, having access to niche equipment or holding interviews with very difficult-to-reach participants, you’re creating risks that could kill your project. So, be sure to think through your choices carefully and make sure that you have backup plans for any existential risks. Remember that a relatively simple methodology executed well generally will typically earn better marks than a highly-complex methodology executed poorly.

Recap: Key Takeaways

We’ve covered a lot of ground here. Let’s recap by looking at the key takeaways:

• Research design refers to the overall plan, structure or strategy that guides a research project, from its conception to the final analysis of data.
• Research designs for quantitative studies include descriptive , correlational , experimental and quasi-experimenta l designs.
• Research designs for qualitative studies include phenomenological , grounded theory , ethnographic and case study designs.
• When choosing a research design, you need to consider a variety of factors, including the type of data you’ll be working with, your research aims and questions, your time and the resources available to you.

If you need a helping hand with your research design (or any other aspect of your research), check out our private coaching services .

Psst... there’s more!

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

You Might Also Like:

10 Comments

Is there any blog article explaining more on Case study research design? Is there a Case study write-up template? Thank you.

Thanks this was quite valuable to clarify such an important concept.

Thanks for this simplified explanations. it is quite very helpful.

This was really helpful. thanks

Thank you for your explanation. I think case study research design and the use of secondary data in researches needs to be talked about more in your videos and articles because there a lot of case studies research design tailored projects out there.

Please is there any template for a case study research design whose data type is a secondary data on your repository?

This post is very clear, comprehensive and has been very helpful to me. It has cleared the confusion I had in regard to research design and methodology.

This post is helpful, easy to understand, and deconstructs what a research design is. Thanks

how to cite this page

Thank you very much for the post. It is wonderful and has cleared many worries in my mind regarding research designs. I really appreciate .

how can I put this blog as my reference(APA style) in bibliography part?

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

An official website of the United States government

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

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

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

What is Qualitative in Qualitative Research

Patrik aspers.

1 Department of Sociology, Uppsala University, Uppsala, Sweden

2 Seminar for Sociology, Universität St. Gallen, St. Gallen, Switzerland

3 Department of Media and Social Sciences, University of Stavanger, Stavanger, Norway

What is qualitative research? If we look for a precise definition of qualitative research, and specifically for one that addresses its distinctive feature of being “qualitative,” the literature is meager. In this article we systematically search, identify and analyze a sample of 89 sources using or attempting to define the term “qualitative.” Then, drawing on ideas we find scattered across existing work, and based on Becker’s classic study of marijuana consumption, we formulate and illustrate a definition that tries to capture its core elements. We define qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied. This formulation is developed as a tool to help improve research designs while stressing that a qualitative dimension is present in quantitative work as well. Additionally, it can facilitate teaching, communication between researchers, diminish the gap between qualitative and quantitative researchers, help to address critiques of qualitative methods, and be used as a standard of evaluation of qualitative research.

If we assume that there is something called qualitative research, what exactly is this qualitative feature? And how could we evaluate qualitative research as good or not? Is it fundamentally different from quantitative research? In practice, most active qualitative researchers working with empirical material intuitively know what is involved in doing qualitative research, yet perhaps surprisingly, a clear definition addressing its key feature is still missing.

To address the question of what is qualitative we turn to the accounts of “qualitative research” in textbooks and also in empirical work. In his classic, explorative, interview study of deviance Howard Becker ( 1963 ) asks ‘How does one become a marijuana user?’ In contrast to pre-dispositional and psychological-individualistic theories of deviant behavior, Becker’s inherently social explanation contends that becoming a user of this substance is the result of a three-phase sequential learning process. First, potential users need to learn how to smoke it properly to produce the “correct” effects. If not, they are likely to stop experimenting with it. Second, they need to discover the effects associated with it; in other words, to get “high,” individuals not only have to experience what the drug does, but also to become aware that those sensations are related to using it. Third, they require learning to savor the feelings related to its consumption – to develop an acquired taste. Becker, who played music himself, gets close to the phenomenon by observing, taking part, and by talking to people consuming the drug: “half of the fifty interviews were conducted with musicians, the other half covered a wide range of people, including laborers, machinists, and people in the professions” (Becker 1963 :56).

Another central aspect derived through the common-to-all-research interplay between induction and deduction (Becker 2017 ), is that during the course of his research Becker adds scientifically meaningful new distinctions in the form of three phases—distinctions, or findings if you will, that strongly affect the course of his research: its focus, the material that he collects, and which eventually impact his findings. Each phase typically unfolds through social interaction, and often with input from experienced users in “a sequence of social experiences during which the person acquires a conception of the meaning of the behavior, and perceptions and judgments of objects and situations, all of which make the activity possible and desirable” (Becker 1963 :235). In this study the increased understanding of smoking dope is a result of a combination of the meaning of the actors, and the conceptual distinctions that Becker introduces based on the views expressed by his respondents. Understanding is the result of research and is due to an iterative process in which data, concepts and evidence are connected with one another (Becker 2017 ).

Indeed, there are many definitions of qualitative research, but if we look for a definition that addresses its distinctive feature of being “qualitative,” the literature across the broad field of social science is meager. The main reason behind this article lies in the paradox, which, to put it bluntly, is that researchers act as if they know what it is, but they cannot formulate a coherent definition. Sociologists and others will of course continue to conduct good studies that show the relevance and value of qualitative research addressing scientific and practical problems in society. However, our paper is grounded in the idea that providing a clear definition will help us improve the work that we do. Among researchers who practice qualitative research there is clearly much knowledge. We suggest that a definition makes this knowledge more explicit. If the first rationale for writing this paper refers to the “internal” aim of improving qualitative research, the second refers to the increased “external” pressure that especially many qualitative researchers feel; pressure that comes both from society as well as from other scientific approaches. There is a strong core in qualitative research, and leading researchers tend to agree on what it is and how it is done. Our critique is not directed at the practice of qualitative research, but we do claim that the type of systematic work we do has not yet been done, and that it is useful to improve the field and its status in relation to quantitative research.

The literature on the “internal” aim of improving, or at least clarifying qualitative research is large, and we do not claim to be the first to notice the vagueness of the term “qualitative” (Strauss and Corbin 1998 ). Also, others have noted that there is no single definition of it (Long and Godfrey 2004 :182), that there are many different views on qualitative research (Denzin and Lincoln 2003 :11; Jovanović 2011 :3), and that more generally, we need to define its meaning (Best 2004 :54). Strauss and Corbin ( 1998 ), for example, as well as Nelson et al. (1992:2 cited in Denzin and Lincoln 2003 :11), and Flick ( 2007 :ix–x), have recognized that the term is problematic: “Actually, the term ‘qualitative research’ is confusing because it can mean different things to different people” (Strauss and Corbin 1998 :10–11). Hammersley has discussed the possibility of addressing the problem, but states that “the task of providing an account of the distinctive features of qualitative research is far from straightforward” ( 2013 :2). This confusion, as he has recently further argued (Hammersley 2018 ), is also salient in relation to ethnography where different philosophical and methodological approaches lead to a lack of agreement about what it means.

Others (e.g. Hammersley 2018 ; Fine and Hancock 2017 ) have also identified the treat to qualitative research that comes from external forces, seen from the point of view of “qualitative research.” This threat can be further divided into that which comes from inside academia, such as the critique voiced by “quantitative research” and outside of academia, including, for example, New Public Management. Hammersley ( 2018 ), zooming in on one type of qualitative research, ethnography, has argued that it is under treat. Similarly to Fine ( 2003 ), and before him Gans ( 1999 ), he writes that ethnography’ has acquired a range of meanings, and comes in many different versions, these often reflecting sharply divergent epistemological orientations. And already more than twenty years ago while reviewing Denzin and Lincoln’ s Handbook of Qualitative Methods Fine argued:

While this increasing centrality [of qualitative research] might lead one to believe that consensual standards have developed, this belief would be misleading. As the methodology becomes more widely accepted, querulous challengers have raised fundamental questions that collectively have undercut the traditional models of how qualitative research is to be fashioned and presented (1995:417).

According to Hammersley, there are today “serious treats to the practice of ethnographic work, on almost any definition” ( 2018 :1). He lists five external treats: (1) that social research must be accountable and able to show its impact on society; (2) the current emphasis on “big data” and the emphasis on quantitative data and evidence; (3) the labor market pressure in academia that leaves less time for fieldwork (see also Fine and Hancock 2017 ); (4) problems of access to fields; and (5) the increased ethical scrutiny of projects, to which ethnography is particularly exposed. Hammersley discusses some more or less insufficient existing definitions of ethnography.

The current situation, as Hammersley and others note—and in relation not only to ethnography but also qualitative research in general, and as our empirical study shows—is not just unsatisfactory, it may even be harmful for the entire field of qualitative research, and does not help social science at large. We suggest that the lack of clarity of qualitative research is a real problem that must be addressed.

Towards a Definition of Qualitative Research

Seen in an historical light, what is today called qualitative, or sometimes ethnographic, interpretative research – or a number of other terms – has more or less always existed. At the time the founders of sociology – Simmel, Weber, Durkheim and, before them, Marx – were writing, and during the era of the Methodenstreit (“dispute about methods”) in which the German historical school emphasized scientific methods (cf. Swedberg 1990 ), we can at least speak of qualitative forerunners.

Perhaps the most extended discussion of what later became known as qualitative methods in a classic work is Bronisław Malinowski’s ( 1922 ) Argonauts in the Western Pacific , although even this study does not explicitly address the meaning of “qualitative.” In Weber’s ([1921–-22] 1978) work we find a tension between scientific explanations that are based on observation and quantification and interpretative research (see also Lazarsfeld and Barton 1982 ).

If we look through major sociology journals like the American Sociological Review , American Journal of Sociology , or Social Forces we will not find the term qualitative sociology before the 1970s. And certainly before then much of what we consider qualitative classics in sociology, like Becker’ study ( 1963 ), had already been produced. Indeed, the Chicago School often combined qualitative and quantitative data within the same study (Fine 1995 ). Our point being that before a disciplinary self-awareness the term quantitative preceded qualitative, and the articulation of the former was a political move to claim scientific status (Denzin and Lincoln 2005 ). In the US the World War II seem to have sparked a critique of sociological work, including “qualitative work,” that did not follow the scientific canon (Rawls 2018 ), which was underpinned by a scientifically oriented and value free philosophy of science. As a result the attempts and practice of integrating qualitative and quantitative sociology at Chicago lost ground to sociology that was more oriented to surveys and quantitative work at Columbia under Merton-Lazarsfeld. The quantitative tradition was also able to present textbooks (Lundberg 1951 ) that facilitated the use this approach and its “methods.” The practices of the qualitative tradition, by and large, remained tacit or was part of the mentoring transferred from the renowned masters to their students.

This glimpse into history leads us back to the lack of a coherent account condensed in a definition of qualitative research. Many of the attempts to define the term do not meet the requirements of a proper definition: A definition should be clear, avoid tautology, demarcate its domain in relation to the environment, and ideally only use words in its definiens that themselves are not in need of definition (Hempel 1966 ). A definition can enhance precision and thus clarity by identifying the core of the phenomenon. Preferably, a definition should be short. The typical definition we have found, however, is an ostensive definition, which indicates what qualitative research is about without informing us about what it actually is :

Qualitative research is multimethod in focus, involving an interpretative, 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. Qualitative research involves the studied use and collection of a variety of empirical materials – case study, personal experience, introspective, life story, interview, observational, historical, interactional, and visual texts – that describe routine and problematic moments and meanings in individuals’ lives. (Denzin and Lincoln 2005 :2)

Flick claims that the label “qualitative research” is indeed used as an umbrella for a number of approaches ( 2007 :2–4; 2002 :6), and it is not difficult to identify research fitting this designation. Moreover, whatever it is, it has grown dramatically over the past five decades. In addition, courses have been developed, methods have flourished, arguments about its future have been advanced (for example, Denzin and Lincoln 1994) and criticized (for example, Snow and Morrill 1995 ), and dedicated journals and books have mushroomed. Most social scientists have a clear idea of research and how it differs from journalism, politics and other activities. But the question of what is qualitative in qualitative research is either eluded or eschewed.

We maintain that this lacuna hinders systematic knowledge production based on qualitative research. Paul Lazarsfeld noted the lack of “codification” as early as 1955 when he reviewed 100 qualitative studies in order to offer a codification of the practices (Lazarsfeld and Barton 1982 :239). Since then many texts on “qualitative research” and its methods have been published, including recent attempts (Goertz and Mahoney 2012 ) similar to Lazarsfeld’s. These studies have tried to extract what is qualitative by looking at the large number of empirical “qualitative” studies. Our novel strategy complements these endeavors by taking another approach and looking at the attempts to codify these practices in the form of a definition, as well as to a minor extent take Becker’s study as an exemplar of what qualitative researchers actually do, and what the characteristic of being ‘qualitative’ denotes and implies. We claim that qualitative researchers, if there is such a thing as “qualitative research,” should be able to codify their practices in a condensed, yet general way expressed in language.

Lingering problems of “generalizability” and “how many cases do I need” (Small 2009 ) are blocking advancement – in this line of work qualitative approaches are said to differ considerably from quantitative ones, while some of the former unsuccessfully mimic principles related to the latter (Small 2009 ). Additionally, quantitative researchers sometimes unfairly criticize the first based on their own quality criteria. Scholars like Goertz and Mahoney ( 2012 ) have successfully focused on the different norms and practices beyond what they argue are essentially two different cultures: those working with either qualitative or quantitative methods. Instead, similarly to Becker ( 2017 ) who has recently questioned the usefulness of the distinction between qualitative and quantitative research, we focus on similarities.

The current situation also impedes both students and researchers in focusing their studies and understanding each other’s work (Lazarsfeld and Barton 1982 :239). A third consequence is providing an opening for critiques by scholars operating within different traditions (Valsiner 2000 :101). A fourth issue is that the “implicit use of methods in qualitative research makes the field far less standardized than the quantitative paradigm” (Goertz and Mahoney 2012 :9). Relatedly, the National Science Foundation in the US organized two workshops in 2004 and 2005 to address the scientific foundations of qualitative research involving strategies to improve it and to develop standards of evaluation in qualitative research. However, a specific focus on its distinguishing feature of being “qualitative” while being implicitly acknowledged, was discussed only briefly (for example, Best 2004 ).

In 2014 a theme issue was published in this journal on “Methods, Materials, and Meanings: Designing Cultural Analysis,” discussing central issues in (cultural) qualitative research (Berezin 2014 ; Biernacki 2014 ; Glaeser 2014 ; Lamont and Swidler 2014 ; Spillman 2014). We agree with many of the arguments put forward, such as the risk of methodological tribalism, and that we should not waste energy on debating methods separated from research questions. Nonetheless, a clarification of the relation to what is called “quantitative research” is of outmost importance to avoid misunderstandings and misguided debates between “qualitative” and “quantitative” researchers. Our strategy means that researchers, “qualitative” or “quantitative” they may be, in their actual practice may combine qualitative work and quantitative work.

In this article we accomplish three tasks. First, we systematically survey the literature for meanings of qualitative research by looking at how researchers have defined it. Drawing upon existing knowledge we find that the different meanings and ideas of qualitative research are not yet coherently integrated into one satisfactory definition. Next, we advance our contribution by offering a definition of qualitative research and illustrate its meaning and use partially by expanding on the brief example introduced earlier related to Becker’s work ( 1963 ). We offer a systematic analysis of central themes of what researchers consider to be the core of “qualitative,” regardless of style of work. These themes – which we summarize in terms of four keywords: distinction, process, closeness, improved understanding – constitute part of our literature review, in which each one appears, sometimes with others, but never all in the same definition. They serve as the foundation of our contribution. Our categories are overlapping. Their use is primarily to organize the large amount of definitions we have identified and analyzed, and not necessarily to draw a clear distinction between them. Finally, we continue the elaboration discussed above on the advantages of a clear definition of qualitative research.

In a hermeneutic fashion we propose that there is something meaningful that deserves to be labelled “qualitative research” (Gadamer 1990 ). To approach the question “What is qualitative in qualitative research?” we have surveyed the literature. In conducting our survey we first traced the word’s etymology in dictionaries, encyclopedias, handbooks of the social sciences and of methods and textbooks, mainly in English, which is common to methodology courses. It should be noted that we have zoomed in on sociology and its literature. This discipline has been the site of the largest debate and development of methods that can be called “qualitative,” which suggests that this field should be examined in great detail.

In an ideal situation we should expect that one good definition, or at least some common ideas, would have emerged over the years. This common core of qualitative research should be so accepted that it would appear in at least some textbooks. Since this is not what we found, we decided to pursue an inductive approach to capture maximal variation in the field of qualitative research; we searched in a selection of handbooks, textbooks, book chapters, and books, to which we added the analysis of journal articles. Our sample comprises a total of 89 references.

In practice we focused on the discipline that has had a clear discussion of methods, namely sociology. We also conducted a broad search in the JSTOR database to identify scholarly sociology articles published between 1998 and 2017 in English with a focus on defining or explaining qualitative research. We specifically zoom in on this time frame because we would have expect that this more mature period would have produced clear discussions on the meaning of qualitative research. To find these articles we combined a number of keywords to search the content and/or the title: qualitative (which was always included), definition, empirical, research, methodology, studies, fieldwork, interview and observation .

As a second phase of our research we searched within nine major sociological journals ( American Journal of Sociology , Sociological Theory , American Sociological Review , Contemporary Sociology , Sociological Forum , Sociological Theory , Qualitative Research , Qualitative Sociology and Qualitative Sociology Review ) for articles also published during the past 19 years (1998–2017) that had the term “qualitative” in the title and attempted to define qualitative research.

Lastly we picked two additional journals, Qualitative Research and Qualitative Sociology , in which we could expect to find texts addressing the notion of “qualitative.” From Qualitative Research we chose Volume 14, Issue 6, December 2014, and from Qualitative Sociology we chose Volume 36, Issue 2, June 2017. Within each of these we selected the first article; then we picked the second article of three prior issues. Again we went back another three issues and investigated article number three. Finally we went back another three issues and perused article number four. This selection criteria was used to get a manageable sample for the analysis.

The coding process of the 89 references we gathered in our selected review began soon after the first round of material was gathered, and we reduced the complexity created by our maximum variation sampling (Snow and Anderson 1993 :22) to four different categories within which questions on the nature and properties of qualitative research were discussed. We call them: Qualitative and Quantitative Research, Qualitative Research, Fieldwork, and Grounded Theory. This – which may appear as an illogical grouping – merely reflects the “context” in which the matter of “qualitative” is discussed. If the selection process of the material – books and articles – was informed by pre-knowledge, we used an inductive strategy to code the material. When studying our material, we identified four central notions related to “qualitative” that appear in various combinations in the literature which indicate what is the core of qualitative research. We have labeled them: “distinctions”, “process,” “closeness,” and “improved understanding.” During the research process the categories and notions were improved, refined, changed, and reordered. The coding ended when a sense of saturation in the material arose. In the presentation below all quotations and references come from our empirical material of texts on qualitative research.

Analysis – What is Qualitative Research?

In this section we describe the four categories we identified in the coding, how they differently discuss qualitative research, as well as their overall content. Some salient quotations are selected to represent the type of text sorted under each of the four categories. What we present are examples from the literature.

Qualitative and Quantitative

This analytic category comprises quotations comparing qualitative and quantitative research, a distinction that is frequently used (Brown 2010 :231); in effect this is a conceptual pair that structures the discussion and that may be associated with opposing interests. While the general goal of quantitative and qualitative research is the same – to understand the world better – their methodologies and focus in certain respects differ substantially (Becker 1966 :55). Quantity refers to that property of something that can be determined by measurement. In a dictionary of Statistics and Methodology we find that “(a) When referring to *variables, ‘qualitative’ is another term for *categorical or *nominal. (b) When speaking of kinds of research, ‘qualitative’ refers to studies of subjects that are hard to quantify, such as art history. Qualitative research tends to be a residual category for almost any kind of non-quantitative research” (Stiles 1998:183). But it should be obvious that one could employ a quantitative approach when studying, for example, art history.

The same dictionary states that quantitative is “said of variables or research that can be handled numerically, usually (too sharply) contrasted with *qualitative variables and research” (Stiles 1998:184). From a qualitative perspective “quantitative research” is about numbers and counting, and from a quantitative perspective qualitative research is everything that is not about numbers. But this does not say much about what is “qualitative.” If we turn to encyclopedias we find that in the 1932 edition of the Encyclopedia of the Social Sciences there is no mention of “qualitative.” In the Encyclopedia from 1968 we can read:

Qualitative Analysis. For methods of obtaining, analyzing, and describing data, see [the various entries:] CONTENT ANALYSIS; COUNTED DATA; EVALUATION RESEARCH, FIELD WORK; GRAPHIC PRESENTATION; HISTORIOGRAPHY, especially the article on THE RHETORIC OF HISTORY; INTERVIEWING; OBSERVATION; PERSONALITY MEASUREMENT; PROJECTIVE METHODS; PSYCHOANALYSIS, article on EXPERIMENTAL METHODS; SURVEY ANALYSIS, TABULAR PRESENTATION; TYPOLOGIES. (Vol. 13:225)

Some, like Alford, divide researchers into methodologists or, in his words, “quantitative and qualitative specialists” (Alford 1998 :12). Qualitative research uses a variety of methods, such as intensive interviews or in-depth analysis of historical materials, and it is concerned with a comprehensive account of some event or unit (King et al. 1994 :4). Like quantitative research it can be utilized to study a variety of issues, but it tends to focus on meanings and motivations that underlie cultural symbols, personal experiences, phenomena and detailed understanding of processes in the social world. In short, qualitative research centers on understanding processes, experiences, and the meanings people assign to things (Kalof et al. 2008 :79).

Others simply say that qualitative methods are inherently unscientific (Jovanović 2011 :19). Hood, for instance, argues that words are intrinsically less precise than numbers, and that they are therefore more prone to subjective analysis, leading to biased results (Hood 2006 :219). Qualitative methodologies have raised concerns over the limitations of quantitative templates (Brady et al. 2004 :4). Scholars such as King et al. ( 1994 ), for instance, argue that non-statistical research can produce more reliable results if researchers pay attention to the rules of scientific inference commonly stated in quantitative research. Also, researchers such as Becker ( 1966 :59; 1970 :42–43) have asserted that, if conducted properly, qualitative research and in particular ethnographic field methods, can lead to more accurate results than quantitative studies, in particular, survey research and laboratory experiments.

Some researchers, such as Kalof, Dan, and Dietz ( 2008 :79) claim that the boundaries between the two approaches are becoming blurred, and Small ( 2009 ) argues that currently much qualitative research (especially in North America) tries unsuccessfully and unnecessarily to emulate quantitative standards. For others, qualitative research tends to be more humanistic and discursive (King et al. 1994 :4). Ragin ( 1994 ), and similarly also Becker, ( 1996 :53), Marchel and Owens ( 2007 :303) think that the main distinction between the two styles is overstated and does not rest on the simple dichotomy of “numbers versus words” (Ragin 1994 :xii). Some claim that quantitative data can be utilized to discover associations, but in order to unveil cause and effect a complex research design involving the use of qualitative approaches needs to be devised (Gilbert 2009 :35). Consequently, qualitative data are useful for understanding the nuances lying beyond those processes as they unfold (Gilbert 2009 :35). Others contend that qualitative research is particularly well suited both to identify causality and to uncover fine descriptive distinctions (Fine and Hallett 2014 ; Lichterman and Isaac Reed 2014 ; Katz 2015 ).

There are other ways to separate these two traditions, including normative statements about what qualitative research should be (that is, better or worse than quantitative approaches, concerned with scientific approaches to societal change or vice versa; Snow and Morrill 1995 ; Denzin and Lincoln 2005 ), or whether it should develop falsifiable statements; Best 2004 ).

We propose that quantitative research is largely concerned with pre-determined variables (Small 2008 ); the analysis concerns the relations between variables. These categories are primarily not questioned in the study, only their frequency or degree, or the correlations between them (cf. Franzosi 2016 ). If a researcher studies wage differences between women and men, he or she works with given categories: x number of men are compared with y number of women, with a certain wage attributed to each person. The idea is not to move beyond the given categories of wage, men and women; they are the starting point as well as the end point, and undergo no “qualitative change.” Qualitative research, in contrast, investigates relations between categories that are themselves subject to change in the research process. Returning to Becker’s study ( 1963 ), we see that he questioned pre-dispositional theories of deviant behavior working with pre-determined variables such as an individual’s combination of personal qualities or emotional problems. His take, in contrast, was to understand marijuana consumption by developing “variables” as part of the investigation. Thereby he presented new variables, or as we would say today, theoretical concepts, but which are grounded in the empirical material.

Qualitative Research

This category contains quotations that refer to descriptions of qualitative research without making comparisons with quantitative research. Researchers such as Denzin and Lincoln, who have written a series of influential handbooks on qualitative methods (1994; Denzin and Lincoln 2003 ; 2005 ), citing Nelson et al. (1992:4), argue that because qualitative research is “interdisciplinary, transdisciplinary, and sometimes counterdisciplinary” it is difficult to derive one single definition of it (Jovanović 2011 :3). According to them, in fact, “the field” is “many things at the same time,” involving contradictions, tensions over its focus, methods, and how to derive interpretations and findings ( 2003 : 11). Similarly, others, such as Flick ( 2007 :ix–x) contend that agreeing on an accepted definition has increasingly become problematic, and that qualitative research has possibly matured different identities. However, Best holds that “the proliferation of many sorts of activities under the label of qualitative sociology threatens to confuse our discussions” ( 2004 :54). Atkinson’s position is more definite: “the current state of qualitative research and research methods is confused” ( 2005 :3–4).

Qualitative research is about interpretation (Blumer 1969 ; Strauss and Corbin 1998 ; Denzin and Lincoln 2003 ), or Verstehen [understanding] (Frankfort-Nachmias and Nachmias 1996 ). It is “multi-method,” involving the collection and use of a variety of empirical materials (Denzin and Lincoln 1998; Silverman 2013 ) and approaches (Silverman 2005 ; Flick 2007 ). It focuses not only on the objective nature of behavior but also on its subjective meanings: individuals’ own accounts of their attitudes, motivations, behavior (McIntyre 2005 :127; Creswell 2009 ), events and situations (Bryman 1989) – what people say and do in specific places and institutions (Goodwin and Horowitz 2002 :35–36) in social and temporal contexts (Morrill and Fine 1997). For this reason, following Weber ([1921-22] 1978), it can be described as an interpretative science (McIntyre 2005 :127). But could quantitative research also be concerned with these questions? Also, as pointed out below, does all qualitative research focus on subjective meaning, as some scholars suggest?

Others also distinguish qualitative research by claiming that it collects data using a naturalistic approach (Denzin and Lincoln 2005 :2; Creswell 2009 ), focusing on the meaning actors ascribe to their actions. But again, does all qualitative research need to be collected in situ? And does qualitative research have to be inherently concerned with meaning? Flick ( 2007 ), referring to Denzin and Lincoln ( 2005 ), mentions conversation analysis as an example of qualitative research that is not concerned with the meanings people bring to a situation, but rather with the formal organization of talk. Still others, such as Ragin ( 1994 :85), note that qualitative research is often (especially early on in the project, we would add) less structured than other kinds of social research – a characteristic connected to its flexibility and that can lead both to potentially better, but also worse results. But is this not a feature of this type of research, rather than a defining description of its essence? Wouldn’t this comment also apply, albeit to varying degrees, to quantitative research?

In addition, Strauss ( 2003 ), along with others, such as Alvesson and Kärreman ( 2011 :10–76), argue that qualitative researchers struggle to capture and represent complex phenomena partially because they tend to collect a large amount of data. While his analysis is correct at some points – “It is necessary to do detailed, intensive, microscopic examination of the data in order to bring out the amazing complexity of what lies in, behind, and beyond those data” (Strauss 2003 :10) – much of his analysis concerns the supposed focus of qualitative research and its challenges, rather than exactly what it is about. But even in this instance we would make a weak case arguing that these are strictly the defining features of qualitative research. Some researchers seem to focus on the approach or the methods used, or even on the way material is analyzed. Several researchers stress the naturalistic assumption of investigating the world, suggesting that meaning and interpretation appear to be a core matter of qualitative research.

We can also see that in this category there is no consensus about specific qualitative methods nor about qualitative data. Many emphasize interpretation, but quantitative research, too, involves interpretation; the results of a regression analysis, for example, certainly have to be interpreted, and the form of meta-analysis that factor analysis provides indeed requires interpretation However, there is no interpretation of quantitative raw data, i.e., numbers in tables. One common thread is that qualitative researchers have to get to grips with their data in order to understand what is being studied in great detail, irrespective of the type of empirical material that is being analyzed. This observation is connected to the fact that qualitative researchers routinely make several adjustments of focus and research design as their studies progress, in many cases until the very end of the project (Kalof et al. 2008 ). If you, like Becker, do not start out with a detailed theory, adjustments such as the emergence and refinement of research questions will occur during the research process. We have thus found a number of useful reflections about qualitative research scattered across different sources, but none of them effectively describe the defining characteristics of this approach.

Although qualitative research does not appear to be defined in terms of a specific method, it is certainly common that fieldwork, i.e., research that entails that the researcher spends considerable time in the field that is studied and use the knowledge gained as data, is seen as emblematic of or even identical to qualitative research. But because we understand that fieldwork tends to focus primarily on the collection and analysis of qualitative data, we expected to find within it discussions on the meaning of “qualitative.” But, again, this was not the case.

Instead, we found material on the history of this approach (for example, Frankfort-Nachmias and Nachmias 1996 ; Atkinson et al. 2001), including how it has changed; for example, by adopting a more self-reflexive practice (Heyl 2001), as well as the different nomenclature that has been adopted, such as fieldwork, ethnography, qualitative research, naturalistic research, participant observation and so on (for example, Lofland et al. 2006 ; Gans 1999 ).

We retrieved definitions of ethnography, such as “the study of people acting in the natural courses of their daily lives,” involving a “resocialization of the researcher” (Emerson 1988 :1) through intense immersion in others’ social worlds (see also examples in Hammersley 2018 ). This may be accomplished by direct observation and also participation (Neuman 2007 :276), although others, such as Denzin ( 1970 :185), have long recognized other types of observation, including non-participant (“fly on the wall”). In this category we have also isolated claims and opposing views, arguing that this type of research is distinguished primarily by where it is conducted (natural settings) (Hughes 1971:496), and how it is carried out (a variety of methods are applied) or, for some most importantly, by involving an active, empathetic immersion in those being studied (Emerson 1988 :2). We also retrieved descriptions of the goals it attends in relation to how it is taught (understanding subjective meanings of the people studied, primarily develop theory, or contribute to social change) (see for example, Corte and Irwin 2017 ; Frankfort-Nachmias and Nachmias 1996 :281; Trier-Bieniek 2012 :639) by collecting the richest possible data (Lofland et al. 2006 ) to derive “thick descriptions” (Geertz 1973 ), and/or to aim at theoretical statements of general scope and applicability (for example, Emerson 1988 ; Fine 2003 ). We have identified guidelines on how to evaluate it (for example Becker 1996 ; Lamont 2004 ) and have retrieved instructions on how it should be conducted (for example, Lofland et al. 2006 ). For instance, analysis should take place while the data gathering unfolds (Emerson 1988 ; Hammersley and Atkinson 2007 ; Lofland et al. 2006 ), observations should be of long duration (Becker 1970 :54; Goffman 1989 ), and data should be of high quantity (Becker 1970 :52–53), as well as other questionable distinctions between fieldwork and other methods:

Field studies differ from other methods of research in that the researcher performs the task of selecting topics, decides what questions to ask, and forges interest in the course of the research itself . This is in sharp contrast to many ‘theory-driven’ and ‘hypothesis-testing’ methods. (Lofland and Lofland 1995 :5)

But could not, for example, a strictly interview-based study be carried out with the same amount of flexibility, such as sequential interviewing (for example, Small 2009 )? Once again, are quantitative approaches really as inflexible as some qualitative researchers think? Moreover, this category stresses the role of the actors’ meaning, which requires knowledge and close interaction with people, their practices and their lifeworld.

It is clear that field studies – which are seen by some as the “gold standard” of qualitative research – are nonetheless only one way of doing qualitative research. There are other methods, but it is not clear why some are more qualitative than others, or why they are better or worse. Fieldwork is characterized by interaction with the field (the material) and understanding of the phenomenon that is being studied. In Becker’s case, he had general experience from fields in which marihuana was used, based on which he did interviews with actual users in several fields.

Grounded Theory

Another major category we identified in our sample is Grounded Theory. We found descriptions of it most clearly in Glaser and Strauss’ ([1967] 2010 ) original articulation, Strauss and Corbin ( 1998 ) and Charmaz ( 2006 ), as well as many other accounts of what it is for: generating and testing theory (Strauss 2003 :xi). We identified explanations of how this task can be accomplished – such as through two main procedures: constant comparison and theoretical sampling (Emerson 1998:96), and how using it has helped researchers to “think differently” (for example, Strauss and Corbin 1998 :1). We also read descriptions of its main traits, what it entails and fosters – for instance, an exceptional flexibility, an inductive approach (Strauss and Corbin 1998 :31–33; 1990; Esterberg 2002 :7), an ability to step back and critically analyze situations, recognize tendencies towards bias, think abstractly and be open to criticism, enhance sensitivity towards the words and actions of respondents, and develop a sense of absorption and devotion to the research process (Strauss and Corbin 1998 :5–6). Accordingly, we identified discussions of the value of triangulating different methods (both using and not using grounded theory), including quantitative ones, and theories to achieve theoretical development (most comprehensively in Denzin 1970 ; Strauss and Corbin 1998 ; Timmermans and Tavory 2012 ). We have also located arguments about how its practice helps to systematize data collection, analysis and presentation of results (Glaser and Strauss [1967] 2010 :16).

Grounded theory offers a systematic approach which requires researchers to get close to the field; closeness is a requirement of identifying questions and developing new concepts or making further distinctions with regard to old concepts. In contrast to other qualitative approaches, grounded theory emphasizes the detailed coding process, and the numerous fine-tuned distinctions that the researcher makes during the process. Within this category, too, we could not find a satisfying discussion of the meaning of qualitative research.

Defining Qualitative Research

In sum, our analysis shows that some notions reappear in the discussion of qualitative research, such as understanding, interpretation, “getting close” and making distinctions. These notions capture aspects of what we think is “qualitative.” However, a comprehensive definition that is useful and that can further develop the field is lacking, and not even a clear picture of its essential elements appears. In other words no definition emerges from our data, and in our research process we have moved back and forth between our empirical data and the attempt to present a definition. Our concrete strategy, as stated above, is to relate qualitative and quantitative research, or more specifically, qualitative and quantitative work. We use an ideal-typical notion of quantitative research which relies on taken for granted and numbered variables. This means that the data consists of variables on different scales, such as ordinal, but frequently ratio and absolute scales, and the representation of the numbers to the variables, i.e. the justification of the assignment of numbers to object or phenomenon, are not questioned, though the validity may be questioned. In this section we return to the notion of quality and try to clarify it while presenting our contribution.

Broadly, research refers to the activity performed by people trained to obtain knowledge through systematic procedures. Notions such as “objectivity” and “reflexivity,” “systematic,” “theory,” “evidence” and “openness” are here taken for granted in any type of research. Next, building on our empirical analysis we explain the four notions that we have identified as central to qualitative work: distinctions, process, closeness, and improved understanding. In discussing them, ultimately in relation to one another, we make their meaning even more precise. Our idea, in short, is that only when these ideas that we present separately for analytic purposes are brought together can we speak of qualitative research.

Distinctions

We believe that the possibility of making new distinctions is one the defining characteristics of qualitative research. It clearly sets it apart from quantitative analysis which works with taken-for-granted variables, albeit as mentioned, meta-analyses, for example, factor analysis may result in new variables. “Quality” refers essentially to distinctions, as already pointed out by Aristotle. He discusses the term “qualitative” commenting: “By a quality I mean that in virtue of which things are said to be qualified somehow” (Aristotle 1984:14). Quality is about what something is or has, which means that the distinction from its environment is crucial. We see qualitative research as a process in which significant new distinctions are made to the scholarly community; to make distinctions is a key aspect of obtaining new knowledge; a point, as we will see, that also has implications for “quantitative research.” The notion of being “significant” is paramount. New distinctions by themselves are not enough; just adding concepts only increases complexity without furthering our knowledge. The significance of new distinctions is judged against the communal knowledge of the research community. To enable this discussion and judgements central elements of rational discussion are required (cf. Habermas [1981] 1987 ; Davidsson [ 1988 ] 2001) to identify what is new and relevant scientific knowledge. Relatedly, Ragin alludes to the idea of new and useful knowledge at a more concrete level: “Qualitative methods are appropriate for in-depth examination of cases because they aid the identification of key features of cases. Most qualitative methods enhance data” (1994:79). When Becker ( 1963 ) studied deviant behavior and investigated how people became marihuana smokers, he made distinctions between the ways in which people learned how to smoke. This is a classic example of how the strategy of “getting close” to the material, for example the text, people or pictures that are subject to analysis, may enable researchers to obtain deeper insight and new knowledge by making distinctions – in this instance on the initial notion of learning how to smoke. Others have stressed the making of distinctions in relation to coding or theorizing. Emerson et al. ( 1995 ), for example, hold that “qualitative coding is a way of opening up avenues of inquiry,” meaning that the researcher identifies and develops concepts and analytic insights through close examination of and reflection on data (Emerson et al. 1995 :151). Goodwin and Horowitz highlight making distinctions in relation to theory-building writing: “Close engagement with their cases typically requires qualitative researchers to adapt existing theories or to make new conceptual distinctions or theoretical arguments to accommodate new data” ( 2002 : 37). In the ideal-typical quantitative research only existing and so to speak, given, variables would be used. If this is the case no new distinction are made. But, would not also many “quantitative” researchers make new distinctions?

Process does not merely suggest that research takes time. It mainly implies that qualitative new knowledge results from a process that involves several phases, and above all iteration. Qualitative research is about oscillation between theory and evidence, analysis and generating material, between first- and second -order constructs (Schütz 1962 :59), between getting in contact with something, finding sources, becoming deeply familiar with a topic, and then distilling and communicating some of its essential features. The main point is that the categories that the researcher uses, and perhaps takes for granted at the beginning of the research process, usually undergo qualitative changes resulting from what is found. Becker describes how he tested hypotheses and let the jargon of the users develop into theoretical concepts. This happens over time while the study is being conducted, exemplifying what we mean by process.

In the research process, a pilot-study may be used to get a first glance of, for example, the field, how to approach it, and what methods can be used, after which the method and theory are chosen or refined before the main study begins. Thus, the empirical material is often central from the start of the project and frequently leads to adjustments by the researcher. Likewise, during the main study categories are not fixed; the empirical material is seen in light of the theory used, but it is also given the opportunity to kick back, thereby resisting attempts to apply theoretical straightjackets (Becker 1970 :43). In this process, coding and analysis are interwoven, and thus are often important steps for getting closer to the phenomenon and deciding what to focus on next. Becker began his research by interviewing musicians close to him, then asking them to refer him to other musicians, and later on doubling his original sample of about 25 to include individuals in other professions (Becker 1973:46). Additionally, he made use of some participant observation, documents, and interviews with opiate users made available to him by colleagues. As his inductive theory of deviance evolved, Becker expanded his sample in order to fine tune it, and test the accuracy and generality of his hypotheses. In addition, he introduced a negative case and discussed the null hypothesis ( 1963 :44). His phasic career model is thus based on a research design that embraces processual work. Typically, process means to move between “theory” and “material” but also to deal with negative cases, and Becker ( 1998 ) describes how discovering these negative cases impacted his research design and ultimately its findings.

Obviously, all research is process-oriented to some degree. The point is that the ideal-typical quantitative process does not imply change of the data, and iteration between data, evidence, hypotheses, empirical work, and theory. The data, quantified variables, are, in most cases fixed. Merging of data, which of course can be done in a quantitative research process, does not mean new data. New hypotheses are frequently tested, but the “raw data is often the “the same.” Obviously, over time new datasets are made available and put into use.

Another characteristic that is emphasized in our sample is that qualitative researchers – and in particular ethnographers – can, or as Goffman put it, ought to ( 1989 ), get closer to the phenomenon being studied and their data than quantitative researchers (for example, Silverman 2009 :85). Put differently, essentially because of their methods qualitative researchers get into direct close contact with those being investigated and/or the material, such as texts, being analyzed. Becker started out his interview study, as we noted, by talking to those he knew in the field of music to get closer to the phenomenon he was studying. By conducting interviews he got even closer. Had he done more observations, he would undoubtedly have got even closer to the field.

Additionally, ethnographers’ design enables researchers to follow the field over time, and the research they do is almost by definition longitudinal, though the time in the field is studied obviously differs between studies. The general characteristic of closeness over time maximizes the chances of unexpected events, new data (related, for example, to archival research as additional sources, and for ethnography for situations not necessarily previously thought of as instrumental – what Mannay and Morgan ( 2015 ) term the “waiting field”), serendipity (Merton and Barber 2004 ; Åkerström 2013 ), and possibly reactivity, as well as the opportunity to observe disrupted patterns that translate into exemplars of negative cases. Two classic examples of this are Becker’s finding of what medical students call “crocks” (Becker et al. 1961 :317), and Geertz’s ( 1973 ) study of “deep play” in Balinese society.

By getting and staying so close to their data – be it pictures, text or humans interacting (Becker was himself a musician) – for a long time, as the research progressively focuses, qualitative researchers are prompted to continually test their hunches, presuppositions and hypotheses. They test them against a reality that often (but certainly not always), and practically, as well as metaphorically, talks back, whether by validating them, or disqualifying their premises – correctly, as well as incorrectly (Fine 2003 ; Becker 1970 ). This testing nonetheless often leads to new directions for the research. Becker, for example, says that he was initially reading psychological theories, but when facing the data he develops a theory that looks at, you may say, everything but psychological dispositions to explain the use of marihuana. Especially researchers involved with ethnographic methods have a fairly unique opportunity to dig up and then test (in a circular, continuous and temporal way) new research questions and findings as the research progresses, and thereby to derive previously unimagined and uncharted distinctions by getting closer to the phenomenon under study.

Let us stress that getting close is by no means restricted to ethnography. The notion of hermeneutic circle and hermeneutics as a general way of understanding implies that we must get close to the details in order to get the big picture. This also means that qualitative researchers can literally also make use of details of pictures as evidence (cf. Harper 2002). Thus, researchers may get closer both when generating the material or when analyzing it.

Quantitative research, we maintain, in the ideal-typical representation cannot get closer to the data. The data is essentially numbers in tables making up the variables (Franzosi 2016 :138). The data may originally have been “qualitative,” but once reduced to numbers there can only be a type of “hermeneutics” about what the number may stand for. The numbers themselves, however, are non-ambiguous. Thus, in quantitative research, interpretation, if done, is not about the data itself—the numbers—but what the numbers stand for. It follows that the interpretation is essentially done in a more “speculative” mode without direct empirical evidence (cf. Becker 2017 ).

Improved Understanding

While distinction, process and getting closer refer to the qualitative work of the researcher, improved understanding refers to its conditions and outcome of this work. Understanding cuts deeper than explanation, which to some may mean a causally verified correlation between variables. The notion of explanation presupposes the notion of understanding since explanation does not include an idea of how knowledge is gained (Manicas 2006 : 15). Understanding, we argue, is the core concept of what we call the outcome of the process when research has made use of all the other elements that were integrated in the research. Understanding, then, has a special status in qualitative research since it refers both to the conditions of knowledge and the outcome of the process. Understanding can to some extent be seen as the condition of explanation and occurs in a process of interpretation, which naturally refers to meaning (Gadamer 1990 ). It is fundamentally connected to knowing, and to the knowing of how to do things (Heidegger [1927] 2001 ). Conceptually the term hermeneutics is used to account for this process. Heidegger ties hermeneutics to human being and not possible to separate from the understanding of being ( 1988 ). Here we use it in a broader sense, and more connected to method in general (cf. Seiffert 1992 ). The abovementioned aspects – for example, “objectivity” and “reflexivity” – of the approach are conditions of scientific understanding. Understanding is the result of a circular process and means that the parts are understood in light of the whole, and vice versa. Understanding presupposes pre-understanding, or in other words, some knowledge of the phenomenon studied. The pre-understanding, even in the form of prejudices, are in qualitative research process, which we see as iterative, questioned, which gradually or suddenly change due to the iteration of data, evidence and concepts. However, qualitative research generates understanding in the iterative process when the researcher gets closer to the data, e.g., by going back and forth between field and analysis in a process that generates new data that changes the evidence, and, ultimately, the findings. Questioning, to ask questions, and put what one assumes—prejudices and presumption—in question, is central to understand something (Heidegger [1927] 2001 ; Gadamer 1990 :368–384). We propose that this iterative process in which the process of understanding occurs is characteristic of qualitative research.

Improved understanding means that we obtain scientific knowledge of something that we as a scholarly community did not know before, or that we get to know something better. It means that we understand more about how parts are related to one another, and to other things we already understand (see also Fine and Hallett 2014 ). Understanding is an important condition for qualitative research. It is not enough to identify correlations, make distinctions, and work in a process in which one gets close to the field or phenomena. Understanding is accomplished when the elements are integrated in an iterative process.

It is, moreover, possible to understand many things, and researchers, just like children, may come to understand new things every day as they engage with the world. This subjective condition of understanding – namely, that a person gains a better understanding of something –is easily met. To be qualified as “scientific,” the understanding must be general and useful to many; it must be public. But even this generally accessible understanding is not enough in order to speak of “scientific understanding.” Though we as a collective can increase understanding of everything in virtually all potential directions as a result also of qualitative work, we refrain from this “objective” way of understanding, which has no means of discriminating between what we gain in understanding. Scientific understanding means that it is deemed relevant from the scientific horizon (compare Schütz 1962 : 35–38, 46, 63), and that it rests on the pre-understanding that the scientists have and must have in order to understand. In other words, the understanding gained must be deemed useful by other researchers, so that they can build on it. We thus see understanding from a pragmatic, rather than a subjective or objective perspective. Improved understanding is related to the question(s) at hand. Understanding, in order to represent an improvement, must be an improvement in relation to the existing body of knowledge of the scientific community (James [ 1907 ] 1955). Scientific understanding is, by definition, collective, as expressed in Weber’s famous note on objectivity, namely that scientific work aims at truths “which … can claim, even for a Chinese, the validity appropriate to an empirical analysis” ([1904] 1949 :59). By qualifying “improved understanding” we argue that it is a general defining characteristic of qualitative research. Becker‘s ( 1966 ) study and other research of deviant behavior increased our understanding of the social learning processes of how individuals start a behavior. And it also added new knowledge about the labeling of deviant behavior as a social process. Few studies, of course, make the same large contribution as Becker’s, but are nonetheless qualitative research.

Understanding in the phenomenological sense, which is a hallmark of qualitative research, we argue, requires meaning and this meaning is derived from the context, and above all the data being analyzed. The ideal-typical quantitative research operates with given variables with different numbers. This type of material is not enough to establish meaning at the level that truly justifies understanding. In other words, many social science explanations offer ideas about correlations or even causal relations, but this does not mean that the meaning at the level of the data analyzed, is understood. This leads us to say that there are indeed many explanations that meet the criteria of understanding, for example the explanation of how one becomes a marihuana smoker presented by Becker. However, we may also understand a phenomenon without explaining it, and we may have potential explanations, or better correlations, that are not really understood.

We may speak more generally of quantitative research and its data to clarify what we see as an important distinction. The “raw data” that quantitative research—as an idealtypical activity, refers to is not available for further analysis; the numbers, once created, are not to be questioned (Franzosi 2016 : 138). If the researcher is to do “more” or “change” something, this will be done by conjectures based on theoretical knowledge or based on the researcher’s lifeworld. Both qualitative and quantitative research is based on the lifeworld, and all researchers use prejudices and pre-understanding in the research process. This idea is present in the works of Heidegger ( 2001 ) and Heisenberg (cited in Franzosi 2010 :619). Qualitative research, as we argued, involves the interaction and questioning of concepts (theory), data, and evidence.

Ragin ( 2004 :22) points out that “a good definition of qualitative research should be inclusive and should emphasize its key strengths and features, not what it lacks (for example, the use of sophisticated quantitative techniques).” We define qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied. Qualitative research, as defined here, is consequently a combination of two criteria: (i) how to do things –namely, generating and analyzing empirical material, in an iterative process in which one gets closer by making distinctions, and (ii) the outcome –improved understanding novel to the scholarly community. Is our definition applicable to our own study? In this study we have closely read the empirical material that we generated, and the novel distinction of the notion “qualitative research” is the outcome of an iterative process in which both deduction and induction were involved, in which we identified the categories that we analyzed. We thus claim to meet the first criteria, “how to do things.” The second criteria cannot be judged but in a partial way by us, namely that the “outcome” —in concrete form the definition-improves our understanding to others in the scientific community.

We have defined qualitative research, or qualitative scientific work, in relation to quantitative scientific work. Given this definition, qualitative research is about questioning the pre-given (taken for granted) variables, but it is thus also about making new distinctions of any type of phenomenon, for example, by coining new concepts, including the identification of new variables. This process, as we have discussed, is carried out in relation to empirical material, previous research, and thus in relation to theory. Theory and previous research cannot be escaped or bracketed. According to hermeneutic principles all scientific work is grounded in the lifeworld, and as social scientists we can thus never fully bracket our pre-understanding.

We have proposed that quantitative research, as an idealtype, is concerned with pre-determined variables (Small 2008 ). Variables are epistemically fixed, but can vary in terms of dimensions, such as frequency or number. Age is an example; as a variable it can take on different numbers. In relation to quantitative research, qualitative research does not reduce its material to number and variables. If this is done the process of comes to a halt, the researcher gets more distanced from her data, and it makes it no longer possible to make new distinctions that increase our understanding. We have above discussed the components of our definition in relation to quantitative research. Our conclusion is that in the research that is called quantitative there are frequent and necessary qualitative elements.

Further, comparative empirical research on researchers primarily working with ”quantitative” approaches and those working with ”qualitative” approaches, we propose, would perhaps show that there are many similarities in practices of these two approaches. This is not to deny dissimilarities, or the different epistemic and ontic presuppositions that may be more or less strongly associated with the two different strands (see Goertz and Mahoney 2012 ). Our point is nonetheless that prejudices and preconceptions about researchers are unproductive, and that as other researchers have argued, differences may be exaggerated (e.g., Becker 1996 : 53, 2017 ; Marchel and Owens 2007 :303; Ragin 1994 ), and that a qualitative dimension is present in both kinds of work.

Several things follow from our findings. The most important result is the relation to quantitative research. In our analysis we have separated qualitative research from quantitative research. The point is not to label individual researchers, methods, projects, or works as either “quantitative” or “qualitative.” By analyzing, i.e., taking apart, the notions of quantitative and qualitative, we hope to have shown the elements of qualitative research. Our definition captures the elements, and how they, when combined in practice, generate understanding. As many of the quotations we have used suggest, one conclusion of our study holds that qualitative approaches are not inherently connected with a specific method. Put differently, none of the methods that are frequently labelled “qualitative,” such as interviews or participant observation, are inherently “qualitative.” What matters, given our definition, is whether one works qualitatively or quantitatively in the research process, until the results are produced. Consequently, our analysis also suggests that those researchers working with what in the literature and in jargon is often called “quantitative research” are almost bound to make use of what we have identified as qualitative elements in any research project. Our findings also suggest that many” quantitative” researchers, at least to some extent, are engaged with qualitative work, such as when research questions are developed, variables are constructed and combined, and hypotheses are formulated. Furthermore, a research project may hover between “qualitative” and “quantitative” or start out as “qualitative” and later move into a “quantitative” (a distinct strategy that is not similar to “mixed methods” or just simply combining induction and deduction). More generally speaking, the categories of “qualitative” and “quantitative,” unfortunately, often cover up practices, and it may lead to “camps” of researchers opposing one another. For example, regardless of the researcher is primarily oriented to “quantitative” or “qualitative” research, the role of theory is neglected (cf. Swedberg 2017 ). Our results open up for an interaction not characterized by differences, but by different emphasis, and similarities.

Let us take two examples to briefly indicate how qualitative elements can fruitfully be combined with quantitative. Franzosi ( 2010 ) has discussed the relations between quantitative and qualitative approaches, and more specifically the relation between words and numbers. He analyzes texts and argues that scientific meaning cannot be reduced to numbers. Put differently, the meaning of the numbers is to be understood by what is taken for granted, and what is part of the lifeworld (Schütz 1962 ). Franzosi shows how one can go about using qualitative and quantitative methods and data to address scientific questions analyzing violence in Italy at the time when fascism was rising (1919–1922). Aspers ( 2006 ) studied the meaning of fashion photographers. He uses an empirical phenomenological approach, and establishes meaning at the level of actors. In a second step this meaning, and the different ideal-typical photographers constructed as a result of participant observation and interviews, are tested using quantitative data from a database; in the first phase to verify the different ideal-types, in the second phase to use these types to establish new knowledge about the types. In both of these cases—and more examples can be found—authors move from qualitative data and try to keep the meaning established when using the quantitative data.

A second main result of our study is that a definition, and we provided one, offers a way for research to clarify, and even evaluate, what is done. Hence, our definition can guide researchers and students, informing them on how to think about concrete research problems they face, and to show what it means to get closer in a process in which new distinctions are made. The definition can also be used to evaluate the results, given that it is a standard of evaluation (cf. Hammersley 2007 ), to see whether new distinctions are made and whether this improves our understanding of what is researched, in addition to the evaluation of how the research was conducted. By making what is qualitative research explicit it becomes easier to communicate findings, and it is thereby much harder to fly under the radar with substandard research since there are standards of evaluation which make it easier to separate “good” from “not so good” qualitative research.

To conclude, our analysis, which ends with a definition of qualitative research can thus both address the “internal” issues of what is qualitative research, and the “external” critiques that make it harder to do qualitative research, to which both pressure from quantitative methods and general changes in society contribute.

Acknowledgements

Financial Support for this research is given by the European Research Council, CEV (263699). The authors are grateful to Susann Krieglsteiner for assistance in collecting the data. The paper has benefitted from the many useful comments by the three reviewers and the editor, comments by members of the Uppsala Laboratory of Economic Sociology, as well as Jukka Gronow, Sebastian Kohl, Marcin Serafin, Richard Swedberg, Anders Vassenden and Turid Rødne.

Biographies

is professor of sociology at the Department of Sociology, Uppsala University and Universität St. Gallen. His main focus is economic sociology, and in particular, markets. He has published numerous articles and books, including Orderly Fashion (Princeton University Press 2010), Markets (Polity Press 2011) and Re-Imagining Economic Sociology (edited with N. Dodd, Oxford University Press 2015). His book Ethnographic Methods (in Swedish) has already gone through several editions.

is associate professor of sociology at the Department of Media and Social Sciences, University of Stavanger. His research has been published in journals such as Social Psychology Quarterly, Sociological Theory, Teaching Sociology, and Music and Arts in Action. As an ethnographer he is working on a book on he social world of big-wave surfing.

Publisher’s Note

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

Contributor Information

Patrik Aspers, Email: [email protected] .

Ugo Corte, Email: [email protected] .

• Åkerström M. Curiosity and serendipity in qualitative research. Qualitative Sociology Review. 2013; 9 (2):10–18. [ Google Scholar ]
• Alford, Robert R. 1998. The craft of inquiry. Theories, methods, evidence . Oxford: Oxford University Press.
• Alvesson M, Kärreman D. Qualitative research and theory development . Mystery as method . London: SAGE Publications; 2011. [ Google Scholar ]
• Aspers, Patrik. 2006. Markets in Fashion, A Phenomenological Approach. London Routledge.
• Atkinson P. Qualitative research. Unity and diversity. Forum: Qualitative Social Research. 2005; 6 (3):1–15. [ Google Scholar ]
• Becker HS. Outsiders. Studies in the sociology of deviance . New York: The Free Press; 1963. [ Google Scholar ]
• Becker HS. Whose side are we on? Social Problems. 1966; 14 (3):239–247. [ Google Scholar ]
• Becker HS. Sociological work. Method and substance. New Brunswick: Transaction Books; 1970. [ Google Scholar ]
• Becker HS. The epistemology of qualitative research. In: Richard J, Anne C, Shweder RA, editors. Ethnography and human development. Context and meaning in social inquiry. Chicago: University of Chicago Press; 1996. pp. 53–71. [ Google Scholar ]
• Becker HS. Tricks of the trade. How to think about your research while you're doing it. Chicago: University of Chicago Press; 1998. [ Google Scholar ]
• Becker, Howard S. 2017. Evidence . Chigaco: University of Chicago Press.
• Becker H, Geer B, Hughes E, Strauss A. Boys in White, student culture in medical school. New Brunswick: Transaction Publishers; 1961. [ Google Scholar ]
• Berezin M. How do we know what we mean? Epistemological dilemmas in cultural sociology. Qualitative Sociology. 2014; 37 (2):141–151. [ Google Scholar ]
• Best, Joel. 2004. Defining qualitative research. In Workshop on Scientific Foundations of Qualitative Research , eds . Charles, Ragin, Joanne, Nagel, and Patricia White, 53-54. http://www.nsf.gov/pubs/2004/nsf04219/nsf04219.pdf .
• Biernacki R. Humanist interpretation versus coding text samples. Qualitative Sociology. 2014; 37 (2):173–188. [ Google Scholar ]
• Blumer H. Symbolic interactionism: Perspective and method. Berkeley: University of California Press; 1969. [ Google Scholar ]
• Brady H, Collier D, Seawright J. Refocusing the discussion of methodology. In: Henry B, David C, editors. Rethinking social inquiry. Diverse tools, shared standards. Lanham: Rowman and Littlefield; 2004. pp. 3–22. [ Google Scholar ]
• Brown AP. Qualitative method and compromise in applied social research. Qualitative Research. 2010; 10 (2):229–248. [ Google Scholar ]
• Charmaz K. Constructing grounded theory. London: Sage; 2006. [ Google Scholar ]
• Corte, Ugo, and Katherine Irwin. 2017. “The Form and Flow of Teaching Ethnographic Knowledge: Hands-on Approaches for Learning Epistemology” Teaching Sociology 45(3): 209-219.
• Creswell JW. Research design. Qualitative, quantitative, and mixed method approaches. 3. Thousand Oaks: SAGE Publications; 2009. [ Google Scholar ]
• Davidsson D. The myth of the subjective. In: Davidsson D, editor. Subjective, intersubjective, objective. Oxford: Oxford University Press; 1988. pp. 39–52. [ Google Scholar ]
• Denzin NK. The research act: A theoretical introduction to Ssociological methods. Chicago: Aldine Publishing Company Publishers; 1970. [ Google Scholar ]
• Denzin NK, Lincoln YS. Introduction. The discipline and practice of qualitative research. In: Denzin NK, Lincoln YS, editors. Collecting and interpreting qualitative materials. Thousand Oaks: SAGE Publications; 2003. pp. 1–45. [ Google Scholar ]
• Denzin NK, Lincoln YS. Introduction. The discipline and practice of qualitative research. In: Denzin NK, Lincoln YS, editors. The Sage handbook of qualitative research. Thousand Oaks: SAGE Publications; 2005. pp. 1–32. [ Google Scholar ]
• Emerson RM, editor. Contemporary field research. A collection of readings. Prospect Heights: Waveland Press; 1988. [ Google Scholar ]
• Emerson RM, Fretz RI, Shaw LL. Writing ethnographic fieldnotes. Chicago: University of Chicago Press; 1995. [ Google Scholar ]
• Esterberg KG. Qualitative methods in social research. Boston: McGraw-Hill; 2002. [ Google Scholar ]
• Fine, Gary Alan. 1995. Review of “handbook of qualitative research.” Contemporary Sociology 24 (3): 416–418.
• Fine, Gary Alan. 2003. “ Toward a Peopled Ethnography: Developing Theory from Group Life.” Ethnography . 4(1):41-60.
• Fine GA, Hancock BH. The new ethnographer at work. Qualitative Research. 2017; 17 (2):260–268. [ Google Scholar ]
• Fine GA, Hallett T. Stranger and stranger: Creating theory through ethnographic distance and authority. Journal of Organizational Ethnography. 2014; 3 (2):188–203. [ Google Scholar ]
• Flick U. Qualitative research. State of the art. Social Science Information. 2002; 41 (1):5–24. [ Google Scholar ]
• Flick U. Designing qualitative research. London: SAGE Publications; 2007. [ Google Scholar ]
• Frankfort-Nachmias C, Nachmias D. Research methods in the social sciences. 5. London: Edward Arnold; 1996. [ Google Scholar ]
• Franzosi R. Sociology, narrative, and the quality versus quantity debate (Goethe versus Newton): Can computer-assisted story grammars help us understand the rise of Italian fascism (1919- 1922)? Theory and Society. 2010; 39 (6):593–629. [ Google Scholar ]
• Franzosi R. From method and measurement to narrative and number. International journal of social research methodology. 2016; 19 (1):137–141. [ Google Scholar ]
• Gadamer, Hans-Georg. 1990. Wahrheit und Methode, Grundzüge einer philosophischen Hermeneutik . Band 1, Hermeneutik. Tübingen: J.C.B. Mohr.
• Gans H. Participant Observation in an Age of “Ethnography” Journal of Contemporary Ethnography. 1999; 28 (5):540–548. [ Google Scholar ]
• Geertz C. The interpretation of cultures. New York: Basic Books; 1973. [ Google Scholar ]
• Gilbert N. Researching social life. 3. London: SAGE Publications; 2009. [ Google Scholar ]
• Glaeser A. Hermeneutic institutionalism: Towards a new synthesis. Qualitative Sociology. 2014; 37 :207–241. [ Google Scholar ]
• Glaser, Barney G., and Anselm L. Strauss. [1967] 2010. The discovery of grounded theory. Strategies for qualitative research. Hawthorne: Aldine.
• Goertz G, Mahoney J. A tale of two cultures: Qualitative and quantitative research in the social sciences. Princeton: Princeton University Press; 2012. [ Google Scholar ]
• Goffman E. On fieldwork. Journal of Contemporary Ethnography. 1989; 18 (2):123–132. [ Google Scholar ]
• Goodwin J, Horowitz R. Introduction. The methodological strengths and dilemmas of qualitative sociology. Qualitative Sociology. 2002; 25 (1):33–47. [ Google Scholar ]
• Habermas, Jürgen. [1981] 1987. The theory of communicative action . Oxford: Polity Press.
• Hammersley M. The issue of quality in qualitative research. International Journal of Research & Method in Education. 2007; 30 (3):287–305. [ Google Scholar ]
• Hammersley, Martyn. 2013. What is qualitative research? Bloomsbury Publishing.
• Hammersley M. What is ethnography? Can it survive should it? Ethnography and Education. 2018; 13 (1):1–17. [ Google Scholar ]
• Hammersley M, Atkinson P. Ethnography . Principles in practice . London: Tavistock Publications; 2007. [ Google Scholar ]
• Heidegger M. Sein und Zeit. Tübingen: Max Niemeyer Verlag; 2001. [ Google Scholar ]
• Heidegger, Martin. 1988. 1923. Ontologie. Hermeneutik der Faktizität, Gesamtausgabe II. Abteilung: Vorlesungen 1919-1944, Band 63, Frankfurt am Main: Vittorio Klostermann.
• Hempel CG. Philosophy of the natural sciences. Upper Saddle River: Prentice Hall; 1966. [ Google Scholar ]
• Hood JC. Teaching against the text. The case of qualitative methods. Teaching Sociology. 2006; 34 (3):207–223. [ Google Scholar ]
• James W. Pragmatism. New York: Meredian Books; 1907. [ Google Scholar ]
• Jovanović G. Toward a social history of qualitative research. History of the Human Sciences. 2011; 24 (2):1–27. [ Google Scholar ]
• Kalof L, Dan A, Dietz T. Essentials of social research. London: Open University Press; 2008. [ Google Scholar ]
• Katz J. Situational evidence: Strategies for causal reasoning from observational field notes. Sociological Methods & Research. 2015; 44 (1):108–144. [ Google Scholar ]
• King G, Keohane RO, Sidney S, Verba S. Scientific inference in qualitative research. Princeton: Princeton University Press; 1994. Designing social inquiry. [ Google Scholar ]
• Lamont M. Evaluating qualitative research: Some empirical findings and an agenda. In: Lamont M, White P, editors. Report from workshop on interdisciplinary standards for systematic qualitative research. Washington, DC: National Science Foundation; 2004. pp. 91–95. [ Google Scholar ]
• Lamont M, Swidler A. Methodological pluralism and the possibilities and limits of interviewing. Qualitative Sociology. 2014; 37 (2):153–171. [ Google Scholar ]
• Lazarsfeld P, Barton A. Some functions of qualitative analysis in social research. In: Kendall P, editor. The varied sociology of Paul Lazarsfeld. New York: Columbia University Press; 1982. pp. 239–285. [ Google Scholar ]
• Lichterman, Paul, and Isaac Reed I (2014), Theory and Contrastive Explanation in Ethnography. Sociological methods and research. Prepublished 27 October 2014; 10.1177/0049124114554458.
• Lofland J, Lofland L. Analyzing social settings. A guide to qualitative observation and analysis. 3. Belmont: Wadsworth; 1995. [ Google Scholar ]
• Lofland J, Snow DA, Anderson L, Lofland LH. Analyzing social settings. A guide to qualitative observation and analysis. 4. Belmont: Wadsworth/Thomson Learning; 2006. [ Google Scholar ]
• Long AF, Godfrey M. An evaluation tool to assess the quality of qualitative research studies. International Journal of Social Research Methodology. 2004; 7 (2):181–196. [ Google Scholar ]
• Lundberg G. Social research: A study in methods of gathering data. New York: Longmans, Green and Co.; 1951. [ Google Scholar ]
• Malinowski B. Argonauts of the Western Pacific: An account of native Enterprise and adventure in the archipelagoes of Melanesian New Guinea. London: Routledge; 1922. [ Google Scholar ]
• Manicas P. A realist philosophy of science: Explanation and understanding. Cambridge: Cambridge University Press; 2006. [ Google Scholar ]
• Marchel C, Owens S. Qualitative research in psychology. Could William James get a job? History of Psychology. 2007; 10 (4):301–324. [ PubMed ] [ Google Scholar ]
• McIntyre LJ. Need to know. Social science research methods. Boston: McGraw-Hill; 2005. [ Google Scholar ]
• Merton RK, Barber E. The travels and adventures of serendipity . A Study in Sociological Semantics and the Sociology of Science. Princeton: Princeton University Press; 2004. [ Google Scholar ]
• Mannay D, Morgan M. Doing ethnography or applying a qualitative technique? Reflections from the ‘waiting field‘ Qualitative Research. 2015; 15 (2):166–182. [ Google Scholar ]
• Neuman LW. Basics of social research. Qualitative and quantitative approaches. 2. Boston: Pearson Education; 2007. [ Google Scholar ]
• Ragin CC. Constructing social research. The unity and diversity of method. Thousand Oaks: Pine Forge Press; 1994. [ Google Scholar ]
• Ragin, Charles C. 2004. Introduction to session 1: Defining qualitative research. In Workshop on Scientific Foundations of Qualitative Research , 22, ed. Charles C. Ragin, Joane Nagel, Patricia White. http://www.nsf.gov/pubs/2004/nsf04219/nsf04219.pdf
• Rawls, Anne. 2018. The Wartime narrative in US sociology, 1940–7: Stigmatizing qualitative sociology in the name of ‘science,’ European Journal of Social Theory (Online first).
• Schütz A. Collected papers I: The problem of social reality. The Hague: Nijhoff; 1962. [ Google Scholar ]
• Seiffert H. Einführung in die Hermeneutik. Tübingen: Franke; 1992. [ Google Scholar ]
• Silverman D. Doing qualitative research. A practical handbook. 2. London: SAGE Publications; 2005. [ Google Scholar ]
• Silverman D. A very short, fairly interesting and reasonably cheap book about qualitative research. London: SAGE Publications; 2009. [ Google Scholar ]
• Silverman D. What counts as qualitative research? Some cautionary comments. Qualitative Sociology Review. 2013; 9 (2):48–55. [ Google Scholar ]
• Small ML. “How many cases do I need?” on science and the logic of case selection in field-based research. Ethnography. 2009; 10 (1):5–38. [ Google Scholar ]
• Small, Mario L 2008. Lost in translation: How not to make qualitative research more scientific. In Workshop on interdisciplinary standards for systematic qualitative research, ed in Michelle Lamont, and Patricia White, 165–171. Washington, DC: National Science Foundation.
• Snow DA, Anderson L. Down on their luck: A study of homeless street people. Berkeley: University of California Press; 1993. [ Google Scholar ]
• Snow DA, Morrill C. New ethnographies: Review symposium: A revolutionary handbook or a handbook for revolution? Journal of Contemporary Ethnography. 1995; 24 (3):341–349. [ Google Scholar ]
• Strauss AL. Qualitative analysis for social scientists. 14. Chicago: Cambridge University Press; 2003. [ Google Scholar ]
• Strauss AL, Corbin JM. Basics of qualitative research. Techniques and procedures for developing grounded theory. 2. Thousand Oaks: Sage Publications; 1998. [ Google Scholar ]
• Swedberg, Richard. 2017. Theorizing in sociological research: A new perspective, a new departure? Annual Review of Sociology 43: 189–206.
• Swedberg R. The new 'Battle of Methods'. Challenge January–February. 1990; 3 (1):33–38. [ Google Scholar ]
• Timmermans S, Tavory I. Theory construction in qualitative research: From grounded theory to abductive analysis. Sociological Theory. 2012; 30 (3):167–186. [ Google Scholar ]
• Trier-Bieniek A. Framing the telephone interview as a participant-centred tool for qualitative research. A methodological discussion. Qualitative Research. 2012; 12 (6):630–644. [ Google Scholar ]
• Valsiner J. Data as representations. Contextualizing qualitative and quantitative research strategies. Social Science Information. 2000; 39 (1):99–113. [ Google Scholar ]
• Weber, Max. 1904. 1949. Objectivity’ in social Science and social policy. Ed. Edward A. Shils and Henry A. Finch, 49–112. New York: The Free Press.

• Privacy Policy

Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

Also see Research Methods

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Questionnaire – Definition, Types, and Examples

Case Study – Methods, Examples and Guide

Observational Research – Methods and Guide

Quantitative Research – Methods, Types and...

Qualitative Research Methods

Explanatory Research – Types, Methods, Guide

Qualitative Research Design: Start

Qualitative Research Design

What is Qualitative research design?

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypotheses as well as further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much . It could be structured as a stand-alone study, purely relying on qualitative data or it could be part of mixed-methods research that combines qualitative and quantitative data.

Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research. Qualitative research is the opposite of quantitative research, which involves collecting and analyzing numerical data for statistical analysis. Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, history, etc.

While qualitative and quantitative approaches are different, they are not necessarily opposites, and they are certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined that there is a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated together.

Research Paradigms 

• Positivist versus Post-Positivist
• Social Constructivist (this paradigm/ideology mostly birth qualitative studies)

Events Relating to the Qualitative Research and Community Engagement Workshops @ CMU Libraries

CMU Libraries is committed to helping members of our community become data experts. To that end, CMU is offering public facing workshops that discuss Qualitative Research, Coding, and Community Engagement best practices.

The following workshops are a part of a broader series on using data. Please follow the links to register for the events. 

Qualitative Coding

Using Community Data to improve Outcome (Grant Writing)

Survey Design  

Upcoming Event: March 21st, 2024 (12:00pm -1:00 pm)

Community Engagement and Collaboration Event 

Join us for an event to improve, build on and expand the connections between Carnegie Mellon University resources and the Pittsburgh community. CMU resources such as the Libraries and Sustainability Initiative can be leveraged by users not affiliated with the university, but barriers can prevent them from fully engaging.

The conversation features representatives from CMU departments and local organizations about the community engagement efforts currently underway at CMU and opportunities to improve upon them. Speakers will highlight current and ongoing projects and share resources to support future collaboration.

Event Moderators:

Taiwo Lasisi, CLIR Postdoctoral Fellow in Community Data Literacy,  Carnegie Mellon University Libraries

Emma Slayton, Data Curation, Visualization, & GIS Specialist,  Carnegie Mellon University Libraries

Nicky Agate , Associate Dean for Academic Engagement, Carnegie Mellon University Libraries

Chelsea Cohen , The University’s Executive fellow for community engagement, Carnegie Mellon University

Sarah Ceurvorst , Academic Pathways Manager, Program Director, LEAP (Leadership, Excellence, Access, Persistence) Carnegie Mellon University

Julia Poeppibg , Associate Director of Partnership Development, Information Systems, Carnegie Mellon University 

Scott Wolovich , Director of New Sun Rising, Pittsburgh 

Additional workshops and events will be forthcoming. Watch this space for updates. 

Workshop Organizer

Qualitative Research Methods

What are Qualitative Research methods?

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

What constitutes a good research question? Does the question drive research design choices?

According to Doody and Bailey (2014);

 We can only develop a good research question by consulting relevant literature, colleagues, and supervisors experienced in the area of research. (inductive interactions).

Helps to have a directed research aim and objective.

Researchers should not be “ research trendy” and have enough evidence. This is why research objectives are important. It helps to take time, and resources into consideration.

Research questions can be developed from theoretical knowledge, previous research or experience, or a practical need at work (Parahoo 2014). They have numerous roles, such as identifying the importance of the research and providing clarity of purpose for the research, in terms of what the research intends to achieve in the end.

Qualitative Research Questions

What constitutes a good Qualitative research question?

A good qualitative question answers the hows and whys instead of how many or how much. It could be structured as a stand-alone study, purely relying on qualitative data or it could be part of mixed-methods research that combines qualitative and quantitative data. Qualitative research gathers participants' experiences, perceptions and behavior.

Examples of good Qualitative Research Questions:

What are people's thoughts on the new library? 

How does it feel to be a first-generation student attending college?

Difference example (between Qualitative and Quantitative research questions):

How many college students signed up for the new semester? (Quan) 

How do college students feel about the new semester? What are their experiences so far? (Qual)

• Qualitative Research Design Workshop Powerpoint

Foley G, Timonen V. Using Grounded Theory Method to Capture and Analyze Health Care Experiences. Health Serv Res. 2015 Aug;50(4):1195-210. [ PMC free article: PMC4545354 ] [ PubMed: 25523315 ]

Devers KJ. How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research. Health Serv Res. 1999 Dec;34(5 Pt 2):1153-88. [ PMC free article: PMC1089058 ] [ PubMed: 10591278 ]

Huston P, Rowan M. Qualitative studies. Their role in medical research. Can Fam Physician. 1998 Nov;44:2453-8. [ PMC free article: PMC2277956 ] [ PubMed: 9839063 ]

Corner EJ, Murray EJ, Brett SJ. Qualitative, grounded theory exploration of patients' experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open. 2019 Feb 24;9(2):e026348. [ PMC free article: PMC6443050 ] [ PubMed: 30804034 ]

Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018 Dec;24(1):9-18. [ PMC free article: PMC5774281 ] [ PubMed: 29199486 ]

Houghton C, Murphy K, Meehan B, Thomas J, Brooker D, Casey D. From screening to synthesis: using nvivo to enhance transparency in qualitative evidence synthesis. J Clin Nurs. 2017 Mar;26(5-6):873-881. [ PubMed: 27324875 ]

Soratto J, Pires DEP, Friese S. Thematic content analysis using ATLAS.ti software: Potentialities for researchs in health. Rev Bras Enferm. 2020;73(3):e20190250. [ PubMed: 32321144 ]

Zamawe FC. The Implication of Using NVivo Software in Qualitative Data Analysis: Evidence-Based Reflections. Malawi Med J. 2015 Mar;27(1):13-5. [ PMC free article: PMC4478399 ] [ PubMed: 26137192 ]

Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018 Dec;24(1):120-124. [ PMC free article: PMC8816392 ] [ PubMed: 29202616 ]

Saldaña, J. (2021). The coding manual for qualitative researchers. The coding manual for qualitative researchers, 1-440.

O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014 Sep;89(9):1245-51. [ PubMed: 24979285 ]

Palermo C, King O, Brock T, Brown T, Crampton P, Hall H, Macaulay J, Morphet J, Mundy M, Oliaro L, Paynter S, Williams B, Wright C, E Rees C. Setting priorities for health education research: A mixed methods study. Med Teach. 2019 Sep;41(9):1029-1038. [ PubMed: 31141390 ]

• Last Updated: Feb 14, 2024 4:25 PM
• URL: https://guides.library.cmu.edu/c.php?g=1346006

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

9.4 Types of qualitative research designs

Learning objectives.

• Define focus groups and outline how they differ from one-on-one interviews
• Describe how to determine the best size for focus groups
• Identify the important considerations in focus group composition
• Discuss how to moderate focus groups
• Identify the strengths and weaknesses of focus group methodology
• Describe case study research, ethnography, and phenomenology.

There are various types of approaches to qualitative research.  This chapter presents information about focus groups, which are often used in social work research.  It also introduces case studies, ethnography, and phenomenology.

Focus Groups

Focus groups resemble qualitative interviews in that a researcher may prepare a guide in advance and interact with participants by asking them questions. But anyone who has conducted both one-on-one interviews and focus groups knows that each is unique. In an interview, usually one member (the research participant) is most active while the other (the researcher) plays the role of listener, conversation guider, and question-asker. Focus groups , on the other hand, are planned discussions designed to elicit group interaction and “obtain perceptions on a defined area of interest in a permissive, nonthreatening environment” (Krueger & Casey, 2000, p. 5).  In focus groups, the researcher play a different role than in a one-on-one interview. The researcher’s aim is to get participants talking to each other,  to observe interactions among participants, and moderate the discussion.

There are numerous examples of focus group research. In their 2008 study, for example, Amy Slater and Marika Tiggemann (2010) conducted six focus groups with 49 adolescent girls between the ages of 13 and 15 to learn more about girls’ attitudes towards’ participation in sports. In order to get focus group participants to speak with one another rather than with the group facilitator, the focus group interview guide contained just two questions: “Can you tell me some of the reasons that girls stop playing sports or other physical activities?” and “Why do you think girls don’t play as much sport/physical activity as boys?” In another focus group study, Virpi Ylanne and Angie Williams (2009) held nine focus group sessions with adults of different ages to gauge their perceptions of how older characters are represented in television commercials. Among other considerations, the researchers were interested in discovering how focus group participants position themselves and others in terms of age stereotypes and identities during the group discussion. In both examples, the researchers’ core interest in group interaction could not have been assessed had interviews been conducted on a one-on-one basis, making the focus group method an ideal choice.

Who should be in your focus group?

In some ways, focus groups require more planning than other qualitative methods of data collection, such as one-on-one interviews in which a researcher may be better able to the dialogue. Researchers must take care to form focus groups with members who will want to interact with one another and to control the timing of the event so that participants are not asked nor expected to stay for a longer time than they’ve agreed to participate. The researcher should also be prepared to inform focus group participants of their responsibility to maintain the confidentiality of what is said in the group. But while the researcher can and should encourage all focus group members to maintain confidentiality, she should also clarify to participants that the unique nature of the group setting prevents her from being able to promise that confidentiality will be maintained by other participants. Once focus group members leave the research setting, researchers cannot control what they say to other people.

Group size should be determined in part by the topic of the interview and your sense of the likelihood that participants will have much to say without much prompting. If the topic is one about which you think participants feel passionately and will have much to say, a group of 3–5 could make sense. Groups larger than that, especially for heated topics, can easily become unmanageable. Some researchers say that a group of about 6–10 participants is the ideal size for focus group research (Morgan, 1997); others recommend that groups should include 3–12 participants (Adler & Clark, 2008).  The size of the focus group is ultimately the decision of the researcher. When forming groups and deciding how large or small to make them, take into consideration what you know about the topic and participants’ potential interest in, passion for, and feelings about the topic. Also consider your comfort level and experience in conducting focus groups. These factors will help you decide which size is right in your particular case.

It may seem counterintuitive, but in general, it is better to form focus groups consisting of participants who do not know one another than to create groups consisting of friends, relatives, or acquaintances (Agar & MacDonald, 1995).  The reason is that group members who know each other may not share some taken-for-granted knowledge or assumptions. In research, it is precisely the  taken-for-granted knowledge that is often of interest; thus, the focus group researcher should avoid setting up interactions where participants may be discouraged to question or raise issues that they take for granted. However, group members should not be so different from one another that participants will be unlikely to feel comfortable talking with one another.

Focus group researchers must carefully consider the composition of the groups they put together. In his text on conducting focus groups, Morgan (1997) suggests that “homogeneity in background and not homogeneity in attitudes” (p. 36) should be the goal, since participants must feel comfortable speaking up but must also have enough differences to facilitate a productive discussion.  Whatever composition a researcher designs for her focus groups, the important point to keep in mind is that focus group dynamics are shaped by multiple social contexts (Hollander, 2004). Participants’ silences as well as their speech may be shaped by gender, race, class, sexuality, age, or other background characteristics or social dynamics—all of which might be suppressed or exacerbated depending on the composition of the group. Hollander (2004) suggests that researchers must pay careful attention to group composition, must be attentive to group dynamics during the focus group discussion, and should use multiple methods of data collection in order to “untangle participants’ responses and their relationship to the social contexts of the focus group” (p. 632).

The role of the moderator

In addition to the importance of group composition, focus groups also require skillful moderation. A moderator is the researcher tasked with facilitating the conversation in the focus group. Participants may ask each other follow-up questions, agree or disagree with one another, display body language that tells us something about their feelings about the conversation, or even come up with questions not previously conceived of by the researcher. It is just these sorts of interactions and displays that are of interest to the researcher. A researcher conducting focus groups collects data on more than people’s direct responses to her question, as in interviews.

The moderator’s job is not to ask questions to each person individually, but to stimulate conversation between participants. It is important to set ground rules for focus groups at the outset of the discussion. Remind participants you’ve invited them to participate because you want to hear from all of them. Therefore, the group should aim to let just one person speak at a time and avoid letting just a couple of participants dominate the conversation. One way to do this is to begin the discussion by asking participants to briefly introduce themselves or to provide a brief response to an opening question. This will help set the tone of having all group members participate. Also, ask participants to avoid having side conversations; thoughts or reactions to what is said in the group are important and should be shared with everyone.

As the focus group gets rolling, the moderator will play a less active role as participants talk to one another. There may be times when the conversation stagnates or when you, as moderator, wish to guide the conversation in another direction. In these instances, it is important to demonstrate that you’ve been paying attention to what participants have said. Being prepared to interject statements or questions such as “I’d really like to hear more about what Sunil and Joe think about what Dominick and Jae have been saying” or “Several of you have mentioned X. What do others think about this?” will be important for keeping the conversation going. It can also help redirect the conversation, shift the focus to participants who have been less active in the group, and serve as a cue to those who may be dominating the conversation that it is time to allow others to speak. Researchers may choose to use multiple moderators to make managing these various tasks easier.

Moderators are often too busy working with participants to take diligent notes during a focus group. It is helpful to have a note-taker who can record participants’ responses (Liamputtong, 2011). The note-taker creates, in essence, the first draft of interpretation for the data in the study. They note themes in responses, nonverbal cues, and other information to be included in the analysis later on. Focus groups are analyzed in a similar way as interviews; however, the interactive dimension between participants adds another element to the analytical process. Researchers must attend to the group dynamics of each focus group, as “verbal and nonverbal expressions, the tactical use of humour, interruptions in interaction, and disagreement between participants” are all data that are vital to include in analysis (Liamputtong, 2011, p. 175). Note-takers record these elements in field notes, which allows moderators to focus on the conversation.

Strengths and weaknesses of focus groups

Focus groups share many of the strengths and weaknesses of one-on-one qualitative interviews. Both methods can yield very detailed, in-depth information; are excellent for studying social processes; and provide researchers with an opportunity not only to hear what participants say but also to observe what they do in terms of their body language. Focus groups offer the added benefit of giving researchers a chance to collect data on human interaction by observing how group participants respond and react to one another. Like one-on-one qualitative interviews, focus groups can also be quite expensive and time-consuming. However, there may be some savings with focus groups as it takes fewer group events than one-on-one interviews to gather data from the same number of people. Another potential drawback of focus groups, which is not a concern for one-on-one interviews, is that one or two participants might dominate the group, silencing other participants. Careful planning and skillful moderation on the part of the researcher are crucial for avoiding, or at least dealing with, such possibilities. The various strengths and weaknesses of focus group research are summarized in Table 91.

Grounded Theory

Grounded theory has been widely used since its development in the late 1960s (Glaser & Strauss, 1967). Largely derived from schools of sociology, grounded theory involves emersion of the researcher in the field and in the data. Researchers follow a systematic set of procedures and a simultaneous approach to data collection and analysis. Grounded theory is most often used to generate rich explanations of complex actions, processes, and transitions. The primary mode of data collection is one-on-one participant interviews. Sample sizes tend to range from 20 to 30 individuals, sampled purposively (Padgett, 2016). However, sample sizes can be larger or smaller, depending on data saturation. Data saturation is the point in the qualitative research data collection process when no new information is being discovered. Researchers use a constant comparative approach in which previously collected data are analyzed during the same time frame as new data are being collected.  This allows the researchers to determine when new information is no longer being gleaned from data collection and analysis — that data saturation has been reached — in order to conclude the data collection phase.

Rather than apply or test existing grand theories, or “Big T” theories, grounded theory focuses on “small t” theories (Padgett, 2016). Grand theories, or “Big T” theories, are systems of principles, ideas, and concepts used to predict phenomena. These theories are backed up by facts and tested hypotheses. “Small t” theories are speculative and contingent upon specific contexts. In grounded theory, these “small t” theories are grounded in events and experiences and emerge from the analysis of the data collected.

One notable application of grounded theory produced a “small t” theory of acceptance following cancer diagnoses (Jakobsson, Horvath, & Ahlberg, 2005). Using grounded theory, the researchers interviewed nine patients in western Sweden. Data collection and analysis stopped when saturation was reached. The researchers found that action and knowledge, given with respect and continuity led to confidence which led to acceptance. This “small t” theory continues to be applied and further explored in other contexts.

Case study research

Case study research is an intensive longitudinal study of a phenomenon at one or more research sites for the purpose of deriving detailed, contextualized inferences and understanding the dynamic process underlying a phenomenon of interest. Case research is a unique research design in that it can be used in an interpretive manner to build theories or in a positivist manner to test theories. The previous chapter on case research discusses both techniques in depth and provides illustrative exemplars. Furthermore, the case researcher is a neutral observer (direct observation) in the social setting rather than an active participant (participant observation). As with any other interpretive approach, drawing meaningful inferences from case research depends heavily on the observational skills and integrative abilities of the researcher.

Ethnography

The ethnographic research method, derived largely from the field of anthropology, emphasizes studying a phenomenon within the context of its culture. The researcher must be deeply immersed in the social culture over an extended period of time (usually 8 months to 2 years) and should engage, observe, and record the daily life of the studied culture and its social participants within their natural setting. The primary mode of data collection is participant observation, and data analysis involves a “sense-making” approach. In addition, the researcher must take extensive field notes, and narrate her experience in descriptive detail so that readers may experience the same culture as the researcher. In this method, the researcher has two roles: rely on her unique knowledge and engagement to generate insights (theory), and convince the scientific community of the trans-situational nature of the studied phenomenon.

The classic example of ethnographic research is Jane Goodall’s study of primate behaviors, where she lived with chimpanzees in their natural habitat at Gombe National Park in Tanzania, observed their behaviors, interacted with them, and shared their lives. During that process, she learnt and chronicled how chimpanzees seek food and shelter, how they socialize with each other, their communication patterns, their mating behaviors, and so forth. A more contemporary example of ethnographic research is Myra Bluebond-Langer’s (1996)14 study of decision making in families with children suffering from life-threatening illnesses, and the physical, psychological, environmental, ethical, legal, and cultural issues that influence such decision-making. The researcher followed the experiences of approximately 80 children with incurable illnesses and their families for a period of over two years. Data collection involved participant observation and formal/informal conversations with children, their parents and relatives, and health care providers to document their lived experience.

Phenomenology

Phenomenology is a research method that emphasizes the study of conscious experiences as a way of understanding the reality around us. Phenomenology is concerned with the systematic reflection and analysis of phenomena associated with conscious experiences, such as human judgment, perceptions, and actions, with the goal of (1) appreciating and describing social reality from the diverse subjective perspectives of the participants involved, and (2) understanding the symbolic meanings (“deep structure”) underlying these subjective experiences. Phenomenological inquiry requires that researchers eliminate any prior assumptions and personal biases, empathize with the participant’s situation, and tune into existential dimensions of that situation, so that they can fully understand the deep structures that drives the conscious thinking, feeling, and behavior of the studied participants.

Some researchers view phenomenology as a philosophy rather than as a research method. In response to this criticism, Giorgi and Giorgi (2003) developed an existential phenomenological research method to guide studies in this area. This method can be grouped into data collection and data analysis phases. In the data collection phase, participants embedded in a social phenomenon are interviewed to capture their subjective experiences and perspectives regarding the phenomenon under investigation. Examples of questions that may be asked include “can you describe a typical day” or “can you describe that particular incident in more detail?” These interviews are recorded and transcribed for further analysis. During data analysis, the researcher reads the transcripts to: (1) get a sense of the whole, and (2) establish “units of significance” that can faithfully represent participants’ subjective experiences. Examples of such units of significance are concepts such as “felt space” and “felt time,” which are then used to document participants’ psychological experiences. For instance, did participants feel safe, free, trapped, or joyous when experiencing a phenomenon (“felt-space”)? Did they feel that their experience was pressured, slow, or discontinuous (“felt-time”)? Phenomenological analysis should take into account the participants’ temporal landscape (i.e., their sense of past, present, and future), and the researcher must transpose herself in an imaginary sense in the participant’s situation (i.e., temporarily live the participant’s life). The participants’ lived experience is described in form of a narrative or using emergent themes. The analysis then delves into these themes to identify multiple layers of meaning while retaining the fragility and ambiguity of subjects’ lived experiences.

Key Takeaways

• In terms of focus group composition, homogeneity of background among participants is recommended while diverse attitudes within the group are ideal.
• The goal of a focus group is to get participants to talk with one another rather than the researcher.
• Like one-on-one qualitative interviews, focus groups can yield very detailed information, are excellent for studying social processes, and provide researchers with an opportunity to observe participants’ body language; they also allow researchers to observe social interaction.
• Focus groups can be expensive and time-consuming, as are one-on-one interviews; there is also the possibility that a few participants will dominate the group and silence others in the group.
• Other types of qualitative research include case studies, ethnography, and phenomenology.
• Data saturation – the point in the qualitative research data collection process when no new information is being discovered
• Focus groups- planned discussions designed to elicit group interaction and “obtain perceptions on a defined area of interest in a permissive, nonthreatening environment” (Krueger & Casey, 2000, p. 5)
• Moderator- the researcher tasked with facilitating the conversation in the focus group

Image attributions

target group by geralt CC-0

workplace team by Free-Photos CC-0

Foundations of Social Work Research Copyright © 2020 by Rebecca L. Mauldin is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Share This Book

Research design: qualitative, quantitative, and mixed methods approaches / sixth edition

• Published: 15 November 2023
• Volume 58 , pages 1011–1013, ( 2024 )

Cite this article

• James P. Takona   ORCID: orcid.org/0009-0001-4591-8136 1  

4902 Accesses

Explore all metrics

This review examines John W. Creswell and David Creswell’s sixth edition, which covers the most popular research methods, offering readers a comprehensive understanding and practical guidance in qualitative, quantitative, and mixed methods. The review includes observations on existing drawbacks, gaps, and ideas on potential areas for improvement in the book. The book is an excellent entry point for understanding the three broad research designs. It stands out for incorporating various methods and empowering researchers to effectively align them with specific research questions, objectives, and philosophical underpinnings. However, it could be further refined by incorporating newer research approaches and expanding practical aspects such as data collection, sampling strategies, and data analysis techniques. With these improvements, the sixth edition could further solidify its position as a comprehensive and accessible guide adeptly catering to researchers, educators, and students. Despite the book’s many strengths, there are opportunities for refinement in future editions, incorporating newer approaches to research designs and expanding practical aspects such as data collection, sampling strategies, and data analysis techniques. This review highlights that, with these suggested improvements, future editions could not only maintain but also enhance the text’s comprehensive and accessible nature, further solidifying its status as a vital resource for researchers, educators, and student.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Research Design and Methodology

Research Methods and Approach to Analysis Within Chapters

Types of Research Designs

Author information, authors and affiliations.

Coppin State University, Maryland, USA

James P. Takona

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to James P. Takona .

Additional information

Publisher’s note.

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Takona, J.P. Research design: qualitative, quantitative, and mixed methods approaches / sixth edition. Qual Quant 58 , 1011–1013 (2024). https://doi.org/10.1007/s11135-023-01798-2

Download citation

Published : 15 November 2023

Issue Date : February 2024

DOI : https://doi.org/10.1007/s11135-023-01798-2

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Qualitative research
• Quantitative research
• Mixed methods
• Practical guidance
• Research process
• Research designs
• Find a journal
• Publish with us
• Track your research

• Process: Research Design

Ask a Librarian

Research design.

Design are the methods of collecting evidence to address the research questions and theories. For example: observation, surveys, archival research, experiments, among others. A few common methods are described below. For an in-depth examination of research designs, we recommend the following sources.

Recommended sources

• SAGE Research Methods Online Information about writing a research question, conducting a literature review, choosing a research method, collecting data, and writing up the findings. Coverage spans the full range of research methods used in the social and behavioral sciences, plus a wide range of methods used commonly in sciences, health sciences, and humanities.
• Sage Research Methods: Methods Map

Research Methods

Action research.

A term that is used to describe a global family of related approaches that integrate theory and action with the goal of addressing important organizational, community and social issues together with those who experience them. It focuses on the creation of areas for collaborative learning and the design, enactment and evaluation of liberating actions through combining action and reflection, in an ongoing cycle of co-generative knowledge." Action research is cyclical as the researcher explores intervention on a problem and moving through observations and evaluations. Related approaches: collaborative research, mixed methods, participatory action research, ethnography, participant observation.  Coghlan, D., & Brydon-Miller, M. (2014). The SAGE encyclopedia of action research (Vols. 1-2). London, : SAGE Publications Ltd doi: 10.4135/9781446294406

Applied Research

Applied research is inquiry using the application of scientific methodology with the purpose of generating empirical observations to solve critical problems in society. It is widely used in varying contexts, ranging from applied behavior analysis to city planning and public policy and to program evaluation. Applied research can be executed through a diverse range of research strategies that can be solely quantitative, solely qualitative, or a mixed method research design that combines quantitative and qualitative data slices in the same project. What all the multiple facets in applied research projects share is one basic commonality—the practice of conducting research in “nonpure” research conditions because data are needed to help solve a real-life problem.  Salkind, N. J. (2010). Encyclopedia of research design (Vols. 1-0). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412961288

A method that seeks to illuminate a research problem by collecting and detailing observations of a particular entity. Definitions of case study differs across disciplines. Generally, case studies "focus on the interrelationships that constitute the context of a specific entity (such as an organization, event, phenomenon, or person)" and analyze "the relationship between the contextual factors and the entity being studied." The method is adopted with "the explicit purpose of using those insights (of the interactions between contextual relationships and the entity in question) to generate theory and/or contribute to extant theory.  Mills, A. J., Durepos, G., & Wiebe, E. (2010). Encyclopedia of case study research (Vols. 1-0). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412957397

Causal Design

Causality studies may be thought of as understanding a phenomenon in terms of conditional statements in the form, “If X, then Y.” This type of research is used to measure what impact a specific change will have on existing norms and assumptions. Most social scientists seek causal explanations that reflect tests of hypotheses. Causal effect (nomothetic perspective) occurs when variation in one phenomenon, an independent variable, leads to or results, on average, in variation in another phenomenon, the dependent variable.  From https://libguides.usc.edu/writingguide/researchdesigns

Cohort Design

A design in which groups of individuals pass through an institution such as a school but experience different events such as whether or not they have been exposed to a particular course. The groups have not been randomly assigned to whether or not they experience the particular event so it is not possible to determine whether any difference between the groups experiencing the event and those not experiencing the event is due to the event itself.  Cramer, D., & Howitt, D. (2004). The SAGE dictionary of statistics (Vols. 1-0). London, : SAGE Publications, Ltd doi: 10.4135/9780857020123

Experimental Design

Experiments are ways of assessing causal relationships by, in its simplest form, randomly allocating 'subjects' to two groups and then comparing one (the 'control group') in which no changes are made, with the other (the 'test group') who are subjected to some manipulation or stimulus." "The primary purpose of experimental designs is to establish “cause and effect” or more technically, to make causal inferences.  Frey, B. (2018). The SAGE encyclopedia of educational research, measurement, and evaluation (Vols. 1-4). Thousand Oaks,, CA: SAGE Publications, Inc. doi: 10.4135/9781506326139

Meta-analysis

A statistical method that integrates the results of several independent studies considered to be “combinable.” It has become one of the major tools to integrate research findings in social and medical sciences in general and in education and psychology in particular." Essential characteristics of meta-analysis include: "it is undeniably quantitative, that is, it uses numbers and statistical methods for organizing and extracting information; it does not prejudge research findings in terms of research quality (i.e., no a priori arbitrary and nonempirical criteria of research quality are imposed to exclude a large number of studies); it seeks general conclusions from many separate investigations that address related or identical hypotheses.  Salkind, N. J. (2010). Encyclopedia of research design (Vols. 1-0). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412961288

Fieldwork or Field Research

Conducted in a natural setting rather than in a laboratory or at a distance. "Researchers examine how the manipulation of at least one independent variable leads to a change in a dependent variable in the context of the natural environment. When researchers conduct experiments, they study how the manipulation of independent variables, or variables that remain constant, cause a change in a dependent variable, or a factor that changes.  Allen, M. (2017). The sage encyclopedia of communication research methods (Vols. 1-4). Thousand Oaks, CA: SAGE Publications, Inc doi: 10.4135/9781483381411

Longitudinal Research

Although the term is used somewhat differently in different disciplines, it generally refers to research involving data collected at more than one point in time and focused on the measurement and analysis of change over time in the units of study.  Sage Research Methods

Ethnography

Ethnography involves the production of highly detailed accounts of how people in a social setting lead their lives, based on systematic and long-term observation of, and discussion with, those within the setting.  Sage Research Methods

Mixed Methods Research

A process of research in which researchers integrate quantitative and qualitative methods of data collection and analysis to best understand a research purpose. The way this process unfolds in a given study is shaped by mixed methods research content considerations and researchers’ personal, interpersonal, and social contexts  Plano Clark, V. & Ivankova, N. (2016). Why a guide to the field of mixed methods research?: introducing a conceptual framework of the field. In Plano Clark, V., & Ivankova, N. Mixed methods research: A guide to the field (pp. 3-30). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781483398341

Clinical Research

Medical research involving people. The aim of clinical research is to advance medical knowledge by collecting evidence to establish treatments, either through observational studies or through experimental research such as clinical trials." Includes: protocols, clinical trials, pre-post studies.  Sage Research Methods

Qualitative Research

Also known as qualitative inquiry, is an umbrella term used to cover a wide variety of research methods and methodologies that provide holistic, in-depth accounts and attempt to reflect the complicated, contextual, interactive, and interpretive nature of our social world. For example, grounded theory, ethnography, phenomenology, ethnomethodology, narratology, photovoice, and participatory action research (PAR) may all be included under the qualitative label, although each of these individual methods is based on its own set of assumptions and procedures.  Salkind, N. J. (2010). Encyclopedia of research design (Vols. 1-0). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412961288

Quantitative Research

Quantitative research studies produce results that can be used to describe or note numerical changes in measurable characteristics of a population of interest; generalize to other, similar situations; provide explanations of predictions; and explain causal relationships. The fundamental philosophy underlying quantitative research is known as positivism, which is based on the scientific method of research.  Salkind, N. J. (2010). Encyclopedia of research design (Vols. 1-0). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412961288

• University of Colorado Boulder Libraries
• Research Guides
• Research Strategies
• Last Updated: May 29, 2024 9:32 AM
• URL: https://libguides.colorado.edu/strategies/design
• © Regents of the University of Colorado

• Open access
• Published: 22 May 2024

Preparedness for a first clinical placement in nursing: a descriptive qualitative study

• Philippa H. M. Marriott 1 ,
• Jennifer M. Weller-Newton 2   nAff3 &
• Katharine J. Reid 4  

BMC Nursing volume  23 , Article number:  345 ( 2024 ) Cite this article

174 Accesses

2 Altmetric

Metrics details

A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students’ perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students’ emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews ( n  = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants’ feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students’ expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

Conclusions

This unique study of first-year postgraduate entry-to-practice nursing students’ perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students’ narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Peer Review reports

First clinical placements enable nursing students to develop their professional identity through initial socialisation, and where successful, first clinical placement experiences can motivate nursing students to persist with their studies [ 1 , 2 , 3 , 4 ]. Where the transition from the tertiary environment to learning in the healthcare workplace is turbulent, it may impact nursing students’ learning, their confidence and potentially increase attrition rates from educational programs [ 2 , 5 , 6 ]. Attrition from preregistration nursing courses is a global concern, with the COVID-19 pandemic further straining the nursing workforce; thus, the supply of nursing professionals is unlikely to meet demand [ 7 ]. The COVID-19 pandemic has also impacted nursing education, with student nurses augmenting the diminishing nursing workforce [ 7 , 8 ].

The first clinical placement often triggers immense anxiety and fear for nursing students [ 9 , 10 ]. Research suggests that among nursing students, anxiety arises from perceived knowledge deficiencies, role ambiguity, the working environment, caring for ‘real’ people, potentially causing harm, exposure to nudity and death, and ‘not fitting in’ [ 2 , 3 , 11 ]. These stressors are reported internationally and often relate to inadequate preparation for entering the clinical environment [ 2 , 10 , 12 ]. Previous research suggests that high anxiety before the first clinical placement can be related to factors likely to affect patient outcomes, such as self-confidence and efficacy [ 13 ]. High anxiety during clinical placement may impair students’ capacity to learn, thus compromising the value of the clinical environment for learning [ 10 ].

The first clinical placement often occurs soon after commencing nursing training and can challenge students’ beliefs, philosophies, and preconceived ideas about nursing. An experience of cultural or ‘reality’ shock often arises when entering the healthcare setting, creating dissonance between reality and expectations [ 6 , 14 ]. These experiences may be exacerbated by tertiary education providers teaching of ‘ideal’ clinical practice [ 2 , 6 ]. The perceived distance between theoretical knowledge and what is expected in a healthcare placement, as opposed to what occurs on clinical placement, has been well documented as the theory-practice gap or an experience of cognitive dissonance [ 2 , 3 ].

Given the pivotal role of the first clinical placement in nursing students’ trajectories to nursing practice, it is important to understand students’ experiences and to explore how the placement experience shapes initial perceptions. Existing research focusses almost entirely either on describing nursing students’ projected emotions and perceptions prior to undertaking a first clinical placement [ 3 ] or examines student perceptions of reflecting on a completed first placement [ 15 ]. We wished to examine consistency and change in student perception of their first clinical placement by tracking their experiences longitudinally. We focused on a first clinical placement undertaken in a Master of Nursing Science. This two-year postgraduate qualification provides entry-to-practice nursing training for students who have completed any undergraduate qualification. The first clinical placement component of the course aimed to orient students to the clinical environment, support students to acquire skills and develop their clinical reasoning through experiential learning with experienced nursing mentors.

This paper makes a significant contribution to understanding how nursing students’ perceptions might develop over time because of their clinical placement experiences. Our research addresses a further gap in the existing literature, by focusing on students completing an accelerated postgraduate two-year entry-to-practice degree open to students with any prior undergraduate degree. Thus, the current research aimed to understand nursing students’ emotional responses and expectations and their perceptions of preparedness before attending their first clinical placement and to contrast these initial perceptions with their end-of-placement perspectives.

Study design

A descriptive qualitative study was undertaken, utilising a pre- and post-design for data collection. Focus groups with first-year postgraduate entry-to-practice nursing students were conducted before the first clinical placement, with individual semi-structured interviews undertaken during the first clinical placement.

Setting and participants

All first-year students enrolled in the two-year Master of Nursing Science program ( n  = 190) at a tertiary institution in Melbourne, Australia, were eligible to participate. There were no exclusion criteria. At the time of this study, students were enrolled in a semester-long subject focused on nursing assessment and care. They studied the theoretical underpinnings of nursing and science, theoretical and practical nursing clinical skills and Indigenous health over the first six weeks of the course. Students completed a preclinical assessment as a hurdle before commencing a three-week clinical placement in a hospital setting, a subacute or acute environment. Overall, the clinical placement aimed to provide opportunities for experiential learning, skill acquisition, development of clinical reasoning skills and professional socialisation [ 16 , 17 ].

In total, sixteen students participated voluntarily in a focus group of between 60 and 90 min duration; ten of these students also participated in individual interviews of between 30 and 60 min duration, a number sufficient to reach data saturation. Table  1 shows the questions used in the focus groups conducted before clinical placement commenced and the questions for the semi-structured interview questions conducted during clinical placement. Study participants’ undergraduate qualifications included bachelor’s degrees in science, arts and business. A small number of participants had previous healthcare experience (e.g. as healthcare assistants). The participants attended clinical placement in the Melbourne metropolitan, Victorian regional and rural hospital locations.

Data collection

The study comprised two phases. The first phase comprised six focus groups prior to the first clinical placement, and the second phase comprised ten individual semi-structured interviews towards the end of the first clinical placement. Focus groups (with a maximum of four participants) and individual interviews were conducted by the lead author online via Zoom and were audio-recorded. Capping group size to a relatively small number considered diversity of perceptions and opportunities for participants to share their insights and to confirm or contradict their peers, particularly in the online environment [ 18 , 19 ].

Focus groups and interview questions were developed with reference to relevant literature, piloted with volunteer final-year nursing students, and then verified with the coauthors. All focus groups and interviewees received the same structured questions (Table  1 ) to ensure consistency and to facilitate comparison across the placement experience in the development of themes. Selective probing of interviewees’ responses for clarification to gain in-depth responses was undertaken. Nonverbal cues, impressions, or observations were noted.

The lead author was a registered nurse who had a clinical teaching role within the nursing department and was responsible for coordinating clinical placement experiences. To ensure rigour during the data collection process, the lead author maintained a reflective account, exploring her experiences of the discussions, reflecting on her interactions with participants as a researcher and as a clinical educator, and identifying areas for improvement (for instance allowing participants to tell their stories with fewer prompts). These reflections in conjunction with regular discussion with the other authors throughout the data collection period, aided in identifying any researcher biases, feelings and thoughts that possibly influenced the research [ 20 ].

To maintain rigour during the data analysis phase, we adhered to a systematic process involving input from all authors to code the data and to identify, refine and describe the themes and subthemes reported in this work. This comprehensive analytic process, reported in detail in the following section, was designed to ensure that the findings arising from this research were derived from a rigorous approach to analysing the data.

Data analysis

Focus groups and interviews were transcribed using the online transcription service Otter ( https://otter.ai/ ) and then checked and anonymised by the first author. Preliminary data analysis was carried out simultaneously by the first author using thematic content analysis proposed by Braun and Clarke [ 21 ] using NVivo 12 software [ 22 ]. All three authors undertook a detailed reading of the first three transcripts from both the focus groups and interviews and independently identified major themes. This preliminary coding was used as the basis of a discussion session to identify common themes between authors, to clarify sources of disagreement and to establish guidelines for further coding. Subsequent coding of the complete data set by the lead author identified a total of 533 descriptive codes; no descriptive code was duplicated across the themes. Initially, the descriptive codes were grouped into major themes identified from the literature, but with further analysis, themes emerged that were unique to the current study.

The research team met frequently during data analysis to discuss the initial descriptive codes, to confirm the major themes and subthemes, to revise themes on which there was disagreement and to identify any additional themes. Samples of quotes were reviewed by the second and third authors to decide whether these quotes were representative of the identified themes. The process occurred iteratively to refine the thematic categories, to discuss the definitions of each theme and to identify exemplar quotes.

Ethical considerations

The lead author was a clinical teacher and the clinical placement coordinator in the nursing department at the time of the study. Potential risks of perceived coercion and power imbalances were identified because of the lead author’s dual roles as an academic and as a researcher. To manage these potential risks, an academic staff member who was not part of the research study informed students about the study during a face-to-face lecture and ensured that all participants received a plain language statement identifying the lead author’s role and how perceived conflicts of interest would be managed. These included the lead author not undertaking any teaching or assessment role for the duration of the study and ensuring that placement allocations were completed prior to undertaking recruitment for the study. All students who participated in the study provided informed written consent. No financial or other incentives were offered. Approval to conduct the study was granted by the University of Melbourne Human Research Ethics Committee (Ethics ID 1955997.1).

Three main themes emerged describing students’ feelings and perceptions of their first clinical placement. In presenting the findings, before or during has been assigned to participants’ quotes to clarify the timing of students’ perspectives related to the clinical placement.

Major theme 1: Adjusting and managing a raft of feelings

The first theme encompassed the many positive and negative feelings about work-integrated learning expressed by participants before and during their clinical placement. Positive feelings before clinical placement were expressed by participants who were comfortable with the unknown and cautiously optimistic.

I am ready to just go with the flow, roll with the punches (Participant [P]1 before).

Overwhelmingly, however, the majority of feelings and thoughts anticipating the first clinical placement were negatively oriented. Students who expressed feelings of fear, anxiety, lack of knowledge, lack of preparedness, uncertainty about nursing as a career, or strong concerns about being a burden were all classified as conveying negative feelings. These negative feelings were categorised into four subthemes.

Subtheme 1.1 I don’t have enough knowledge

All participants expressed some concerns and anxiety before their first clinical placement. These encompassed concerns about knowledge inadequacy and were linked to a perception of under preparedness. Participants’ fears related to harming patients, responsibility for managing ‘real’ people, medication administration, and incomplete understanding of the language and communication skills within a healthcare setting. Anxiety for many participants merged with the logistics and management of their life during the clinical placement.

I’m scared that they will assume that I have more knowledge than I do (P3 before). I feel quite similar with P10, especially when she said fear of unknown and fear that she might do something wrong (P9 before).

Subtheme 1.2 Worry about judgment, being seen through that lens

Participants voiced concerns that they would be judged negatively by patients or healthcare staff because they perceived that the student nurse belonged to specific social groups related to their cultural background, ethnicity or gender. Affiliation with these groups contributed to students’ sense of self or identity, with students often describing such groups as a community. Before the clinical placement, participants worried that such judgements would impact the support they received on placement and their ability to deliver patient care.

Some older patients might prefer to have nurses from their own background, their own ethnicity, how they would react to me, or if racism is involved (P10 before). I just don’t want to reinforce like, whatever negative perceptions people might have of that community (P16 before).

Participants’ concerns prior to the first clinical placement about judgement or poor treatment because of patients’ preconceived ideas about specific ethnic groups did not eventuate.

I mean, it didn’t really feel like very much of a thing once I was actually there. It is one of those things you stress about, and it does not really amount to anything (P16 during).

Some students’ placement experiences revealed the positive benefits of their cultural background to enhancing patient care. One student affirmed that the placement experience reinforced their commitment to nursing and that this was related to their ability to communicate with patients whose first language was not English.

Yeah, definitely. Like, I can speak a few dialects. You know, I can actually see a difference with a lot of the non-English speaking background people. As soon as you, as soon as they’re aware that you’re trying and you’re trying to speak your language, they, they just open up. Yeah, yes. And it improves the care (P10 during).

However, a perceived lack of judgement was sometimes attributed to wearing the full personal protective equipment required during the COVID-19 pandemic, which meant that their personal features were largely obscured. For this reason, it was more difficult for patients to make assumptions or attributions about students’ ethnic or gender identity based on their appearance.

People tend to assume and call us all girls, which was irritating. It was mostly just because all of us were so covered up, no one could see anyone’s faces (P16 during).

Subtheme 1.3 Is nursing really for me?

Prior to their first clinical placement experience, many participants expressed ambivalence about a nursing career and anticipated that undertaking clinical placement could determine their suitability for the profession. Once exposed to clinical placement, the majority of students were completely committed to their chosen profession, with a minority remaining ambivalent or, in rare cases, choosing to leave the course. Not yet achieving full commitment to a nursing career was related to not wishing to work in the ward they had for their clinical placement, while remaining open to trying different specialities.

I didn’t have an actual idea of what I wanted to do after arts, this wasn’t something that I was aiming towards specifically (P14 before). I think I’m still not 100%, but enough to go on, that I’m happy to continue the course as best as I can (P11 during).

Subtheme 1.4 Being a burden

Before clinical placement, participants had concerns about being burdensome and how this would affect their clinical placement experiences.

If we end up being a burden to them, an extra responsibility for them on top of their day, then we might not be treated as well (P10 before).

A sense of burden remained a theme during the clinical placement for participants for the first five to seven days, after which most participants acknowledged that their role became more active. As students contributed more productively to their placement, their feelings of being a burden reduced.

Major theme 2: Sinking or swimming

The second major theme, sinking or swimming, described participants’ expectations about a successful placement experience and identified themes related to students’ successes (‘swimming’) or difficulties (‘sinking’) during their placement experience. Prior to clinical placement, without a realistic preview of what the experience might entail, participants were uncertain of their role, hoped for ‘nice’ supervising nurses and anticipated an observational role that would keep them afloat.

I will focus on what I want to learn and see if that coincides with what is expected, I guess (P15 before).

During the clinical placement, the reality was very different, with a sense of sinking. Participants discovered, some with shock, that they were expected to participate actively in the healthcare team.

I got the sense that they were not going to muck around, and, you know, they’re ‘gonna’ use the free labour that came with me (P1 during).

Adding to the confusion about the expected placement experience, participants believed that healthcare staff were unclear about students’ scope of practice for a postgraduate entry-to-practice degree, creating misalignment between students’ and supervising nurses’ expectations.

It seems to me like the educators don’t really seem to have a clear picture of what the scope is, and what is actually required or expected of us (P10 during).

In exploring perceived expectations of the clinical placement and the modifying effect of placement on initial expectations, three subthemes were identified: translation to practice is overwhelming, trying to find the rhythm or jigsaw pieces, and individual agency.

Subtheme 2.1 Translation to practice is overwhelming

Before clinical placement, participants described concerns about insufficient knowledge to enable them to engage effectively with the placement experience.

If I am doing an assessment understanding what are those indications and why I would be doing it or not doing it at a certain time (P1 before).

Integrating and applying theoretical content while navigating an unfamiliar clinical environment created a significant gap between theory and practice during clinical placement. As the clinical placement experience proceeded and initial fears dissipated, students became more aware of applying their theoretical knowledge in the clinical context.

We’re learning all this theory and clinical stuff, but then we don’t really have a realistic idea of what it’s like until we’re kind of thrown into it for three weeks (P10 during).

Subtheme 2.2 Trying to find the rhythm or the jigsaw pieces

Before clinical placement, participants described learning theory and clinical skills with contextual unfamiliarity. They had the jigsaw pieces but did not know how to assemble it; they had the music but did not know the final song. When discussing their expectations about clinical placement, the small number of participants with a healthcare background (e.g. as healthcare assistants) proposed realistic answers, whereas others struggled to answer or cited stories from friends or television. With a lack of context, feelings of unpreparedness were exacerbated. Once in the clinical environment, participants further emphasised that they could not identify what they needed to know to successfully prepare for clinical placement.

It was never really pieced together. We’ve learned bits and pieces, and then we’re putting it together ourselves (P8 during). On this course I feel it was this is how you do it, but I did not know how it was supposed to be played, I did not know the rhythm (P4 during).

Subtheme 2.3 Individual agency

Participants’ individual agency, their attitude, self-efficacy, and self-motivation affected their clinical placement experiences. Participant perceptions in advance of the clinical placement experience remained consistent with their perspectives following clinical placement. Before clinical placement, participants who were highly motivated to learn exhibited a growth mindset [ 23 ] and planned to be proactive in delivering patient care. During their clinical placement, initially positive students remained positive and optimistic about their future. Participants who believed that their first clinical placement role would be largely observational and were less proactive about applying their knowledge and skills identified boredom and a lack of learning opportunities on clinical placement.

A shadowing position, we don’t have enough skills and authority to do any work, not do any worthwhile skills (P3 before). I thought it would be a lot busier, because we’re limited with our scope, so there’s not much we can do, it’s just a bit slower than I thought (P12 during).

Individual agency appears to influence a successful first clinical placement; other factors may also be implicated but were not the focus of this study. Further research exploring the relationships between students’ age, life experience, resilience, individual agency, and the use of coping strategies during a first clinical placement would be useful.

Major theme 3: The reality of navigating placement relationships

The third main theme emphasised the reality of navigating clinical placement relationships and explored students’ relationships with healthcare staff, patients, and peers. Before clinical placement, many participants, especially those with healthcare backgrounds, expressed fears about relationships with supervising nurses. They perceived that the dynamics of the team and the healthcare workplace might influence the support they received. Several participants were nervous about attending placement on their own without peers for support, especially if the experience was challenging. Participants identified expectations of being mistreated, believing that it was unavoidable, and prepared themselves to not take it personally.

For me it’s where we’re going to land, are we going to be in a supportive, kind of nurturing environment, or is it just kind of sink or swim? (P5 before). If you don’t really trust them, you’re nervous the entire time and you’ll be like what if I get it wrong (P16 before).

Despite these concerns, students strongly emphasised the value of relationships during their first clinical placement, with these perceptions unchanged by their clinical placement experience. Where relationships were positive, participants felt empowered to be autonomous, and their self-confidence increased.

You get that that instant reaction from the patients. And that makes you feel more confident. So that really got me through the first week (P14 during). I felt like I was intruding, then as I started to build a bit of rapport with the people, and they saw that I was around, I don’t feel that as much now (P1 during).

Such development hinged on the receptiveness and support of supervising nurses, the team on the ward, and patients and could be hindered by poor relationships.

He was the old-style buddy nurse in his fifties, every time I questioned him, he would go ssshh, just listen, no questions, it was very stressful (P10 during). It depends whether the buddy sees us as an extra pair of hands, or we’re learners (P11 during).

Where students experienced poor behaviour from supervising nurses, they described a range of emotional responses to these interactions and also coping strategies including avoiding unfriendly staff and actively seeking out those who were more inclusive.

If they weren’t very nice, it wouldn’t be very enjoyable and if they didn’t trust you, then it would be a bit frustrating, that like I can do this, but you won’t let me (P12 during). If another nurse was not nice to me, and I was their buddy, I would literally just not buddy with them and go and follow whoever was nice to me (P4 during).

Relationships with peers were equally important; students on clinical placement with peers valued the shared experience. In contrast, students who attended clinical placement alone at a regional or rural hospital felt disconnected from the opportunities that learning with peers afforded.

Our research explored the emotional responses and perceptions of preparedness of postgraduate entry-to-practice nursing students prior to and during their first clinical placement. In this study, we described how the perceptions of nursing students remained consistent or were modified by their clinical placement experiences. Our analysis of students’ experiences identified three major themes: adjusting and managing a raft of feelings; sinking or swimming; and the reality of navigating placement relationships. We captured similar themes identified in the literature; however, our study also identified novel aspects of nursing students’ experiences of their first clinical placement.

The key theme, adjusting and managing a raft of feelings, which encapsulates anxiety before clinical placement, is consistent with previous research. This theme included concerns in communicating with healthcare staff and managing registered nurses’ negative attitudes and expectations, in addition to an academic workload [ 11 , 24 ]. Concerns not previously identified in the literature included a fear of judgement or discrimination by healthcare staff or patients that might impact the reputation of marginalised communities. Fortunately, these initial fears largely dissipated during clinical placement. Some students discovered that a diverse cultural background was an asset during their clinical placement. Although these initial fears were ameliorated by clinical placement experiences, evidence of such fears before clinical placement is concerning. Further research to identify appropriate support for nursing students from culturally diverse or marginalised communities is warranted. For example, a Finnish study highlighted the importance of mentoring culturally diverse students, creating a pedagogical atmosphere during clinical placement and integrating cultural diversity into nursing education [ 25 ].

Preclinical expectations of being mistreated can be viewed as an unavoidable phenomenon for nursing students [ 26 ]. The existing literature highlights power imbalances and hierarchical differences within the healthcare system, where student nurses may be marginalised, disrespected, and ignored [ 9 , 27 , 28 ]. During their clinical placement, students in our study reported unintentional incivility by supervising nurses: feeling not wanted, ignored, or asked to remain quiet by supervising nurses who were unfriendly or highly critical. These findings were similar to those of Thomas et al.’s [ 29 ] UK study and were particularly heightened at the beginning of clinical placement. Several students acknowledged that nursing staff fatigue from a high turnover of students on their ward and the COVID-19 pandemic could be contributing factors. In response to such incivility, students reported decreased self-confidence and described becoming quiet and withdrawing from active participation with their patients. Students oriented their behaviour towards repetitive low-level tasks, aiming to please and help their supervising nurse, to the detriment of learning opportunities. Fortunately, these incidents did not appear to impact nursing students’ overall experience of clinical placement. Indeed, students found positive experiences with different supervising nurses and their own self-reflection assisted with coping. Other active strategies to combat incivility identified in the current study that were also identified by Thomas et al. [ 29 ] included avoiding nurses who were uncivil, asking to work with nurses who were ‘nice’ to them, and seeking out support from other staff as a coping strategy. The nursing students in our study were undertaking a postgraduate entry-to-practice qualification and already had an undergraduate degree. The likely greater levels of experience and maturity of this cohort may influence their resilience when working with unsupportive supervising nurses and identifying strategies to manage challenging situations.

The theory-practice gap emerged in the theme of sinking or swimming. A theory-practice gap describes the perceived dissonance between theoretical knowledge and expectations for the first clinical placement, as opposed to the reality of the experience, and has been reported in previous studies (see, for instance, 24 , 30 , 31 , 32 ). Existing research has shown that when the first clinical placement does not meet inexperienced student nurses’ expectations, a disconnect between theory and practice occurs, creating feelings of being lost and insecure within the new environment, potentially impacting students’ motivation and risk of attrition [ 19 , 33 ]. The current study identified further areas exacerbating the theory-practice gap. Before the clinical placement, students without a healthcare background lacked context for their learning. They lacked understanding of nurses’ shift work and were apprehensive about applying clinical skills learned in the classroom. Hence, some students were uncertain if they were prepared for their first clinical placement or even how to prepare, which increased their anxiety. Prior research has demonstrated that applying theoretical knowledge more seamlessly during clinical placement was supported when students knew what to expect [ 6 ]. For instance, a Canadian study exposed students as observers to the healthcare setting before starting clinical placement, enabling early theory to practice connections that minimised misconceptions and false assumptions during clinical placement [ 34 ].

In the current study, the theory-practice gap was further exacerbated during clinical placement, where healthcare staff were confused about students’ scope of practice and the course learning objectives and expectations in a postgraduate entry-to-practice nursing qualification. The central booking system for clinical placements classifies first-year nursing students who participated in this study as equivalent to second-year undergraduate nursing students. Such a classification could create a misalignment between clinical educators’ expectations and their delivery of education versus students’ actual learning needs and capacity [ 3 , 31 ]. Additional communication to healthcare partners is warranted to enhance understanding of the scope of practice and expectations of a first-year postgraduate entry-to-practice nursing student. Educating and empowering students to communicate their learning needs within their scope of practice is also required.

Our research identified a link between students’ personality traits or individual agency and their first clinical placement experience. The importance of a positive orientation towards learning and the nursing profession in preparedness for clinical placement has been highlighted in previous studies [ 31 ]. Students’ experience of their first clinical placement in our study appeared to be strongly influenced by their mindset [ 23 ]. Some students demonstrated motivation to learn, were happy to ‘roll with the punches’, yet remain active in their learning requirements, whereas others perceived their role as observational and expected supervising nurses to provide learning opportunities. Students who anticipated a passive learning approach prior to their first clinical placement reported boredom, limited activity, and lack of opportunities during their first clinical placement. These students could have a lowered sense of self-efficacy, which may lead to a greater risk of doubt, stress, and reduced commitment to the profession [ 35 ]. Self-efficacy theory explores self-perceived confidence and competence around people’s beliefs in their ability to influence events, which is associated with motivation and is key to nursing students progressing in their career path confidently [ 35 , 36 ]. In the current study, students who actively engaged in their learning process used strategies such as self-reflection and sought support from clinical educators, peers and family. Such active approaches to learning appeared to increase their resilience and motivation to learn as they progressed in their first clinical placement.

Important relationships with supervising nurses, peers, or patients were highlighted in the theme of the reality of navigating placement relationships. This theme links with previous research findings about belongingness. Belongingness is a fundamental human need and impacts students’ behaviour, emotions, cognitive processes, overall well-being, and socialisation into the profession [ 37 , 38 ]. Nursing students who experience belongingness feel part of a team and are more likely to report positive experiences. Several students in the current study described how feeling part of a team improved self-confidence and empowered work-integrated learning. Nonetheless, compared with previous literature (see for instance, 2), working as a team and belongingness were infrequent themes. Such infrequency could be related to the short duration of the clinical placement. In shorter clinical placements, nursing students learn a range of technical skills but have less time to develop teamwork skills and experience socialisation to the profession [ 29 , 39 ].

Positive relationships with supervising nurses appeared fundamental to students’ experiences. Previous research has shown that in wards with safe psycho-social climates, where the culture tolerates mistakes, regarding them as learning opportunities, a pedagogical atmosphere prevails [ 25 , 39 ]. Whereas, if nursing students experience insolent behaviours or incivility, this not only impacts learning it can also affect career progression [ 26 ]. Participants who felt safe asking questions were given responsibility, had autonomy to conduct skills within their scope of practice and thrived in their learning. This finding aligns with previous research affirming that a welcoming and supportive clinical placement environment, where staff are caring, approachable and helpful, enables student nurses to flourish [ 36 , 40 , 41 , 42 ]. Related research highlights that students’ perception of a good clinical placement is linked to participation within the community and instructor behaviour over the quality of the clinical environment and opportunities [ 27 , 28 ]. Over a decade ago, a large European study found that the single most important element for students’ clinical learning was the supervisory relationship [ 39 ]. In our study, students identified how supervising nurses impacted their emotions and this was critical to their experience of clinical placement, rather than how effective they were in their teaching, delivery of feedback, or their knowledge base.

Students’ relationships with patients were similarly important for a successful clinical placement. Before the clinical placement, students expressed anxiety and fears in communicating and interacting with patients, particularly if they were dying or acutely unwell, which is reflective of the literature [ 2 , 10 , 11 ]. However, during clinical placement, relationships with patients positively impacted nursing students’ experiences, especially at the beginning when they felt particularly vulnerable in a new environment. Towards the end of clinical placement, feelings of incompetence, nervousness and uncertainty had subsided. Students were more active in patient care, which increased self-confidence, empowerment, and independence, in turn further improving relationships with patients and creating a positive feedback loop [ 36 , 42 , 43 ].

Limitations

This study involved participants from one university and a single course, thus limiting the generalisability of the results. Thus, verification of the major themes identified in this research in future studies is needed. Nonetheless, the purpose of this study was to explore in detail the way in which the experiences of clinical placement for student nurses modified initial emotional responses towards undertaking placement and their perceptions of preparedness. Participants in this study undertook their clinical placement in a variety of different hospital wards in different specialties, which contributed to the rigour of the study in identifying similar themes in nursing students’ experiences across diverse placement contexts.

This study explored the narratives of first-year nursing students undertaking a postgraduate entry-to-practice qualification on their preparedness for clinical placement. Exploring students’ changing perspectives before and during the clinical placement adds to extant knowledge about nursing students’ emotional responses and perceptions of preparedness. Our research highlighted the role that preplacement emotions and expectations may have in shaping nursing students’ clinical placement experiences. Emerging themes from this study highlighted the importance students placed on relationships with peers, patients, and supervising nurses. Significant anxiety and other negative emotions experienced by nursing students prior to the first clinical placement suggests that further research is needed to explore the impact of contextual learning to scaffold students’ transition to the clinical environment. The findings of this research also have significant implications for educational practice. Additional educational support for nursing students prior to entering the clinical environment for the first time might include developing students’ understanding of the clinical environment, such as through increasing students’ understanding of the different roles of nurses in the clinical context through pre-recorded interviews with nurses. Modified approaches to simulated teaching prior to the first clinical placement would also be useful to increase the emphasis on students applying their learning in a team-based, student-led context, rather than emphasising discrete clinical skill competencies. Finally, increasing contact between students and university-based educators throughout the placement would provide further opportunities for students to debrief, to receive support and to manage some of the negative emotions identified in this study. Further supporting the transition to the first clinical placement could be fundamental to reducing the theory-practice gap and allaying anxiety. Such support is crucial during their first clinical placement to reduce attrition and boost the nursing workforce.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the conditions of our ethics approval but may be available from the corresponding author on reasonable request and subject to permission from the Human Research Ethics Committee.

Alshahrani Y, Cusack L, Rasmussen P. Undergraduate nursing students’ strategies for coping with their first clinical placement: descriptive survey study. Nurse Educ Today. 2018;69:104–8.

Article   PubMed   Google Scholar  

Brady M, Price J, Bolland R, Finnerty G. Needing to belong: first practice placement experiences of childrens’ nursing students. Compr Child Adolesc Nurs. 2019;421:24–39.

Article   Google Scholar  

Levett-Jones T, Pitt V, Courtney-Pratt H, Harbrow G, Rossiter R. What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience? Nurse Educ Pract. 2015;154:304–9.

McCloughen A, Levy D, Johnson A, Nguyen H, McKenzie H. Nursing students’ socialisation to emotion management during early clinical placement experiences: a qualitative study. J Clin Nurs. 2020;2913–14:2508–20.

Andrew N, McGuinness C, Reid G, Corcoran T. Greater than the sum of its parts: transition into the first year of undergraduate nursing. Nurse Educ Pract. 2009;91:13–21.

Leducq M, Walsh P, Hinsliff-Smith. K McGarry J. A key transition for student nurses: the first placement experience. Nurse Educ Today. 2012;327:779–81.

Spurlock D Jr. The nursing shortage and the future of nursing education is in our hands. J Nurs Educ. 2020;596:303–4.

Agu CF, Stewart J, McFarlane-Stewart N, Rae T. COVID‐19 pandemic effects on nursing education: looking through the lens of a developing country. Int Nurs Rev. 2021;682:153–8.

Nejad FM, Asadizaker M, Baraz S, Malehi AS. Investigation of nursing student satisfaction with the first clinical education experience in universities of medical sciences in Iran. J Med Life. 2019;121:75–82.

Sun FK, Long A, Tseng YS, Huang HM, You JH, Chiang CY. Undergraduate student nurses’ lived experiences of anxiety during their first clinical practicum: a phenomenological study. Nurse Educ Today. 2016;37:21–6.

Article   CAS   PubMed   Google Scholar  

Gurková E, Zeleníková R. Nursing students perceived stress coping strategies health and supervisory approaches in clinical practice: a Slovak and Czech perspective. Nurse Educ Today. 2018;65:4–10.

Hanson J, Walsh S, Mason M, Wadsworth D, Framp A, Watson K. Speaking up for safety: a graded assertiveness intervention for first year nursing students in preparation for clinical placement: thematic analysis. Nurse Educ Today. 2020;84:104252.

Khalaila R. Simulation in nursing education: an evaluation of students outcomes at their first clinical practice combined with simulations. Nurse Educ Today. 2014;342:252–8.

Cummins AM, Catling C, Hogan R, Homer CS. Addressing culture shock in first year midwifery students: maximising the initial clinical experience. Women Birth. 2014;274:271–5.

Chesser-Smyth PA. The lived experiences of general student nurses on their first clinical placement: a phenomenological study. Nurse Educ Pract. 2005;56:320–7.

Arkan B, Ordin Y, Yılmaz D. Undergraduate nursing students experience related to their clinical learning environment and factors affecting to their clinical learning process. Nurse Educ Pract. 2018;29:127–32.

Cowen KJ, Hubbard LJ, Hancock DC. Expectations and experiences of nursing students in clinical courses: a descriptive study. Nurse Educ Today. 2018;67:15–20.

Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks, California: Sage; 2014.

Jonsén E, Melender HL, Hilli Y. Finnish and Swedish nursing students experiences of their first clinical practice placement—A qualitative study. Nurse Educ Today. 2013;333:297–302.

Watt D. On becoming a qualitative researcher: the value of reflexivity. Qual Rep. 2007;121:82–101.

Google Scholar  

Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf DK, Sher J, editors. APA handbook of research methods in psychology Vol. 2. Research designs: quantitative qualitative neuropsychological and biological. Washington, DC: American Psychological Association; 2012. pp. 57–71.

Chapter   Google Scholar  

Lumivero. - Software Solutions for Data Analysis & Management [Internet]. Lumivero. http://www.lumivero.com .

Yeager DS, Dweck CS. Mindsets that promote resilience: when students believe that personal characteristics can be developed. Educ Psychol. 2012;47(4):302–14.

Kol E, İnce S. Determining the opinions of the first-year nursing students about clinical practice and clinical educators. Nurse Educ Pract. 2018;31:35–40.

Mikkonen K, Merilainen M, Tomietto M. Empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students. J Clin Nurs. 2020;29(3–4):653–61.

Ahn YH, Choi J. Incivility experiences in clinical practicum education among nursing students. Nurse Educ Today. 2019;73:48–53.

Molesworth M. Nursing students first placement: peripherality and marginality within the community of practice. J Nurs Educ. 2017;561:31–8.

Rafati F, Nouhi E, Sabzehvari S, Dehghan-Nayyeri N. Iranian nursing students’ experience of stressors in their first clinical experience. J Prof Nurs. 2017;333:250–7.

Thomas J, Jinks A, Jack B. Finessing incivility: the professional socialisation experiences of student nurses first clinical placement a grounded theory. Nurse Educ Today. 2015;3512:e4–9.

Astin F, McKenna L, Newton J, Moore-Coulson L. Registered nurses–expectations and experiences of first year students–clinical skills and knowledge. Contemp Nurse. 2005;183:279–91.

Kalyani MN, Jamshidi N, Molazem Z, Torabizadeh C, Sharif F. How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study. BMJ Open. 2019;97:e028052.

Maginnis C, Croxon L. Transfer of learning to the nursing clinical practice setting. Rural Remote Health. 2010;102:334–40.

Soler OM, Aguayo-González M, Gutiérrez SSR, Pera MJ, Leyva-Moral JM. Nursing students’ expectations of their first clinical placement: a qualitative study. Nurse Educ Today. 2021;98:104736.

Powell TL, Cooke J, Brakke A. Altered nursing student perspectives: impact of a pre-clinical observation experience at an outpatient oncology setting. Can Oncol Nurs J. 2019;291:34–9.

Bandura AJJW. Self-efficacy. In: Weiner IB, Craighead WE, editors. The Corsini encyclopedia of psychology. Hoboken, NJ: John Wiley & Sons Inc; 2010.

Porteous DJ, Machin A. The lived experience of first year undergraduate student nurses: a hermeneutic phenomenological study. Nurse Educ Today. 2018;60:56–61.

Cooper J, Courtney-Pratt H, Fitzgerald M. Key influences identified by first year undergraduate nursing students as impacting on the quality of clinical placement: a qualitative study. Nurse Educ Today. 2015;359:1004–8.

Levett-Jones T, Lathlean J. The ascent to competence conceptual framework: an outcome of a study of belongingness. J Clin Nurs. 2009;1820:2870–9.

Warne T, Johansson UB, Papastavrou E, Tichelaar E, Tomietto M, Van den Bossche K. Saarikoski M. An exploration of the clinical learning experience of nursing students in nine European countries. Nurse Educ Today. 2010;308:809–15.

Laugaland K, Kaldestad K, Espeland E, McCormack B, Akerjordet K, Aase I. Nursing students experience with clinical placement in nursing homes: a focus group study. BMC Nurs. 2021;201:1–13.

Manninen K, Henriksson EW, Scheja M, Silén C. Authenticity in learning–nursing students experiences at a clinical education ward. Health Educ. 2013;1132:132–43.

Teskereci G, Boz İ. I try to act like a nurse: a phenomenological qualitative study. Nurse Educ Pract. 2019;37:39–44.

Chesser-Smyth PA, Long T. Understanding the influences on self‐confidence among first‐year undergraduate nursing students in Ireland. J Adv Nurs. 2013;691:145–57.

Download references

Acknowledgements

The authors wish to thank the first-year nursing students who participated in this study and generously shared their experiences of undertaking their first clinical placement.

No funding was received for this study.

Author information

Jennifer M. Weller-Newton

Present address: School of Nursing and Midwifery, University of Canberra, Kirinari Drive, Bruce, Canberra, ACT, 2617, Australia

Authors and Affiliations

Department of Nursing, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

Philippa H. M. Marriott

Department of Rural Health, The University of Melbourne, Grattan St, Shepparton, VIC, 3630, Australia

Present address: Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

Katharine J. Reid

You can also search for this author in PubMed   Google Scholar

Contributions

All authors made a substantial contribution to conducting the research and preparing the manuscript for publication. P.M., J.W-N. and K.R. conceptualised the research and designed the study. P.M. undertook the data collection, and all authors were involved in thematic analysis and interpretation. P.M. wrote the first draft of the manuscript, K.R. undertook a further revision and all authors contributed to subsequent versions. All authors approved the final version for submission. Each author is prepared to take public responsibility for the research.

Corresponding author

Correspondence to Katharine J. Reid .

Ethics declarations

Ethics approval and consent to participate.

The research was undertaken in accordance with the National Health and Medical Research Council of Australia’s National Statement on Ethical Conduct in Human Research and the Australian Code for the Responsible Conduct of Research. Ethical approval to conduct the study was obtained from the University of Melbourne Human Research Ethics Committee (Ethics ID 1955997.1). All participants received a plain language statement that described the requirements of the study. All participants provided informed written consent to participate, which was affirmed verbally at the beginning of focus groups and interviews.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Marriott, P.H.M., Weller-Newton, J.M. & Reid, K.J. Preparedness for a first clinical placement in nursing: a descriptive qualitative study. BMC Nurs 23 , 345 (2024). https://doi.org/10.1186/s12912-024-01916-x

Download citation

Received : 17 November 2023

Accepted : 04 April 2024

Published : 22 May 2024

DOI : https://doi.org/10.1186/s12912-024-01916-x

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Postgraduate nursing education
• Nursing students
• Nursing schools
• Clinical skills
• Qualitative research

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

• Open access
• Published: 29 May 2024

Healthcare personnel’s perspectives on health technology in home-based pediatric palliative care: a qualitative study

• Judith Schröder   ORCID: orcid.org/0000-0001-5397-0260 1 ,
• Kirsti Riiser 2 &
• Heidi Holmen 1 , 3  

BMC Palliative Care volume  23 , Article number:  137 ( 2024 ) Cite this article

Metrics details

In the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel’s views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel.

Our study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes.

The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child’s health record within interdisciplinary teams.

The results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.

Peer Review reports

Pediatric palliative care focuses on maximizing the quality of life for children with life-limiting or life-threatening conditions and their families [ 1 ], with home-based care aiming to provide a sense of normalcy based on their preferences [ 1 , 2 , 3 , 4 , 5 ]. One way of supporting home-based care is using health technology, which has been suggested to reduce traveling, enhance communication between families and healthcare personnel, and enable peer-to-peer support from pediatric specialists in hospitals for home-care teams [ 3 , 4 , 5 , 6 , 7 ]. However, there are various understandings and definitions of what health technology entails [ 3 , 4 , 5 , 6 , 7 ]. In our study, health technology encompasses the broad utilization of information and communication technologies to enhance patient-centered care, including eHealth [ 4 ], telehealth [ 5 ], telemedicine [ 3 ], or digital health [ 6 ], hence adopting a comprehensive approach.

One important aim of health technology in home-based pediatric palliative care is to enhance the accessibility of specialized pediatric palliative care [ 3 , 4 , 5 , 6 , 7 ]. Previous research on health technology in palliative care comprises videoconferencing, remote patient monitoring for assessment, mobile applications for information sharing, and electronic health records accessible in different healthcare settings [ 8 , 9 ]. However, research has predominantly focused on using these tools in palliative care for adults, with limited exploration in pediatric palliative care [ 3 , 4 , 5 , 6 , 7 ]. In pediatric palliative care, videoconferencing has gained the most attention because it is suggested to facilitate consultations, allow for valuable face-to-face interactions, and promote individualized patient-centered care [ 3 , 4 , 5 , 6 , 7 , 10 , 11 ]. Furthermore, videoconferencing can be useful for healthcare personnel for effective care team meetings, peer-to-peer support, and education [ 4 , 6 ]. However, videoconferencing is often used as a supplementary tool rather than a complete substitute for in-person meetings [ 3 , 4 , 5 , 6 , 10 , 11 ]. Various factors have been reported to hinder the widespread adoption of videoconferencing among healthcare personnel. These include hesitations towards engaging in sensitive conversations over video and concerns about privacy [ 3 , 4 , 5 , 6 ]. Moreover, when multiple members of the care team participate in the same videoconference it can create an overload of excessive healthcare-related information for families, which could potentially lead to over-servicing and risk overwhelming families [ 10 , 11 ]. Furthermore, research suggests that healthcare personnel might require time to acclimate to using video technology in clinical practice and may experience a lack of control when working with unfamiliar and uncomfortable technological interfaces [ 11 ]. Finally, healthcare personnel expressed concerns about potential impacts on the relationship they build with children and their families, and they worried that videoconferences might impede, disrupt, or alter this crucial relationship [ 4 , 5 , 10 , 11 ]. These hesitations compromise the potential efficiency and cost-saving benefits of videoconferencing [ 3 , 4 , 5 , 6 ].

Research emphasizes that healthcare personnel play a crucial role in implementing health technologies in home-based pediatric palliative care [ 3 , 4 , 5 , 6 ]. If healthcare personnel encounter challenges or hold negative attitudes toward health technology, it may lead to reduced acceptance and less utilization in clinical practice [ 10 , 11 ]. However, there is limited research available addressing the use of health technology by healthcare personnel in home-based pediatric palliative care [ 3 , 4 , 5 , 6 ]. Our study examined healthcare personnel’s perspectives on using health technology in this context in Norway, aiming to explore its potentials and limitations.

Our study employed a qualitative descriptive and exploratory approach, giving comprehensive insights into healthcare personnel’s perspectives through focus groups.

Setting, recruitment, participants

The publicly funded Norwegian healthcare system offers comprehensive and free coverage to all residents, with primary healthcare services being organized and managed by municipalities [ 12 ]. Efforts have been made to establish a comprehensive children’s palliative care service, supported by national guidelines published by the Norwegian Directorate of Health in 2016 [ 13 ]. The commitment to delivering healthcare services for seriously ill children also finds prominence in the government’s digitalization strategy for the 2019–2025 period [ 14 ], emphasizing the importance of providing citizens with a user-friendly and seamless experience through utilization and exchange of data within a collaborative digital ecosystem. The use of health technology in Norway, as in many other countries, is implemented to help enhance and streamline home-based healthcare services [ 14 ]. The use of health technology can address important aspects, including the efficient utilization of resources, financial sustainability, and the environmental impact of healthcare services [ 12 ]. Additionally, health technology can enable timely care delivery to rural and remote populations [ 15 ].

We applied purposive sampling, targeting healthcare personnel involved in primary healthcare services in Norway with valuable expertise in home-based pediatric palliative care [ 16 ]. The first author JS obtained contact information of healthcare personnel through three sources: the advisory group of the research project “Children in Palliative Care - health technology in home-based pediatric palliative care” (CHIP homeTec) [ 17 ], and pediatric palliative care teams at two university hospitals. Eight municipal healthcare services were contacted and invited to receive information about the study design by phone and email. Of these, five municipal services accepted their participation in the study, while three declined due to heavy workloads.

The participants were healthcare personnel employed in primary healthcare services that were located across different regions in Norway. These primary healthcare services served populations ranging from 3,750 to 77,550 inhabitants and encompassed areas from 70 to 2,500 square kilometers. The jurisdictions of these primary healthcare services included both urban and rural areas. Five focus groups were created with 22 participants. One group included three participants, another had four participants, and the remaining three groups had five participants each. One participant was male. Table  1 presents the self-reported professions of study participants and their respective years of experience in pediatric palliative care. The participants included physiotherapists ( n  = 8), occupational therapists ( n  = 6), public health nurses ( n  = 2), child and youth workers ( n  = 2), assistant nurses ( n  = 2), one palliative care nurse, and one social worker. All participants were providing primary healthcare services to children in general and specifically to children with palliative care needs. The participants’ work experience in pediatric palliative care ranged from 6 months to 30 years, with an overall median duration of 11 years.

Data collection

Before participating in the focus groups, all participants completed a web-based questionnaire regarding their profession, workplace, and years of experience in pediatric palliative care. The Service for Sensitive Data (TSD) provided by the University of Oslo was utilized to collect and store all data from the questionnaires. The TSD server is specifically designed to ensure data security [ 18 ].

We conducted focus groups by following established guidelines [ 19 ]. A pilot focus group was conducted to test the brief and flexible semistructured interview guide and the audio recording tool. The interview guide was designed to be broad and flexible, stimulating wide-ranging discussions on the use of health technology by healthcare personnel with minimal steering from the moderator [ 20 ]. Starting with open-ended questions about general experiences in pediatric palliative care often led participants to relate to positive experiences and what was working well for them. To facilitate a balanced conversation, we incorporated specific prompts addressing barriers and limitations. Additionally, conversations around desired innovations for streamlining home-based pediatric palliative care naturally highlighted the potential benefits of health technology. The complete interview guide in English language is available as supplementary material 1 .

JS (moderator) and KR or HH (secretary) met the respondents for the first time at the designated focus group. At the fourth focus group, another Ph.D. candidate filled in as the secretary. The focus groups were conducted during working hours between March and April 2023 at the participants’ workplaces. The purpose of the research project, the background and research interests of the researchers, and the roles of the moderator and secretary were presented to the participants before the interviews started. A brief introduction to health technology as communication and information technology used in remote care was given. The interviews were recorded digitally, and the recordings were stored and transcribed onto the TSD server [ 18 ]. Three of the focus groups were transcribed by JS, and two were transcribed using Whisper, a speech recognition model that transcribes audio files [ 21 ]. JS ensured the accuracy of the transcriptions produced by Whisper by thoroughly reviewing and editing them multiple times. All transcriptions were edited and adapted to written language norms. The focus groups lasted between 63 and 87 min.

We employed reflexive thematic analysis, which offers theoretical flexibility and systematic guidelines for a comprehensive exploration of the dataset [ 22 ]. The analysis followed a constructivist paradigm, aiming to understand the meaning that the participants attributed to their perspectives on health technology in home-based pediatric palliative care.

JS analyzed the data by repeatedly listening to the recorded discussions and reviewing the transcripts to become familiar with the data. KR and HH were given access to the transcripts, and we met to exchange our initial thoughts and reflections on the dataset.

Progressing to the second phase of generating the initial codes [ 22 ], we conducted an inductive approach to best represent meaning as communicated by the participants and identify relevant sections of data within the dataset; we then subsequently categorized similar codes and their associated meanings (Table  2 ). In phase three, we developed provisional candidate themes on shared meaning by grouping codes [ 22 ]. This process was not strictly linear because we switched between phases three and four, where themes were continuously re-evaluated to uncover underlying contradictions and deeper insights into the participants’ perspectives. We were cognizant of our role as cocreators of themes and approached the interpretation of data through the lens of our perceptions and understanding of previous research [ 22 ]. JS prepared a summary for each theme during phase five and shared these summaries with KR and HH. Together, we worked collaboratively to enhance, clarify, and label the identified themes. In our analysis, we concentrated on identifying the main themes that provided a detailed, interpretive, and contextualized narrative of our dataset [ 22 ]. As a result, we did not establish any subthemes. Finally, JS created an analytical narrative that addressed the research question, which was reviewed and edited by KR and HH for accuracy and clarity.

Preunderstanding

All authors (JS, KR, HH) are actively engage in the CHIP homeTec research project, which investigates the utilization of health technology in home-based pediatric palliative care [ 17 ]. Our preunderstanding has been influenced by our previous systematic review. The results from this review highlighted the needs of healthcare personnel when delivering home-based pediatric palliative care. These needs encompass the establishment of relationships with both the child and their family, effective collaboration within the healthcare team, and the provision of services in an environment that guarantees fairness and long-term sustainability [ 23 ].

Ethical considerations

Our study was approved by the Norwegian Agency for Shared Services in Education and Research, which concluded that our study was in accordance with the Personal Data Act (reference number 657413). Because our study solely involved healthcare personnel and did not collect health data, it did not require permission from a regional committee for research ethics. Prior to participating in the focus groups, all individuals were extensively informed, both verbally and through written communication, about the voluntary nature of their involvement, along with the assurance of anonymity, confidentiality, and option to withdraw from the study without providing any reasons. Written informed consent was obtained from all participants before their participation in the focus groups.

The focus group participants reflected on the potentials and limitations of health technology by referring to existing health technologies in their practice, the experiences they acquired during the COVID-19 pandemic, and how they used social media in everyday life. This combination of informal and formal experience with health technology, combined with the many years of experience in home-based pediatric palliative care, gave the participants a broad foundation for discussions. The participants in all groups demonstrated an understanding of pediatric palliative care as a service that offers care, comfort, and emotional support while aiming to improve the quality of life for children with life-limiting or life-threatening conditions and their families.

The participants commonly utilized videoconferencing and electronic patient records as health technology solutions in their work. Additionally, some participants had experience with software applications specifically designed for children with cognitive impairments and limited language ability, as well as software applications used to encourage physical activity.

The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care .

Balancing in-person interaction and time in pediatric palliative care

The participants emphasized that, within pediatric palliative care, health technology must be employed with caution and should be guided by a clear purpose that weighs the benefits of use against possible distress or harm to the family. The participants deemed it essential to emphasize that, although health technology can serve as a helpful supplement, it could never fully replace the unique competence and invaluable human connection that healthcare personnel provide to the families they serve. They emphasized a sensitive and holistic approach to care, relying on in-person interactions and strong relationships built on trust and empathy as critical aspects that technology cannot replicate.

The personal meetings, which I think are enormously important, should not be fully replaced (by technology) . (Occupational therapist, group 3)

Some participants added that in-person interaction in the children’s homes can provide a valuable break for families dealing with exhausting situations and, therefore, can have a positive impact on the quality of life of both the child and family.

The participants also highlighted the therapeutic value of hands-on evaluation, where healthcare personnel apply their many years of experience and expertise to assess the child’s condition, an expertise that health technology cannot replicate. They further argued that, the utilization of health technology falls short of conveying the essential nonverbal cues related to the child’s well-being.

It can be a small tension in the child’s body that you interpret as something not quite right. Can we try to figure out what it is? A sigh that lasts too long, or an expiration that doesn’t come where you expect that it should. What is it? It is much easier to act as a therapist when you can be physically present. (Physiotherapist, group 5)

The participants were concerned that current health technologies can be burdensome and time-consuming, which takes time away from caring for children and their families. They highlighted specific issues with current electronic medical records and messaging platforms as examples of suboptimal technologies. Their experiences revealed several challenges, such as a lack of integration between different systems, the annoyance of two-factor authentication, connectivity problems with portable devices, and character limits in existing messaging platforms.

There is only a maximum number of characters you can write. (…). And then I have to write four messages because I have to complete what I have to say. And then I have to divide it into four parts. In fact, the system should make everyone’s everyday life more efficient. But it doesn’t because it’s not good enough. (Occupational therapist, group 3)

The citation above illustrates the trouble healthcare personnel faced when trying to use a messaging platform to communicate with parents and serves as an example of how health technology hinders—rather than helps—in providing comprehensive palliative care.

Although in-person interactions were deemed critical, the participants discussed situations in which health technology could be particularly useful. One such example was when healthcare personnel have a cold and there is a risk of infecting the child and family during a home visit, using technology could be a practical alternative instead of canceling the visit.

Exchange of information can improve timely and appropriate care

The participants also discussed the crucial aspects of interdisciplinary collaboration in pediatric palliative care. Although the multidisciplinary nature of the palliative care team was acknowledged as highly beneficial for the child and family, it posed a challenge for the participants to establish efficient collaboration. Ensuring they had the latest updates on the child’s status before home visits was a concern because of the many professionals involved in care delivery and the often-unpredictable illness trajectory of the children. Communication and information exchange between parents, healthcare personnel, educational staff, and personal assistants was viewed as critical. However, the participants recognized a lack of tools that could facilitate effective information flow, which resulted in frequent use of traditional communication methods such as phone calls and emails. These practices were not only reported to be time-consuming but also raised concerns regarding the protection of confidentiality for the child. The participants pointed out that the obstacles to information exchange could lead to delays in necessary care, potentially affecting outcomes for children and their families.

To overcome care fragmentation and promote seamless exchange of information, the participants envisioned one shared digital platform to serve as a central source of information. This platform should allow all care team members access to the child’s health data, daily reports, and advance care plan, regardless of their location or the time of day. As a result, healthcare personnel might be informed and better prepared for home visits.

In situations where there are multiple people involved and handovers are necessary, one shared platform would be beneficial. It would allow for better preparation and understanding of what to expect before meeting the child and family in their home. (Public nurse, Group 1)

The participants progressed in their dialogue by contemplating strategies for how to engage healthcare, educational, and welfare professionals, all of whom deliver services to children and families in their homes, in the exchange of information. They highlighted the potential of one shared digital platform that could bring the various professions together.

Some participants said that they only needed access to crucial information relevant to their work rather than all kinds of information. Others feared accountability for tasks that they might not grasp thoroughly from their professional perspective, emphasizing the need for a comprehensive dialogue before task allocation.

Furthermore, the participants emphasized the potential benefits of features such as chat messages and videoconferencing, underscoring the importance of direct verbal information.

In many cases, what could have been highly beneficial is a group chat. A straightforward, old-fashioned group chat. So much information comes through different channels. (Physiotherapist, group 5)

Communication technologies were praised for their ability to improve meeting efficiency by uniting all care team members, regardless of their location, promoting timely and effective information sharing across the team, and providing easy access to peer support. The participants also recognized the potential of these functionalities to alleviate burdensome traveling for the children and their families.

Some participants suggested that parents should have access to the shared digital platform as well, considering their role as the child’s primary caregivers and important members of the care team. However, others acknowledged that parents could feel overwhelmed with excessive information and that healthcare personnel would hesitate to share all the details with the parents. Furthermore, some participants requested communication technologies that resonate with and engage young people. They emphasized the importance of interactive platforms that enable direct communication with adolescents, free from parental interference, for the exchange of relevant information.

The power of visual documentation in pediatric palliative care

An important aspect consistently discussed across all focus groups was the possibility of supplementing written documentation with photos and videos to facilitate understanding of the child’s health condition in both acute cases and over time. The participants recognized pediatric palliative care as a prolonged duration of care characterized by a complex progression of the child’s condition. The participants suggested that visual documentation could provide more comprehensive and factual firsthand information. This could help reduce the element of personal interpretation and the potential errors that can commonly occur in unspecific written reports. Visual documentation was suggested to ensure accuracy in assessing and managing the child’s condition, function, and progression. The importance of visual documentation was highlighted as particularly relevant in communication with hospital staff, which tended to rely on observations from home care personnel to reassess ongoing treatments.

Do you trust yourself in everything you see? There are also variations from day to day and week to week. So, there’s something about getting that documented for quality assurance. There will be an interpretation anyway, but still, then, several are involved in that interpretation. (Physiotherapist, group 1)

Two focus groups shared their experiences with a software application specifically designed for children with cognitive impairments and limited or no language ability [ 24 ]. This application enabled participants to document information using videos, photos, and textual descriptions.

You get to know the child through the screen in a way, and can see how you do it, when the child is to be lifted into a chair. What does it mean when a child makes this sound or this facial expression? A way for me to get to know the child is through this app . (Child and youth worker, group 2)

The participants discussed, based on their experiences, how visual documentation played a vital role in maintaining care, information exchange, and transitions during personnel shifts as well as being a valuable training resource, particularly for training assistants on the proper utilization of specialized equipment.

Our study aimed to explore healthcare personnel’s perspectives on the potential and limitations of health technology in home-based pediatric palliative care. The themes have underscored that technology can support care but must be carefully integrated to ensure that it adds to the individualized patient-centered approach in pediatric palliative care. Additionally, our analysis emphasized the potential of one shared digital platform that can store and exchange pertinent healthcare information, including multimedia files, enabling healthcare personnel to deliver timely and appropriate home-based pediatric palliative care.

The participants emphasized that pediatric palliative care aims to meet the comprehensive needs of both the child and the family. Our results corresponded with previous research describing that the use of health technology should be balanced with in-person interaction [ 3 , 4 , 5 , 6 ]. However, a systematic review explored how hands-on practitioners adapted to web-based formats during the COVID-19 pandemic and found various methods to overcome the lack of physical closeness [ 25 ]. The methods used by practitioners included improved communication skills for clear instructions, using visual aids like dolls, invoking sensorial memories, utilizing additional tools for engagement, incorporating music and singing, sending materials to participants’ homes, and encouraging the use of emojis or participation in polls [ 25 ]. Nevertheless, the successful implementation of these methods necessitated practitioners dedicating sufficient time for preparation, including briefing individuals who may assume their role in the child’s home as well as ensuring clear communication and setting expectations for effective web-based consultations [ 25 ]. This can be challenging given the time constraints already faced by healthcare personnel in home-based pediatric palliative care. While health technology can offer accessible and time-saving services, particularly for patients living in rural areas with limited access to healthcare resources or facilities [ 25 ], our results also showed that health technology may disrupt or change established practices that place a strong emphasis on in-person interaction and assessment. Future research should incorporate co-design principles for developing health technology [ 6 ] or focus on specific evaluations aligned with the assessment of the child’s condition [ 5 ]. Additionally, addressing healthcare personnel’s knowledge and perceptions may enhance the adaptation and utilization of health technology in home-based pediatric palliative care [ 4 ].

The desire for one shared digital platform for exchanging information across health services was expressed in all focus groups. In this regard, our study can offer unique insights into the potential of health technology, expanding beyond existing research that has primarily focused on videoconferencing [ 3 , 4 , 5 , 6 , 10 , 11 ]. The idea that all participants in the healthcare team can be “connected” by sharing and presenting timely, accurate, and relevant information about the child’s health is in line with Caulfield and Donnelly’s connected health model [ 26 ]. Caulfield and Donnelly underlined the value of information exchange in enhancing care models and introduced the connected health model as a sociotechnical approach that links people, processes, and technology through more intelligent utilization of data, devices, and communication platforms [ 26 , 27 , 28 ]. Research in palliative care has emphasized the information exchange value of electronic health records available across healthcare settings because information exchange improves continuity of care, ensures that patients are treated in line with their wishes, and streamlines clinical workflow [ 9 , 29 , 30 ].

One shared digital platform for the exchange of information about a child’s health and well-being in pediatric palliative care must be user-friendly and functional to be clinically relevant [ 29 , 30 ]. Usability can be secured either by integrating the platform with existing electronic health record systems or replacing current health record systems altogether. Structuring documentation by using templates, order sets, and prompts has been suggested to alleviate the challenge of locating pertinent information [ 9 , 29 , 30 ]. However, previous research has suggested that healthcare personnel can encounter difficulties in rapidly accessing relevant information within electronic health records in the context of palliative care [ 29 ]. The often-long time frame of pediatric palliative care services, combined with the complex interdisciplinary team documentation, may challenge the organization of information within one shared digital platform. Our results underscored the need for user-friendly and functional technology that minimizes the time burden placed on healthcare personnel. Using health technology as a tool to enhance the efficiency of information exchange has also been highlighted as a core potential in previous research [ 29 , 30 ].

In considering user-friendly and functional health technology, it is crucial to evaluate how well these technologies fulfill the specific requirements and needs of healthcare personnel who provide home-based pediatric palliative care [ 6 , 31 ]. The assumption that health technology can effectively address resource efficiency, financial sustainability, and reduced environmental impact of healthcare services [ 32 ] has highlighted the increasing array of health technologies expected to be implemented in the future. Given the dynamic nature of palliative care, regular evaluations are necessary to ensure that current health technology solutions continue to meet the evolving needs of healthcare personnel [ 6 , 31 ]. Engaging healthcare personnel in the evaluation and design process can help improve the usability and functionality of health technology and prevent it from adding additional strain to healthcare services; this involves actively seeking out healthcare personnel’s insights and perspectives to optimize current technology solutions or collaboratively design new ones that effectively support their work tasks [ 6 , 31 ].

Our study uncovered contrasting viewpoints among the participants about whether parents should have access to the suggested shared digital platform. The potential to involve patients in managing their health has also been acknowledged in Caulfield and Donnelly’s connected health model [ 26 ]. Previous research has been limited regarding the experiences of children, parents, and healthcare personnel when sharing day-to-day information and evaluations. However, a systematic review highlighted how parents in pediatric palliative care report a greater sense of control over their family’s care at home and appreciate the ability to stay connected with healthcare personnel in the hospital [ 4 ]. It is important to acknowledge the fundamental importance of parents throughout their children’s lives in terms of communication and decision-making [ 33 ]. As time progresses, most parents develop unique skills in caring for their children, managing symptoms, and administering medication [ 2 ]. Thus, parents become valuable sources of information about their children’s care needs. Enabling access to one shared digital platform can enhance care coordination and ensure a family-centered approach. However, the families of children with palliative care needs often face challenges in terms of time management and responsibilities [ 33 ]. Introducing health technology may bring about additional complexities and demands for these caregivers [ 4 ]. Therefore, it is crucial to acknowledge and prioritize the preferences and needs of each family when considering the provision of access to health information, regardless of the use of health technology. An ideal would be to provide access to one shared digital platform as an optional feature tailored to the specific requirements and preferences of individual families, which is in line with established standards for pediatric palliative care [ 1 ].

In our study, the participants also highlighted the importance of health technology enabling direct communication with children, independent of parental involvement. Today children may feel more comfortable using digital solutions to interact with healthcare personnel. Therefore, research need to explore how health technology can enhance communication and interaction with children in the context of home-based pediatric palliative care. Allowing children to digitally report their health outcomes, can actively involve them in decisions regarding their care and treatment [ 4 , 34 ].

Strengths and limitations

We (JS, KR, HH) have varied clinical experiences in healthcare services which might led us to not prompt participants for further elaboration on their perspectives. However, our expertise with qualitative research methods helped us remain aware that we should not take the participants’ perspectives for granted. Moreover, the focus groups were conducted with a moderator and a secretary, allowing for an effective division of responsibilities, and reducing the risk of missing important perspectives. The focus groups were conducted in different health regions of Norway, ensuring geographical spread and greater variation in the data.

The focus groups primarily included physiotherapists and occupational therapists with their respective work responsibilities. The distinct roles and duties they held potentially restricted the transferability of the results to other professions like nurses or physicians. It is possible that nurses and physicians would have presented different or supplementary perspectives, thereby enhancing the discussions within the focus groups. However, one focus group did not include physiotherapists or occupational therapists, and the topics discussed were similar to those raised in the other groups. In discussing health technology in a general sense, the participants might have overlooked nuances and specificity related to the implementation and integration of specific health technology. However, the themes developed in this study encompassed both well-known aspects of implementing health technology and novel insights, indicating a substantial variation in the dataset.

Our results showed that health technology in home-based pediatric palliative care can present both potential and limitations. Health technology has the potential to improve information sharing and, in turn, strengthen connections within the care team, leading to more proactive and efficient home-based pediatric palliative care. However, it is essential to recognize that close relationship and in-person interaction with the child is crucial in home-based pediatric palliative care and cannot be replaced by technology. Furthermore, there is a need for continuous evaluation to ensure that the health technology being used is effective, reliable, and suitable for the unique nature of home-based pediatric palliative care. Continuous evaluation of health technology is necessary to ensure the specific needs of healthcare personnel providing home-based pediatric palliative care. Future research should address the limitations of current health technology and consider the opinions for information sharing between all parties to maximize the benefits of health technology in enhancing home-based pediatric palliative care.

Data availability

The data transcripts generated and analyzed during our study are not publicly available because of legal restrictions. However, interested individuals may request access to the data from the authors. It is important to note that obtaining the data will require a reasonable request and permission from the Norwegian Agency for Shared Services in Education and Research.

Benini F, Papadatou D, Bernadá M, Craig F, De Zen L, Downing J, et al. International standards for pediatric palliative care: from IMPaCCT to GO-PPaCS. J Pain Symptom Manage. 2022;63(5):e529–43.

Article   PubMed   Google Scholar  

Malcolm C, Knighting K, Taylor C. Home-based end of Life Care for Children and their families – a systematic scoping review and narrative synthesis. J Pediatr Nurs. 2020;55:126–33.

Miller KA, Baird J, Lira J, Herrera Eguizabal J, Fei S, Kysh L, et al. The use of telemedicine for home-based palliative care for children with serious illness: a scoping review. J Pain Symptom Manag. 2021;62(3):619–e366.

Article   Google Scholar  

Holmen H, Riiser K, Winger A. Home-based pediatric palliative care and electronic health: systematic mixed methods review. J Med Internet Res. 2020;22(2):e16248–e.

Article   PubMed   PubMed Central   Google Scholar  

Bradford N, Armfield NR, Young J, Smith AC. The case for home based telehealth in pediatric palliative care: a systematic review. BMC Palliat Care. 2013;12(1):4–16.

Bird M, Li L, Ouellette C, Hopkins K, McGillion MH, Carter N. Use of synchronous digital health technologies for the care of children with special health care needs and their families: scoping review. JMIR Pediatr Parent. 2019;21(11):e15106–e.

Delemere E, Maguire R. The role of Connected Health technologies in supporting families affected by paediatric cancer: a systematic review. Psychooncology. 2021;30(1):3–15.

Disalvo D, Agar M, Caplan G, Murtagh FEM, Luckett T, Heneka N, et al. Virtual models of care for people with palliative care needs living in their own home: a systematic meta-review and narrative synthesis. Palliat Med. 2021;35(8):1385–406.

Finucane AM, O’Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med. 2021;4(1):64.

Weaver MS, Neumann ML, Navaneethan H, Robinson JE, Hinds PS. Human touch via touchscreen: rural nurses’ experiential perspectives on telehealth use in pediatric hospice care. J Pain Symptom Manag. 2020;60(5):1027–33.

Bradford NK, Young J, Armfield NR, Herbert A, Smith AC. Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us? BMC Palliat Care. 2014;13(1):10.

Aas E, Iversen T, Kaarboe O. The Economic sustainability of the norwegian healthcare system. United Kingdom: Emerald Publishing Limited; 2021. pp. 81–101.

Google Scholar  

The Norwegian Directorate of Health. Palliative care for children and young people, National guidelines. 2016. https://www.helsedirektoratet.no/retningslinjer/palliasjon-til-barn-og-unge

Ministry of Local Government and Regional Development. One digital public sector. Digital strategy for the public sector 2019–2025. In: Development MoLGaR, editor. 2019.

Lundgren A, Randall L, Norlén G. State of the Nordic Region 2020 -Wellbeing, health and digitalisation. Copenhagen: Nordic Council of Minesters; 2020.

Book   Google Scholar  

Nick E. Purposeful sampling. In: Nick E, editor. Sampling and choosing cases in qualitative research: a Realist Approach. London: SAGE Publications Ltd; 2013. p. 33.

Holmen H. Gathering evidence for evidence-based health technology to support communication in homebased pediatric palliative care – CHIP homeTec Oslo: The Research Council of Norway; 2021. https://prosjektbanken.forskningsradet.no/en/project/FORISS/314850?Kilde=FORISS&distribution=Ar&chart=bar&calcType=funding&Sprak=no&sortBy=date&sortOrder=desc&resultCount=30&offset=30

TSD. Tjeneste for Sensitive Data. 2.0 ed. Oslo: IT-Department, University of Oslo; 2024.

Brinkmann S, Kvale S. Planning an interview study. Doing interviews. Qualitative Research Kit. Second ed. London: SAGE Publications Ltd; 2018. p. 39.

Brinkmann S, Kvale S. Interview variations. Doing Interviews. Qualitative Research Kit. Second ed. 55 City Road: 55 City Road: SAGE Publications Ltd; 2018. p. 73.

Radford A, Kim JW, Xu T, Brockman G, McLeavey C, Sutskever I. Robust Speech Recognition via Large-Scale Weak Supervision. arXivorg. 2022.

Braun V, Clarke V, Braun V. Thematic analysis: a practical guide. Los Angeles: SAGE; 2022.

Schröder J, Riiser K, Holmen H. The needs of healthcare personnel who provide home-based pediatric palliative care: a mixed method systematic review. BMC Health Serv Res. 2024;24(1):45.

Livetools AS. KnowMe Kongsberg 2024. https://www.knowme.no/

Gauhe G, Cisneros REK, Ward J, Hohenschurz-Schmidt DJ. Creatively adapting touch-based practices to the web format during the COVID-19 pandemic: systematic review. J Med Internet Res. 2023;25(10):e46355–e.

Caulfield BM, Donnelly SC. What is connected health and why will it change your practice? QJM. 2013;106(8):703–7.

Article   CAS   PubMed   Google Scholar  

Delemere E, Gitonga I, Maguire R. Utility, barriers and facilitators to the use of connected health to support families impacted by paediatric cancer: a qualitative analysis. Support Care Cancer. 2022;30(8):6755–66.

Pattichis CS, Panayides AS. Connected health. Front Digit Health. 2019;1:1–3.

Bush RA, Pérez A, Baum T, Etland C, Connelly CD. A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care. JAMIA Open. 2018;1(2):294–303.

Meyer D, Kernebeck S, Busse TS, Ehlers J, Wager J, Zernikow B, et al. Electronic health records in specialized pediatric palliative care: a qualitative needs assessment among professionals experienced and inexperienced in electronic documentation. Children. 2021;8(3):249.

Hancock S, Preston N, Jones H, Gadoud A. Telehealth in palliative care is being described but not evaluated: a systematic review. BMC Palliat Care. 2019;18(1):114.

World Health Organization. Global strategy on digital health 2020–2025. 2021. https://apps.who.int/iris/bitstream/handle/10665/344249/9789240020924-eng.pdf

Winger A, Kvarme LG, Løyland B, Kristiansen C, Helseth S, Ravn IH. Family experiences with palliative care for children at home: a systematic literature review. BMC Palliat Care. 2020;19(1):165.

Holmen H, Winger A, Steindal SA, Riiser K, Castor C, Kvarme LG, et al. Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs—a scoping review. BMC Palliat Care. 2023;22(1):148.

Download references

Acknowledgements

We express our sincere gratitude to the healthcare personnel for generously contributing their time and participating in our study. Their willingness to share their valuable experiences has been essential to our research. Additionally, we would like to extend our appreciation to all individuals who helped us in the recruitment process and thank Linda Johanne Martinsen for her help as the secretary in focus group four.

Our work was funded by the Research Council of Norway, grant nr. 314850.

Open access funding provided by OsloMet - Oslo Metropolitan University

Author information

Authors and affiliations.

Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway

Judith Schröder & Heidi Holmen

Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway

Kirsti Riiser

Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway

Heidi Holmen

You can also search for this author in PubMed   Google Scholar

Contributions

Our study was a result of significant contributions from all three authors. They collectively played essential roles in designing the study, collecting and analyzing the data, and interpreting the results. JS took the lead in drafting the manuscript, while KR and HH provided critical revisions and edits. The final manuscript was reviewed and approved by all three authors, who granted their consent for its publication.

Corresponding author

Correspondence to Judith Schröder .

Ethics declarations

Ethics approval and consent to participate.

Our study was approved by the Norwegian Agency for Shared Services in Education and Research, which concluded that the study was in accordance with the Personal Data Act (reference number 657413). Because our study solely involved healthcare personnel and did not collect health data, it did not require permission from a regional committee for research ethics. Prior to participating in the focus groups, all individuals were extensively informed, both verbally and through written communication, about the voluntary nature of their involvement, along with the assurance of anonymity, confidentiality, and option to withdraw from the study without providing any reasons. Written informed consent was obtained from all participants before their participation in the focus groups.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Schröder, J., Riiser, K. & Holmen, H. Healthcare personnel’s perspectives on health technology in home-based pediatric palliative care: a qualitative study. BMC Palliat Care 23 , 137 (2024). https://doi.org/10.1186/s12904-024-01464-w

Download citation

Received : 07 February 2024

Accepted : 22 May 2024

Published : 29 May 2024

DOI : https://doi.org/10.1186/s12904-024-01464-w

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Pediatric palliative care
• Healthcare personnel
• Digital health

BMC Palliative Care

ISSN: 1472-684X

• Submission enquiries: [email protected]
• General enquiries: [email protected]

• Open access
• Published: 29 May 2024

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

• Samina Idrees 1 ,
• Gillian Young 1 ,
• Brian Dunne 2 ,
• Donnie Antony 2 ,
• Leslie Meredith 1 &
• Maria Mathews 1  

BMC Health Services Research volume  24 , Article number:  680 ( 2024 ) Cite this article

Metrics details

Person-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.

We conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.

We interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.

Conclusions

The person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Peer Review reports

The community-care sector facilitates the coordination and administration of in-home and community-based health and social services. Community-care services include supports for independent living, residential services, complex medical care, and community-participation services to support personal and professional goals (e.g., education, employment, and recreation-based supports) [ 1 ]. There is substantial heterogeneity in the clinical and demographic characteristics of the community-care population, including individuals with physical and developmental disabilities, and complex medical needs [ 2 ]. We refer to the individuals served by these organizations as ‘persons-supported’ in line with person-first language conventions [ 3 , 4 ].

In recent decades, governments across the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery [ 5 , 6 , 7 , 8 ]. Person-centred care encompasses a broad framework designed to direct care delivery, as opposed to a singular standardized process. In the context of community-care, person-centred planning refers to a model of care provision in which programs and services are developed in collaboration with persons-supported and tailored to their unique needs and desired outcomes [ 9 , 10 ].

In Ontario, Canada, community-care services are funded by the Ministry of Health (MOH) and the Ministry of Children, Community and Social Services (MCCSS). Service agreements between these ministries and individual agencies can be complex and contingent on different factors including compliance with a number of regulatory items and policies [ 7 , 11 ]. MOH provides funding for health-based services including in-home physiotherapy, respiratory therapy, and personal support services, among several others. MOH funds Home and Community Care Support Services (HCCSS), a network of organizations responsible for coordinating the delivery of in-home and community-based care in the province. MCCSS funds social service agencies including those providing community participation and residential support for people with intellectual and developmental disabilities (IDDs).

Several tools and resources have been developed to aid organizations in providing person-centred care and organizations may differ in their use of these tools and their specific approach. Although regional mandates provide a framework for directing care delivery, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. In addition, as noted by a recent scoping review, there is limited literature on the implementation process and impact of person-centred planning on individual outcomes [ 12 ]. Using a pragmatic, qualitative, descriptive approach [ 13 ], we outline how community-care organizations enact a person-centred approach to care and the factors that shape their enactment. By describing existing practices in the context of the community-care sector, we aim to provide insight on how to optimize care delivery to improve outcomes and inform current policy. This study is part of a larger, multi-methods project examining the implementation of person-centred care plans in the community-care sector. This project encompasses qualitative interviews with representatives from different community-care organizations, as well as staff and persons-supported at a partner community-care organization. This paper focuses on analyzing data from interviews with representatives from different community-care organizations.

We conducted semi-structured interviews with administrators from community-care organizations in Southwestern Ontario (roughly the Ontario Health West Region) between October 2022 and January 2023. We included community-care organizations funded by MOH or MCCSS. We excluded organizations that did not provide services in Southwestern Ontario. We identified eligible organizations and participants by searching online databases, including community resource lists, as well as through consultation with members of the research team.

We used maximum variation sampling [ 14 ], to recruit participants from organizations with a wide range of characteristics including location (i.e., urban, rural), organization type (i.e., for-profit, not-for-profit), and types of services provided (e.g., residential, recreation, transportation, etc.) We contacted eligible organizations via email, providing them with study information and inviting them to participate. We recruited until the data reached saturation, defined as the point at which there was sufficient data to enable rigorous analysis [ 14 , 15 ].

In each interview, we asked participants about their organization’s approach to developing and updating individual service agreements or person-centred care plans, and the supports and barriers (e.g., organizational, funding, staffing, etc.) that facilitate or hinder the implementation of these plans (Supplementary Material 1 : Interview Guide). We also collected information on relevant participant and organizational characteristics, including participant gender, position, years of experience, organization location, type (i.e., for-profit, not-for-profit), services offered, years in operation, and client load. The interviews were approximately one hour in length and conducted virtually via Zoom (Zoom Video Communications Inc.) or by telephone. The interviews were audio-recorded and transcribed verbatim. Interviewer field notes were also used in data analysis.

We analyzed the data thematically [ 16 ]. The coding process followed a collaborative and multi-step approach. Initially, three members of the research team independently reviewed and coded a selection of transcripts to identify key ideas and patterns in the data, and form a preliminary coding template. We then met to consolidate individual coding efforts. We compared coding of each transcript, resolving conflicts through discussion and consensus. In coding subsequent transcripts and through a series of meetings, we worked together to finalize the codebook to reflect more analytic codes. We used the finalized template to code all interview transcripts in NVivo (QSR International), a software designed to facilitate qualitative data analysis. We refined the codebook on an as-needed basis by incorporating novel insights gleaned from the coding of additional transcripts, reflecting the iterative nature of the analysis.

We increased the robustness of our methodology by pre-testing interview questions, documenting interview and transcription protocols, using experienced interviewers, and confirming meaning with participants in interviews [ 14 , 15 , 16 ]. We kept detailed records of interviews, field notes, and drafts of the coding template. We made efforts to identify negative cases and provided rich descriptions and illustrative quotes [ 17 ]. We included individuals directly involved in the administration of community-care services on our research team. These individuals provided important context and feedback at each stage of the research process.

This study was approved by the research ethics board at Western University. We obtained informed consent from participants prior to the onset of interviews. We maintained confidentiality through secure storage of interview data (e.g., audio recordings), password-protection of sensitive documents, and the de-identification of transcripts.

Positionality

The authors represent a multidisciplinary team of researchers, clinicians, and community-care leaders. The community-care leaders and clinicians on our team provided key practical expertise to inform the development of interview questions and the analysis of study findings.

We interviewed administrators across 12 community-care organizations in Southwestern Ontario. The sample included representatives from seven organizations that received funding from MCCSS, three organizations that received funding from MOH, and two organizations that received funding from both MCCSS and MOH (Table  1 ). Eleven organizations were not-for-profit, one was a for-profit agency. The organizations provided care in rural ( n =  3), urban ( n =  4), or both rural and urban populations ( n =  5). Seven of the 12 participants were women, nine had been working with their organization for more than 11 years, and all had been working in the community-care sector for more than 12 years (Table  2 ).

We identified three key categories or processes relating to organizational characteristics and their impact on the design and delivery of person-centred care plans: (1) organizational context, (2) organizational culture, and (3) the development and implementation of person-centred care plans.

Organizational context

Organizational context refers to the characteristics of persons-supported, and the nature of services provided. Organizational context accounts for the considerable heterogeneity across organizations in the community-care sector and their approach to person-centred care plans.

Populations served

The majority of organizations included in the study supported individuals with IDDs: “all of the people have been identified as having a developmental disability. That’s part of the eligibility criteria for any funded developmental service in Ontario.” [P10]. Participants described how eligibility was ascertained through the referral process: “ the DSO [Developmental Services Ontario] figures all of that out and then refers them to us .” [P08]. These descriptions highlighted a common access point for publicly-funded adult developmental services in the province. Accordingly, these organizations were primarily funded by MCCSS. Other organizations focused on medically complex individuals including those with acquired brain injuries or those unable to access out-patient services due to physical disabilities: “the typical reason for referral is going to be around a physical impairment… But, with this medically complex population, you’re often seeing comorbidities where there may be some cognitive impairment, early dementia.” [P04]. In these organizations, eligibility and referral were usually coordinated by HCCSS. These insights highlighted the diverse characteristics of community-care populations, emphasizing the need to consider both physical and cognitive health challenges in care provision approaches.

Services offered

The characteristics of persons-supported informed the context of care and the type of services offered by the organization. The different dimensions of services offered within this sector include social and medical care, short and long-term care provision, in-home and community-care, and full and part-time care.

Nature of care: social vs. medical

Many organizations serving individuals with IDDs employed a holistic, psychosocial model of care, designed to support all areas of an individual’s life including supports for independent-living, and community-based education, employment, and recreation services to support personal and professional goals: “we support people in their homes, so residential supports. We also support people in the community, to be a part of the community, participate in the community and also to work in the community.” [P06]. These descriptions reflect a comprehensive approach to care, aiming to address needs within and beyond residential settings to promote active participation within the broader community. In contrast, some organizations followed a biomedical model of care, designed to support specific health needs: “We provide all five therapies… physiotherapy, occupational therapy, speech, social work, and nutrition. In some locations we provide visiting nursing, at some locations shift nursing. We have some clinic-nursing… and we provide personal support and home-making services in a number of locations as well.” [P04]. These organizations adopted a more clinically-focused approach to care. In either instance, the care model and the nature of services offered were largely determined by an organization’s mandate including which gaps they aimed to fill within the community. Many organizations described providing a mixture of social and medical care for individuals with complex needs. However, the implementation of care plans could be impacted by the lack of integration between social and medical care sectors, as some participants spoke to the importance of “[integrating] all of the different healthcare sector services… [including] acute care and public health and home and community care and primary care, and mental health and addictions.” [P04].

Duration of care: short-term vs. long-term

The duration of care also varied based on the needs of persons-supported. Organizations serving individuals with IDDs usually offered support across the lifespan: “We support adults with developmental disabilities and we support them from 18 [years] up until the end of their life.” [P06]. Some organizations provided temporary supports aimed at addressing specific health needs: “For therapies – these are all short-term interventions and typically they’re very specific and focused on certain goals. And so, you may get a referral for physiotherapy that is authorized for three visits or five visits” [P04], or crisis situations (e.g., homelessness): “Our services are then brought in to help provide some level of support, guidance, stabilization resource, and once essentially sustainability and positive outcomes are achieved—then our services are immediately withdrawn.” [P12]. One organization employed a model of care with two service streams, an initial rehabilitation stream that was intended to be short-term and an ongoing service stream for individuals requiring continuing support.

In-home vs. community-based care

Many organizations provided in-home care and community-based supports, where residential supports were designed to help individuals lead independent lives, and community-based supports encouraged participation in community activities to further inclusion and address personal and professional goals. One participant spoke about the range of services offered in the home and community:

“There’s probably two big categories of [services we offer]: community support services—so that includes things like adult day programs, assisted living, meals on wheels, transportation, friendly visiting … and things like blood pressure clinics, exercise programs… and then on the other side we do home care services. In the home care basket, we provide personal support, and we also provide social work support.” [P05].

Likewise, another participant spoke in further detail on the types of services that allow individuals to live independently within their homes, or in community-based residential settings (e.g., long-term care facilities):

“We provide accommodation supports to about 100 people living in our community—which means that we will provide support to them in their own homes. So, anywhere from an hour a week to 24 hours a day. And that service can include things from personal care to home management to money management, cooking, cleaning, and being out and about in communities—so community participation. We also provide supports for about 50 people living in long-term care facilities and that is all community participation support. So, minus the last 2 and a half years because of the pandemic, what that means is that a person living in a long-term care facility with a developmental disability can have our support to get out and about for 2 or 3 hours a week, on average.” [P10].

Full-time vs. part-time support

The person-supported’s needs also determined whether they would receive care within their homes and if they would be supported on a full-time (i.e., 24 h a day, 7 days a week) or part-time basis:

“ It really does range from that intensive 24- hour/7 day a week support, which we actually do provide that level of intense support in the family home, if that’s needed. And then, all the way through to just occasional advocacy support and phone check-in.” [P01].

Organizational Culture

Organizational culture was described as a key influence in the development and implementation of person-centred care plans. The culture of the organization includes their perceptions, attitudes and beliefs surrounding persons-supported; their model of care provision; as well as their willingness to evolve and adapt service provision to optimize care delivery.

Perceptions, attitudes, and beliefs regarding persons-supported

Participants described their organization’s view of persons-supported, with many organizations adopting an inclusionary framework where persons-supported were afforded the same rights and dignities as others in the community. This organizational philosophy was described as being deeply intertwined with an organization’s approach to personalizing programs and services:

“…an organization needs to be able to listen to the people who are receiving the service… and support them, to learn more, figure out, articulate, whatever it is, the service or the supports that they need in order to get and move forward with their life.” [P10].

The focus on the person-supported, their needs, likes, and dislikes, was echoed across organizations, with an emphasis on the impact of “culture and trying to embed for each person who delivers service the importance of understanding the individual.” [P05]. Participants also described their organization’s approach to allowing persons-supported to take risks, make mistakes, and live life on their own terms:

“You have to go and venture out and take some [risks]… We try to exercise that philosophy - people with disabilities should have the same rights and responsibilities as other people in the community. Whether that’s birthing or education, getting a job, having a house they can be proud of, accessing community supports, whether that be [a] library or community centre, or service club, whatever that is.” [P03].

Model of care provision

The model of care provision was heavily influenced by the organization’s values and philosophy. Several organizations employed a flexible model of care where supports were developed around the needs, preferences, and desired outcomes of the person-supported:

“…if we don’t offer [the program they want], we certainly build it. Honestly, most of our programs were either created or built by someone coming to us [and] saying ‘I want to do this with my life,’ or …‘my son would like to do art.’” [P02].

Although there were similarities in models across the different organizations, one participant noted that flexibility can be limited in the congregate care setting as staff must tend to the needs of a group as opposed to an individual:

“Our typical plan of operation outside of the congregate setting is we design services around the needs of the person. We don’t ask them to fit into what we need, we build services for what they need. Within the congregate care setting, we have a specific set of rules and regulations for safety and well-being of the other people that are here.” [P11].

Evolving service orientation

In organizations serving individuals with IDDs, many described shifting from program-based services to more individualized and community-based supports: “The goal was always to get people involved in their community and build in some of those natural supports … [we] are looking to support people in their own communities based on their individual plans.” [P07]. One participant described this model as a person-directed approach as opposed to person-centred, citing the limitations of program-based services in meeting individual needs:

“[Persons-supported] couldn’t [do] what they wanted because they were part of a bigger group. We would listen to the bigger group, but if one person didn’t want to go bowling … we couldn’t support them because everybody had to go bowling.” [P06].

The focus on individualized support could potentially lead to increased inclusion for persons-supported in their communities:

“… people go to Tim Horton’s, and if they go every day at 9 they probably, eventually will meet other people that go at 9 o’clock and maybe strike up a conversation and get to know somebody and join a table … and meet people in the community.” [P02].

By creating routines centred on individual preferences, the person-supported becomes a part of a community with shared interests and values.

Person-centred care plans

Community-care organizations enacted a person-centred approach by creating person-centred care plans for each person-supported. Although all participants said their organization provided person-centred services, there was considerable variation in the specific processes for developing, implementing, and updating care plans.

Developing a person-centred care plan

The development of a care plan includes assessment, consultation, and prioritization. The initial development of the care plan usually involved an assessment of an individual’s needs and goals. Participants described agency-specific assessment processes that often incorporated information from service referrals: “ In addition to the material we get from the DSO [Disability Services Ontario] we facilitate the delivery of an intake package specifically for our services. And that intake package helps to further understand the nature and needs of an individual.” [P12]. Agency-specific assessment processes differed by the nature of services provided and the characteristics of the population. However, most organizations included assessments of “not only physical functioning capabilities, but also cognitive.” [P01]. Assessment also included an appraisal of the suitability of the organization’s services. In instances where persons-supported were seeking residential placements or independent-living support, organizations assessed their ability to carry out the activities of daily living:

“[Our internal assessment] is an overview of all areas of their life. From, ‘do they need assistance with baking, cooking, groceries, cleaning, laundry? Is there going to be day program opportunities included in that residential request for placement? What the medical needs are?’” [P02].

In contrast, the person-supported’s community-based activities were primarily informed by their interests and desired outcomes: “We talk about what kinds of goals they want to work on. What kind of outcomes we’re looking for…” [P06].

The development of the care plan also included a consultation phase, involving conversations with the person-supported, their family members, and potentially external care providers: “We would use the application information, we’d use the supports intensity scale, but we’d also spend time with the person and their connections, their family and friends, in their home to figure out what are the kinds of things that this person needs assistance with.” [P10]. Participants described the person-supported’s view as taking precedence in these meetings: “We definitely include the family or [alternate] decision-maker in that plan, but the person-supported ultimately has the final stamp of approval.” [P08]. Many participants also acknowledged the difficulty of identifying and incorporating the person-supported’s view in cases where opinions clash and the person-supported has difficulty communicating and/or is non-verbal: “Some of the people we support are very good at expressing what they want. Some people are not. Some of our staff are really strong in expressing what they support. …And some of the family members are very strong. So you have to be very careful that the [person-supported] is not being lost in the middle of it.” [P06].

Participants also noted that some persons-supported preferred not to have a care plan:

“Some of the people say ‘I hate [the plans] I don’t want to do them’…. we look at it in a different way then. We’ll use graphic art, we’ll use video, we’ll think outside the box to get them to somehow—because at the end of the day when we’re audited by MCCSS every [person-supported] either has to have [a plan]… or there has to be [an approval of] why it wasn’t completed.” [P02].

Plan development may also include a prioritization process, particularly in cases where resources are limited. A person-supported’s goals could be prioritized using different schemas. One participant noted that “the support coordinator takes the cue from the person-supported - … what they’ve identified as ‘have to have’ and ‘nice to have’. … because the ‘have to haves’ are prioritized.” [P09]. Likewise, the person-supported’s preference could also be identified through “[an] exercise, called ‘what’s important for and what’s important to .’” [P06]. This model, based on a Helen Sanderson approach [ 18 ], was described as being helpful in highlighting what is important to the person-supported, as opposed to what others (i.e., friends, family, staff, etc.) feel is important for them.

Several organizations updated care plans throughout the year, to document progress towards goals, adapt to changing needs and plan for future goals: “We revisit the plan periodically through the year. And if they say the goal is done, we may set another goal.” [P06]. Organizations may also change plans to adapt to the person-supported’s changing health status or personal capacity.

Implementing a person-centred care plan

The implementation of care plans differed based on the nature of services provided by the organization. The delivery of health-based or personal support services often involved matching the length and intensity of care with the individual’s needs and capacity:

“Sometimes that is a long time, sometimes it’s a short time, sometimes it’s an intervention that’s needed for a bit, and then the person is able to function.” [P05].

In contrast, the delivery of community-based services involved matching activities and staff by interests: “[if] a person-supported wants to go out and be involved in the music community, then we pull the staff pool in and match them up according to interest.” [P06].

Broad personal goals were broken down into smaller, specific activities. For example, one participant described their organization’s plan in helping a person-supported achieve his professional goal of securing employment:

“[The person-supported] said ‘Okay, I want a job.’ So for three weeks he was matched up with a facilitator. They came up with an action plan in terms of how to get a job, what kind of job he’s looking for, where he wants to go, where he wants to apply, how to conduct an interview. And after three weeks he got a job.” [P09].

Organizations that provided residential services focused on developing independent-living skills. One participant described their organization’s plan to empowering persons-supported by allowing them to make their own financial decisions:

“If one month they’re looking after their own finances, and they’ve overspent. Well, maybe we help them out with a grocery card or something and say ‘okay, next month how are you going to do this?’ [The person-supported may say], ‘well, maybe I’ll put so much money aside each week rather than doing a big grocery shop the first week and not having enough money left at the end of the month.’” [P03].

The participant noted that “a tremendous amount of learning [happens] when a person is allowed to [take] risks and make their own decisions.” [P03].

Likewise, participants representing organizations that provided residential services described tailoring care to the persons-supported’s sleeping schedule and daily routine:

“We develop a plan and tweak it as we go. With [the person-supported] coming to the home, what worked well was, we found that he wanted to sleep in, so we adjusted the [staff] time. We took a look at his [medication] times in the morning… and [changed] his [medication] times. We found that he wanted to sleep [until] later in the day, so he would get up at 10 o’clock, so then instead of having breakfast, lunch, and supper he would just have a bigger brunch. Just really tailoring the plan around the person-supported, and it’s worked out well.” [P08].

These examples highlight how organizational context and culture influence how organizations operationalize person-centred care plans; the same individual may experience different approaches to care and engage in different activities depending on the organization they receive services from.

In this paper, we described key elements of the person-centred planning process across different community-care organizations in Southwestern Ontario. We also identified that the context and culture of an organization play a central role in informing the process by which services are personalized to an individual’s needs. These findings shed light on the diversity of factors that influence the implementation of person-centred care plans and the degree to which organizations are able to address medical and social needs in an integrated fashion. They also inform future evaluations of person and system-related outcomes of person-centred planning.

There are regulations around individualizing services delivered by community-care organizations, whereby care providers must allow persons-supported to participate in the development and evaluation of their care plans. HCCSS or MOH-funded services are largely focused on in-home rehabilitation or medical care. In contrast, MCCSS-funded organizations often focus on developing independent living skills or promoting community participation, thus highlighting the role of the funding agency in determining organizational context as well as the nature of services and personalization of care plans.

We also identified organizational culture as a key influence in the person-centred planning process. In previous reports, organizational culture, and specifically the way in which staff perceive and view persons-supported and their decision-making capabilities can impact the effective delivery of person-centred care [ 19 ]. Staff support, including their commitment to persons-supported and the person-centred process, has been regarded as one of the most powerful predictors of positive outcomes and goal attainment in the developmental services sector [ 20 , 21 ]. Moreover, in order to be successful, commitment to this process should extend across all levels of the organization, be fully integrated into organizational service delivery, and be reflected in organizational philosophy, values and views of persons-supported [ 22 , 23 , 24 ].

MCCSS mandates that agencies serving individuals with IDDs develop an individual service plan (ISP) for each person-supported, one “that address[es] the person’s goals, preferences and needs.” [ 7 ]. We reference ISPs as person-centred care plans, as is in line with the view of participants in interviews. There are a series of checklists designed to measure compliance with these policies, and the process is iterative, with mandated annual reviews of care plans and active participation by the person-supported [ 25 ]. In our study, the agencies funded by MCCSS adhered to the general framework outlined by these regulations and informed service delivery accordingly. However, participants also described areas for improvement with respect to the implementation of these policies in practice. These policies, while well-intentioned, may imply a one-size-fits-all approach and appear more as an administrative exercise as opposed to a meaningful endeavor designed to optimize care. Participants spoke about individuals who preferred not to have an ISP, and how that in and of itself is a person-centred approach, respecting the person’s wishes. Additionally, we heard about how the goal-setting process may not be realistic as it can be perceived as unnatural to have goals at each point in one’s life. Moreover, participants noted challenges in implementing person-centred care in shared residential settings (e.g., group homes) or in cases where persons-supported had difficulty communicating.

Prior research indicates that individuals living in semi-independent settings fare better across several quality-of-life measures relative to individuals living in group homes, including decreased social dissatisfaction, increased community participation, increased participation in activities of daily living, and increased empowerment [ 26 ]. Furthermore, a recent study by İsvan et al. (2023) found that individuals living in the community (e.g., own home, family home, or foster home) exhibit greater autonomy in making everyday and life decisions, and greater satisfaction with their inclusion in the community [ 27 ]. These findings may be indicative of a reduced focus on person-centred care plan development and implementation in congregate care settings, where limited staff capacity can make it difficult to tend to the needs of everyone in the home. However, poor outcomes may also be explained by potentially more complex health challenges or more severe disability in persons-supported living in congregate care settings. The challenges described in our study are consistent with calls to improve the quality of care provided in residential group home settings [ 28 , 29 ].

In line with our findings, previous literature also describes challenges in implementing person-centred planning for individuals who have difficulty communicating or are non-verbal [ 19 , 30 , 31 , 32 ]. Communication has also been identified as a barrier to patient-centred care for adults with IDDs in healthcare settings [ 33 , 34 ]. Other reports have identified a need for increased training and awareness of diverse communication styles (including careful observation of non-verbal cues) to aid staff in including persons-supported in the development of care plans [ 35 , 36 , 37 ]. Importantly, these methods take substantial time which is often limited, and compounded by staffing shortages that are widespread across the sector [ 38 ]. Similar barriers were identified in interviews with staff and persons-supported at a partner community-care agency within our larger project [ 39 ]; other papers from the project examine strategies used by the organization to overcome these barriers.

Limitations

The findings from this study should be interpreted in the context of the following limitations. There is a risk for social desirability bias, whereby participants may feel pressure to present their care plan process in a more positive light due to societal norms and expectations [ 40 ]. Additionally, the experiences and views of community-care organizations may vary by region and organization type (i.e., for-profit vs. not-for-profit). In this study, we limited participation to agencies providing services in Southwestern Ontario and we were only able to interview one for-profit agency, despite concerted recruitment efforts. Consequently, we may not have fully captured how financial pressures, or different contextual and cultural components of an organization impact their implementation of care plans.

The person-centred planning process in community-care organizations is largely informed by the characteristics of the population served and the nature of services offered (i.e., organizational context). This process usually involves initial and continued consultations with persons-supported to tailor plans to their specific needs and desired outcomes. There are ongoing challenges in the implementation of person-centred planning, including a need for increased adaptability and clarity in current regulations. In some areas, there may be benefit to incorporating nuance in the application of policies (e.g., in cases where a person-supported does not want to have a formal plan in place). In other areas, it may be helpful to have increased guidance on how to optimize care delivery to improve outcomes (e.g., in cases where a person-supported has difficulty communicating, or is residing in a group home). Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Data availability

The datasets generated and analyzed in the current study are not publicly available to maintain participant confidentiality, however access may be granted by the corresponding author upon reasonable request.

Abbreviations

Acquired Brain Injury

Disability Services Ontario

Home and Community Care Support Services

Intellectual and Developmental Disabilities

Individual Service Plan

Ministry of Children, Community and Social Services

Ministry of Health

Purbhoo D, Wojtak A. Patient and family-centred home and community care: realizing the opportunity. Nurs Leadersh Tor Ont. 2018;31(2):40–51.

Article   PubMed   Google Scholar  

Lin E, Balogh RS, Durbin A, Holder L, Gupta N, Volpe T et al. Addressing gaps in the health care services used by adults with developmental disabilities in Ontario. ICES. 2019 [cited 2023 Aug 30]. https://www.ices.on.ca/publications/research-reports/addressing-gaps-in-the-health-care-services-used-by-adults-with-developmental-disabilities-in-ontario/

American Psychological Association. APA Guidelines for Assessment and Intervention with Persons with Disabilities: (502822022-001). 2022 [cited 2023 Aug 30]; http://doi.apa.org/get-pe-doi.cfm?doi=10.1037/e502822022-001

Dunn DS, Andrews EE. Person-first and identity-first language: developing psychologists’ cultural competence using disability language. Am Psychol. 2015;70(3):255–64.

Burke C. Building a stronger system for people with developmental disabilities: a six-month progress report from Commissioner Courtney Burke. New York Office for People with Developmental Disabilities; 2011. https://opwdd.ny.gov/system/files/documents/2019/12/6_month_progress_report_0.pdf

Government of Manitoba. Agency service coordination manual: 5.1 person-centred planning. 2021. https://www.gov.mb.ca/fs/clds/asc-manual/pubs/5.1-person-centred-planning.pdf

Government of Ontario. Services and supports to promote the social inclusion of Persons with Developmental Disabilities Act, 2008. 2008 [cited 2023 Aug 30]. https://www.ontario.ca/laws/regulation/100299#:~:text=O.-,Reg.,and other relevant clinical assessments

State of Michigan. Person Centered Planning.pdf. 2018.

O’Brien CL, O’Brien J. The origins of person-centered planning: a community of practice perspective.

Sanderson H. Person Centred Planning. York, Joseph Rowntree Foundation; 2000.

Government of Ontario. Ontario.ca. 2019 [cited 2023 Sep 4]. Connecting Care Act, 2019: Home and Community Care Services. https://www.ontario.ca/laws/regulation/220187#BK17

Dong M. Examining individualized participatory approaches to care for individuals with intellectual and developmental disabilities. University of Western Ontario; 2023. https://ir.lib.uwo.ca/etd/9517

Doyle L, McCabe C, Keogh B, Brady A, McCann M. An overview of the qualitative descriptive design within nursing research. J Res Nurs. 2020;25(5):443–55.

Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. SAGE; 2014. p. 305.

Berg BL. Qualitative research methods for the social sciences: 2nd ed. Bostan, MA: Allyn and Bacon; 1995. p. 421.

Google Scholar  

Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. SAGE; 2012. p. 321.

Yin RK. Case study research design and methods. 5th ed. Thousand Oaks, CA: SAGE; 2014. p. 282.

Helen Sanderson Associates. Helen Sanderson Associates. [cited 2023 Oct 31]. Sorting important to/for. http://helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/sorting-important-tofor/

Hughes CA. The benefits and barriers to person centered planning for adults with developmental disabilities. [Saint Paul, Minnesota, USA]: St. Catherine University; 2013. https://sophia.stkate.edu/msw_papers/191

Heller T, Miller AB, Hsieh K, Sterns H. Later-life planning: promoting knowledge of options and choice-making. Ment Retard. 2000;38(5):395–406.

Article   CAS   PubMed   Google Scholar  

Ratti V, Hassiotis A, Crabtree J, Deb S, Gallagher P, Unwin G. The effectiveness of person-centred planning for people with intellectual disabilities: a systematic review. Res Dev Disabil. 2016;57:63–84.

Kaehne A, Beyer S. Person-centred reviews as a mechanism for planning the post-school transition of young people with intellectual disability. J Intellect Disabil Res. 2014;58(7):603–13.

Parley FF. Person-centred outcomes: are outcomes improved where a person-centred care model is used? J Learn Disabil. 2001;5(4):299–308.

Article   Google Scholar  

Sanderson H, Thompson J, Kilbane J. The emergence of person-centred planning as evidence‐based practice. J Integr Care. 2006;14(2):18–25.

Government of Ontario. Ministry of Children, Community and Social Services. Developmental service (DS) compliance inspection: indicator list. 2021 [cited 2023 Sep 4]. https://www.mcss.gov.on.ca/documents/en/mcss/developmental/EN_DS_Indicator_List.pdf

Stancliffe RJ, Keane S. Outcomes and costs of community living: a matched comparison of group homes and semi-independent living. J Intellect Dev Disabil. 2000;25(4):281–305.

İsvan N, Bonardi A, Hiersteiner D. Effects of person-centred planning and practices on the health and well-being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data. J Intellect Disabil Res. 2023 [cited 2023 Sep 4]; https://onlinelibrary.wiley.com/doi/abs/ https://doi.org/10.1111/jir.13015

Office of the Auditor General of Ontario. 3.10: residential services for people with developmental disabilities. 2014. https://www.auditor.on.ca/en/content/annualreports/arreports/en14/310en14.pdf

Office of the Auditor General of Ontario. 1.10 residential services for people with developmental disabilities. 2016. https://www.auditor.on.ca/en/content/annualreports/arreports/en16/v2_110en16.pdf

Robertson J, Emerson E, Hatton C, Elliott J, McIntosh B, Swift P, et al. Person-centred planning: factors associated with successful outcomes for people with intellectual disabilities. J Intellect Disabil Res JIDR. 2007;51(Pt 3):232–43.

Everson JM, Zhang D, Person-Centered Planning. Characteristics, inhibitors, and supports. Educ Train Ment Retard Dev Disabil. 2000;35(1):36–43.

Claes C, Van Hove G, Vandevelde S, van Loon J, Schalock RL. Person-centered planning: analysis of research and effectiveness. Intellect Dev Disabil. 2010;48(6):432–53.

Stringer K, Terry AL, Ryan BL, Pike A. Patient-centred primary care of adults with severe and profound intellectual and developmental disabilities. Can Fam Physician. 2018;64(Suppl 2):S63–9.

PubMed   PubMed Central   Google Scholar  

Badcock E, Sakellariou D. Treating him… like a piece of meat: poor communication as a barrier to care for people with learning disabilities. Disabil Stud Q. 2022 [cited 2023 Sep 4];42(1). https://dsq-sds.org/index.php/dsq/article/view/7408

Mansell J, Beadle-Brown J. Person-centred planning or person-centred action? Policy and Practice in Intellectual Disability Services. J Appl Res Intellect Disabil. 2004;17(1):1–9.

Bigby C, Frawley P. Social work practice and intellectual disability: working to support change. Bloomsbury Publishing; 2018. p. 253.

Taylor JE, Taylor JA. Person-centered planning: evidence-based practice, challenges, and potential for the 21st century. J Soc Work Disabil Rehabil. 2013;12(3):213–35.

Zijlstra R, Vlaskamp C, Buntinx W. Direct-care staff turnover: an indicator of the quality of life of individuals with profound multiple disabilities. Eur J Mental Disabil. 2001;(22):39–55.

Canadian Institutes of Health Research (CIHR), CIHR-Institute of Health Services and Policy Research (CIHR-IHSPR) and partners. Evidence brief booklet: quadruple aim & equity catalyst grants. 2024 [cited 2024 Apr 2]. https://face2face.events/wp-content/uploads/2024/01/Evidence-Brief-Booklet-Quadruple-Aim-and-Equity-EN.pdf

Bergen N, Labonté R. Everything is perfect, and we have no problems: detecting and limiting social desirability bias in qualitative research. Qual Health Res. 2020;30(5):783–92.

Download references

Acknowledgements

The authors thank Ruth Armstrong, from PHSS - Medical & Complex Care in Community, for her valuable feedback and support throughout the research process.

This research was funded by the Canadian Institutes of Health Research. The funding agency had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and affiliations.

Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada

Samina Idrees, Gillian Young, Leslie Meredith & Maria Mathews

PHSS - Medical & Complex Care in Community, 620 Colborne St, London, ON, N6B 3R9, Canada

Brian Dunne & Donnie Antony

You can also search for this author in PubMed   Google Scholar

Contributions

S.I. conducted the interviews, developed the coding template, coded the data, thematically analyzed the data, and prepared the manuscript. G.Y. helped develop the coding template, and reviewed and approved the final manuscript. B.D. and D.A. helped conceptualize the study, aided in the interpretation and analysis of study findings, and reviewed and approved the final manuscript. L.M. coordinated research activities, aided in the interpretation and analysis of study findings, and reviewed and approved the final manuscript. M.M. conceptualized the study, supervised its implementation, and was a major contributor in reviewing and editing the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Maria Mathews .

Ethics declarations

Ethics approval and consent to participate.

This study was approved by the research ethics board at Western University. We obtained informed consent from participants prior to the onset of interviews.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Idrees, S., Young, G., Dunne, B. et al. The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada. BMC Health Serv Res 24 , 680 (2024). https://doi.org/10.1186/s12913-024-11089-7

Download citation

Received : 14 February 2024

Accepted : 08 May 2024

Published : 29 May 2024

DOI : https://doi.org/10.1186/s12913-024-11089-7

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Person-centred planning
• Community-based care
• Integrated care
• Social services
• Health services
• Organizational culture
• Qualitative study

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

• Open access
• Published: 27 May 2024

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

• Marjan Mirzania 1 ,
• Elham Shakibazadeh 1 ,
• Meghan A. Bohren 2 ,
• Sedigheh Hantoushzadeh 3 ,
• Abdoljavad Khajavi 4 &
• Abbas Rahimi Foroushani 5  

Reproductive Health volume  21 , Article number:  70 ( 2024 ) Cite this article

Metrics details

Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR).

An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18.

The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating).

Conclusions

This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.

Plain English summary

Evidence suggests that mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In this qualitative study, through 30 in-depth interviews with key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals), we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). The data were analyzed using directed content analysis and a deductive approach in MAXQDA 18 software. The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability; presence of birth companions: e.g., patient needs and resources); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief childbirth guidelines: e.g., networks and communications). This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs.

Peer Review reports

Despite the recognition of every woman's right to enjoy the highest attainable standard of health, including the right to dignified and respectful care [ 1 ], evidence shows that mistreatment during childbirth is a common experience among women worldwide [ 2 , 3 ]. It is increasingly recognized as an urgent public health priority and a poor quality of care index [ 1 , 4 ], and is a critical determinant of women's decisions regarding place of birth, mode of birth, lactation, mother-child bonding, and childbirth experiences [ 5 , 6 ]. The prevalence of mistreatment among women seeking maternity care varies across different settings, from 43% in Latin America and the Caribbean [ 7 ] to 76.3% in Europe (Germany and the Netherlands) [ 8 ]. The prevalence in Iran is likewise high, reported as 75.7% [ 9 ] and 100% [ 10 ]. Women in Iran have experienced verbal abuse, frequent and painful vaginal examinations, lack of continuity of care, empathy, participation in decision-making, choice of preferred birth position, privacy, and birth companions [ 11 , 12 , 13 , 14 ].

In recent years, some interventions have been developed, implemented, and showed promising results on reducing mistreatment and promoting respectful care for all women [ 15 , 16 , 17 , 18 ]. The Heshima project reported reductions in most forms of disrespect and abuse (D&A) in 13 health facilities in Kenya [ 15 ]. A study by Kujawski et al. (2017) in two hospitals in Tanzania (Staha project) showed a 66% reduction in the odds of women experiencing D&A after the intervention [ 17 ]. Asfa et al.'s (2020) study in Ethiopia showed that the intervention led to an 18% reduction in the number of mistreatment components [ 18 ].

In Iran, the Ministry of Health and Medical Education (MOHME) has developed a list of programs and practices to ensure maternal dignity during childbirth, such as the mother's bill of rights, maternal dignity training package, maternal dignity seminars for maternity healthcare providers (MHCPs) [ 19 , 20 ], and emphasis on respectful maternity care (RMC) in the national guidelines for normal childbirth [ 21 ]. However, these actions did not make effective changes in the maternity quality of care. It seems that the programs implemented by the MOHME were not developed using context- and evidence-based approaches. There were also lacks of precise guidance on their effective implementation. Furthermore, the available research evidence on respectful/disrespectful maternity care in Iran has focused on the prevalence [ 9 , 10 ], development and psychometrics of instruments [ 22 , 23 ], and descriptions of women and healthcare providers’ experiences [ 24 , 25 ], and few interventional studies have been conducted to reduce D&A or promote RMC, including workshops for midwives [ 26 , 27 ]. It seems that healthcare providers training alone is not a sufficient solution [ 28 ]. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in health facilities.

Prior to implementing any evidence-based intervention/innovation (EBI), it is important to identify the factors affecting its implementation in “real-world” settings to increase its adoption, scale-up, and sustainability [ 29 ]. It has been shown that many interventions that were effective in “in-vitro” and controlled conditions or small-scale fail in the real world due to contextual factors that acted against the implementation [ 30 , 31 ]. Implementation science (IS) helps to identify factors that can support or inhibit implementation and to optimize intervention implementation. Therefore, although it is necessary to prove the effectiveness of interventions in trials, this is not sufficient to ensure successful implementation at scale. Therefore, it is necessary to understand why intervention works, how, for whom, and in what settings, and what strategies are needed to improve its implementation [ 32 , 33 ].

In recent years, several models, theories, and implementation frameworks have been developed. The Consolidated Framework for Implementation Research (CFIR) [ 31 ] was developed by combining 19 theories on dissemination, innovation, implementation, organizational change, knowledge translation, and research uptake [ 34 ]. The CFIR is a “determinant framework” that consists of five domains, including the intervention characteristics (key features of an intervention), outer setting (features of the external context such as economic, political, and social environments of the intervention), inner setting (features of the organization such as structural, political, and cultural environments), characteristics of individuals involved (features of implementers such as cultural, organizational, and professional norms), and process of implementation (strategies or tactics that might influence the success of implementation) with 39 constructs/sub-constructs [ 34 , 35 ] (Additional file 1 : CFIR).

Despite attention to intervention studies to promote RMC or prevent mistreatment during childbirth, few studies have examined the implementation process of such interventions, and there is little insight into how the contextual conditions surrounding the implementation of these interventions contribute to their success or failure. To address this gap, we chose a qualitative method to obtain the experiences and perspectives of key stakeholders on the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth in Iran using CFIR. Qualitative research methods are appropriate when seeking an in-depth understanding of participants' perspectives.

This qualitative study was part of a larger implementation research project focusing on the development and implementation of a context-specific intervention to reduce disrespectful maternity care and evaluation of strategies to improve implementation. The project was initiated in October 2021 in five public teaching hospitals in Tehran, Iran, and consists of five phases: (1) needs assessment (to assess knowledge, attitudes and practices of maternity healthcare providers about mistreatment of women during labour and childbirth, and the manifestations of mistreatment and its influencing factors), (2) identifying interventions to reduce mistreatment of women during childbirth, (3) identifying the implementation challenges of interventions, (4) designing implementation strategies for the intervention, and (5) testing implementation strategies in a real-life setting. The findings of phase 1 of the project are described elsewhere [ 11 , 36 ].

Identifying interventions to reduce mistreatment of women during childbirth

Based on the findings of phase 1 of the project, we created a logical model of the mistreatment problem based on the PRECEDE health-planning model [ 37 ]. According to the determinants of mistreatment based on the model, multi-level intervention was identified to address mistreatment drivers (Fig. 1 ). In this phase 3 of the project, we selected interventions from each level (individual, healthcare provider, hospital, and national health system) that are currently being implemented in Iran's health system to gain in-depth understanding of the challenges that affect proper implementation. Interventions implemented at each level are presented in Table 1 . This study investigated the implementation challenges of these interventions.

Logic model of the study

Study design and participants

We conducted an exploratory qualitative study consisting of individual in-depth interviews between July 2022 and February 2023 in Tehran, Iran. Participants included key stakeholders at different levels of the health system (including healthcare providers, managers, experts, policy makers, and decision makers) with sufficient knowledge, direct experience, and/or collaboration in the implementation of each of the studied interventions. We selected participants using purposive sampling to obtain diverse perspectives and experiences and then used the snowball method to recruit more participants. We aimed for maximum variation among participants according to age, education, organizational role, and work experience. Key stakeholders were selected from three levels: macro (Ministry of Health and Medical Education (MOHME): four participants), meso (universities of medical sciences and health services: 12 participants), and micro (hospitals: 14 participants). These individuals were invited to participate by phone calls and/or in-person. The eligibility criteria for this study were familiarity and/or executive responsibility in any of the studied interventions and having at least five years of work experience.

Data collection

We developed the initial semi-structured interview guide based on sample interviews at http://cfirguide.org [ 42 ]. Damschroder et al. (2009) recommend that researchers try to select constructs from CFIR that are most related to their study setting [ 34 ]. Therefore, the interview guide was revised using study-related constructs (Additional file 2 : interview guide). We then pilot-tested this by conducting two initial interviews, which were not analyzed. Interviews were conducted in Persian by the lead author (M.M.), a female PhD candidate in Health Education and Promotion with previous experience in qualitative studies who had no prior interactions with the participants. To prepare participants for the interview, interview guide questions were sent to them in advance via email. Additionally, at the beginning of the interviews, the purpose of the study, guarantee of confidentiality and anonymity of information, nature of voluntary participation, and the possibility of withdrawing from the study at any time were explained to the participants. All participants provided written informed consent and permission for audio recordings. The interviews were conducted in participants' workplaces (in a private room) and during their preferred accommodation. The duration of the interviews ranged from 40 to 60 min, during which the interviewer made field notes. The demographic characteristics of the participants (including age, gender, education, organizational role, and number of years of work experience) were recorded at the end of each interview. The interviews continued until data saturation was reached. Saturation was obtained after the 28th interview; however, to ensure that no new information emerged, data collection continued until the 30th interview. All the invited individuals participated in the interviews, and no repeat interviews were conducted.

Data analysis

Data analysis was conducted simultaneously with data collection, using directed content analysis [ 43 ] and a deductive approach. After each interview, M.M. listened to the recorded audios several times, transcribed verbatim in Persian, and returned to the participants for comments and/or corrections. E.Sh. (female professor in Health Education and Promotion; an experienced qualitative researcher) checked the transcripts for accuracy and consistency. Prior to coding the data, a categorization matrix was developed based on the interview guide (i.e., CFIR constructs). Next, two authors (M.M. and E.Sh.) independently analyzed the data. We marked and color-coded the significant segments of the text. We put those color-coded text segments together and gave codes. We categorized the codes according to their differences and similarities, and linked them to pre-specified categorizations in sub-themes and themes. If disagreements arose in coding, the authors discussed until consensus was reached. The MAXQDA 18 software was used to manage the data [ 44 ]. We translated selected quotes into English to support the themes developed throughout the analysis.

The trustworthiness of this study was tested based on the four criteria of Lincoln and Guba [ 45 ]. The credibility of the data was ensured through prolonged engagement with the data, applying a sampling technique with maximum variation, multiple data sources (including field notes, audio recordings, and transcripts), and providing initial codes to the three participants for approval. To enhance the transferability of the data, we conducted interviews with participants who had the most experience and knowledge of each of the studied interventions. Furthermore, dependability was obtained by analyzing the data separately by the two members of the research team. To assess confirmability, a qualitative research specialist, who did not participate in this study, confirmed the data analysis process. This paper was reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist [ 46 ] (Additional file 3 : COREQ Checklist).

Characteristics of participants

Thirty in-depth interviews were conducted with the key stakeholders. The mean age of the participants was 49.5 years (range: 35-65 years). Most participants (73.4%) held an MD or PhD degree. Four participants worked in MOHME, 12 in medical universities, and 14 in hospitals; more than half had over 20 years of work experience (Table 2 ).

The identified challenges

The challenges of implementing each intervention (currently implemented in the system) were identified and categorized using the domains and constructs/sub-constructs of the CFIR (Table 3 ).

Individual-level interventions

At the individual level, two interventions were listed according to the determinants of mistreatment based on the model: childbirth preparation classes and the presence of birth companions (Fig.  1 ). Both interventions are implemented in the system; however, there were serious challenges in the settings, as outline below.

Training of pregnant women about the process of labour and childbirth, respectful care and their rights during childbirth

In our study, participants shared opinions about the challenges of implementing childbirth preparation classes in five CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of individuals involved, and process of implementation).

Intervention characteristics

Adaptability.

The level of adaptability of the intervention (childbirth preparation classes) was described as a key barrier to its implementation by most participants. They believed that non-compliance of the conditions and facilities of maternity hospitals with the educational content of the classes, improper timing of the start of classes (from the 20th week of pregnancy), and poor announcements can weaken the implementation of the intervention. The participants suggested that for effective childbirth preparation classes, the situations of facilities of maternity hospitals can be tailored and refined according to the educational content of the classes. Additionally, classes should be held in the early phases of pregnancy and widely announced.

“The training that women receive in classes is different from that implemented in maternity hospitals. For example, we teach that they can move during labour, take their preferred position during childbirth, and have a chosen companion. However, in practice, this has not been implemented in maternity hospitals ...” (Reproductive Health Specialist, University level) “Announcing about childbirth preparation classes in hospitals and health centers is poor. Only 18% of the pregnant women participated in classes. We did not announce them correctly…” (Health Policy Specialist, MOHME level)

Design quality and packaging

Weakness in the design quality and packaging of childbirth preparation classes prevent their successful implementation. Some participants (obstetricians) reported a lack of a multidisciplinary team in holding classes as a barrier to implementation. They believed that classes should be managed by a team and should not be exclusive to midwives. However, the midwives stated that the content of the classes was such that it could be handled by them, but the presence of a psychologist in some sessions could play an important role in the success of the classes.

“We must accept that midwives cannot cover all sessions. Psychologists, nutritionists, and obstetricians can be used in these classes.” (Obstetrician, Hospital level)

Outer setting

Patient needs and resources.

Lack of training about RMC was also considered a fundamental factor. Most participants highlighted that women do not understand respectful care principles and their rights during childbirth, and this should be integrated into the content of childbirth preparation classes.

“… They should be aware of their rights during childbirth. This should be integrated into the content of the childbirth preparation classes.” (Obstetrician, MOHME level)

Cosmopolitanism

A crucial factor affecting childbirth preparation class implementation was the poor collaboration of the private sector to hold classes. Participants reported that since most pregnant women receive their care from the private sector (obstetricians and/or midwives' offices), there is a need to establish efficient mechanisms for more support and collaboration of these sectors in holding classes.

“Participation of the private sector is essential because 70% of pregnant women receive their care from obstetricians and midwives.” (Midwife, University level)

Inner setting

Organizational incentives and rewards.

A few participants expressed concerns about the poor implementation of childbirth preparation classes following the low participation of pregnant women in classes. They believed that setting enough incentives could affect women’s degree of engagement and commitment to participate in classes.

“Between 9-10% of pregnant women attend our classes (health centers), and this rate is very low ... If incentives are provided, they are more motivated to participate.” (Reproductive Health Specialist, University level)

Available resources

Participants reported that poor physical environment and staff shortages were barriers to implementing childbirth preparation classes.

“In some hospitals, there is no standard space to hold classes, especially in private hospitals.” (Midwife, Hospital level) “Dedicated instructors should be considered in these classes. Here, they appoint one person as an instructor, and at the same time, she has to work shifts in the maternity hospital because they do not have staff.” (Midwife, Hospital level)

Characteristics of individuals involved

Other personal attributes.

Instructors’ skill and interest was another challenge that was highlighted by some participants: “Unfortunately, some of our midwives (as instructors of classes) are rarely interested in training or do not have enough skills …” (Reproductive Health Specialist, Hospital level)

Process of implementation

Poor execution of childbirth preparation classes, especially during the COVID-19 pandemic, was an important challenge discussed by participants. They also believed that focusing on quantity and neglecting the quality of the classes made them not have the proper efficiency, and their goal was rarely reached: “The classes are implemented, but they are not implemented according to plan and properly ... Unfortunately, we focused on the quantity of the classes, for example, the forms we have to complete and the statistics we have to give to the MOHME.” (Reproductive Health Specialist, University level)

Reflecting and evaluating

Supervising implementation and continuous evaluation were crucial factors emphasized by the participants. They acknowledged that the MOHME should supervise the implementation of childbirth preparation classes in hospitals and health centers through regular inspections. In addition, evaluate the progress and quality of their implementation through an external evaluation.

“I think the biggest challenge of childbirth preparation classes is that there is no supervision of their implementation … There should be a monitoring and auditing system.” (Reproductive Health Specialist, MOHME level)

Presence of birth companions

In this study, the challenges of implementing birth companions in four CFIR domains (outer setting, inner setting, characteristics of individuals involved, and process of implementation) were discussed by the participants.

According to the participants, the lack of knowledge of companions could be a barrier to their attendance at maternity hospitals. Some participants believed that a person going to be a birth companion should be required to participate in childbirth preparation classes and receive training:

“Companions have limited knowledge. I think birth companions should be required to participate in childbirth preparation classes because those who are trained in these classes are helpful to both labouring women and us providers.” (Reproductive Health Specialist, Hospital level)

Structural characteristics

The lack of physical space in some maternity hospitals was another factor that some participants stated: “Some of our maternity hospitals do not have a standard structure, for example, Hospital X, which is a hall with 12 beds and set up some extra beds because of the high visits, so there will be no place for the presence of a birth companion.” (Health Policy Specialist, MOHME level)

The participants also reported cultural issues as barriers to the implementation of birth companions. They noted that most of the time, if the companion is a partner, due to the feminine environment of maternity hospitals and female providers’ unwillingness to be accompanied by men in the delivery room; they are not allowed to be accompanied.

“The companion is not allowed to enter the maternity hospital; why? Because my colleague (midwife or doctor) does not like a man to be in the labour room, she says, 'No, sir, you go out and let a woman come.” (Reproductive Health Specialist, MOHME level)

Compatibility

One potential barrier to implementation was concern about the compatibility of the presence of birth companions with the existing workflows of maternity staff. The participants agreed that the interference of birth companions in the clinical duties of staff was a major factor for not allowing a companion.

“As a midwife who worked in a maternity hospital for several years and was strongly against the presence of birth companions, I say that our main challenge was the interference of companions. For example, when a labouring woman's serum runs out, the companion comes many times and warns …” (Midwife, University level)

Some participants believed that the unwillingness of staff was an important barrier. They mentioned that staff prevents the presence of birth companions because of the perception that the companion is witnessing their performance as an advocate for the woman, which may cause them to expect more attention to labouring women.

“The companion is like an advocate; it is like a hidden camera. Why do some staff members not like companions to enter maternity hospitals? This is because it controls their performance …” (Obstetrician, Hospital level)

Another factor was related to lack of supervision. The participants highlighted the need for continuous supervision of the implementation of birth companion guidelines in hospitals: “The presence of birth companions has a guideline that has been communicated to all hospitals, but in many hospitals, especially public hospitals, it is not implemented because it is not supervising ...” (Obstetrician, University level)

Healthcare provider-level intervention

At this level, five interventions were listed according to the determinants of mistreatment based on the model (Fig. 1 ). However, one of them (integrating RMC into the in-service training of maternity staff) is implemented in the system. The challenges of this intervention were identified as follows:

Integrating RMC into in-service training of maternity staff

Participants in this study reported intervention implementation challenges in the four CFIR domains (outer setting, inner setting, characteristics of individuals involved, and process of implementation).

External policies and incentives

Regulations and guidelines related to in-service training of staff affect the quality and efficiency of courses. Weakness in some regulations and guidelines has caused staff to be given a quantitative view, which means that many of them participate in the training course to obtain a certificate, rather than improve their knowledge, skills, and behavior, and/or increase the organization's productivity.

“… Unfortunately, our regulations and guidelines are quantitative; that is, they dictate that if a person spends X hours in a year, it will be included in his/her evaluation and career promotion. Therefore, staff members only participate in courses to complete their duty hours and obtain a certificate.” (Midwife, University level)

Relative priority

Obtaining a license to hold an in-service training course was one of the challenges mentioned by some of the participants. They expressed the belief that the necessity of holding a respectful care training course should be clarified in the steering committee of training and empowerment of human resources in such a way that the course is included in the specialized and mandatory training of employees, not general and optional; thus, it is effective in their career development and they have sufficient motivation to participate in the course.

“One of the challenges is to obtain a license to hold the course. You must justify the necessity of holding a respectful care training course in such a way that the course is included in the job description of the maternity staff.” (Public Health- related manager, University level)

Allocation of an insufficient budget for staff training was an important challenge reported by some participants. They found that staff participation in training courses required more financial support: “Unfortunately, the investment in training staff is very low. The per capita education budget for healthcare staff training this year is 800,000 Iranian rials (IRR), is very small.” (Public Health- related manager, MOHME level)

Similarly, the lack of experienced instructors is considered a challenge. When the instructor of an in-service training course does not have specialized knowledge and teaching ability, the course does not have the necessary efficiency and is not welcomed.

Access to knowledge and information

The participants also believed that informing the staff about the value and importance of the training course played an important role in its successful implementation. They highlighted that information and materials about the importance of RMC should already be provided to the maternity staff. A participant said: “First, it clarifies the importance of respectful care training for the maternity staff. They need to know how much their behavior with labouring women can affect their mental health status as well as their decisions for future pregnancies.” (Health Services Management Specialist, University level)

Knowledge and beliefs about the intervention

Managers do not believe in in-service training for staff, and lack of support for them has caused the need for this training to not be included in the organization's plans and priorities.

“Some managers do not support participation in training courses, and they do not believe that these courses have many benefits for the individual and organization.” (Public Health- related manager, University level)

Another major challenge was the weakness of evaluating the effectiveness of the training courses. The participants acknowledged that, although the evaluation of the effectiveness of courses is done using Kirkpatrick's model [ 47 ], it is often incomplete or limited to the first two levels of this model, and the third and fourth levels are not done because of problems and complexity.

“... Our current evaluation method is flawed, and we do not evaluate almost any of our courses at the level of behavior; therefore, we cannot be sure if the person who participated in the course acquired the expected capabilities.” (Reproductive Health Specialist, University level)

Hospital-level intervention

At the hospital level, four interventions were listed based on the model (Fig. 1 ). Of these, the evaluation of the performance of MHCPs is implemented in the system. The identified challenges for this intervention were as follows:

Evaluating the performance of MHCPs about mistreatment and/or RMC

In our study, participants discussed the intervention implementation challenges in two CFIR domains (outer setting and process of implementation).

Some participants complained of weakness in laws and regulations. They stated that to supervise the performance of MHCPs in laws and regulations (including the Support of Family and Youth Population Act), the merit pay of providers dependent on the satisfaction of pregnant women is defined. However, they are not included in the payment systems of all MHCPs. Furthermore, participants expressed concern that these laws (such as reducing merit pay or warnings) were not very effective in supervising the performance of the providers.

“Currently, in the Support of Family and Youth Population Act, merit pay of the providers depends on the satisfaction of pregnant women, but unfortunately not for all providers (including obstetricians or residents). We are pursuing this to be modified.” (Health Policy Specialist, MOHME level)

Poor execution of the intervention (mother’s satisfaction questionnaire) was considered important. Participants stated that, although all hospitals were required to implement and provide feedback to the MOHME, the providers often completed the questionnaire. To solve this problem, an electronic satisfaction questionnaire is currently being designed, whose links will be sent to women, and their satisfaction reports will be registered in the Ministry of Health's portal. However, owing to the poor support of the Information Technology (IT) unit, it has not yet been implemented.

“… Unfortunately, the questionnaires were completed by the providers, without the mother being informed. Currently, an electronic questionnaire is designed, the report of which will be registered in the Ministry of Health's portal, but it has not yet been implemented.” (Reproductive Health Specialist, Hospital level)

National health system-level intervention

At the national health system level, the implementation of pain relief during childbirth guidelines was listed based on the model (Fig. 1 ). This intervention is implemented in the system, and its challenges were as follows:

Implementation of pain relief during childbirth guidelines

In this study, the participants identified implementation challenges in the four CFIR domains (outer setting, inner setting, characteristics of individuals involved, and process of implementation).

Participants mentioned the lack of knowledge of pregnant women as an important challenge in implementing pain relief during childbirth. They believed that most women are unaware of the option of pain relief during childbirth. Pregnancy is an important time to inform and prepare women about pain relief options during childbirth; however, women are unaware of this right and do not demand it.

“… Pregnant women do not have sufficient information regarding pain relief during childbirth … so they do not demand ... Information about this should be provided during pregnancy (for example, in childbirth preparation classes), but when labouring women come to the maternity hospital, we have to go and explain … I think that this is not the right time for training.” (Anesthesiologist, Hospital level)

Some participants also pointed out that a large number of their clients are Afghan women who refuse pain relief, because they do not have insurance coverage and would be required to pay out-of-pocket.

“... Most of our clients are Afghan women. They do not have insurance and have to pay for it. Therefore, they do not do (pain relief during childbirth).” (Obstetrician, Hospital level)

The presence of good networking and relationships with external organizations, such as insurance organizations, to modify pain relief during childbirth tariffs and motivate staff was described by participants as an effective factor in implementation.

“The support of insurance organizations is also crucial for the implementation of pain relief during childbirth; tariffs should be revised, but unfortunately, they do not collaborate.” (Obstetrician, MOHME level)

MOHME policies and support were critical for the successful implementation of pain relief during childbirth. Some participants believed that being free of charge for pain relief during childbirth in public hospitals was one of the factors facilitating its implementation. However, the participants reported that some measures of the MOHME, including the absence of on-call anesthesiologists in hospitals were another challenge for the implementation of the program.

“... The hospital should have an on-call anesthetist, which unfortunately the MOHME took it away ... Therefore; we do not have the possibility of pain relief during childbirth at night because we there is not have an on-call anesthesiologist. There is an aesthesia resident, but it is normal that she/he does not spend X hours on pain relief during childbirth and quickly performs a caesarean section.” (Obstetrician, Hospital level)

Networks and communications

Poor working relationships between obstetricians and anesthesiologists were key barriers. Some participants believed that obstetricians are the primary decision-makers for pain relief during childbirth, and if they approve, labouring woman will be referred to anesthesiologists, but unfortunately, they do not collaborate enough in this regard. A participant stated:

“Obstetricians should select labouring women based on the criteria and then refer to them. Unfortunately, they do not collaborate with us …” (Anesthesiologist, Hospital level)

The availability of resources during the implementation process was critical for success. The participants complained about the low tariff allocated to pain relief during childbirth and considered it a fundamental barrier to non-collaboration of anesthesiologists in the implementation of the program. Furthermore, the lack of staff (anesthesiologists and nurse anesthetists) to offer top-ups and continuous monitoring adds to this factor.

“Pain relief during childbirth is a time-consuming process, but the tariff is so low that the anesthesiologist does not want to perform it. However, there is a shortage of anesthesiologists and nurse anesthetists in most hospitals.” (Anesthesiologist, Hospital level)

Similarly, limited access to knowledge and information about pain relief during childbirth for the provider team was considered another challenge. The participants identified a lack of adequate training for providers prior to implementing the program as a contributing factor.

“Prior to the implementation of this program (pain relief during childbirth), sufficient training should have been provided to all team members (including anesthesiologists, obstetricians, and midwifes), and the purpose and importance of the program were well introduced. We were not justified at all as to why we wanted to do this program ...” (Obstetrician, Hospital level)

Another challenge was the lack of knowledge and misconceptions of providers (obstetricians and midwives) regarding pain relief during childbirth. For example, it is believed that pain relief during childbirth is associated with an increased risk of prolonged labour, poor maternal and infant outcomes, and an increased chance of cesarean section. The participants believed that there was a serious need to spread awareness and cultivate a positive attitude among providers about the benefits of pain relief during childbirth and eliminate misconceptions by holding training courses.

“I think the most important challenge is misconceptions. Still, many obstetricians do not agree with pain relief during childbirth; it is believed that it prolongs the labour process or may have complications for the mother and/or the infant; all this is due to lack of knowledge. This belief needs to be corrected.” (Anesthesiologist, Hospital level)

According to most participants, the lack of expertise and skills of anesthesiologists was another barrier to implementation. They acknowledged that pain relief during childbirth is one of the important abilities that anesthesia residents should acquire, which has not been considered in their educational curriculum. Anesthesiology residents spend a short period of one month in the maternity ward, so they do not acquire enough skills.

“Pain relief during childbirth requires expertise and skill ... However, it has not been considered an important topic in the educational curriculum of anesthesiologists.” (Midwife, University level)

Some participants felt that pain relief during childbirth had not been implemented according to the implementation plan. They emphasized the identification of program problems and the importance of proper planning: “At first, the process of pain relief during childbirth in our hospitals was increasing; for example, in our hospital, we had about 500 pain relief during childbirths per month, but currently we do not have four ... We were weak in execution; we have implemented the program since 2014, but unfortunately, I can say that we have been unsuccessful thus far.” (Anesthesiologist, Hospital level)

In addition, supervising the implementation of pain relief during childbirth in hospitals was another factor mentioned by some participants. They stated that internal and external inspections should be used to supervise the performance of the team in providing pain relief during childbirth.

“There must be supervision ... If it is not done (pain relief during childbirth), it is not supervised that why was it not done? The mother did not request or you (providers) did not?” (Health Education and Promotion Specialist, University level)

In this study, using the CFIR, we identified perspectives of key stakeholders from different levels of the health system regarding the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth in Iran. Overall, the findings showed that through the lens of CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of individuals involved, and process of implementation), there are several challenges to successfully implementing current interventions. Documenting the findings of such studies can help formulate appropriate strategies to improve the implementation of interventions to reduce mistreatment during childbirth as well as the development of high-quality maternity care guidelines in similar settings.

In our study, the most identified challenges to successfully implementing the interventions were related to the outer- and inner-setting domains. The key role of the outer setting [ 48 , 49 ] and inner setting [ 50 ], which emphasize the external influences on the intervention and characteristics of the implementing organization, has been highlighted in other studies for successful implementation. Our findings showed that all proposed interventions were influenced by factors from the outer setting. Patients’ needs and resources could challenge the implementation of childbirth preparation classes, birth companionship, and pain relief during childbirth. Participants reported that women were not trained in childbirth preparation classes about respectful care principles and their rights during childbirth, birth companions were not trained, and most women were unaware of pain relief during childbirth. Previous studies are in agreement with our findings and reflect the need for respectful care education for women [ 51 , 52 ], the presence of a trained birth companion [ 25 , 53 ], and training programs to increase women's awareness of pain relief options during childbirth [ 54 ]. In this study, poor collaboration with external organizations was also identified as a barrier to the implementation of childbirth preparation classes and pain relief during childbirth. The Heshima project in Kenya showed that participatory design of interventions at the policy, facility, and community levels played a significant role in the public acceptance of maternity care and health rights; therefore, the successful implementation and sustainability of the RMC intervention requires the formation of partnerships with external organizations [ 55 ]. Furthermore, our findings showed that external policies (including weakness in regulations and guidelines) challenge the implementation of interventions (including integrating RMC into in-service training, evaluating the performance of MHCPs, and pain relief during childbirth). Similar to our findings, Warren et al. (2017) reported that the free maternity care policy in Kenya affected the quality of care by increasing the demand for health facilities, delays in financing, augmented provider workloads and shortages, and posed challenges to the implementation of RMC [ 55 ]. In another study (2021), the existing policy in the West Bank to prevent the presence of birth companions in public facilities was reported by participants as a factor for mistreatment during childbirth [ 56 ].

Inner setting factors that affected the implementation of interventions were structural characteristics, networks and communications, culture, compatibility, relative priority, organizational incentives and rewards, and readiness for implementation (available resources and access to knowledge and information). Participants acknowledged that structural characteristics (including a lack of physical space), cultural issues, and incompatibility can act as barriers to birth companion intervention. Studies support the findings of our study that the limitations of the physical structure of hospitals make it difficult to allow birth companions [ 28 , 57 ]. In addition, in our study, as in some cultures, the presence of male partners was not socially acceptable, especially during childbirth [ 58 ], and there were concerns about the interference of birth companions in healthcare providers’ medical decisions [ 58 ]. Moreover, in this study, participants stressed the importance of holding a respectful care training course for providers. Healthcare providers have been shown to have a negative attitude toward respectful care [ 59 ], which is often less important than other aspects of care [ 60 ]. Poor working relationships between providers were another factor affecting implementation. Similarly, poor teamwork among obstetricians, midwives, and anesthesiologists was highlighted as an important barrier to implementing labour analgesia in Wu et al.'s study [ 61 ]. Moreover, in our study, lack of resources (including physical space, human resources, money, and training) was described as a potential barrier to readiness for implementation. In addition, limited access to knowledge and information about the intervention was another barrier to readiness for implementation. Our findings are consistent with previous studies that have examined how inner setting characteristics such as readiness for implementation [ 55 ] and organizational rewards and incentives [ 62 ] influence implementation.

The intervention characteristics domain, which emphasizes the importance of the need to adapt the intervention to enhance its fit with the context [ 63 ], is a critical determinant of the success of implementation [ 34 , 64 , 65 ]. In our study, adaptability and design quality and packaging were seen as important factors in the implementation of childbirth preparation classes. The findings showed that the situations of facilities of maternity hospitals do not adapt the content of the classes, the timing of the start of the classes are not appropriate, and they are not announced correctly. Previous studies have assessed the factors influencing childbirth preparation classes; for example, a study conducted by Otogara (2017) reported the need for the presence of a psychologist consultant as well as appropriate timing and information for successful implementation of classes [ 66 ].

The domain of the characteristics of individuals involved in the intervention is also crucial to ensure the success of implementation [ 34 ]. Our findings showed that the personal attributes of individuals within the organization (such as interest, skills, and expertise), as well as their knowledge and beliefs about the intervention, are other key factors that can hinder implementation. Other studies have similarly shown that competent, skilled, and motivated service providers are important for RMC provision [ 67 ]. Moreover, providers' knowledge and understanding of RMC are reported to be important in designing interventions to address mistreatment in maternity care [ 68 ]. In Mexico, training and enabling healthcare providers to promote respectful delivery care have been noted [ 69 ].

In our study, the implementation process domain was identified as a key factor in the implementation of all the studied interventions. Participants noted suboptimal execution, lack of supervision, and weakness in evaluating posed challenges for implementing interventions. Previous studies have revealed the key role of monitoring and evaluation interventions in the success of RMC implementation [ 15 , 70 ]. This was implemented in the Hashima project by applying mechanisms to report cases of disrespect, such as customer service desks, suggestion boxes and supervisory visits at the facility level [ 15 ].

Overall, our study has potential implications for practice and research. This study highlights practical benefits for policy makers and practitioners of maternal health programs in Iran and other contexts. We suggest that they consider the findings of this study when implementing their current programs and policies regarding the quality of maternity care. Moreover, intervention studies focusing on RMC and/or mistreatment during childbirth appear to be relatively limited in high-income countries (HICs), and research and implementation efforts in these settings must continue. The implementation process of these interventions has been inadequately explored, thus affecting their comparability. Using the CFIR, this study provides important insights into how the contextual conditions surrounding the implementation of multi-level interventions to reduce mistreatment during childbirth contribute to their success or failure. Therefore, the findings of this study can provide evidence for formulating effective strategies with the potential to increase the positive experiences of childbirth for women.

Strengths and limitations

To the best of our knowledge, this is the first attempt to identify the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth in Iran and provides important insights into the contextual conditions around the implementation of each of the interventions. Our findings can be useful for other developing countries (LMICs) in similar contexts, especially those in the Eastern Mediterranean region. Reflecting the perspectives of key stakeholders from the micro- to macro-level of the health system was another strength of our study. Furthermore, the use of CFIR as the most common framework in IS allowed us to comprehensively identify the effective factors in the implementation of each intervention. However, given that the interviews were conducted with key stakeholders involved in the interventions, there is a possibility of a social desirability bias (underreporting of actual experiences and challenges due to their roles). We tried to mitigate this limitation by guaranteeing the confidentiality and anonymity of information as well as, conducting interviews in a private room. Also, this study focused on the interventions that are currently implemented in Iran's health system; and further research is needed to explore the implementation challenges of other interventions intended to reduce mistreatment during childbirth.

Our findings revealed potential challenges for implementing a multi-level intervention to reduce mistreatment of women during childbirth in the domains of intervention characteristics, outer setting, inner setting, characteristics of individuals involved, and process of implementation of the CFIR. Addressing these challenges is necessary to improve the implementation of interventions to reduce mistreatment during childbirth in Iran.

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to privacy restrictions of the participants but are available from the corresponding author on reasonable request.

Abbreviations

Disrespect and Abuse

Respectful Maternity Care

Evidence-Based Intervention/Innovation

Implementation Science

Consolidated Framework for Implementation Research

Ministry of Health and Medical Education

Maternity Healthcare Providers

Consolidated Criteria for Reporting Qualitative Research

Iranian Rials

Information Technology

High-Income Countries

Low and Middle Income Countries

World Health Organization. WHO Statement: The Prevention and Elimination of Disrespect and Abuse During Facility-based Childbirth: Geneva: World Health Organization; 2014.

Shemelis D, Gelagay AA, Boke MM. Prevalence and risk factor for mistreatment in childbirth: In health facilities of Gondar city Ethiopia. Plos One. 2022;17:e0268014. https://doi.org/10.1371/journal.pone.0268014 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Tello HJ, Téllez DJ, Gonzales JE. Identifying obstetric mistreatment experiences in US birth narratives: Application of internationally informed mistreatment typologies. MCN Am J Maternal/Child Nurs. 2022;47:138–46.

Article   Google Scholar  

Sando D, Ratcliffe H, McDonald K, Spiegelman D, Lyatuu G, Mwanyika-Sando M, Emil F, Wegner MN, Chalamilla G, Langer A. The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania. BMC Pregn Childb. 2016;16:1–10. https://doi.org/10.1186/s12884-016-1019-4 .

Hajizadeh K, Vaezi M, Meedya S. Mohammad Alizadeh Charandabi S, Mirghafourvand M: Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol. Reprod Health. 2020;17:1–7. https://doi.org/10.1186/s12978-020-0863-x .

Padmanaban S, Udayakumar JR, Sironmani V. Respectful maternity care initiative-beneficiaries interview-in KMC hospital Chennai. Int J Clinical Obstet Gynaecol. 2021;5:214–7.

Tobasía-Hege C, Pinart M, Madeira S, Guedes A, Reveiz L, Valdez-Santiago R, Pileggi V, Arenas-Monreal L, Rojas-Carmona A, Piña-Pozas M. Irrespeto y maltrato durante el parto y el aborto en América Latina: revisión sistemática y metaanálisis. Rev Panam Salud Publica. 2019;43:e36. https://doi.org/10.26633/RPSP.2019.36 .

Article   PubMed   PubMed Central   Google Scholar  

Reuther ML. Prevalence of Obstetric Violence in Europe: Exploring Associations with trust, and care-Seeking Intention. Bachelor's thesis, University of Twente. 2021.

Hajizadeh K, Vaezi M, Meedya S, Mohammad AlizadehCharandabi S, Mirghafourvand M. Prevalence and predictors of perceived disrespectful maternity care in postpartum Iranian women: a cross-sectional study. BMC Pregn Childb. 2020;20:1–10. https://doi.org/10.1186/s12884-020-03124-2 .

Shakibazadeh E, Taherkhani F, Yekaninejad MS, Shojaeizadeh D, Tajvar M. Prevalence of disrespectful maternity care in hospitals affiliated with TUMS and its associated factors. HAYAT. 2021;27:262–77.

Google Scholar  

Mirzania M, Shakibazadeh E, Bohren MA, Hantoushzadeh S, Babaey F, Khajavi A, Foroushani AR. Mistreatment of women during childbirth and its influencing factors in public maternity hospitals in Tehran, Iran: a multi-stakeholder qualitative study. Reprod Health. 2023;20:79. https://doi.org/10.1186/s12978-023-01620-0 .

Gholipour R, Shahoei R, Ghader Khani G. The quality of midwifery care from the perspective of healthcare service recipients using the SERVQUAL model in Sanandaj comprehensive health centers in 2018. J Clin Nurs Midw. 2019;8:337–46.

Mirlohi V, Ehsanpour S, Kohan S. Health providers’ compliance with pregnant women’s Bill of Rights in labor and delivery in Iran. Iran J Nurs Midw Res. 2015;20:565–9. https://doi.org/10.4103/1735-9066.164503 .

Tabrizi JS, Askari S, Fardiazar Z, Koshavar H, Gholipour K. Service quality of delivered care from the perception of women with caesarean section and normal delivery. Health Promot Perspect. 2014;4:137–43. https://doi.org/10.5681/hpp.2014.018 .

Abuya T, Ndwiga C, Ritter J, Kanya L, Bellows B, Binkin N, Warren CE. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. BMC Pregn Childb. 2015;15:1–14. https://doi.org/10.1186/s12884-015-0645-6 .

Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016;13:1–13. https://doi.org/10.1186/s12978-016-0187-z .

Kujawski SA, Freedman LP, Ramsey K, Mbaruku G, Mbuyita S, Moyo W, Kruk ME. Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga region, Tanzania: a comparative before-and-after study. Plos Med. 2017;14:e1002341. https://doi.org/10.1371/journal.pmed.1002341 .

Asefa A, Morgan A, Gebremedhin S, Tekle E, Abebe S, Magge H, Kermode M. Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals. BMJ Open. 2020;10:e038871. https://doi.org/10.1136/bmjopen-2020-038871 .

Safaee M, Golmakani N, Abedian Z. Respect to the bill of mothers rights in labor and delivery by midwife responsible for delivery through 360° evaluation in training maternities affiliated to Mashhad University of medical science in 2014. Iran J Obstetr Gynecol Infertil. 2017;20:43–51. https://doi.org/10.22038/IJOGI.2017.8623 .

Vosogh Moghadam A, Rostamina Goran N, Babaey F, Turkestani F, Mazaheripour Z. Promoting normal childbirth with the focus on maternal dignity. Islamic Republic of Iran, Tehran: Ministry of Health and Medical Education; 2017.

Ministry of Health and Medical Education. National guidelines for normal delivery. Islamic Republic of Iran, Tehran: Ministry of Health and Medical Education; 2019.

Hajizadeh K, AsghariJafarabadi M, Vaezi M, Meedya S, Mohammad Alizadeh-Charandabi S, Mirghafourvand M. The psychometric properties of the respectful maternity care (RMC) for an Iranian population. BMC Health Serv Res. 2020;20:1–7. https://doi.org/10.1186/s12913-020-05729-x .

Esmkhani M, Namadian M, Nooroozy A, Korte JE. Psychometric properties of a Persian version of respectful maternity care questionnaire. BMC Pregn Childb. 2021;21:1–9. https://doi.org/10.1186/s12884-021-03693-w .

Taghizadeh Z, Ebadi A, Jaafarpour M. Childbirth violence-based negative health consequences: a qualitative study in Iranian women. BMC Pregn Child. 2021;21:1–10. https://doi.org/10.1186/s12884-021-03986-0 .

Moridi M, Pazandeh F, Hajian S, Potrata B. Midwives’ perspectives of respectful maternity care during childbirth: a qualitative study. Plos One. 2020;15:e0229941. https://doi.org/10.1371/journal.pone.0229941 .

Abdollahpour S, Bayrami R, Ghasem Zadeh N, Alinezhad V. Investigating the effect of implementation of respecting pregnant women traning workshop on knowledge and performance of midwives. Nurs Midw J. 2023;21:334–42.

Alipour S: Effectiveness of Educational Intervention of Midwives Working in Hospitals of Tehran University of Medical Sciences on Providing Respectful Care for Mothers. Tehran: Tehran University of Medical Sciences; 2021.

Asefa A, Morgan A, Bohren MA, Kermode M. Lessons learned through respectful maternity care training and its implementation in Ethiopia: an interventional mixed methods study. Reprod Health. 2020;17:103. https://doi.org/10.1186/s12978-020-00953-4 .

Peters DH, Adam T, Alonge O, Agyepong IA, Tran N: Implementation research: what it is and how to do it. BMJ 2013;347. https://doi.org/10.1136/bmj.f6753

Theobald S, Brandes N, Gyapong M, El-Saharty S, Proctor E, Diaz T, Wanji S, Elloker S, Raven J, Elsey H. Implementation research: new imperatives and opportunities in global health. Lancet. 2018;392:2214–28. https://doi.org/10.1016/S0140-6736(18)32205-0 .

Article   PubMed   Google Scholar  

Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated consolidated framework for implementation research based on user feedback. Implement Sci. 2022;17:1–16. https://doi.org/10.1186/s13012-022-01245-0 .

Ridde V. Need for more and better implementation science in global health. BMJ Special J. 2016;1:e000115.

Nilsen P. Making sense of implementation theories, models, and frameworks. Implement Sci. 2015;10:53. https://doi.org/10.1186/s13012-015-0242-0 .

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:1–15. https://doi.org/10.1186/1748-5908-4-50 .

Keith RE, Crosson JC, O’Malley AS, Cromp D, Taylor EF. Using the consolidated framework for implementation research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci. 2017;12:1–12. https://doi.org/10.1186/s13012-017-0550-7 .

Mirzania M, Shakibazadeh E, Bohren MA, Babaey F, Hantoushzadeh S, Khajavi A, Rahimi Foroushani A: Knowledge, attitude and practice of healthcare providers on mistreatment of women during labour and childbirth: a cross-sectional study in Tehran, Iran, 2021, under review. https://doi.org/10.21203/rs.3.rs-1806039/v1 .

Green L, Kreuter M. Health Program Planning: An Educational and Ecological Approach. 4th ed. New York: McGraw Hill; 2005.

Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeili-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Fam Reprod Health. 2016;10:115.

Halil H, Benti A, Zeleke Y, Abdo R. Mistreatment and its associated factors among women during labor and delivery in hospitals of Silte Town, Southern Ethiopia. J Midw Reprod Health. 2020;8:2342–9. https://doi.org/10.22038/jmrh.2020.43343.1512 .

Maung TM, Show KL, Mon NO, Tunçalp Ö, Aye NS, Soe YY, Bohren MA. A qualitative study on acceptability of the mistreatment of women during childbirth in Myanmar. Reprod Health. 2020;17:1–14. https://doi.org/10.1186/s12978-020-0907-2 .

Azizi M, Kamali M, Elyasi F, Shirzad M. Fear of childbirth in Iran: a systematic review of psychological intervention research. Int J Reprod BioMed. 2021;19:401. https://doi.org/10.18502/ijrm.v19i5.9250 .

Consolidated Framework for Implementation Research: .Available from: http://www.cfirguide.org/ . Assessed on 10 May 2022.

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88. https://doi.org/10.1177/1049732305276687 .

VERBI Software. MAXQDA Qualitative Data Analysis Software. Marburg: VERBI Software; 2018.

Lincoln Y, Guba E. Naturalistic inquiry: Newbury Park. CA: Sage; 1985.

Book   Google Scholar  

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042 .

Kirkpatrick DL. Techniques for evaluating training programs. Train Dev J. 1979;33:78–92.

Bruns EJ, Parker EM, Hensley S, Pullmann MD, Benjamin PH, Lyon AR, Hoagwood KE. The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare. Implement Sci. 2019;14:1–13. https://doi.org/10.1186/s13012-019-0944-9 .

Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38:4–23. https://doi.org/10.1007/s10488-010-0327-7 .

Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res. 2015;17:e5091. https://doi.org/10.2196/jmir.5091 .

Hajizadeh K, Vaezi M, Meedya S, Mohammad AlizadehCharandabi S, Mirghafourvand M. Respectful maternity care and its relationship with childbirth experience in Iranian women: a prospective cohort study. BMC Pregn Childb. 2020;20:1–8. https://doi.org/10.1186/s12884-020-03118-0 .

Bayrami R, Baghaei R. Exploring the barriers to pregnant women’s engagement in the childbirth process from Iranian midwives’ point of view: A qualitative study. Proc Singapore Healthc. 2022;31:20101058221089990. https://doi.org/10.1177/20101058221089990 .

Lathwal P, Vyas H, Singh P, Deviga T. Knowledge, attitude, and factors affecting implementation of birth companionship during labor among obstetricians, nurses and pregnant women at a tertiary care teaching hospital. J Public Health Prim Care. 2022;3:15. https://doi.org/10.4103/jphpc.jphpc_17_21 .

Moradi F, Hashemian M, Hosseini F, Shafiei S, Alidousti K: Knowledge, perception, and desire for pain relief in labor among Iranian pregnant women. Res Square. 2022. https://doi.org/10.21203/rs.3.rs-2313039/v1

Warren CE, Ndwiga C, Sripad P, Medich M, Njeru A, Maranga A, Odhiambo G, Abuya T. Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research. BMC Womens Health. 2017;17:1–18. https://doi.org/10.1186/s12905-017-0425-8 .

Dwekat IMM, Ismail TAT, Ibrahim MI, Ghrayeb F. Exploring factors contributing to mistreatment of women during childbirth in West Bank Palestine. Women Birth. 2021;34:344–51. https://doi.org/10.1016/j.wombi.2020.07.004 .

Ige WB, Cele WB. Barriers to the provision of respectful maternity care during childbirth by midwives in South-West, Nigeria: Findings from semi-structured interviews with midwives. Int Afr Nurs Sci. 2022;17:100449. https://doi.org/10.1016/j.ijans.2022.100449 .

Kabakian-Khasholian T, Portela A. Companion of choice at birth: factors affecting implementation. BMC Pregn Childb. 2017;17:1–13. https://doi.org/10.1186/s12884-017-1447-9 .

Berhe H, Berhe H, Bayray A, Godifay H, Beedemariam G. Status of caring, respectful and compassionate health care practice in Tigrai regional state: patients’ perspective. Int J Caring Sci. 2017;10:1119.

Jemal K, Hailu D, Mekonnen M, Tesfa B, Bekele K, Kinati T. The importance of compassion and respectful care for the health workforce: a mixed-methods study. J Public Health. 2021;31:167–78. https://doi.org/10.1007/s10389-021-01495-0 .

Wu J, Ling K, Song W, Yao S. Perspective on the low labor analgesia rate and practical solutions for improvement in China. Chin Med J. 2020;133:606–8. https://doi.org/10.1097/CM9.0000000000000660 .

Washio Y. Incentive use for improving maternal health: perspective from behavioral science. Psychol Rep. 2018;121:42–7. https://doi.org/10.1177/0033294117720937 .

Moore G, Campbell M, Copeland L, Craig P, Movsisyan A, Hoddinott P, Littlecott H, O’Cathain A, Pfadenhauer L, Rehfuess E. Adapting interventions to new contexts—the ADAPT guidance. BMJ. 2021;374:n1679. https://doi.org/10.1136/bmj.n1679 .

Fixsen DL, Blase KA. Active Implementation Frameworks. In Handbook on Implementation Science: Edward Elgar Publishing; 2020.

Harvey G, Kitson A. Promoting Action on Research Implementation in Health Services: The Integrated-PARIHS Framework. In Handbook on Implementation Science: Edward Elgar Publishing; 2020.

Otogara M, Karimi-Shahanjarini A, Hazavehei SMM, Poorolajal J, Radnia N, Akrami F, Bagheri F. Exploring perceptions of instructors about childbirth preparation training courses: a qualitative study. Electr Phys. 2017;9:4215–24. https://doi.org/10.19082/4215 .

Wilson-Mitchell K, Marowitz A, Lori JR. Midwives’ perceptions of barriers to respectful maternity care for adolescent mothers in Jamaica: a qualitative study. Int J Childbirth. 2018;8:18–34.

D-zomeku VM, Mensah BAB, Nakua EK, Agbadi P, Lori JR, Donkor P. Exploring midwives’ understanding of respectful maternal care in Kumasi, Ghana: qualitative inquiry. Plos One. 2020;15:e0220538. https://doi.org/10.1371/journal.pone.0220538 .

Nigenda G, Montaño M, Aranda Z, Aristizabal P, Ortiz F, Ortega S, Juárez A, Macías V, Zárate-Grajales RA, Flores H: Achievements and challenges in the development of a respectful delivery care model provided by partners in health in rural Mexico: a mixed methods analysis. 2022. https://doi.org/10.21203/rs.3.rs-1570068/v1 .

Reis V, Deller B, Catherine Carr C, Smith J. Respectful Maternity Care: Country Experiences. Washington DC: USAID; 2012.

Download references

Acknowledgments

This study was part of a PhD dissertation. We thank the Tehran University of Medical Sciences (TUMS) and the Health Information Management Research Center, TUMS for their financial support. We appreciate the sincere collaboration of all participants who provided valuable information in the interviews.

This study received funding from the Deputy for Education at Tehran University of Medical Sciences (TUMS) (9811108001) and Health Information Management Research Center, TUMS (1401-3-208-62407). The role of the funders is to monitor the corresponding study planning and progression.

Author information

Authors and affiliations.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Marjan Mirzania & Elham Shakibazadeh

Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia

Meghan A. Bohren

Department of Obstetrics and Gynecology, School of Medicine, Vali-E-Asr Reproductive Health research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Sedigheh Hantoushzadeh

Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran

Abdoljavad Khajavi

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abbas Rahimi Foroushani

You can also search for this author in PubMed   Google Scholar

Contributions

E.Sh. and M.M. conceived and designed the project with input from all authors. M.M. developed the interview guide, conducted the interviews, coded and analyzed the data, and drafted the manuscript. E.Sh. contributed to the development of the interview guide, coding and analysis the data, and drafting of the manuscript. M.B., S.H., A.Kh., and A.RF. participated in the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elham Shakibazadeh .

Ethics declarations

Ethics approval and consent to participate.

The study was reviewed and approved by the Ethics Committee of Tehran University of Medical Sciences (code number: IR.TUMS.SPH.REC.1400.169). Written informed consent was obtained from all participants prior to the interviews. This study was performed in accordance with the principles set out in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Supplementary Information

Supplementary material 1., supplementary material 2., supplementary material 3., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Mirzania, M., Shakibazadeh, E., Bohren, M.A. et al. Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research. Reprod Health 21 , 70 (2024). https://doi.org/10.1186/s12978-024-01813-1

Download citation

Received : 10 May 2023

Accepted : 14 May 2024

Published : 27 May 2024

DOI : https://doi.org/10.1186/s12978-024-01813-1

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Maternity care
• Mistreatment
• Multi-level intervention
• Implementation research
• Qualitative study

Reproductive Health

ISSN: 1742-4755

• General enquiries: [email protected]