qualitative research question examples in health

Qualitative Research Questions: Gain Powerful Insights + 25 Examples

We review the basics of qualitative research questions, including their key components, how to craft them effectively, & 25 example questions.

Einstein was many things—a physicist, a philosopher, and, undoubtedly, a mastermind. He also had an incredible way with words. His quote, "Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted," is particularly poignant when it comes to research. 

Some inquiries call for a quantitative approach, for counting and measuring data in order to arrive at general conclusions. Other investigations, like qualitative research, rely on deep exploration and understanding of individual cases in order to develop a greater understanding of the whole. That’s what we’re going to focus on today.

Qualitative research questions focus on the "how" and "why" of things, rather than the "what". They ask about people's experiences and perceptions , and can be used to explore a wide range of topics.

The following article will discuss the basics of qualitative research questions, including their key components, and how to craft them effectively. You'll also find 25 examples of effective qualitative research questions you can use as inspiration for your own studies.

Let’s get started!

What are qualitative research questions, and when are they used?

When researchers set out to conduct a study on a certain topic, their research is chiefly directed by an overarching question . This question provides focus for the study and helps determine what kind of data will be collected.

By starting with a question, we gain parameters and objectives for our line of research. What are we studying? For what purpose? How will we know when we’ve achieved our goals?

Of course, some of these questions can be described as quantitative in nature. When a research question is quantitative, it usually seeks to measure or calculate something in a systematic way.

For example:

• How many people in our town use the library?
• What is the average income of families in our city?
• How much does the average person weigh?

Other research questions, however—and the ones we will be focusing on in this article—are qualitative in nature. Qualitative research questions are open-ended and seek to explore a given topic in-depth.

According to the Australian & New Zealand Journal of Psychiatry , “Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans’ lives and social worlds.”

This type of research can be used to gain a better understanding of people’s thoughts, feelings and experiences by “addressing questions beyond ‘what works’, towards ‘what works for whom when, how and why, and focusing on intervention improvement rather than accreditation,” states one paper in Neurological Research and Practice .

Qualitative questions often produce rich data that can help researchers develop hypotheses for further quantitative study.

• What are people’s thoughts on the new library?
• How does it feel to be a first-generation student at our school?
• How do people feel about the changes taking place in our town?

As stated by a paper in Human Reproduction , “...‘qualitative’ methods are used to answer questions about experience, meaning, and perspective, most often from the standpoint of the participant. These data are usually not amenable to counting or measuring.”

Both quantitative and qualitative questions have their uses; in fact, they often complement each other. A well-designed research study will include a mix of both types of questions in order to gain a fuller understanding of the topic at hand.

If you would like to recruit unlimited participants for qualitative research for free and only pay for the interview you conduct, try using Respondent  today. 

Crafting qualitative research questions for powerful insights

Now that we have a basic understanding of what qualitative research questions are and when they are used, let’s take a look at how you can begin crafting your own.

According to a study in the International Journal of Qualitative Studies in Education, there is a certain process researchers should follow when crafting their questions, which we’ll explore in more depth.

1. Beginning the process 

Start with a point of interest or curiosity, and pose a draft question or ‘self-question’. What do you want to know about the topic at hand? What is your specific curiosity? You may find it helpful to begin by writing several questions.

For example, if you’re interested in understanding how your customer base feels about a recent change to your product, you might ask: 

• What made you decide to try the new product?
• How do you feel about the change?
• What do you think of the new design/functionality?
• What benefits do you see in the change?

2. Create one overarching, guiding question 

At this point, narrow down the draft questions into one specific question. “Sometimes, these broader research questions are not stated as questions, but rather as goals for the study.”

As an example of this, you might narrow down these three questions: 

into the following question: 

• What are our customers’ thoughts on the recent change to our product?

3. Theoretical framing 

As you read the relevant literature and apply theory to your research, the question should be altered to achieve better outcomes. Experts agree that pursuing a qualitative line of inquiry should open up the possibility for questioning your original theories and altering the conceptual framework with which the research began.

If we continue with the current example, it’s possible you may uncover new data that informs your research and changes your question. For instance, you may discover that customers’ feelings about the change are not just a reaction to the change itself, but also to how it was implemented. In this case, your question would need to reflect this new information: 

• How did customers react to the process of the change, as well as the change itself?

4. Ethical considerations 

A study in the International Journal of Qualitative Studies in Education stresses that ethics are “a central issue when a researcher proposes to study the lives of others, especially marginalized populations.” Consider how your question or inquiry will affect the people it relates to—their lives and their safety. Shape your question to avoid physical, emotional, or mental upset for the focus group.

In analyzing your question from this perspective, if you feel that it may cause harm, you should consider changing the question or ending your research project. Perhaps you’ve discovered that your question encourages harmful or invasive questioning, in which case you should reformulate it.

5. Writing the question 

The actual process of writing the question comes only after considering the above points. The purpose of crafting your research questions is to delve into what your study is specifically about” Remember that qualitative research questions are not trying to find the cause of an effect, but rather to explore the effect itself.

Your questions should be clear, concise, and understandable to those outside of your field. In addition, they should generate rich data. The questions you choose will also depend on the type of research you are conducting: 

• If you’re doing a phenomenological study, your questions might be open-ended, in order to allow participants to share their experiences in their own words.
• If you’re doing a grounded-theory study, your questions might be focused on generating a list of categories or themes.
• If you’re doing ethnography, your questions might be about understanding the culture you’re studying.

Whenyou have well-written questions, it is much easier to develop your research design and collect data that accurately reflects your inquiry.

In writing your questions, it may help you to refer to this simple flowchart process for constructing questions:

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25 examples of expertly crafted qualitative research questions

It's easy enough to cover the theory of writing a qualitative research question, but sometimes it's best if you can see the process in practice. In this section, we'll list 25 examples of B2B and B2C-related qualitative questions.

Let's begin with five questions. We'll show you the question, explain why it's considered qualitative, and then give you an example of how it can be used in research.

1. What is the customer's perception of our company's brand?

Qualitative research questions are often open-ended and invite respondents to share their thoughts and feelings on a subject. This question is qualitative because it seeks customer feedback on the company's brand. 

This question can be used in research to understand how customers feel about the company's branding, what they like and don't like about it, and whether they would recommend it to others.

2. Why do customers buy our product?

This question is also qualitative because it seeks to understand the customer's motivations for purchasing a product. It can be used in research to identify the reasons  customers buy a certain product, what needs or desires the product fulfills for them, and how they feel about the purchase after using the product.

3. How do our customers interact with our products?

Again, this question is qualitative because it seeks to understand customer behavior. In this case, it can be used in research to see how customers use the product, how they interact with it, and what emotions or thoughts the product evokes in them.

4. What are our customers' biggest frustrations with our products?

By seeking to understand customer frustrations, this question is qualitative and can provide valuable insights. It can be used in research to help identify areas in which the company needs to make improvements with its products.

5. How do our customers feel about our customer service?

Rather than asking why customers like or dislike something, this question asks how they feel. This qualitative question can provide insights into customer satisfaction or dissatisfaction with a company. 

This type of question can be used in research to understand what customers think of the company's customer service and whether they feel it meets their needs.

20 more examples to refer to when writing your question

Now that you’re aware of what makes certain questions qualitative, let's move into 20 more examples of qualitative research questions:

• How do your customers react when updates are made to your app interface?
• How do customers feel when they complete their purchase through your ecommerce site?
• What are your customers' main frustrations with your service?
• How do people feel about the quality of your products compared to those of your competitors?
• What motivates customers to refer their friends and family members to your product or service?
• What are the main benefits your customers receive from using your product or service?
• How do people feel when they finish a purchase on your website?
• What are the main motivations behind customer loyalty to your brand?
• How does your app make people feel emotionally?
• For younger generations using your app, how does it make them feel about themselves?
• What reputation do people associate with your brand?
• How inclusive do people find your app?
• In what ways are your customers' experiences unique to them?
• What are the main areas of improvement your customers would like to see in your product or service?
• How do people feel about their interactions with your tech team?
• What are the top five reasons people use your online marketplace?
• How does using your app make people feel in terms of connectedness?
• What emotions do people experience when they're using your product or service?
• Aside from the features of your product, what else about it attracts customers?
• How does your company culture make people feel?

As you can see, these kinds of questions are completely open-ended. In a way, they allow the research and discoveries made along the way to direct the research. The questions are merely a starting point from which to explore.

This video offers tips on how to write good qualitative research questions, produced by Qualitative Research Expert, Kimberly Baker.

Wrap-up: crafting your own qualitative research questions.

Over the course of this article, we've explored what qualitative research questions are, why they matter, and how they should be written. Hopefully you now have a clear understanding of how to craft your own.

Remember, qualitative research questions should always be designed to explore a certain experience or phenomena in-depth, in order to generate powerful insights. As you write your questions, be sure to keep the following in mind:

• Are you being inclusive of all relevant perspectives?
• Are your questions specific enough to generate clear answers?
• Will your questions allow for an in-depth exploration of the topic at hand?
• Do the questions reflect your research goals and objectives?

If you can answer "yes" to all of the questions above, and you've followed the tips for writing qualitative research questions we shared in this article, then you're well on your way to crafting powerful queries that will yield valuable insights.

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How to write qualitative research questions.

11 min read Here’s how to write effective qualitative research questions for your projects, and why getting it right matters so much.

What is qualitative research?

Qualitative research is a blanket term covering a wide range of research methods and theoretical framing approaches. The unifying factor in all these types of qualitative study is that they deal with data that cannot be counted. Typically this means things like people’s stories, feelings, opinions and emotions , and the meanings they ascribe to their experiences.

Qualitative study is one of two main categories of research, the other being quantitative research. Quantitative research deals with numerical data – that which can be counted and quantified, and which is mostly concerned with trends and patterns in large-scale datasets.

What are research questions?

Research questions are questions you are trying to answer with your research. To put it another way, your research question is the reason for your study, and the beginning point for your research design. There is normally only one research question per study, although if your project is very complex, you may have multiple research questions that are closely linked to one central question.

A good qualitative research question sums up your research objective. It’s a way of expressing the central question of your research, identifying your particular topic and the central issue you are examining.

Research questions are quite different from survey questions, questions used in focus groups or interview questions. A long list of questions is used in these types of study, as opposed to one central question. Additionally, interview or survey questions are asked of participants, whereas research questions are only for the researcher to maintain a clear understanding of the research design.

Research questions are used in both qualitative and quantitative research , although what makes a good research question might vary between the two.

In fact, the type of research questions you are asking can help you decide whether you need to take a quantitative or qualitative approach to your research project.

Discover the fundamentals of qualitative research

Quantitative vs. qualitative research questions

Writing research questions is very important in both qualitative and quantitative research, but the research questions that perform best in the two types of studies are quite different.

Quantitative research questions

Quantitative research questions usually relate to quantities, similarities and differences.

It might reflect the researchers’ interest in determining whether relationships between variables exist, and if so whether they are statistically significant. Or it may focus on establishing differences between things through comparison, and using statistical analysis to determine whether those differences are meaningful or due to chance.

• How much? This kind of research question is one of the simplest. It focuses on quantifying something. For example:

How many Yoruba speakers are there in the state of Maine?

• What is the connection?

This type of quantitative research question examines how one variable affects another.

For example:

How does a low level of sunlight affect the mood scores (1-10) of Antarctic explorers during winter?

• What is the difference? Quantitative research questions in this category identify two categories and measure the difference between them using numerical data.

Do white cats stay cooler than tabby cats in hot weather?

If your research question fits into one of the above categories, you’re probably going to be doing a quantitative study.

Qualitative research questions

Qualitative research questions focus on exploring phenomena, meanings and experiences.

Unlike quantitative research, qualitative research isn’t about finding causal relationships between variables. So although qualitative research questions might touch on topics that involve one variable influencing another, or looking at the difference between things, finding and quantifying those relationships isn’t the primary objective.

In fact, you as a qualitative researcher might end up studying a very similar topic to your colleague who is doing a quantitative study, but your areas of focus will be quite different. Your research methods will also be different – they might include focus groups, ethnography studies, and other kinds of qualitative study.

A few example qualitative research questions:

• What is it like being an Antarctic explorer during winter?
• What are the experiences of Yoruba speakers in the USA?
• How do white cat owners describe their pets?

Qualitative research question types

Marshall and Rossman (1989) identified 4 qualitative research question types, each with its own typical research strategy and methods.

• Exploratory questions

Exploratory questions are used when relatively little is known about the research topic. The process researchers follow when pursuing exploratory questions might involve interviewing participants, holding focus groups, or diving deep with a case study.

• Explanatory questions

With explanatory questions, the research topic is approached with a view to understanding the causes that lie behind phenomena. However, unlike a quantitative project, the focus of explanatory questions is on qualitative analysis of multiple interconnected factors that have influenced a particular group or area, rather than a provable causal link between dependent and independent variables.

• Descriptive questions

As the name suggests, descriptive questions aim to document and record what is happening. In answering descriptive questions , researchers might interact directly with participants with surveys or interviews, as well as using observational studies and ethnography studies that collect data on how participants interact with their wider environment.

• Predictive questions

Predictive questions start from the phenomena of interest and investigate what ramifications it might have in the future. Answering predictive questions may involve looking back as well as forward, with content analysis, questionnaires and studies of non-verbal communication (kinesics).

Why are good qualitative research questions important?

We know research questions are very important. But what makes them so essential? (And is that question a qualitative or quantitative one?)

Getting your qualitative research questions right has a number of benefits.

• It defines your qualitative research project Qualitative research questions definitively nail down the research population, the thing you’re examining, and what the nature of your answer will be.This means you can explain your research project to other people both inside and outside your business or organization. That could be critical when it comes to securing funding for your project, recruiting participants and members of your research team, and ultimately for publishing your results. It can also help you assess right the ethical considerations for your population of study.
• It maintains focus Good qualitative research questions help researchers to stick to the area of focus as they carry out their research. Keeping the research question in mind will help them steer away from tangents during their research or while they are carrying out qualitative research interviews. This holds true whatever the qualitative methods are, whether it’s a focus group, survey, thematic analysis or other type of inquiry.That doesn’t mean the research project can’t morph and change during its execution – sometimes this is acceptable and even welcome – but having a research question helps demarcate the starting point for the research. It can be referred back to if the scope and focus of the project does change.
• It helps make sure your outcomes are achievable

Because qualitative research questions help determine the kind of results you’re going to get, it helps make sure those results are achievable. By formulating good qualitative research questions in advance, you can make sure the things you want to know and the way you’re going to investigate them are grounded in practical reality. Otherwise, you may be at risk of taking on a research project that can’t be satisfactorily completed.

Developing good qualitative research questions

All researchers use research questions to define their parameters, keep their study on track and maintain focus on the research topic. This is especially important with qualitative questions, where there may be exploratory or inductive methods in use that introduce researchers to new and interesting areas of inquiry. Here are some tips for writing good qualitative research questions.

1. Keep it specific

Broader research questions are difficult to act on. They may also be open to interpretation, or leave some parameters undefined.

Strong example: How do Baby Boomers in the USA feel about their gender identity?

Weak example: Do people feel different about gender now?

2. Be original

Look for research questions that haven’t been widely addressed by others already.

Strong example: What are the effects of video calling on women’s experiences of work?

Weak example: Are women given less respect than men at work?

3. Make it research-worthy

Don’t ask a question that can be answered with a ‘yes’ or ‘no’, or with a quick Google search.

Strong example: What do people like and dislike about living in a highly multi-lingual country?

Weak example: What languages are spoken in India?

4. Focus your question

Don’t roll multiple topics or questions into one. Qualitative data may involve multiple topics, but your qualitative questions should be focused.

Strong example: What is the experience of disabled children and their families when using social services?

Weak example: How can we improve social services for children affected by poverty and disability?

4. Focus on your own discipline, not someone else’s

Avoid asking questions that are for the politicians, police or others to address.

Strong example: What does it feel like to be the victim of a hate crime?

Weak example: How can hate crimes be prevented?

5. Ask something researchable

Big questions, questions about hypothetical events or questions that would require vastly more resources than you have access to are not useful starting points for qualitative studies. Qualitative words or subjective ideas that lack definition are also not helpful.

Strong example: How do perceptions of physical beauty vary between today’s youth and their parents’ generation?

Weak example: Which country has the most beautiful people in it?

Related resources

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

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What’s in a Qualitative Research Question?

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

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

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

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

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

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

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

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

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

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

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

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

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

Other Qualitative Research Question Examples

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

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

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

Unclear : How do students experience progressing to college?

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

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

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How to Write Qualitative Research Questions: Types & Examples

Qualitative research questions focus on depth and quality, exploring the “why and how” behind decisions, without relying on statistical tools.

Unlike quantitative research, which aims to collect tangible, measurable data from a broader demographic, qualitative analysis involves smaller, focused datasets, identifying patterns for insights.

The information collected by qualitative surveys can vary from text to images, demanding a deep understanding of the subject, and therefore, crafting precise qualitative research questions is crucial for success.

In this guide, we’ll discuss how to write effective qualitative research questions, explore various types, and highlight characteristics of good qualitative research questions.

Let’s dive in!

What Are Qualitative Research Questions?

Qualitative questions aim to understand the depth and nuances of a phenomenon, focusing on “why” and “how” rather than quantifiable measures.

They explore subjective experiences, perspectives, and behaviors, often using open-ended inquiries to gather rich, descriptive data.

Unlike quantitative questions, which seek numerical data, qualitative questions try to find out meanings, patterns, and underlying processes within a specific context.

These questions are essential for exploring complex issues, generating hypotheses, and gaining deeper insights into human behavior and phenomena.

Here’s an example of a qualitative research question:

“How do you perceive and navigate organizational culture within a tech startup environment?”

This question asks about the respondent’s subjective interpretations and experiences of organizational culture within a specific context, such as a tech startup.

It seeks to uncover insights into the values, norms, and practices that shape workplace dynamics and employee behaviors, providing qualitative data for analysis and understanding.

When Should We Use Qualitative Research Questions?

Qualitative research questions typically aim to open up conversations, encourage detailed narratives, and foster a deep understanding of the subject matter. Here are some scenarios they are best suited for:

• Exploring Complex Phenomena : When the research topic involves understanding complex processes, behaviors, or interactions that cannot be quantified easily, qualitative questions help delve into these intricate details.
• Understanding Contexts and Cultures : To grasp the nuances of different social contexts, cultures, or subcultures, qualitative research questions allow for an in-depth exploration of these environments and how they influence individuals and groups.
• Exploring Perceptions and Experiences : When the aim is to understand people’s perceptions, experiences, or feelings about a particular subject, qualitative questions facilitate capturing the depth and variety of these perspectives.
• Developing Concepts or Theories : In the early stages of research, where concepts or theories are not yet well-developed, qualitative questions can help generate hypotheses, identify variables, and develop theoretical frameworks based on observations and interpretations.
• Investigating Processes : To understand how processes unfold over time and the factors that influence these processes, qualitative questions are useful for capturing the dynamics and complexities involved.
• Seeking to Understand Change : When researching how individuals or groups experience change, adapt to new circumstances, or make decisions, qualitative research questions can provide insights into the motivations, challenges, and strategies involved.
• Studying Phenomena Not Easily Quantified : For phenomena that are not easily captured through quantitative measures, such as emotions, beliefs, or motivations, qualitative questions can probe these abstract concepts more effectively.
• Addressing Sensitive or Taboo Topics : In studies where topics may be sensitive, controversial, or taboo, qualitative research questions allow for a respectful and empathetic exploration of these subjects, providing space for participants to share their experiences in their own words.

How to Write Qualitative Research Questions?

Read this guide to learn how you can craft well-thought-out qualitative research questions:

1. Begin with Your Research Goals

The first step in formulating qualitative research questions is to have a clear understanding of what you aim to discover or understand through your research. There are two types of qualitative questionnaires or research – Ontological and Epistemological.

Finding out the nature of your research influences all aspects of your research design, including the formulation of research questions.

Subsequently:

• Identify your main objective : Consider the broader context of your study. Are you trying to explore a phenomenon, understand a process, or interpret the meanings behind behaviors? Your main objective should guide the formulation of your questions, ensuring they are aligned with what you seek to achieve.
• Focus on the ‘how’ and ‘why’ : Qualitative research is inherently exploratory and aims to understand the nuances of human behavior and experience. Starting your questions with “how” or “why” encourages a deeper investigation into the motivations, processes, and contexts underlying the subject matter. This approach facilitates an open-ended exploration, allowing participants to provide rich, detailed responses that illuminate their perspectives and experiences.

Take a quick look at the following visual for a better understanding:

So, if you are doing Ontological research, ensure that the questions focus on the “what” aspects of reality (the premise of your research) and opt for the nature of the knowledge for Epistemological research.

2. Choose the Right Structure

The structure of your research questions significantly impacts the depth and quality of data you collect. Opting for an open-ended format allows respondents the flexibility to express themselves freely, providing insights that pre-defined answers might miss.

• Open-ended format : These questions do not constrain respondents to a set of predetermined answers, unlike closed-ended questions. By allowing participants to articulate their thoughts in their own words, you can uncover nuances and complexities in their responses that might otherwise be overlooked.
• Avoid yes/no questions : Yes/no questions tend to limit the depth of responses. While they might be useful for gathering straightforward factual information, they are not conducive to exploring the depths and nuances that qualitative research seeks to uncover. Encouraging participants to elaborate on their experiences and perspectives leads to richer, more informative data.

For example, take a look at some qualitative questions examples shown in the following image:

3. Be Clear and Specific

Clarity and specificity in your questions are crucial to ensure that participants understand what is being asked and that their responses are relevant to your research objectives.

• Use clear language : Use straightforward, understandable language in your questions. Avoid jargon, acronyms, or overly technical terms that might confuse participants or lead to misinterpretation. The goal is to make your questions accessible to everyone involved in your study.
• Be specific : While maintaining the open-ended nature of qualitative questions, it’s important to narrow down your focus to specific aspects of the phenomenon you’re studying. This specificity helps guide participants’ responses and ensures that the data you collect directly relates to your research objectives.

4. Ensure Relevance and Feasibility

Each question should be carefully considered for its relevance to your research goals and its feasibility, given the constraints of your study.

• Relevance : Questions should be crafted to address the core objectives of your research directly. They should probe areas that are essential to understanding the phenomenon under investigation and should align with your theoretical framework or literature review findings.
• Feasibility : Consider the practical aspects of your research, including the time available for data collection and analysis, resources, and access to participants. Questions should be designed to elicit meaningful responses within the constraints of your study, ensuring that you can gather and analyze data effectively.

5. Focus on a Single Concept or Theme per Question

To ensure clarity and depth, each question should concentrate on a single idea or theme. However, if your main qualitative research question is tough to understand or has a complex structure, you can create sub-questions in limited numbers and with a “ladder structure”.

This will help your respondents understand the overall research objective in mind, and your research can be executed in a better manner.

For example, suppose your main question is – “What is the current state of illiteracy in your state?”

Then, you can create the following subquestions: 

“How does illiteracy block progress in your state?”

“How would you best describe the feelings you have about illiteracy in your state?”

For an even better understanding, you can see the various examples of qualitative research questions in the following image:

Types of Qualitative Research Questions With Examples

Qualitative survey questions primarily focus on a specific group of respondents that are participating in case studies, surveys, ethnography studies, etc., rather than numbers or statistics.

As a result, the questions are mostly open-ended and can be subdivided into the following types as discussed below:

1. Descriptive Questions

Descriptive research questions aim to detail the “what” of a phenomenon, providing a comprehensive overview of the context, individuals, or situations under study. These questions are foundational, helping to establish a baseline understanding of the research topic.

• What are the daily experiences of teachers in urban elementary schools?
• What strategies do small businesses employ to adapt to rapid technological changes?
• How do young adults describe their transition from college to the workforce?
• What are the coping mechanisms of families with members suffering from chronic illnesses?
• How do community leaders perceive the impact of gentrification in their neighborhoods?

2. Interpretive Questions

Interpretive questions seek to understand the “how” and “why” behind a phenomenon, focusing on the meanings people attach to their experiences. These questions delve into the subjective interpretations and perceptions of participants.

• How do survivors of natural disasters interpret their experiences of recovery and rebuilding?
• Why do individuals engage in voluntary work within their communities?
• How do parents interpret and navigate the challenges of remote schooling for their children?
• Why do consumers prefer local products over global brands in certain markets?
• How do artists interpret the influence of digital media on traditional art forms?

3. Comparative Questions

Comparative research questions are designed to explore differences and similarities between groups, settings, or time periods. These questions can help to highlight the impact of specific variables on the phenomenon under study.

• How do the strategies for managing work-life balance compare between remote and office workers?
• What are the differences in consumer behavior towards sustainable products in urban versus rural areas?
• How do parenting styles in single-parent households compare to those in dual-parent households?
• What are the similarities and differences in leadership styles across different cultures?
• How has the perception of online privacy changed among teenagers over the past decade?

4. Process-oriented Questions

These questions focus on understanding the processes or sequences of events over time. They aim to uncover the “how” of a phenomenon, tracing the development, changes, or evolution of specific situations or behaviors.

• How do non-profit organizations develop and implement community outreach programs?
• What is the process of decision-making in high-stakes business environments?
• How do individuals navigate the process of career transition after significant industry changes?
• What are the stages of adaptation for immigrants in a new country?
• How do social movements evolve from inception to national recognition?

5. Evaluative Questions

Evaluative questions aim to assess the effectiveness, value, or impact of a program, policy, or phenomenon. These questions are critical for understanding the outcomes and implications of various initiatives or situations.

• How effective are online therapy sessions compared to in-person sessions in treating anxiety?
• What is the impact of community gardening programs on neighborhood cohesion?
• How do participants evaluate the outcomes of leadership training programs in their professional development?
• What are the perceived benefits and drawbacks of telecommuting for employees and employers?
• How do residents evaluate the effectiveness of local government policies on waste management?

6. One-on-One Questions

The one-on-one questions are asked to a single person and can be thought of as individual interviews that you can conduct online via phone and video chat as well.

The main aim of such questions is to ask your customers or people in the focus group a series of questions about their purchase motivations. These questions might also come with follow-ups, and if your customers respond with some interesting fact or detail, dig deeper and explore the findings as much as you want.

• What makes you happy in regard to [your research topic]?
• If I could make a wish of yours come true, what do you desire the most?
• What do you still find hard to come to terms with?
• Have you bought [your product] before?
• If so, what was your initial motivation behind the purchase?

7. Exploratory Questions

These questions are designed to enhance your understanding of a particular topic. However, while asking exploratory questions, you must ensure that there are no preconceived notions or biases to it. The more transparent and bias-free your questions are, the better and fair results you will get.

• What is the effect of personal smart devices on today’s youth?
• Do you feel that smart devices have positively or negatively impacted you?
• How do your kids spend their weekends?
• What do you do on a typical weekend morning?

8. Predictive Questions

The predictive questions are used for qualitative research that is focused on the future outcomes of an action or a series of actions. So, you will be using past information to predict the reactions of respondents to hypothetical events that might or might not happen in the future.

These questions come in extremely handy for identifying your customers’ current brand expectations, pain points, and purchase motivation.

• Are you more likely to buy a product when a celebrity promotes it?
• Would you ever try a new product because one of your favorite celebs claims that it actually worked for them?
• Would people in your neighborhood enjoy a park with rides and exercise options?
• How often would you go to a park with your kids if it had free rides?

9. Focus Groups

These questions are mostly asked in person to the customer or respondent groups. The in-person nature of these surveys or studies ensures that the group members get a safe and comfortable environment to express their thoughts and feelings about your brand or services.

• How would you describe your ease of using our product?
• How well do you think you were able to do this task before you started using our product?
• What do you like about our promotional campaigns?
• How well do you think our ads convey the meaning?

10. In-Home Videos

Collecting video feedback from customers in their comfortable, natural settings offers a unique perspective. At home, customers are more relaxed and less concerned about their mannerisms, posture, and choice of words when responding.

This approach is partly why Vogue’s 73 Questions Series is highly popular among celebrities and viewers alike. In-home videos provide insights into customers in a relaxed environment, encouraging them to be honest and share genuine experiences.

• What was your first reaction when you used our product for the first time?
• How well do you think our product performed compared to your expectations?
• What was your worst experience with our product?
• What made you switch to our brand?

11. Online Focus Groups

Online focus groups mirror the traditional, in-person format but are conducted virtually, offering a more cost-effective and efficient approach to gathering data. This digital format extends your reach and allows a rapid collection of responses from a broader audience through online platforms.

You can utilize social media and other digital forums to create communities of respondents and initiate meaningful discussions. Once you have them started, you can simply observe the exchange of thoughts and gather massive amounts of interesting insights!

• What do you like best about our product?
• How familiar are you with this particular service or product we offer?
• What are your concerns with our product?
• What changes can we make to make our product better?

Ask the Right Qualitative Research Questions for Meaningful Insights From Your Respondents

Watch: How to Create a Survey Using ProProfs Survey Maker

By now, you might have realized that manually creating a list of qualitative research questions is a daunting task. Keeping numerous considerations in mind, it’s easy to run out of ideas while crafting qualitative survey questions.

However, investing in smart survey tools, like ProProfs Survey Maker, can significantly streamline this process, allowing you to create various types of surveys in minutes.

With this survey tool , you can generate forms, NPS surveys , tests, quizzes, and assessments.

It’s also useful for conducting polls, sidebar surveys, and in-app surveys. Offering over 100 templates and more than 1,000,000 ready-to-use examples of phenomenological research questions, this software simplifies the task immensely.

Equipped with the right tools and the professional tips shared here, you’re well-prepared to conduct thorough research studies and obtain valuable insights that drive impactful results.

Frequently Asked Questions

1. how do you choose qualitative research questions.

To choose qualitative research questions, identify your main research goal, focus on exploring ‘how’ and ‘why’ aspects, ensure questions are open-ended, and align them with your theoretical framework and methodology.

2. Why are good qualitative research questions important?

Good qualitative research questions are important because they guide the research focus, enable the exploration of depth and complexity, and facilitate the gathering of rich, detailed insights into human experiences and behaviors.

About the author

Emma David is a seasoned market research professional with 8+ years of experience. Having kick-started her journey in research, she has developed rich expertise in employee engagement, survey creation and administration, and data management. Emma believes in the power of data to shape business performance positively. She continues to help brands and businesses make strategic decisions and improve their market standing through her understanding of research methodologies.

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Qualitative Research – a practical guide for health and social care researchers and practitioners

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Darshini Ayton, Monash University

Tess Tsindos, Monash University

Danielle Berkovic, Monash University

Copyright Year: 2023

Last Update: 2024

ISBN 13: 9780645755404

Publisher: Monash University

Language: English

Formats Available

Conditions of use.

Table of Contents

• Acknowledgement of Country
• About the authors
• Accessibility statement
• Introduction to research
• Research design
• Data collection
• Data analysis
• Writing qualitative research
• Peer review statement
• Licensing and attribution information
• Version history

Ancillary Material

About the book.

This guide is designed to support health and social care researchers and practitioners to integrate qualitative research into the evidence base of health and social care research. Qualitative research designs are diverse and each design has a different focus that will inform the approach undertaken and the results that are generated. The aim is to move beyond the “what” of qualitative research to the “how”, by (1) outlining key qualitative research designs for health and social care research – descriptive, phenomenology, action research, case study, ethnography, and grounded theory; (2) a decision tool of how to select the appropriate design based on a guiding prompting question, the research question and available resources, time and expertise; (3) an overview of mixed methods research and qualitative research in evaluation studies; (4) a practical guide to data collection and analysis; (5) providing examples of qualitative research to illustrate the scope and opportunities; and (6) tips on communicating qualitative research.

About the Contributors

Associate Professor Darshini Ayton is the Deputy Head of the Health and Social Care Unit at Monash University in Melbourne, Australia. She is a transdisciplinary implementation researcher with a focus on improving health and social care for older Australians and operates at the nexus of implementation science, health and social care policies, public health and consumer engagement. She has led qualitative research studies in hospitals, aged care, not-for-profit organisations and for government and utilises a range of data collection methods.  Associate Professor Ayton established and is the director of the highly successful Qualitative Research Methods for Public Health short course which has been running since 2014.

Dr Tess Tsindos  is a Research Fellow with the Health and Social Care Unit at Monash University in Melbourne, Australia. She is a public health researcher and lecturer with strong qualitative and mixed methods research experience conducting research studies in hospital and community health settings, not-for-profit organisations and for government. Prior to working in academia, Dr Tsindos worked in community care for government and not-for-profit organisations for more than 25 years. Dr Tsindos has a strong evaluation background having conducted numerous evaluations for a range of health and social care organisations. Based on this experience she coordinated the Bachelor of Health Science/Public Health Evaluation unit and the Master of Public Health Evaluation unit and developed the Evaluating Public Health Programs short course in 2022. Dr Tsindos is the Unit Coordinator of the Master of Public Health Qualitative Research Methods Unit which was established in 2022.

Dr Danielle Berkovic  is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia. She is a public health and consumer-led researcher with strong qualitative and mixed-methods research experience focused on improving health services and clinical guidelines for people with arthritis and other musculoskeletal conditions. She has conducted qualitative research studies in hospitals and community health settings. Dr Berkovic currently provides qualitative input into Australia’s first Living Guideline for the pharmacological management of inflammatory arthritis. Dr Berkovic is passionate about incorporating qualitative research methods into traditionally clinical and quantitative spaces and enjoys teaching clinicians and up-and-coming researchers about the benefits of qualitative research.

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4.4 Qualitative research questions

Learning objectives.

• List the key terms associated with qualitative research questions
• Distinguish between qualitative and quantitative research questions

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

Let’s work through an example from our last section. In Table 4.1, a student asked, “What is the relationship between sexual orientation or gender identity and homelessness for late adolescents in foster care?” In this question, it is pretty clear that the student believes that adolescents in foster care who identify as LGBTQ may be at greater risk for homelessness. This is a nomothetic causal relationship—LGBTQ status causes homelessness.

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

Because qualitative questions usually look for idiographic causal explanationsthey look different than quantitative questions. (For a detailed discussion of idiographic causal explanations, see DeCarlo (2018), Chapter 7.2) .  Table 4.3 below takes the final research questions from Table 4.1 and adapts them for qualitative research. The guidelines for research questions previously described in this chapter still apply, but there are some new elements to qualitative research questions that are not present in quantitative questions. First, qualitative research questions often ask about lived experience, personal experience, understanding, meaning, and stories. These keywords indicate that you will be using qualitative methods. Second, qualitative research questions may be more general and less specific. Instead of asking how one concept causes another, we are asking about how people understand or feel about a concept. They may also contain only one variable, rather than asking about relationships between multiple variables.

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

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

Key Takeaways

• Qualitative research questions often contain words like lived experience, personal experience, understanding, meaning, and stories.
• Qualitative research questions can change and evolve as the researcher conducts the study.

Image attributions

Empathy by  sean macentee   cc-by-2.0.

Guidebook for Social Work Literature Reviews and Research Questions Copyright © 2020 by Rebecca Mauldin and Matthew DeCarlo is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Health (Nursing, Medicine, Allied Health)

• Find Articles/Databases
• Reference Resources
• Evidence Summaries & Clinical Guidelines
• Drug Information
• Health Data & Statistics
• Patient/Consumer Facing Materials
• Images and Streaming Video
• Grey Literature
• Mobile Apps & "Point of Care" Tools
• Tests & Measures This link opens in a new window
• Citing Sources
• Selecting Databases
• Framing Research Questions
• Crafting a Search
• Narrowing / Filtering a Search
• Expanding a Search
• Cited Reference Searching
• Saving Searches
• Term Glossary
• Critical Appraisal Resources
• What are Literature Reviews?
• Conducting & Reporting Systematic Reviews
• Finding Systematic Reviews
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• Finding Full Text

Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what  kind  of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. 

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. 

 Across most frameworks, you’ll often be considering:

• a who (who was studied - a population or sample)
• a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
• a how ([how] did the [what] affect the [who] - an outcome, an effect). 

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations  (C) improve blood sugar control  (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?" 

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews.  Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do  preparation programs (E) influence the development of teaching competence  (O) among novice nurse educators  (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of  undergraduate nursing students  (S)  in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools  (Context) teach, measure, and maintain nursing students ' (P)  technological literacy  (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations  improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

• What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
• What are the measures of effective blood sugar control?
• What kinds of interventions would fall under the umbrella of 'telehealth'?
• What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
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• Next: Crafting a Search >>
• Last Updated: May 2, 2024 10:52 AM
• URL: https://guides.nyu.edu/health

55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

• Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

• How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

• Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

• Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

• Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

• Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

• Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

• Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

• Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

• Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

• Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

• Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

• Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

Get started today

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• Volume 13, Issue 2
• Qualitative Research Methods in Mental Health
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• Sarah Peters
• Correspondence to : Dr Sarah Peters, School of Psychological Sciences, The University of Manchester, Coupland Building 1, Oxford Road M13 9PL, UK; sarah.peters{at}manchester.ac.uk

As the evidence base for the study of mental health problems develops, there is a need for increasingly rigorous and systematic research methodologies. Complex questions require complex methodological approaches. Recognising this, the MRC guidelines for developing and testing complex interventions place qualitative methods as integral to each stage of intervention development and implementation. However, mental health research has lagged behind many other healthcare specialities in using qualitative methods within its evidence base. Rigour in qualitative research raises many similar issues to quantitative research and also some additional challenges. This article examines the role of qualitative methods within mental heath research, describes key methodological and analytical approaches and offers guidance on how to differentiate between poor and good quality qualitative research.

https://doi.org/10.1136/ebmh.13.2.35

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The trajectory of qualitative methods in mental health research

Qualitative methodologies have a clear home within the study of mental health research. Early and, arguably, seminal work into the study of mental illnesses and their management was based on detailed observation, moving towards theory using inductive reasoning. Case studies have been long established in psychiatry to present detailed analysis of unusual cases or novel treatments. Participant observation was the principle method used in Goffman's seminal study of psychiatric patients in asylums that informed his ideas about the institutionalising and medicalising of mental illness by medical practice. 1 However, the 20th century saw the ‘behaviourist revolution’, a movement where quantification and experimentation dominated. Researchers sought to identify cause and effects, and reasoning became more deductive – seeking to use data to confirm theory. The study of health and illness was determined by contemporary thinking about disease, taking a biomedical stance. Psychologists and clinical health researchers exploited natural science methodologies, attempting to measure phenomenon in their smallest entities and do so as objectively as possible. This reductionist and positivist philosophy shaped advances in research methods and meant that qualitative exploration failed to develop as a credible scientific approach. Indeed, ‘objectivity’ and the ‘discovery of truth’ have become synonymous with ‘scientific enquiry’ and qualitative methods are easily dismissed as ‘anecdotal’. The underlying epistemology of this approach chimes well with medical practice for which training is predominately in laboratory and basic sciences (such as physics and chemistry) within which the discourse of natural laws dominate. To this end, research in psychiatry still remains overwhelmingly quantitative. 2

Underlying all research paradigms are assumptions. However, most traditional researchers remain unaware of these until they start to use alternative paradigms. Key assumptions of quantitative research are that facts exist that can be quantified and measured and that these should be examined, as far as possible, objectively, partialling out or controlling for the context within which they exist. There are research questions within mental health where this approach can hold: where phenomenon of interest can be reliably and meaningfully quantified and measured, it is feasible to use data to test predictions and examine change. However, for many questions these assumptions prove unsatisfying. It is often not possible or desirable to try and create laboratory conditions for the research; indeed it would be ecologically invalid to do so. For example, to understand the experience of an individual who has been newly diagnosed with schizophrenia, it is clearly important to consider the context within which they live, their family, social grouping and media messages they are exposed to. Table 1 depicts the key differences between the two methodological approaches and core underlying assumptions for each.

• View inline

Comparison of underlying assumptions of quantitative and qualitative research approaches

It should be cautioned that it is easy to fall into the trap of categorising studies as either quantitative or qualitative. The two traditions are often positioned within the literature as opposing and in conflict. This division is unhelpful and likely to impede methodological advancement. Though, undeniably, there are differences in the two approaches to research, there are also many exceptions that expose this dichotomy to be simplistic: some qualitative studies seek to test a priori hypotheses, and some quantitative studies are atheoretical and exploratory. 3 Hence it is more useful to consider research methodologies as lying along a spectrum and that researchers should be familiar with the full range of methodologies, so that a method is chosen according to the research question rather than the researcher's ability.

Rationale for qualitative methods in current mental health research

There are a number of scientific, practical and ethical reasons why mental health is an area that can particularly benefit from qualitative enquiry. Mental health research is complex. Health problems are multifactorial in their aetiology and the consequences they have on the individual, families and societies. Management can involve self-help, pharmacological, educative, social and psychotherapeutic approaches. Services involved are often multidisciplinary and require liaison between a number of individuals including professionals, service-users and relatives. Many problems are exacerbated by poor treatment compliance and lack of access to, or engagement with, appropriate services. 4

Engagement with mental health research can also be challenging. Topics may be highly sensitive or private. Individuals may have impaired capacity or be at high risk. During the research process there may be revelations of suicidal ideation or criminal activity. Hence mental health research can raise additional ethical issues. In other cases scepticism of services makes for reluctant research participants. However, if we accept the case that meaningful research can be based in subjective enquiry then qualitative methods provide a way of giving voice to participants. Qualitative methods offer an effective way of involving service-users in developing interventions for mental health problems 5 ensuring that the questions asked are meaningful to individuals. This may be particularly beneficial if participants are stakeholders, for example potential users of a new service.

Qualitative methods are valuable for individuals who have limited literacy skills who struggle with pencil and paper measures. For example qualitative research has proved fruitful in understanding children's concepts of mental illness and associated services. 6

How qualitative enquiry is used within mental health research

There are a range of types of research question where qualitative methods prove useful – from the development and testing of theory, to the piloting and establishing efficacy of treatment approaches, to understanding issues around translation and implementation into routine practice. Each is discussed in turn.

Development and testing of theory

Qualitative methods are important in exploratory work and in generating understanding of a phenomenon, stimulating new ideas or building new theory. For example, stigma is a concept that is recognised as a barrier to accessing services and also an added burden to mental health. A focus-group study sought to understand the meaning of stigma from the perspectives of individuals with schizophrenia, their relatives and health professionals. 7 From this they developed a four-dimensional theory which has subsequently informed interventions to reduce stigma and discrimination that target not only engagement with psychiatric services but also interactions with the public and work. 7

Development of tools and measures

Qualitative methods access personal accounts, capturing how individuals talk about a lived experience. This can be invaluable for designing new research tools. For example, Mavaddat and colleagues used focus groups with 56 patients with severe or common mental health problems to explore their experiences of primary care management. 8 Nine focus groups were conducted and analysis identified key themes. From these, items were generated to form a Patient Experience Questionnaire, of which the psychometric properties were subsequently examined quantitatively in a larger sample. Not only can dimensions be identified, the rich qualitative data provide terminology that is meaningful to service users that can then be incorporated into question items.

Development and testing of interventions

As we have seen, qualitative methods can inform the development of new interventions. The gold-standard methodology for investigating treatment effectiveness is the randomised controlled trial (RCT), with the principle output being an effect size or demonstration that the primary outcome was significantly improved for participants in the intervention arm compared with those in the control/comparison arm. Nevertheless, what will be familiar for researchers and clinicians involved in trials is that immense research and clinical learning arises from these substantial, often lengthy and expensive research endeavours. Qualitative methods provide a means to empirically capture these lessons, whether they are about recruitment, therapy training/supervision, treatment delivery or content. These data are essential to improve the feasibility and acceptability of further trials and developing the intervention. Conducting qualitative work prior to embarking on an RCT can inform the design, delivery and recruitment, as well as engage relevant stakeholders early in the process; all of these can prevent costly errors. Qualitative research can also be used during a trial to identify reasons for poor recruitment: in one RCT, implementing findings from this type of investigation led to an increased randomisation rate from 40% to 70%. 9

Nesting qualitative research within a trial can be viewed as taking out an insurance policy as data are generated which can later help explain negative or surprising findings. A recent trial of reattribution training for GPs to manage medically unexplained symptoms demonstrated substantial improvements in GP consultation behaviour. 10 However, effects on clinical outcomes were counterintuitive. A series of nested qualitative studies helped shed light as to why this was the case: patients' illness models were complex, and they resisted engaging with GPs (who they perceived as having more simplistic and dualistic understanding) because they were anxious it would lead to non-identification or misdiagnosis of any potential future disease 11 , an issue that can be addressed in future interventions. Even if the insights are unsurprising to those involved in the research, the data collected have been generated systematically and can be subjected to peer review and disseminated. For this reason, there is an increasing expectation from funding bodies that qualitative methodologies are integral to psychosocial intervention research.

Translation and implementation into clinical practice

Trials provide limited information about how treatments can be implemented into clinical practice or applied to another context. Psychological interventions are more effective when delivered within trial settings by experts involved in their development than when they are delivered within clinical settings. 12 Qualitative methods can help us understand how to implement research findings into routine practice. 13

Understanding what stakeholders value about a service and what barriers exist to its uptake is another evidence base to inform clinicians' practice. Relapse prevention is an effective psychoeducation approach that helps individuals with bipolar disorder extend time to relapse. Qualitative methodologies identified which aspects of the intervention service-users and care-coordinators value, and hence, are likely to utilise in routine care. 14 The intervention facilitated better understanding of bipolar disorder (by both parties), demonstrating, in turn, a rationale for medication. Patients discovered new, empowering and less socially isolated ways of managing their symptoms, which had important impacts on interactions with healthcare staff and family members. Furthermore, care-coordinators' reported how they used elements of the intervention when working with clients with other diagnoses. The research also provided insights as to where difficulties may occur when implementing a particular intervention into routine care. For example, for care-coordinators this proved a novel way of working with clients that was more emotionally demanding, thus highlighting the need for supervision and managerial support. 14

Beginners guide to qualitative approaches: one size doesn't fit all

Just as there is a range of quantitative research designs and statistical analyses to choose from, so there are many types of qualitative methods. Choosing a method can be daunting to an inexperienced or beginner-level qualitative researcher, for it requires engaging with new terms and ways of thinking about knowledge. The following summary sets out analytic and data-generation approaches that are used commonly in mental health research. It is not intended to be comprehensive and is provided only as a point of access/familiarisation to researchers less familiar with the literature.

Data generation

Qualitative data are generated in several ways. Most commonly, researchers seek a sample and conduct a series of individual in-depth interviews, seeking participants' views on topics of interest. Typically these last upwards of 45 min and are organised on the basis of a schedule of topics identified from the literature or pilot work. This does not act as a questionnaire, however; rather, it acts as a flexible framework for exploring areas of interest. The researcher combines open questions to elicit free responses, with focused questions for probing and prompting participants to provide effective responses. Usually interviews are audio-recorded and transcribed verbatim for subsequent analysis.

As interviews are held in privately, and on one-to-one basis, they provide scope to develop a trusting relationship so that participants are comfortable disclosing socially undesirable views. For example, in a study of practice nurses views of chronic fatigue syndrome, some nurses described patients as lazy or illegitimate – a view that challenges the stereotype of a nursing professional as a sympathetic and caring person. 15 This gives important information about the education and supervision required to enable or train general nurses to ensure that they are capable of delivering psychological interventions for these types of problems.

Alternatively, groups of participants are brought together for a focus group, which usually lasts for 2 hours. Although it is tempting to consider focus groups as an efficient way of acquiring data from several participants simultaneously, there are disadvantages. They are difficult to organise for geographically dispersed or busy participants, and there are compromises to confidentiality, particularly within ‘captive’ populations (eg, within an organisation individuals may be unwilling to criticise). Group dynamics must be considered; the presence of a dominant or self-professed expert can inhibit the group and, therefore, prevent useful data generation. When the subject mater is sensitive, individuals may be unwilling to discuss experiences in a group, although it often promotes a shared experience that can be empowering. Most of these problems are avoided by careful planning of the group composition and ensuring the group is conducted by a highly skilled facilitator. Lester and colleagues 16 used focus-group sessions with patients and health professionals to understand the experience of dealing with serious mental illness. Though initially participants were observed via focus-group sessions that used patient-only and health professional only groups, subsequently on combined focus groups were used that contained both patients and health professionals. 16 The primary advantage of focus groups is that they enable generation of data about how individuals discuss and interact about a phenomenon; thus, a well-conducted focus group can be an extremely rich source of data.

A different type of data are naturally occurring dialogue and behaviours. These may be recorded through observation and detailed field notes (see ethnography in Table 2 ) or analysed from audio/ video-recordings. Other data sources include texts, for example, diaries, clinical notes, Internet blogs and so on. Qualitative data can even be generated through postal surveys. We thematically analysed responses to an open-ended question set within a survey about medical educators' views of behavioural and social sciences (BSS). 17 From this, key barriers to integrating BSS within medical training were identified, which included an entrenched biomedical mindset. The themes were analysed in relation to existing literature and revealed that despite radical changes in medical training, the power of the hidden curriculum persists. 17

Key features of a range of analytical approaches used within mental health research

Analysing qualitative data

Researchers bring a wide range of analytical approaches to the data. A comprehensive and detailed discussion of the philosophy underlying different methods is beyond the scope of this paper; however, a summary of the key analytical approaches used in mental health research are provided in Table 2 . An illustrative example is provided for each approach to offer some insight into the commonalities and differences between methodologies. The procedure for analysis for all methods involves successive stages of data familiarisation/immersion, followed by seeking and reviewing patterns within the data, which may then be defined and categorized as specific themes. Researchers move back and forth between data generation and analysis, confirming or disconfirming emerging ideas. The relationship of the analysis to theory-testing or theory-building depends on the methodology used.

Some approaches are more common in healthcare than others. Interpretative phenomenological (lPA) analysis and thematic analysis have proved particularly popular. In contrast, ethnographic research requires a high level of researcher investment and reflexivity and can prove challenging for NHS ethic committees. Consequently, it remains under used in healthcare research.

Recruitment and sampling

Quantitative research is interested in identifying the typical, or average. By contrast, qualitative research aims to discover and examine the breadth of views held within a community. This includes extreme or deviant views and views that are absent. Consequently, qualitative researchers do not necessarily (though in some circumstances they may) seek to identify a representative sample. Instead, the aim may be to sample across the range of views. Hence, qualitative research can comment on what views exist and what this means, but it is not possible to infer the proportions of people from the wider population that hold a particular view.

However, sampling for a qualitative study is not any less systematic or considered. In a quantitative study one would take a statistical approach to sampling, for example, selecting a random sample or recruiting consecutive referrals, or every 10th out-patient attendee. Qualitative studies, instead, often elect to use theoretical means to identify a sample. This is often purposive; that is, the researcher uses theoretical principles to choose the attributes of included participants. Healey and colleagues conducted a study to understand the reasons for individuals with bipolar disorder misusing substances. 18 They sought to include participants who were current users of each substance group, and the recruitment strategy evolved to actively target specific cases.

Qualitative studies typically use far smaller samples than quantitative studies. The number varies depending on the richness of the data yielded and the type of analytic approach that can range from a single case to more than 100 participants. As with all research, it is unethical to recruit more participants than needed to address the question at hand; a qualitative sample should be sufficient for thematic saturation to be achieved from the data.

Ensuring that findings are valid and generalisable

A common question from individuals new to qualitative research is how can findings from a study of few participants be generalised to the wider population? In some circumstances, findings from an individual study (quantitative or qualitative) may have limited generalisability; therefore, more studies may need to be conducted, in order to build local knowledge that can then be tested or explored across similar groups. 4 However, all qualitative studies should create new insights that have theoretical or clinical relevance which enables the study to extend understanding beyond the individual participants and to the wider population. In some cases, this can lead to generation of new theory (see grounded theory in Table 2 ).

Reliability and validity are two important ways of ascertaining rigor in quantitative research. Qualitative research seeks to understand individual construction and, by definition, is subjective. It is unlikely, therefore, that a study could ever be repeated with exactly the same circumstances. Instead, qualitative research is concerned with the question of whether the findings are trustworthy; that is, if the same circumstances were to prevail, would the same conclusions would be drawn?

There are a number of ways to maximise trustworthiness. One is triangulation, of which there are three subtypes. Data triangulation involves using data from several sources (eg, interviews, documentation, observation). A research team may include members from different backgrounds (eg, psychology, psychiatry, sociology), enabling a range of perspectives to be used within the discussion and interpretation of the data. This is termed researcher triangulation . The final subtype, theoretical triangulation, requires using more than one theory to examine the research question. Another technique to establish the trustworthiness of the findings is to use respondent validation. Here, the final or interim analysis is presented to members of the population of interest to ascertain whether interpretations made are valid.

An important aspect of all qualitative studies is researcher reflexivity. Here researchers consider their role and how their experience and knowledge might influence the generation, analysis and interpretation of the data. As with all well-conducted research, a clear record of progress should be kept – to enable scrutiny of recruitment, data generation and development of analysis. However, transparency is particularly important in qualitative research as the concepts and views evolve and are refined during the process.

Judging quality in qualitative research

Within all fields of research there are better and worse ways of conducting a study, and range of quality in mental health qualitative research is variable. Many of the principles for judging quality in qualitative research are the same for judging quality in any other type of research. However, several guidelines have been developed to help readers, reviewers and editors who lack methodological expertise to feel more confident in appraising qualitative studies. Guidelines are a prerequisite for the relatively recent advance of methodologies for systematic reviewing of qualitative literature (see meta-synthesis in Table 2 ). Box 1 provides some key questions that should be considered while studying a qualitative report.

Box 1 Guidelines for authors and reviewers of qualitative research (adapted from Malterud 35 )

▶ Is the research question relevant and clearly stated?

Reflexivity

▶ Are the researcher's motives and background presented?

Method, sampling and data collection

▶ Is a qualitative method appropriate and justified?

▶ Is the sampling strategy clearly described and justified?

▶ Is the method for data generation fully described

▶ Are the characteristics of the sample sufficiently described?

Theoretical framework

▶ Was a theoretical framework used and stated?

▶ Are the principles and procedures for data organisation and analysis described and justified?

▶ Are strategies used to test the trustworthiness of the findings?

▶ Are the findings relevant to the aim of the study?

▶ Are data (e.g. quotes) used to support and enrich the findings?

▶ Are the conclusions directly linked to the study? Are you convinced?

▶ Do the findings have clinical or theoretical value?

▶ Are findings compared to appropriate theoretical and empirical literature?

▶ Are questions about the internal and external validity and reflexivity discussed?

▶ Are shortcomings of the design, and the implications these have on findings, examined?

▶ Are clinical/theoretical implications of the findings made?

Presentation

▶ Is the report understandable and clearly contextualised?

▶ Is it possible to distinguish between the voices of informants and researchers?

▶ Are sources from the field used and appropriately referenced?

Conclusions and future directions

Qualitative research has enormous potential within the field of mental health research, yet researchers are only beginning to exploit the range of methods they use at each stage of enquiry. Strengths of qualitative research primarily lie in developing theory and increasing understanding about effective implementation of treatments and how best to support clinicians and service users in managing mental health problems. An important development in the field is how to integrate methodological approaches to address questions. This raises a number of challenges, such as how to integrate textual and numerical data and how to reconcile different epistemologies. A distinction can be made between mixed- method design (eg, quantitative and qualitative data are gathered and findings combined within a single or series of studies) and mixed- model study, a pragmatist approach, whereby aspects of qualitative and quantitative research are combined at different stages during a research process. 19 Qualitative research is still often viewed as only a support function or as secondary to quantitative research; however, this situation is likely to evolve as more researchers gain a broader skill set.

Though it is undeniable that there has been a marked increase in the volume and quality of qualitative research published within the past two decades, mental health research has been surprisingly slow to develop, compared to other disciplines e.g. general practice and nursing, with relatively fewer qualitative research findings reaching mainstream psychiatric journals. 2 This does not appear to reflect overall editorial policy; however, it may be partly due to the lack of confidence on the part of editors and reviewers while identifying rigorous qualitative research data for further publication. 20 However, the skilled researcher should no longer find him or herself forced into a position of defending a single-methodology camp (quantitative vs qualitative), but should be equipped with the necessary methodological and analytical skills to study and interpret data and to appraise and interpret others' findings from a full range of methodological techniques.

• Crawford MJ ,
• Cordingley L
• Dowrick C ,
• Edwards S ,
• ↵ MRC Developing and Evaluating Complex Interventions 2008
• Nelson ML ,
• Quintana SM
• Schulze B ,
• Angermeyer MC
• Mavaddat N ,
• Lester HE ,
• Donovan J ,
• Morriss R ,
• Barkham M ,
• Stiles WB ,
• Connell J ,
• Chew-Graham C ,
• England E ,
• Kinderman P ,
• Tashakkoria A ,
• Ritchie J ,
• Ssebunnya J ,
• Chilvers R ,
• Glasman D ,
• Finlay WM ,
• Strauss A ,
• Hodges BD ,
• Dobransky K
• Dixon-Woods M ,
• Fitzpatrick R ,
• Espíndola CR ,

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• Open access
• Published: 13 December 2018

Using qualitative Health Research methods to improve patient and public involvement and engagement in research

• Danielle E. Rolfe 1 ,
• Vivian R. Ramsden 2 ,
• Davina Banner 3 &
• Ian D. Graham 1  

Research Involvement and Engagement volume  4 , Article number:  49 ( 2018 ) Cite this article

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Plain English summary

Patient engagement (or patient and public involvement) in health research is becoming a requirement for many health research funders, yet many researchers have little or no experience in engaging patients as partners as opposed to research subjects. Additionally, many patients have no experience providing input on the research design or acting as a decision-making partner on a research team. Several potential risks exist when patient engagement is done poorly, despite best intentions. Some of these risks are that: (1) patients’ involvement is merely tokenism (patients are involved but their suggestions have little influence on how research is conducted); (2) engaged patients do not represent the diversity of people affected by the research; and, (3) research outcomes lack relevance to patients’ lives and experiences.

Qualitative health research (the collection and systematic analysis of non-quantitative data about peoples’ experiences of health or illness and the healthcare system) offers several approaches that can help to mitigate these risks. Several qualitative health research methods, when done well, can help research teams to: (1) accurately incorporate patients’ perspectives and experiences into the design and conduct of research; (2) engage diverse patient perspectives; and, (3) treat patients as equal and ongoing partners on the research team.

This commentary presents several established qualitative health research methods that are relevant to patient engagement in research. The hope is that this paper will inspire readers to seek more information about qualitative health research, and consider how its established methods may help improve the quality and ethical conduct of patient engagement for health research.

Research funders in several countries have posited a new vision for research that involves patients and the public as co-applicants for the funding, and as collaborative partners in decision-making at various stages and/or throughout the research process. Patient engagement (or patient and public involvement) in health research is presented as a more democratic approach that leads to research that is relevant to the lives of the people affected by its outcomes. What is missing from the recent proliferation of resources and publications detailing the practical aspects of patient engagement is a recognition of how existing research methods can inform patient engagement initiatives. Qualitative health research, for example, has established methods of collecting and analyzing non-quantitative data about individuals’ and communities’ lived experiences with health, illness and/or the healthcare system. Included in the paradigm of qualitative health research is participatory health research, which offers approaches to partnering with individuals and communities to design and conduct research that addresses their needs and priorities.

The purpose of this commentary is to explore how qualitative health research methods can inform and support meaningful engagement with patients as partners. Specifically, this paper addresses issues of: rigour (how can patient engagement in research be done well?); representation (are the right patients being engaged?); and, reflexivity (is engagement being done in ways that are meaningful, ethical and equitable?). Various qualitative research methods are presented to increase the rigour found within patient engagement. Approaches to engage more diverse patient perspectives are presented to improve representation beyond the common practice of engaging only one or two patients. Reflexivity, or the practice of identifying and articulating how research processes and outcomes are constructed by the respective personal and professional experiences of researchers and patients, is presented to support the development of authentic, sustainable, equitable and meaningful engagement of patients as partners in health research.

Conclusions

Researchers will need to engage patients as stakeholders in order to satisfy the overlapping mandate in health policy, care and research for engaging patients as partners in decision-making. This paper presents several suggestions to ground patient engagement approaches in established research designs and methods.

Peer Review reports

Patient engagement (or patient and public involvement) in research involves partnering with ‘patients’ (a term more often used in Canada and the US, that is inclusive of individuals, caregivers, and/or members of the public) to facilitate research related to health or healthcare services. Rather than research subjects or participants, patients are engaged as partners in the research process. This partnership is intended to be meaningful and ongoing, from the outset of planning a research project, and/or at various stages throughout the research process. Engagement can include the involvement of patients in defining a research question, identifying appropriate outcomes and methods, collecting and interpreting data, and developing and delivering a knowledge translation strategy [ 1 ].

The concept of engaging non-researchers throughout the research process is not new to participatory health researchers, or integrated knowledge translation researchers, as the latter involves ongoing collaboration with clinicians, health planners and policy makers throughout the research process in order to generate new knowledge [ 2 , 3 ]. Patients, however, are less frequently included as partners on health research teams, or as knowledge users in integrated knowledge translation research teams compared to clinicians, healthcare managers and policy-makers, as these individuals are perceived as having “the authority to invoke change in the practice or policy setting.” (p.2) [ 2 ] Recent requirements for patient engagement by health research funders [ 4 , 5 , 6 ], ,and mandates by most healthcare planners and organizations to engage patients in healthcare improvement initiatives, suggest that it would be prudent for integrated knowledge translation (and indeed all) health researchers to begin engaging patients as knowledge users in many, if not all, of their research projects.

Training and tools for patient engagement are being developed and implemented in Canada via the Canadian Institutes for Health Research (CIHR) Strategy for Patient Oriented Research (SPOR) initiative, in the US via Patient Centered Outcomes Research Institute (PCORI), and very practical resources are already available from the UK’s more established INVOLVE Advisory Group [ 5 , 6 , 7 ]. What is seldom provided by these ‘get started’ guides, however, are rigorous methods and evidence-based approaches to engaging diverse patient perspectives, and ensuring that their experiences, values and advice are appropriately incorporated into the research process.

The purpose of this commentary is to stimulate readers’ further discussion and inquiry into qualitative health research methods as a means of fostering the more meaningfully engagement of patients as partners for research. Specifically, this paper will address issues of: rigour (how do we know that the interpretation of patients’ perspectives has been done well and is applicable to other patients?); representation (are multiple and diverse patient perspectives being sought?); and, reflexivity (is engagement being done ethically and equitably?). This commentary alone is insufficient to guide researchers and patient partners to use the methods presented as part of their patient engagement efforts. However, with increased understanding of these approaches and perhaps guidance from experienced qualitative health researchers, integrated knowledge translation and health researchers alike may be better prepared to engage patients in a meaningful way in research that has the potential to improve health and healthcare experiences and outcomes.

What can be learned from methods utilized in qualitative health research?

There is wide variation in researchers’ and healthcare providers’ openness to engaging patients [ 8 ]. Often, the patients that are engaged are a select group of individuals known to the research team, sometimes do not reflect the target population of the research, are involved at a consultative rather than a partnership level, and are more likely to be involved in the planning rather than the dissemination of research [ 9 , 10 , 11 ]. As a result, patient engagement can be seen as tokenistic and the antithesis of the intention of most patient engagement initiatives, which is to have patients’ diverse experiences and perspectives help to shape what and how research is done. The principles, values, and practices of qualitative health research (e.g., relativism, social equity, inductive reasoning) have rich epistemological traditions that align with the conceptual and practical spirit of patient engagement. It is beyond the scope of this commentary, however, to describe in detail the qualitative research paradigm, and readers are encouraged to gain greater knowledge of this topic via relevant courses and texts. Nevertheless, several qualitative research considerations and methods can be applied to the practice of patient engagement, and the following sections describe three of these: rigour, representation and reflexivity.

Rigour: Interpreting and incorporating patients’ experiences into the design and conduct of research

When patient engagement strategies go beyond the inclusion of a few patient partners on the research team, for example, by using focus groups, interviews, community forums, or other methods of seeking input from a broad range of patient perspectives, the diversity of patients’ experiences or perspectives may be a challenge to quickly draw conclusions from in order to make decisions about the study design. To make these decisions, members of the research team (which should include patient partners) may discuss what they heard about patients’ perspectives and suggestions, and then unsystematically incorporate these suggestions, or they may take a vote, try to achieve consensus, implement a Delphi technique [ 12 ], or use another approach designed specifically for patient engagement like the James Lind Alliance technique for priority setting [ 13 ]. Although the information gathered from patients is not data (and indeed would require ethical review to be used as such), a number of qualitative research practices designed to increase rigour can be employed to help ensure that the interpretation and incorporation of patients’ experiences and perspectives has been done systematically and could be reproduced [ 14 ]. These practices include member checking , dense description , and constant comparative analysis . To borrow key descriptors of rigour from qualitative research, these techniques improve “credibility” (i.e., accurate representations of patients’ experiences and preferences that are likely to be understood or recognized by other patients in similar situations – known in quantitative research as internal validity), and “transferability” (or the ability to apply what was found among a group of engaged patients to other patients in similar contexts – known in quantitative research as external validity) [ 15 ].

Member checking

Member checking in qualitative research involves “taking ideas back to the research participants for their confirmation” (p. 111) [ 16 ]. The objective of member checking is to ensure that a researcher’s interpretation of the data (whether a single interview with a participant, or after analyzing several interviews with participants) accurately reflects the participants’ intended meaning (in the case of a member check with a single participant about their interview), or their lived experience (in the case of sharing an overall finding about several individuals with one or more participants) [ 16 ]. For research involving patient engagement, member checking can be utilized to follow-up with patients who may have been engaged at one or only a few time points, or on an on-going basis with patient partners. A summary of what was understood and what decisions were made based on patients’ recommendations could be used to initiate this discussion and followed up with questions such as, “have I understood correctly what you intended to communicate to me?” or “do you see yourself or your experience(s) reflected in these findings or suggestions for the design of the study?”

Dense description

As with quantitative research, detailed information about qualitative research methods and study participants is needed to enable other researchers to understand the context and focus of the research and to establish how these findings relate more broadly. This helps researchers to not only potentially repeat the study, but to extend its findings to similar participants in similar contexts. Dense description provides details of the social, demographic and health profile of participants (e.g., gender, education, health conditions, etc.), as well as the setting and context of their experiences (i.e., where they live, what access to healthcare they have). In this way, dense description improves the transferability of study findings to similar individuals in similar situations [ 15 ]. To date, most studies involving patient engagement provide limited details about their engagement processes and who was engaged [ 17 ]. This omission may be done intentionally (e.g., to protect the privacy of engaged patients, particularly those with stigmatizing health conditions), or as a practical constraint such as publication word limits. Nonetheless, reporting of patient engagement using some aspects of dense description of participants (as appropriate), the ways that they were engaged, and recommendations that emanated from engaged patients can also contribute to greater transferability and understanding of how patient engagement influenced the design of a research study.

Constant comparative analysis

Constant comparative analysis is a method commonly used in grounded theory qualitative research [ 18 ]. Put simply, the understanding of a phenomenon or experience that a researcher acquires through engaging with participants is constantly redeveloped and refined based on subsequent participant interactions. This process of adapting to new information in order to make it more relevant is similar to processes used in rapid cycle evaluation during implementation research [ 19 ]. This method can be usefully adapted and applied to research involving ongoing collaboration and partnership with several engaged patient partners, and/or engagement strategies that seek the perspectives of many patients at various points in the research process. For example, if, in addition to having ongoing patient partners, a larger group of patients provides input and advice (e.g., a steering or advisory committee) at different stages in the research process, their input may result in multiple course corrections during the design and conduct of the research processes to incorporate their suggestions. These suggestions may result in refinement of earlier decisions made about study design or conduct, and as such, the research process becomes more iterative rather than linear. In this way, engaged patients and patient partners are able to provide their input and experience to improve each step of the research process from formulating an appropriate research question or objective, determining best approaches to conducting the research and sharing it with those most affected by the outcomes.

Representation: Gathering diverse perspectives to design relevant and appropriate research studies

The intention of engaging patients is to have their lived experience of health care or a health condition contribute to the optimization of a research project design [ 20 ]. Development of a meaningful and sustainable relationship with patient partners requires considerable time, a demonstrated commitment to partnership by both the patient partners and the researcher(s), resources to facilitate patient partners’ engagement, and often, an individual designated to support the development of this relationship [ 17 , 21 ]. This may lead some research teams to sustain this relationship with only one or two patients who are often previously known to the research team [ 17 ]. The limitation of this approach is that the experiences of these one or two individuals may not adequately reflect the diverse perspectives of patients that may be affected by the research or its outcomes. The notion of gaining ‘ the patient perspective’ from a single or only a few individuals has already been problematized [ 22 , 23 ]. To be sure, the engagement of a single patient is better than none at all, but the engagement of a broader and diverse population of patients should be considered to better inform the research design, and to help prevent further perpetuation of health disparities. Key issues to be considered include (1) how engagement can be made accessible to patients from diverse backgrounds, and (2) which engagement strategies (e.g., ranging from a community information forum to full partnership on the research team) are most appropriate to reach the target population [ 24 ].

Making engagement accessible

Expecting patient partner(s) to attend regular research team meetings held during working hours in a boardroom setting in a hospital, research institute or university limits the participation of many individuals. To support the participation and diversity of engaged patients, effort should be made to increase the accessibility and emotional safety of engagement initiatives [ 25 ]. A budget must be allocated for patient partners’ transportation, childcare or caregiving support, remuneration for time or time taken off work and, at the very least, covering expenses related to their engagement. Another consideration that is often made by qualitative health researchers is whether brief counselling support can be provided to patients should the sharing of their experiences result in emotional distress. There are some resources that can help with planning for costs [ 26 ], including an online cost calculator [ 27 ].

Engagement strategies

Patient partners can be coached to consider the needs and experiences of people unlike them, but there are other methods of engagement that can help to gain a more fulsome perspective of what is likely a diverse patient population that is the focus of the research study. In qualitative health research, this is known as purposeful or purposive sampling: finding people who can provide information-rich descriptions of the phenomenon under study [ 28 ]. Engagement may require different approaches (e.g., deliberative group processes, community forums, focus groups, and patient partners on the research team), at different times in the research process to reach different individuals or populations (e.g., marginalized patients, or patients or caregivers experiencing illnesses that inhibit their ability to maintain an ongoing relationship with the research team). Engagement strategies of different forms at different times may be required. For example, ongoing engagement may occur with patient partners who are members of the research team (e.g., co-applicants on a research grant), and intermittent engagement may be sought from other patients through other methods that may be more time-limited or accessible to a diverse population of patients (e.g., a one-time focus group, community forum, or ongoing online discussion) to address issues that may arise during various stages of the research or dissemination processes. The result of this approach is that patients are not only consulted or involved (one-time or low commitment methods), but are also members of the research team and have the ability to help make decisions about the research being undertaken.

Engagement can generate a wealth of information from very diverse perspectives. Each iteration of engagement may yield new information. Knowing when enough information has been gathered to make decisions with the research team (that includes patient partners) about how the research may be designed or conducted can be challenging. One approach from qualitative research that can be adapted for patient engagement initiatives is theoretical saturation [ 29 ], or “the point in analysis when…further data gathering and analysis add little new to the conceptualization, though variations can always be discovered.” (p. 263) [ 18 ]. That is, a one-time engagement strategy (e.g., a discussion with a single patient partner) may be insufficient to acquire the diverse perspectives of the individuals that will be affected by the research or its outcomes. Additional strategies (e.g., focus groups or interviews with several individuals) may be initiated until many patients identify similar issues or recommendations.

Engagement approaches should also consider: how patients are initially engaged (e.g., through known or new networks, posted notices, telephone or in-person recruitment) and whether involvement has been offered widely enough to garner multiple perspectives; how patients’ experiences are shared (e.g., community forums, formal meetings, individual or group discussions) and whether facilitation enables broad participation; and finally, how patients’ participation and experiences are incorporated into the research planning and design, with patients having equal decision-making capacity to other research team members. Several publications and tools are available that can help guide researchers who are new to processes of engaging patients in research [ 24 , 30 , 31 , 32 , 33 , 34 ], but unfortunately few address how to evaluate the effectiveness of engagement [ 35 ].

Reflexivity: Ensuring meaningful and authentic engagement

In qualitative research, reflexivity is an ongoing process of “the researcher’s scrutiny of his or her research experience, decisions, and interpretations in ways that bring the researcher into the process and allow the reader to assess how and to what extent the researcher’s interests, positions, and assumptions influenced inquiry. A reflexive stance informs how the researcher conducts his or her research, relates to the research participants, and represents them in written reports,” (p.188–189) [ 16 ]. The concept of reflexivity can be applied to research involving patient engagement by continually and explicitly considering how decisions about the research study were made. All members of the research team must consider (and perhaps discuss): (1) how patient partners are invited to participate in research planning and decision-making; (2) how their input is received relative to other team members (i.e., do their suggestions garner the same respect as researchers’ or providers’?); and, (3) whether engaged patients or patient partners feel sufficiently safe, able and respected to share their experiences, preferences and recommendations with the research team.

Ideally, reflexivity becomes a practice within the research team and may be operationalized through regular check-ins with patients and researchers about their comfort in sharing their views, and whether they feel that their views have been considered and taken onboard. Power dynamics should also be considered during patient engagement initiatives. For example, reflecting on how community forums, focus groups or interviews are to be facilitated, including a consideration of who is at the table/who is not, who speaks/who does not, whose suggestions are implemented/whose are not? Reflexivity can be practiced through informal discussions, or using methods that may allow more candid responses by engaged patients (e.g., anonymous online survey or feedback forms). At the very least, if these practices were not conducted throughout the research process, the research team (including patient partners) should endeavor to reflect upon team dynamics and consider how these may have contributed to the research design or outcomes. For example, were physicians and researchers seen as experts and patients felt less welcome or able to share their personal experiences? Were patients only engaged by telephone rather than in-person and did this influence their ability to easily engage in decision-making? Reflexive practices may be usefully supplemented by formal evaluation of the process of patient engagement from the perspective of patients and other research team members [ 36 , 37 ], and some tools are available to do this [ 35 ].

A note about language

One way to address the team dynamic between researchers, professional knowledge users (such as clinicians or health policy planners) and patients is to consider the language used to engage with patients in the planning of patient engagement strategies. That is, the term ‘patient engagement’ is a construction of an individual’s identity that exists only within the healthcare setting, and in the context of a patient-provider dynamic. This term does not consider how people make decisions about their health and healthcare within a broader context of their family, community, and culture [ 22 , 38 ]. This may be why research communities in some countries (e.g., the United Kingdom) use the term ‘patient and public involvement’. Additionally, research that involves communities defined by geography, shared experiences, cultural or ethnic identity, as is the case with participatory health research, may refer to ‘community engagement.’ Regardless of the term used, partnerships with patients, the public, or with communities need to be conceived instead as person-to-person interactions between researchers and individuals who are most affected by the research. Discussions with engaged patients should be conducted early on to determine how to best describe their role on the team or during engagement initiatives (e.g., as patient partners, community members, or people with lived experience).

Tokenism is the “difference between…the empty ritual of participation and having the real power needed to affect the outcome,” (p.2) [ 39 ]. Ongoing reflection on the power dynamic between researchers and engaged patients, a central tenet of critical qualitative health research [ 40 , 41 ], can increase the likelihood that engagement involves equitable processes and will result in meaningful engagement experiences by patients rather than tokenism [ 36 , 42 ]. Patient engagement initiatives should strive for “partnership” amongst all team members, and not just reflect a patient-clinician or researcher-subject dynamic [ 43 ]. To develop meaningful, authentic and sustainable relationships with engaged patients, methods used for participatory, action or community-based research (approaches that fall under the paradigm of qualitative inquiry) provide detailed experiential guidance [ 44 ]. For example, a realist review of community-based participatory research projects reported that gaining and maintaining trust with patient or community partners, although time-intensive, is foundational to equitable and sustainable partnerships that benefit communities and individuals [ 45 , 46 ]. Additionally, Chapter Nine of the Canadian Tri-Council Policy Statement on Research involving Humans, which has to date been applied to research involving First Nations, Inuit and, Métis Peoples in Canada [ 47 ], provides useful information and direction that can be applied to working with patient partners on research [ 48 ].

Authentic patient engagement should include their involvement at all stages of the research process [ 49 , 50 ], but this is often not the case [ 10 ]. .Since patient partners are not research subjects or participants, their engagement does not (usually) require ethics approval, and they can be engaged as partners as early as during the submission of grant applications [ 49 ]. This early engagement helps to incorporate patients’ perspectives into the proposed research before the project is wedded to particular objectives, outcomes and methods, and can also serve to allocate needed resources to support patient engagement (including remuneration for patient partners’ time). Training in research for patient partners can also support their meaningful engagement by increasing their ability to fully engage in decision-making with other members of the research team [ 51 , 52 ]. Patient partners may also thrive in co-leading the dissemination of findings to healthcare providers, researchers, patients or communities most affected by the research [ 53 ].

Patient engagement has gained increasing popularity, but many research organizations are still at the early stages of developing approaches and methods, many of which are based on experience rather than evidence. As health researchers and members of the public will increasingly need to partner for research to satisfy the overlapping mandate of patient engagement in health policy, healthcare and research, the qualitative research methods highlighted in this commentary provide some suggestions to foster rigorous, meaningful and sustained engagement initiatives while addressing broader issues of power and representation. By incorporating evidence-based methods of gathering and learning from multiple and diverse patient perspectives, we will hopefully conduct better patient engaged research, live out the democratic ideals of patient engagement, and ultimately contribute to research that is more relevant to the lives of patients; as well as, contribute to the improved delivery of healthcare services. In addition to the references provided in this paper, readers are encouraged to learn more about the meaningful engagement of patients in research from several key texts [ 54 , 55 , 56 ].

Abbreviations

Canadian Institutes for Health Research

Patient Centered Outcomes Research Institute

Strategy for Patient Oriented Research

Canadian Institutes of Health Research. Strategy for Patient-Oriented Research. 2014. http://www.cihr-irsc.gc.ca/e/documents/spor_framework-en.pdf . Accessed 27 Sep 2017.

Google Scholar  

Kothari A, Wathen CN. Integrated knowledge translation: digging deeper, moving forward. J Epidemiol Community Health. 2017;71:619–23. https://doi.org/10.1136/jech-2016-208490 .

Article   PubMed   Google Scholar  

Gagliardi AR, Berta W, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: a scoping review. Implement Sci. 2016;11:38. https://doi.org/10.1186/s13012-016-0399-1 .

Article   PubMed   PubMed Central   Google Scholar  

Canadian Institutes of Health Research. Strategy for Patient-Oriented Research - CIHR. http://www.cihr-irsc.gc.ca/e/41204.html . Accessed 20 Sep 2017.

Patient-Centered Outcomes Research Institute. Patient-Centered Outcomes Research Institute website. https://www.pcori.org/ . Accessed 20 Sep 2017.

National Institute for Health Research. INVOLVE | INVOLVE Supporting public involvement in NHS, public health and social care research. http://www.invo.org.uk/ . Accessed 27 Sep 2017.

Canadian Institutes of Health Research. SPOR SUPPORT Units - CIHR. http://www.cihr-irsc.gc.ca/e/45859.html . Accessed 27 Sep 2017.

Ocloo J, Matthews R. From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ Qual Saf. 2016;25:626–32.

Hearld KR, Hearld LR, Hall AG. Engaging patients as partners in research: factors associated with awareness, interest, and engagement as research partners. SAGE open Med. 2017;5:2050312116686709. https://doi.org/10.1177/2050312116686709.

Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, et al. Patient engagement in research: a systematic review. BMC Health Serv Res. 2014;14:89. https://doi.org/10.1186/1472-6963-14-89 .

Concannon TW, Fuster M, Saunders T, Patel K, Wong JB, Leslie LK, et al. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research. J Gen Intern Med. 2014;29:1692–701.

Oostendorp LJM, Durand M-A, Lloyd A, Elwyn G. Measuring organisational readiness for patient engagement (MORE): an international online Delphi consensus study. BMC Health Serv Res. 2015;15:61. https://doi.org/10.1186/s12913-015-0717-3 .

Boddy K, Cowan K, Gibson A, Britten N. Does funded research reflect the priorities of people living with type 1 diabetes? A secondary analysis of research questions. BMJ Open. 2017;7:e016540. https://doi.org/10.1136/bmjopen-2017-016540 .

Mays N, Pope C. Rigour and qualitative research. BMJ Br Med J. 1995;311:109–12.

Article   CAS   Google Scholar  

Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45:214–22.

Article   CAS   PubMed   Google Scholar  

Charmaz K. Constructing grounded theory : a practical guide through qualitative analysis. London: Sage Publications; 2006.

Wilson P, Mathie E, Keenan J, McNeilly E, Goodman C, Howe A, et al. ReseArch with patient and public invOlvement: a RealisT evaluation – the RAPPORT study. Heal Serv Deliv Res. 2015;3:1–176. https://doi.org/10.3310/hsdr03380 .

Corbin JM, Strauss AL, Strauss AL. Basics of qualitative research : techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications; 2008.

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;12:15. https://doi.org/10.1186/s13012-017-0550-7 .

Esmail L, Moore E. Evaluating patient and stakeholder engagement in research: moving from theory to practice. J Comp Eff Res. 2015;4:133–45. https://doi.org/10.2217/cer.14.79 .

Brett J, Staniszewska S, Mockford C, Herron-Marx S, Hughes J, Tysall C, et al. A systematic review of the impact of patient and public involvement on service users, researchers and communities. Patient. 2014;7:387–95.

Rowland P, McMillan S, McGillicuddy P, Richards J. What is “the patient perspective” in patient engagement programs? Implicit logics and parallels to feminist theories. Heal An Interdiscip J Soc Study Heal Illn Med. 2016. https://doi.org/10.1177/1363459316644494 .

Article   Google Scholar  

Martin GP. “Ordinary people only”: knowledge, representativeness, and the publics of public participation in healthcare. Sociol Health Illn. 2008;30:35–54. https://doi.org/10.1111/j.1467-9566.2007.01027.x .

Snow B, Tweedie K, Pederson A, Shrestha H, Bachmann L. Patient Engagement: Heard and valued. 2013. http://www.cfhi-fcass.ca/sf-docs/default-source/patient-engagement/awesome_workbook-fraserhealth.pdf . Accessed 24 Jan 2018.

Montesanti SR, Abelson J, Lavis JN, Dunn JR. Enabling the participation of marginalized populations: case studies from a health service organization in Ontario. Canada Health Promot Int. 2017;32(4):636–49. https://doi.org/10.1093/heapro/dav118.

The Change Foundation. Should Money Come into It? A Tool for Deciding Whether to Pay Patient- Engagement Participants. Toronto; 2015. http://www.changefoundation.ca/site/wp-content/uploads/2016/05/Should-money-come-into-it.pdf . Accessed 18 June 2018

INVOLVE. Involvement Cost Calculator | INVOLVE. http://www.invo.org.uk/resource-centre/payment-and-recognition-for-public-involvement/involvement-cost-calculator/ . Accessed 11 Oct 2017.

Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks: Sage Publications; 2002.

Kerr C, Nixon A, Wild D. Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Rev Pharmacoecon Outcomes Res. 2010;10(3):269–81. https://doi.org/10.1586/erp.10.30 .

Canadian Institutes of Health Research. CIHR’S Citizen Engagement Handbook. http://www.cihr-irsc.gc.ca/e/documents/ce_handbook_e.pdf . Accessed 18 June 2018.

Elliott J, Heesterbeek S, Lukensmeyer CJ, Slocum N. Participatory and deliberative methods toolkit how to connect with citizens: a practitioner’s manual. King Baudouin Foundation; 2005. https://www.kbs-frb.be/en/Virtual-Library/2006/294864 . Accessed 28 Sep 2017.

Robbins M, Tufte J, Hsu C. Learning to “swim” with the experts: experiences of two patient co-investigators for a project funded by the Patient-Centered Outcomes Research Institute. Perm J. 2016;20:85–8.

PubMed   PubMed Central   Google Scholar  

Gauvin F-P, Abelson J, Lavis JN. Strengthening public and patient engagement in health technology assessment in Ontario. 2014. https://www.mcmasterforum.org/docs/default-source/product-documents/evidence-briefs/public-engagement-in-health-technology-assessement-in-ontario-eb.pdf?sfvrsn=2 . Accessed 18 June 2018.

Abelson J, Montesanti S, Li K, Gauvin F-P, Martin E. Effective strategies for interactive public engagement in the development of healthcare policies and Programs. 2010; https://www.cfhi-fcass.ca/sf-docs/default-source/commissionedresearch-reports/Abelson_EN_FINAL.pdf?sfvrsn=0. . Accessed 16 Nov 2018.

Abelson J. Public and patient engagement evaluation tool (version 1.0), vol. 0; 2015. https://www.fhs.mcmaster.ca/publicandpatientengagement/ppeet_request_form.html ! Accessed 18 June 2018

Johnson DS, Bush MT, Brandzel S, Wernli KJ. The patient voice in research—evolution of a role. Res Involv Engagem. 2016;2:6. https://doi.org/10.1186/s40900-016-0020-4 .

Crocker JC, Boylan AM, Bostock J, Locock L. Is it worth it? Patient and public views on the impact of their involvement in health research and its assessment: a UK-based qualitative interview study. Health Expect. 2017;20(3):519–28. https://doi.org/10.1111/hex.12479 .

Renedo A, Marston C. Healthcare professionals’ representations of “patient and public involvement” and creation of “public participant” identities: implications for the development of inclusive and bottom-up community participation initiatives. J Community Appl Soc Psychol. 2011;21:268–80. https://doi.org/10.1002/casp.1092 .

Hahn DL, Hoffmann AE, Felzien M, LeMaster JW, Xu J, Fagnan LJ. Tokenism in patient engagement. Fam Pract. 2017;34(3):290–5. https://doi.org/10.1093/fampra/cmw097.

Hart C, Poole JM, Facey ME, Parsons JA. Holding firm: power, push-Back, and opportunities in navigating the liminal space of critical qualitative Health Research. Qual Health Res. 2017;27:1765–74. https://doi.org/10.1177/1049732317715631 .

Eakin JM. Educating critical qualitative health researchers in the land of the randomized controlled trial. Qual Inq. 2016;22:107–18. https://doi.org/10.1177/1077800415617207 .

Safo S, Cunningham C, Beckman A, Haughton L, Starrels JL. “A place at the table:” a qualitative analysis of community board members’ experiences with academic HIV/AIDS research. BMC Med Res Methodol. 2016;16:80. https://doi.org/10.1186/s12874-016-0181-8 .

Thompson J, Bissell P, Cooper C, Armitage CJ, Barber R, Walker S, et al. Credibility and the “professionalized” lay expert: reflections on the dilemmas and opportunities of public involvement in health research. Heal Interdiscip J Soc Study Heal Illn Med. 2012;16:602–18. https://doi.org/10.1177/1363459312441008 .

Burke JG, Jones J, Yonas M, Guizzetti L, Virata MC, Costlow M, et al. PCOR, CER, and CBPR: alphabet soup or complementary fields of Health Research? Clin Transl Sci. 2013;6:493–6. https://doi.org/10.1111/cts.12064 .

Jagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T, Wong G, et al. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health. 2015;15:725. https://doi.org/10.1186/s12889-015-1949-1 .

Jagosh J, Macaulay AC, Pluye P, Salsberg J, Bush PL, Henderson J, et al. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90:311–46. https://doi.org/10.1111/j.1468-0009.2012.00665.x .

Government of Canada IAP on RE. TCPS 2 - Chapter 9 Research Involving the First Nations, Inuit and Métis Peoples of Canada. http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/chapter9-chapitre9/ . Accessed 16 Oct 2017.

Ramsden VR, Crowe J, Rabbitskin N, Rolfe D, Macaulay A. Authentic engagement, co-creation and action research. In: Goodyear-smith F, Mash B, editors. How to do primary care research. Boca Raton: CRC press, medicine, Taylor & Francis Group; 2019.

Ramsden VR, Salsberg J, Herbert CP, Westfall JM, LeMaster J, Macaulay AC. Patient- and community-oriented research: how is authentic engagement identified in grant applications? Can Fam Physician. 2017;63:74–6.

Woolf SH, Zimmerman E, Haley A, Krist AH. Authentic engagement of patients and communities can transform research, practice, and policy. Health Aff. 2016;35:590–4.

Parkes JH, Pyer M, Wray P, Taylor J. Partners in projects: preparing for public involvement in health and social care research. Health Policy. 2014;117:399–408. https://doi.org/10.1016/j.healthpol.2014.04.014 .

Norman N, Bennett C, Cowart S, Felzien M, Flores M, Flores R, et al. Boot camp translation: a method for building a community of solution. J Am Board Fam Med. 2013;26:254–63. https://doi.org/10.3122/jabfm.2013.03.120253 .

Ramsden VR, Rabbitskin N, Westfall JM, Felzien M, Braden J, Sand J. Is knowledge translation without patient or community engagement flawed. Fam Pract. 2016:1–3.

Denzin NK, Lincoln YS. SAGE Handbook of qualitative research. 3rd ed. Thousand Oaks: Sage Publications; 2005.

Pearce V, Baraitser P, Smith G, Greenhalgh T. Experience-based co-design. In: User involvement in health care. Oxford: Wiley-Blackwell; 2010. p. 28–51. https://doi.org/10.1002/9781444325164.ch3 .

Chapter   Google Scholar  

Hulatt I, Lowes L. Involving service users in health and social care research: Routledge; 2005. https://doi.org/10.4324/9780203865651.

Book   Google Scholar  

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Acknowledgements

This paper was drafted in response to a call for concept papers related to integrated knowledge translation issued by the Integrated Knowledge Translation Research Network (CIHR FDN #143237).

This paper was commissioned by the Integrated Knowledge Translation Network (IKTRN). The IKTRN brings together knowledge users and researchers to advance the science and practice of integrated knowledge translation and train the next generation of integrated knowledge translation researchers. Honorariums were provided for completed papers. The IKTRN is funded by a Canadian Institutes of Health Research Foundation Grant (FDN #143247).

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Rolfe, D.E., Ramsden, V.R., Banner, D. et al. Using qualitative Health Research methods to improve patient and public involvement and engagement in research. Res Involv Engagem 4 , 49 (2018). https://doi.org/10.1186/s40900-018-0129-8

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DOI : https://doi.org/10.1186/s40900-018-0129-8

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Qualitative Research

• What is Qualitative Research
• PEO for Qualitative Questions
• SPIDER for Mixed Methods Qualitative Research Questions
• Finding Qualitative Research Articles
• Critical Appraisal of Qualitative Research Articles
• Mixed Methods Research
• Qualitative Synthesis

PEO: Answering a Qualitative Question

PEO is an acronym that can help you create a search strategy for finding research to answer a qualitative research question.

• Patient, Population or Problem you are investigating
• Exposure to an illness, a risk factor, screening, rehabilitation service, etc.
• Outcome or themes include experiences, attitudes, feelings, improvement in condition, mobility, responsiveness to treatment, care, quality of life or daily living.

Example of PEO in Action

FINAL BOOLEAN SEARCH:

(Acute care OR acute setting OR hospital* OR inpatient* OR ward*) AND (Nurs* OR professional* OR practitioner* OR staff OR personnel) AND (Dementia OR alzheimer*) AND ( Attitude* OR opinion* OR perception* OR perspective* OR belief*)

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83 Qualitative Research Questions & Examples

Qualitative research questions help you understand consumer sentiment. They’re strategically designed to show organizations how and why people feel the way they do about a brand, product, or service. It looks beyond the numbers and is one of the most telling types of market research a company can do.

The UK Data Service describes this perfectly, saying, “The value of qualitative research is that it gives a voice to the lived experience .”

Read on to see seven use cases and 83 qualitative research questions, with the added bonus of examples that show how to get similar insights faster with Similarweb Research Intelligence.

What is a qualitative research question?

A qualitative research question explores a topic in-depth, aiming to better understand the subject through interviews, observations, and other non-numerical data. Qualitative research questions are open-ended, helping to uncover a target audience’s opinions, beliefs, and motivations.

How to choose qualitative research questions?

Choosing the right qualitative research questions can be incremental to the success of your research and the findings you uncover. Here’s my six-step process for choosing the best qualitative research questions.

• Start by understanding the purpose of your research. What do you want to learn? What outcome are you hoping to achieve?
• Consider who you are researching. What are their experiences, attitudes, and beliefs? How can you best capture these in your research questions ?
• Keep your questions open-ended . Qualitative research questions should not be too narrow or too broad. Aim to ask specific questions to provide meaningful answers but broad enough to allow for exploration.
• Balance your research questions. You don’t want all of your questions to be the same type. Aim to mix up your questions to get a variety of answers.
• Ensure your research questions are ethical and free from bias. Always have a second (and third) person check for unconscious bias.
• Consider the language you use. Your questions should be written in a way that is clear and easy to understand. Avoid using jargon , acronyms, or overly technical language.

Types of qualitative research questions

For a question to be considered qualitative, it usually needs to be open-ended. However, as I’ll explain, there can sometimes be a slight cross-over between quantitative and qualitative research questions.

Open-ended questions

These allow for a wide range of responses and can be formatted with multiple-choice answers or a free-text box to collect additional details. The next two types of qualitative questions are considered open questions, but each has its own style and purpose.

• Probing questions are used to delve deeper into a respondent’s thoughts, such as “Can you tell me more about why you feel that way?”
• Comparative questions ask people to compare two or more items, such as “Which product do you prefer and why?” These qualitative questions are highly useful for understanding brand awareness , competitive analysis , and more.

Closed-ended questions

These ask respondents to choose from a predetermined set of responses, such as “On a scale of 1-5, how satisfied are you with the new product?” While they’re traditionally quantitative, adding a free text box that asks for extra comments into why a specific rating was chosen will provide qualitative insights alongside their respective quantitative research question responses.

• Ranking questions get people to rank items in order of preference, such as “Please rank these products in terms of quality.” They’re advantageous in many scenarios, like product development, competitive analysis, and brand awareness.
• Likert scale questions ask people to rate items on a scale, such as “On a scale of 1-5, how satisfied are you with the new product?” Ideal for placement on websites and emails to gather quick, snappy feedback.

Qualitative research question examples

There are many applications of qualitative research and lots of ways you can put your findings to work for the success of your business. Here’s a summary of the most common use cases for qualitative questions and examples to ask.

Qualitative questions for identifying customer needs and motivations

These types of questions help you find out why customers choose products or services and what they are looking for when making a purchase.

• What factors do you consider when deciding to buy a product?
• What would make you choose one product or service over another?
• What are the most important elements of a product that you would buy?
• What features do you look for when purchasing a product?
• What qualities do you look for in a company’s products?
• Do you prefer localized or global brands when making a purchase?
• How do you determine the value of a product?
• What do you think is the most important factor when choosing a product?
• How do you decide if a product or service is worth the money?
• Do you have any specific expectations when purchasing a product?
• Do you prefer to purchase products or services online or in person?
• What kind of customer service do you expect when buying a product?
• How do you decide when it is time to switch to a different product?
• Where do you research products before you decide to buy?
• What do you think is the most important customer value when making a purchase?

Qualitative research questions to enhance customer experience

Use these questions to reveal insights into how customers interact with a company’s products or services and how those experiences can be improved.

• What aspects of our product or service do customers find most valuable?
• How do customers perceive our customer service?
• What factors are most important to customers when purchasing?
• What do customers think of our brand?
• What do customers think of our current marketing efforts?
• How do customers feel about the features and benefits of our product?
• How do customers feel about the price of our product or service?
• How could we improve the customer experience?
• What do customers think of our website or app?
• What do customers think of our customer support?
• What could we do to make our product or service easier to use?
• What do customers think of our competitors?
• What is your preferred way to access our site?
• How do customers feel about our delivery/shipping times?
• What do customers think of our loyalty programs?

Qualitative research question example for customer experience

• ‍♀️ Question: What is your preferred way to access our site?
• Insight sought: How mobile-dominant are consumers? Should you invest more in mobile optimization or mobile marketing?
• Challenges with traditional qualitative research methods: While using this type of question is ideal if you have a large database to survey when placed on a site or sent to a limited customer list, it only gives you a point-in-time perspective from a limited group of people.
• A new approach: You can get better, broader insights quicker with Similarweb Digital Research Intelligence. To fully inform your research, you need to know preferences at the industry or market level.
• ⏰ Time to insight: 30 seconds
• ✅ How it’s done: Similarweb offers multiple ways to answer this question without going through a lengthy qualitative research process. 

First, I’m going to do a website market analysis of the banking credit and lending market in the finance sector to get a clearer picture of industry benchmarks.

Here, I can view device preferences across any industry or market instantly. It shows me the device distribution for any country across any period. This clearly answers the question of how mobile dominate my target audience is , with 59.79% opting to access site via a desktop vs. 40.21% via mobile

I then use the trends section to show me the exact split between mobile and web traffic for each key player in my space. Let’s say I’m about to embark on a competitive campaign that targets customers of Chase and Bank of America ; I can see both their audiences are highly desktop dominant compared with others in their space .

Qualitative question examples for developing new products or services

Research questions like this can help you understand customer pain points and give you insights to develop products that meet those needs.

• What is the primary reason you would choose to purchase a product from our company?
• How do you currently use products or services that are similar to ours?
• Is there anything that could be improved with products currently on the market?
• What features would you like to see added to our products?
• How do you prefer to contact a customer service team?
• What do you think sets our company apart from our competitors?
• What other product or service offerings would like to see us offer?
• What type of information would help you make decisions about buying a product?
• What type of advertising methods are most effective in getting your attention?
• What is the biggest deterrent to purchasing products from us?

Qualitative research question example for service development

• ‍♀️ Question: What type of advertising methods are most effective in getting your attention?
• Insight sought: The marketing channels and/or content that performs best with a target audience .
• Challenges with traditional qualitative research methods: When using qualitative research surveys to answer questions like this, the sample size is limited, and bias could be at play.
• A better approach: The most authentic insights come from viewing real actions and results that take place in the digital world. No questions or answers are needed to uncover this intel, and the information you seek is readily available in less than a minute.
• ⏰ Time to insight: 5 minutes
• ✅ How it’s done: There are a few ways to approach this. You can either take an industry-wide perspective or hone in on specific competitors to unpack their individual successes. Here, I’ll quickly show a snapshot with a whole market perspective.

Using the market analysis element of Similarweb Digital Intelligence, I select my industry or market, which I’ve kept as banking and credit. A quick click into marketing channels shows me which channels drive the highest traffic in my market. Taking direct traffic out of the equation, for now, I can see that referrals and organic traffic are the two highest-performing channels in this market.

Similarweb allows me to view the specific referral partners and pages across these channels. 

Looking closely at referrals in this market, I’ve chosen chase.com and its five closest rivals . I select referrals in the channel traffic element of marketing channels. I see that Capital One is a clear winner, gaining almost 25 million visits due to referral partnerships.

Next, I get to see exactly who is referring traffic to Capital One and the total traffic share for each referrer. I can see the growth as a percentage and how that has changed, along with an engagement score that rates the average engagement level of that audience segment. This is particularly useful when deciding on which new referral partnerships to pursue.  

Once I’ve identified the channels and campaigns that yield the best results, I can then use Similarweb to dive into the various ad creatives and content that have the greatest impact.

These ads are just a few of those listed in the creatives section from my competitive website analysis of Capital One. You can filter this list by the specific campaign, publishers, and ad networks to view those that matter to you most. You can also discover video ad creatives in the same place too.

In just five minutes ⏰ 

• I’ve captured audience loyalty statistics across my market
• Spotted the most competitive players
• Identified the marketing channels my audience is most responsive to
• I know which content and campaigns are driving the highest traffic volume
• I’ve created a target list for new referral partners and have been able to prioritize this based on results and engagement figures from my rivals
• I can see the types of creatives that my target audience is responding to, giving me ideas for ways to generate effective copy for future campaigns

Qualitative questions to determine pricing strategies

Companies need to make sure pricing stays relevant and competitive. Use these questions to determine customer perceptions on pricing and develop pricing strategies to maximize profits and reduce churn.

• How do you feel about our pricing structure?
• How does our pricing compare to other similar products?
• What value do you feel you get from our pricing?
• How could we make our pricing more attractive?
• What would be an ideal price for our product?
• Which features of our product that you would like to see priced differently?
• What discounts or deals would you like to see us offer?
• How do you feel about the amount you have to pay for our product?

Get Faster Answers to Qualitative Research Questions with Similarweb Today

Qualitative research question example for determining pricing strategies.

• ‍♀️ Question: What discounts or deals would you like to see us offer?
• Insight sought: The promotions or campaigns that resonate with your target audience.
• Challenges with traditional qualitative research methods: Consumers don’t always recall the types of ads or campaigns they respond to. Over time, their needs and habits change. Your sample size is limited to those you ask, leaving a huge pool of unknowns at play.
• A better approach: While qualitative insights are good to know, you get the most accurate picture of the highest-performing promotion and campaigns by looking at data collected directly from the web. These analytics are real-world, real-time, and based on the collective actions of many, instead of the limited survey group you approach. By getting a complete picture across an entire market, your decisions are better informed and more aligned with current market trends and behaviors.
• ✅ How it’s done: Similarweb’s Popular Pages feature shows the content, products, campaigns, and pages with the highest growth for any website. So, if you’re trying to unpack the successes of others in your space and find out what content resonates with a target audience, there’s a far quicker way to get answers to these questions with Similarweb.

Here, I’m using Capital One as an example site. I can see trending pages on their site showing the largest increase in page views. Other filters include campaign, best-performing, and new–each of which shows you page URLs, share of traffic, and growth as a percentage. This page is particularly useful for staying on top of trending topics , campaigns, and new content being pushed out in a market by key competitors.

Qualitative research questions for product development teams

It’s vital to stay in touch with changing consumer needs. These questions can also be used for new product or service development, but this time, it’s from the perspective of a product manager or development team. 

• What are customers’ primary needs and wants for this product?
• What do customers think of our current product offerings?
• What is the most important feature or benefit of our product?
• How can we improve our product to meet customers’ needs better?
• What do customers like or dislike about our competitors’ products?
• What do customers look for when deciding between our product and a competitor’s?
• How have customer needs and wants for this product changed over time?
• What motivates customers to purchase this product?
• What is the most important thing customers want from this product?
• What features or benefits are most important when selecting a product?
• What do customers perceive to be our product’s pros and cons?
• What would make customers switch from a competitor’s product to ours?
• How do customers perceive our product in comparison to similar products?
• What do customers think of our pricing and value proposition?
• What do customers think of our product’s design, usability, and aesthetics?

Qualitative questions examples to understand customer segments

Market segmentation seeks to create groups of consumers with shared characteristics. Use these questions to learn more about different customer segments and how to target them with tailored messaging.

• What motivates customers to make a purchase?
• How do customers perceive our brand in comparison to our competitors?
• How do customers feel about our product quality?
• How do customers define quality in our products?
• What factors influence customers’ purchasing decisions ?
• What are the most important aspects of customer service?
• What do customers think of our customer service?
• What do customers think of our pricing?
• How do customers rate our product offerings?
• How do customers prefer to make purchases (online, in-store, etc.)?

Qualitative research question example for understanding customer segments

• ‍♀️ Question: Which social media channels are you most active on?
• Insight sought: Formulate a social media strategy . Specifically, the social media channels most likely to succeed with a target audience.
• Challenges with traditional qualitative research methods: Qualitative research question responses are limited to those you ask, giving you a limited sample size. Questions like this are usually at risk of some bias, and this may not be reflective of real-world actions.
• A better approach: Get a complete picture of social media preferences for an entire market or specific audience belonging to rival firms. Insights are available in real-time, and are based on the actions of many, not a select group of participants. Data is readily available, easy to understand, and expandable at a moment’s notice.
• ✅ How it’s done: Using Similarweb’s website analysis feature, you can get a clear breakdown of social media stats for your audience using the marketing channels element. It shows the percentage of visits from each channel to your site, respective growth, and specific referral pages by each platform. All data is expandable, meaning you can select any platform, period, and region to drill down and get more accurate intel, instantly.

This example shows me Bank of America’s social media distribution, with YouTube , Linkedin , and Facebook taking the top three spots, and accounting for almost 80% of traffic being driven from social media.

When doing any type of market research, it’s important to benchmark performance against industry averages and perform a social media competitive analysis to verify rival performance across the same channels.

Qualitative questions to inform competitive analysis

Organizations must assess market sentiment toward other players to compete and beat rival firms. Whether you want to increase market share , challenge industry leaders , or reduce churn, understanding how people view you vs. the competition is key.

• What is the overall perception of our competitors’ product offerings in the market?
• What attributes do our competitors prioritize in their customer experience?
• What strategies do our competitors use to differentiate their products from ours?
• How do our competitors position their products in relation to ours?
• How do our competitors’ pricing models compare to ours?
• What do consumers think of our competitors’ product quality?
• What do consumers think of our competitors’ customer service?
• What are the key drivers of purchase decisions in our market?
• What is the impact of our competitors’ marketing campaigns on our market share ? 10. How do our competitors leverage social media to promote their products?

Qualitative research question example for competitive analysis

• ‍♀️ Question: What other companies do you shop with for x?
• Insight sought: W ho are your competitors? Which of your rival’s sites do your customers visit? How loyal are consumers in your market?
• Challenges with traditional qualitative research methods:  Sample size is limited, and customers could be unwilling to reveal which competitors they shop with, or how often they around. Where finances are involved, people can act with reluctance or bias, and be unwilling to reveal other suppliers they do business with.
• A better approach: Get a complete picture of your audience’s loyalty, see who else they shop with, and how many other sites they visit in your competitive group. Find out the size of the untapped opportunity and which players are doing a better job at attracting unique visitors – without having to ask people to reveal their preferences.
• ✅ How it’s done: Similarweb website analysis shows you the competitive sites your audience visits, giving you access to data that shows cross-visitation habits, audience loyalty, and untapped potential in a matter of minutes.

Using the audience interests element of Similarweb website analysis, you can view the cross-browsing behaviors of a website’s audience instantly. You can see a matrix that shows the percentage of visitors on a target site and any rival site they may have visited.

With the Similarweb audience overlap feature, view the cross-visitation habits of an audience across specific websites. In this example, I chose chase.com and its four closest competitors to review. For each intersection, you see the number of unique visitors and the overall proportion of each site’s audience it represents. It also shows the volume of unreached potential visitors.

Here, you can see a direct comparison of the audience loyalty represented in a bar graph. It shows a breakdown of each site’s audience based on how many other sites they have visited. Those sites with the highest loyalty show fewer additional sites visited.

From the perspective of chase.com, I can see 47% of their visitors do not visit rival sites. 33% of their audience visited 1 or more sites in this group, 14% visited 2 or more sites, 4% visited 3 or more sites, and just 0.8% viewed all sites in this comparison. 

How to answer qualitative research questions with Similarweb

Similarweb Research Intelligence drastically improves market research efficiency and time to insight. Both of these can impact the bottom line and the pace at which organizations can adapt and flex when markets shift, and rivals change tactics.

Outdated practices, while still useful, take time . And with a quicker, more efficient way to garner similar insights, opting for the fast lane puts you at a competitive advantage.

With a birds-eye view of the actions and behaviors of companies and consumers across a market , you can answer certain research questions without the need to plan, do, and review extensive qualitative market research .

Wrapping up

Qualitative research methods have been around for centuries. From designing the questions to finding the best distribution channels, collecting and analyzing findings takes time to get the insights you need. Similarweb Digital Research Intelligence drastically improves efficiency and time to insight. Both of which impact the bottom line and the pace at which organizations can adapt and flex when markets shift.

Similarweb’s suite of digital intelligence solutions offers unbiased, accurate, honest insights you can trust for analyzing any industry, market, or audience.

• Methodologies used for data collection are robust, transparent, and trustworthy.
• Clear presentation of data via an easy-to-use, intuitive platform.
• It updates dynamically–giving you the freshest data about an industry or market.
• Data is available via an API – so you can plug into platforms like Tableau or PowerBI to streamline your analyses.
• Filter and refine results according to your needs.

Are quantitative or qualitative research questions best?

Both have their place and purpose in market research. Qualitative research questions seek to provide details, whereas quantitative market research gives you numerical statistics that are easier and quicker to analyze. You get more flexibility with qualitative questions, and they’re non-directional.

What are the advantages of qualitative research?

Qualitative research is advantageous because it allows researchers to better understand their subject matter by exploring people’s attitudes, behaviors, and motivations in a particular context. It also allows researchers to uncover new insights that may not have been discovered with quantitative research methods.

What are some of the challenges of qualitative research?

Qualitative research can be time-consuming and costly, typically involving in-depth interviews and focus groups. Additionally, there are challenges associated with the reliability and validity of the collected data, as there is no universal standard for interpreting the results.

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25 Qualitative market research questions (and how to write your own)

25 examples of qualitative research questions, how to write your own insightful qualitative market research questions, ask the right qualitative market research questions to the correct audience.

There’s something very satisfying about being asked a great question that really gets you thinking. And in qualitative market research, it’s especially valuable.

If you ask the right person the right question, you’ll be able to uncover next steps — both small ones and big leaps — that will lead you to a better brand.

If you approach qualitative research right, you can get rich and valuable insights into your customers’ behaviors, and how to play into them.

You’ll learn about how customers interact, their motivations, and how to be there when they need you. And, you’ll uncover things about your brand that are difficult to find out from the inside.

We’re about to show you 25 qualitative research questions across six categories, that will allow you to take a deep dive into your target customers’ brain. These research questions are perfect to use in focus groups or with Attest’s Video Responses feature .

Qualitative research questions come in all shapes and sizes. We’ve split them up in several categories to inspire you to mix it up in your next survey or interview and make them work for your choice of qualitative research question types and methods.

Descriptive qualitative research questions

Descriptive questions are effective qualitative research questions that allow participants to describe experiences, opinions and more.

• Describe how this product/service has changed the way you approach [specific task/activity]. This question digs into the tangible impacts of your product on daily life, revealing how it reshapes routines or approaches to tasks.It’s a great way to highlight the practical value and possibly discover unexpected benefits that your product brings to the table.
• If you were to introduce this product/service to a friend, what would you say? Asking this encourages users to put their experience into their words, almost like a personal pitch. It’s a fun and low barrier approach to find out what stands out to them and what they value most about your offering.
• What three words would you use to describe this product/service after your first use? If you’re looking for immediate, instinctive reactions, qualitative research questions like these work best.They allow the user to give a quick snapshot and not have to think long and hard about an answer. Encourage them to respond with the first thing that comes to mind — no wrong answers.
• What aspect of this product/service do you think is underrated? This seeks to uncover hidden gems within your product that may not be getting the spotlight they deserve — even internally.It’s a clever way to find out about features or benefits that might be flying under the radar but have the potential to be major selling points.

Understand the nuance from in your audience’s behaviors

Getting that nuance through qual research will help you explain thy why to your quant ‘whats’, and give you much-needed inspiration during ideation

Comparative qualitative research questions

Using comparative qualitative research questions you can invite respondents to talk about your brand, product or services in comparison to others. It can help you understand the differences between you and your competitors, from your consumers’ perspective.

These qualitative research questions are a great addition to numbers, scores and other numerical data derived from quantitative research questions in a quantitative study.

• What differences do you notice between this brand and its competitors in terms of value provided? This question invites customers to think critically about the unique advantages or shortcomings of your product compared to the competition.It’s insightful because it can highlight what customers value most about your brand and whether you are doubling down on the right USPs according to them.
• In what situation would you prefer this competitors’ product/service over ours? Asking this might seem a bit daring, but it’s a golden opportunity to gain honest feedback on where your product may fall short for certain users or use cases.Research questions like this can uncover specific features, price points, or scenarios where competitors have an edge, offering you clear directions for strategic improvements or innovations.
• How does the ease of use of this product/service compare to others you have used in the past? This question zeros in on usability, a crucial aspect of customer satisfaction. It offers direct feedback on how user-friendly your product is compared to others, highlighting areas where you excel or need improvement.
• When choosing between this product/service and others, what factor weighs most heavily on your decision? Understanding the key factors that influence choice can help you fine-tune your offerings and marketing messages to better meet customer needs and preferences.If you look at the answers and compare the marketing efforts of your own brand and main competitors, you’ll be able to spot where you could make improvements.
• Can you identify a feature in a competing product/service that you wish ours had? Sometimes asking what feature they’d love is tricky: it might be hard to dream up. But if you give users the opportunity to shop from your competitors’ features, it might be easier.Qualitative research questions like these are therefore a smart and straightforward way to identify gaps in your product from a user perspective.

Exploratory qualitative research questions

Exploratory qualitative research questions are used in qualitative methods to tap into potential opportunities, and uncover insights that haven’t been previously considered. Add these research questions to your qualitative research studies if you’re on the hunt for new ideas.

• What challenges are you currently facing that this product/service does not address? This question is a gem in qualitative studies because it shines a light on the gaps between what your product offers and what your users actually need.By understanding these challenges, you’re not just guessing; you’re directly addressing the needs that matter most to your users, making every feature more aligned with their real-world problems.
• If you could add any premium features to this product/service, big or small, while the price remains the same, what would it be? Research questions like these open up a playground for users’ imaginations, allowing you to peek into their deepest wishes.It’s a creative way to use qualitative research to uncover independent variables (new features) that could make your product indispensable.
• What would make you stop using this product/service tomorrow? This one might sound a bit scary, but it’s crucial. It helps you pinpoint the deal breakers that could push your users away.Think of it as a preventive measure; by understanding these thresholds, you can steer clear of them in your future updates or service improvements. This question is a cornerstone in crafting a research design that seeks to minimize risks and maximize satisfaction.
• What’s a feature you never knew you needed until you started using this product/service? These insights are gold for marketing and product development, revealing the unexpected delights that can turn casual users into loyal fans.Plus, it’s a great way to highlight the qualitative words or phrases that resonate most with your audience, giving you a direct line to what makes your product stand out.
• If this product/service no longer existed, what would be the biggest gap in your routine or activities? This qualitative question helps to understand the role your product plays in users’ lives, emphasizing its importance and potential areas for highlighting in marketing efforts.Knowing what would replace you also tells you a great deal about the value your product offers.

Experience-based qualitative research questions

These qualitative research questions focus on the personal experiences of your users, and try to understand their journey and interactions with the product or service deeply.

• Describe a situation where this product/service met or exceeded your expectations. The feedback from this research question can reveal the “wow” factors that differentiate your offering in the market. It’s a great way to identify the elements of your product or service that surprise and delight customers.These qualitative questions will also highlight the specific words they use for this will also be great to fine-tune your communications and choice of words. You might be describing the right benefits already, but maybe not in the words they relate to most.
• What’s missing from your experience with this product/service? This research question is a direct line to understanding your customers’ unmet needs and desires. It encourages them to share their thoughts on how your product or service could be more useful, enjoyable, or relevant to their lives.
• What was your initial impression of this product/service, and how has it evolved? A classic, but nonetheless a valuable qualitative research question. If peoples’ experiences with your product change their impression of it over time, it’s crucial you dig into what those experiences are, to better match your marketing to the real world.Especially if impressions tend to take a more negative turn after some experiences, but also when it’s the other way around — don’t undersell your product!

Behavioral qualitative research questions

Behavioral qualitative research questions seek to understand the actions and behaviors of consumers, particularly in relation to your product or service. Adding these to your qualitative study will make it more relevant to daily life applications.

• Have you been using products/services like ours in ways that you didn’t think you would initially? This is a good qualitative research question to learn about unconventional or alternative use cases of your product. Of course, it doesn’t mean you immediately need to pivot, but it can help you map out uncharted or ignored territory and find fans in niche parts of your market.
• Has this product/service replaced something else you used to rely on? If so, what? We’re going there: ask about the ”ex”. Knowing who or what came before you and why things didn’t work out will help you be better in many ways. So, make sure to follow up this question with another one digging into the reasons for the break-up.
• What activity or task do you most frequently pair with this product/service? This might not seem immediately relevant, but it can tell you a great deal about your customer’s behavior. Knowing what place you have in their routine or what products they combine yours with can help you uncover big possibilities for innovations or even partnerships.
• How has this product/service influenced your daily habits or routines? This question doesn’t just focus on the functional benefits of your product, but also how those manifest in someone’s daily life. Do people highlight time they won back, or pleasure gained? Have they made any other changes that are relevant to you? There’s a lot to learn from small habit changes!

Emotional qualitative research questions

These qualitative questions explore the emotional connections and reactions participants have towards a particular topic, product, service, or brand. The qualitative questions examples below specifically bring a human side to quantitative research.

• How does this product/service fit into the moments that matter most to you? This might not be interesting for every product or brand, but if your brand is aiming to significantly impact people’s lives and important moments, this is a must-ask. Are they taking your products along to big moments in their lives? Does it provide them with comfort, confidence or something else when they need it? Research questions like this go way beyond functionality and tap into emotional significance — which is great for brands who really want to integrate with people’s lives.
• How does using this product/service make you feel compared to not using it at all? Are people frustrated when they run out of your product? Sad? Do they miss it at all? This question can reveal some powerful feelings around your product.
• How does this product/service affect your mood? This is a fun question to ask and can give you a great insight into what emotions your product evokes in general. Maybe some people don’t think about how they feel with your product, but others might get a confidence boost out of it, or chuckle every time they read your product copy. This question can reveal teeny tiny details that could matter a lot.

How this team aced their pitch with qual insights

Qual research helped Barrows understand glasses wearers’ pain points and wow a prospective client.

Got a burning question? Here’s how to make it part of a successful qualitative research project.

1. Set clear objectives

Knowing why you’re asking something is what helps you ask it the right way. Ask yourself what your general research objective is and how each of your qualitative research questions helps you get to the main answer.

For every qualitative research question you ask, find out IF it leads you closer to your goals, and make sure you can explain HOW it does so.

2. Ask open-ended questions the right way

There’s an art in asking great open-ended questions. Here’s an example of both seemingly similar open-ended, qualitative research questions, but one’s good, and one’s not:

“Why do you think people say this new smartwatch is better than others on the market?”

“What feedback are you hearing about this smartwatch in comparison to other smartwatches you know?”

The first one already works with the assumption and bias that your product is great. You’re practically putting words into your respondent’s mouth/answer box. The next one lets them come up with their own, unbiased response.

Good qualitative research questions should be:

• Unbiased: avoid qualitative research questions that are leading or show any form of bias whatsoever.
• Clear: only ask one thing at a time, and make it clear what that actually is.
• Relevant: make sure your question makes sense. Not just in the whole qualitative research, but also in the place it has in your survey or interview.
• Truly open: some quantitative research questions are sometimes disguised as qualitative research questions. Make sure yours is truly open and qualitative.

If you tick these boxes, your respondents will feel encouraged to express their opinions and motivations freely, which in turn will add depth and context to your research findings.

3. Balance between structured questions and flexibility

Let’s talk about flow. Imagine the panic that would set in if your first question in a job interview would be ”and how do you tackle problems with coworkers?”

Timing matters. Mixing up the question matters. This will create a great flow and keep respondents engaged and enthusiastic, and will avoid confusion.

Make sure to give respondents space to add comments or feedback where needed, but do so in a structured way, so your data remains easy to analyze.

4. Take measures to avoid survey bias

We’re circling back to bias for a second, but just because there’s more to be said and done. Avoiding bias in your surveys and qualitative research questions isn’t just about avoiding certain words or biased language, it also helps to choose a well-mixed and representative audience. On top of that, make sure your survey churns out high-quality data, not just high-volume. Read more about how we work on keeping your data in great shape.

5. Conduct pilot testing before launching large surveys

Do a mic-check before you send your qualitative research survey out to thousands of people. With pilot testing, you make sure your survey’s research questions are as-to-the-point as you hoped it to be. Send it to a small slice of your total audience, but make sure that the pilot group is just as representative as the total one will be.

When you hit that sweet spot of the right qualitative research questions and a perfectly represented audience , the feedback you receive from qualitative research isn’t just data—it’s a roadmap to deeper understanding and connection with your audience. For those looking to dive into the rich world of conducting qualitative research, Attest offers the market research tools and audience reach you need to make every question count. Check out how Attest can help bring your qualitative research to life.

VP Customer Success 

Sam joined Attest in 2019 and leads the Customer Research Team. Sam and her team support brands through their market research journey, helping them carry out effective research and uncover insights to unlock new areas for growth.

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Writing Survey Questions

Perhaps the most important part of the survey process is the creation of questions that accurately measure the opinions, experiences and behaviors of the public. Accurate random sampling will be wasted if the information gathered is built on a shaky foundation of ambiguous or biased questions. Creating good measures involves both writing good questions and organizing them to form the questionnaire.

Questionnaire design is a multistage process that requires attention to many details at once. Designing the questionnaire is complicated because surveys can ask about topics in varying degrees of detail, questions can be asked in different ways, and questions asked earlier in a survey may influence how people respond to later questions. Researchers are also often interested in measuring change over time and therefore must be attentive to how opinions or behaviors have been measured in prior surveys.

Surveyors may conduct pilot tests or focus groups in the early stages of questionnaire development in order to better understand how people think about an issue or comprehend a question. Pretesting a survey is an essential step in the questionnaire design process to evaluate how people respond to the overall questionnaire and specific questions, especially when questions are being introduced for the first time.

For many years, surveyors approached questionnaire design as an art, but substantial research over the past forty years has demonstrated that there is a lot of science involved in crafting a good survey questionnaire. Here, we discuss the pitfalls and best practices of designing questionnaires.

Question development

There are several steps involved in developing a survey questionnaire. The first is identifying what topics will be covered in the survey. For Pew Research Center surveys, this involves thinking about what is happening in our nation and the world and what will be relevant to the public, policymakers and the media. We also track opinion on a variety of issues over time so we often ensure that we update these trends on a regular basis to better understand whether people’s opinions are changing.

At Pew Research Center, questionnaire development is a collaborative and iterative process where staff meet to discuss drafts of the questionnaire several times over the course of its development. We frequently test new survey questions ahead of time through qualitative research methods such as  focus groups , cognitive interviews, pretesting (often using an  online, opt-in sample ), or a combination of these approaches. Researchers use insights from this testing to refine questions before they are asked in a production survey, such as on the ATP.

Measuring change over time

Many surveyors want to track changes over time in people’s attitudes, opinions and behaviors. To measure change, questions are asked at two or more points in time. A cross-sectional design surveys different people in the same population at multiple points in time. A panel, such as the ATP, surveys the same people over time. However, it is common for the set of people in survey panels to change over time as new panelists are added and some prior panelists drop out. Many of the questions in Pew Research Center surveys have been asked in prior polls. Asking the same questions at different points in time allows us to report on changes in the overall views of the general public (or a subset of the public, such as registered voters, men or Black Americans), or what we call “trending the data”.

When measuring change over time, it is important to use the same question wording and to be sensitive to where the question is asked in the questionnaire to maintain a similar context as when the question was asked previously (see  question wording  and  question order  for further information). All of our survey reports include a topline questionnaire that provides the exact question wording and sequencing, along with results from the current survey and previous surveys in which we asked the question.

The Center’s transition from conducting U.S. surveys by live telephone interviewing to an online panel (around 2014 to 2020) complicated some opinion trends, but not others. Opinion trends that ask about sensitive topics (e.g., personal finances or attending religious services ) or that elicited volunteered answers (e.g., “neither” or “don’t know”) over the phone tended to show larger differences than other trends when shifting from phone polls to the online ATP. The Center adopted several strategies for coping with changes to data trends that may be related to this change in methodology. If there is evidence suggesting that a change in a trend stems from switching from phone to online measurement, Center reports flag that possibility for readers to try to head off confusion or erroneous conclusions.

Open- and closed-ended questions

One of the most significant decisions that can affect how people answer questions is whether the question is posed as an open-ended question, where respondents provide a response in their own words, or a closed-ended question, where they are asked to choose from a list of answer choices.

For example, in a poll conducted after the 2008 presidential election, people responded very differently to two versions of the question: “What one issue mattered most to you in deciding how you voted for president?” One was closed-ended and the other open-ended. In the closed-ended version, respondents were provided five options and could volunteer an option not on the list.

When explicitly offered the economy as a response, more than half of respondents (58%) chose this answer; only 35% of those who responded to the open-ended version volunteered the economy. Moreover, among those asked the closed-ended version, fewer than one-in-ten (8%) provided a response other than the five they were read. By contrast, fully 43% of those asked the open-ended version provided a response not listed in the closed-ended version of the question. All of the other issues were chosen at least slightly more often when explicitly offered in the closed-ended version than in the open-ended version. (Also see  “High Marks for the Campaign, a High Bar for Obama”  for more information.)

Researchers will sometimes conduct a pilot study using open-ended questions to discover which answers are most common. They will then develop closed-ended questions based off that pilot study that include the most common responses as answer choices. In this way, the questions may better reflect what the public is thinking, how they view a particular issue, or bring certain issues to light that the researchers may not have been aware of.

When asking closed-ended questions, the choice of options provided, how each option is described, the number of response options offered, and the order in which options are read can all influence how people respond. One example of the impact of how categories are defined can be found in a Pew Research Center poll conducted in January 2002. When half of the sample was asked whether it was “more important for President Bush to focus on domestic policy or foreign policy,” 52% chose domestic policy while only 34% said foreign policy. When the category “foreign policy” was narrowed to a specific aspect – “the war on terrorism” – far more people chose it; only 33% chose domestic policy while 52% chose the war on terrorism.

In most circumstances, the number of answer choices should be kept to a relatively small number – just four or perhaps five at most – especially in telephone surveys. Psychological research indicates that people have a hard time keeping more than this number of choices in mind at one time. When the question is asking about an objective fact and/or demographics, such as the religious affiliation of the respondent, more categories can be used. In fact, they are encouraged to ensure inclusivity. For example, Pew Research Center’s standard religion questions include more than 12 different categories, beginning with the most common affiliations (Protestant and Catholic). Most respondents have no trouble with this question because they can expect to see their religious group within that list in a self-administered survey.

In addition to the number and choice of response options offered, the order of answer categories can influence how people respond to closed-ended questions. Research suggests that in telephone surveys respondents more frequently choose items heard later in a list (a “recency effect”), and in self-administered surveys, they tend to choose items at the top of the list (a “primacy” effect).

Because of concerns about the effects of category order on responses to closed-ended questions, many sets of response options in Pew Research Center’s surveys are programmed to be randomized to ensure that the options are not asked in the same order for each respondent. Rotating or randomizing means that questions or items in a list are not asked in the same order to each respondent. Answers to questions are sometimes affected by questions that precede them. By presenting questions in a different order to each respondent, we ensure that each question gets asked in the same context as every other question the same number of times (e.g., first, last or any position in between). This does not eliminate the potential impact of previous questions on the current question, but it does ensure that this bias is spread randomly across all of the questions or items in the list. For instance, in the example discussed above about what issue mattered most in people’s vote, the order of the five issues in the closed-ended version of the question was randomized so that no one issue appeared early or late in the list for all respondents. Randomization of response items does not eliminate order effects, but it does ensure that this type of bias is spread randomly.

Questions with ordinal response categories – those with an underlying order (e.g., excellent, good, only fair, poor OR very favorable, mostly favorable, mostly unfavorable, very unfavorable) – are generally not randomized because the order of the categories conveys important information to help respondents answer the question. Generally, these types of scales should be presented in order so respondents can easily place their responses along the continuum, but the order can be reversed for some respondents. For example, in one of Pew Research Center’s questions about abortion, half of the sample is asked whether abortion should be “legal in all cases, legal in most cases, illegal in most cases, illegal in all cases,” while the other half of the sample is asked the same question with the response categories read in reverse order, starting with “illegal in all cases.” Again, reversing the order does not eliminate the recency effect but distributes it randomly across the population.

Question wording

The choice of words and phrases in a question is critical in expressing the meaning and intent of the question to the respondent and ensuring that all respondents interpret the question the same way. Even small wording differences can substantially affect the answers people provide.

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An example of a wording difference that had a significant impact on responses comes from a January 2003 Pew Research Center survey. When people were asked whether they would “favor or oppose taking military action in Iraq to end Saddam Hussein’s rule,” 68% said they favored military action while 25% said they opposed military action. However, when asked whether they would “favor or oppose taking military action in Iraq to end Saddam Hussein’s rule  even if it meant that U.S. forces might suffer thousands of casualties, ” responses were dramatically different; only 43% said they favored military action, while 48% said they opposed it. The introduction of U.S. casualties altered the context of the question and influenced whether people favored or opposed military action in Iraq.

There has been a substantial amount of research to gauge the impact of different ways of asking questions and how to minimize differences in the way respondents interpret what is being asked. The issues related to question wording are more numerous than can be treated adequately in this short space, but below are a few of the important things to consider:

First, it is important to ask questions that are clear and specific and that each respondent will be able to answer. If a question is open-ended, it should be evident to respondents that they can answer in their own words and what type of response they should provide (an issue or problem, a month, number of days, etc.). Closed-ended questions should include all reasonable responses (i.e., the list of options is exhaustive) and the response categories should not overlap (i.e., response options should be mutually exclusive). Further, it is important to discern when it is best to use forced-choice close-ended questions (often denoted with a radio button in online surveys) versus “select-all-that-apply” lists (or check-all boxes). A 2019 Center study found that forced-choice questions tend to yield more accurate responses, especially for sensitive questions.  Based on that research, the Center generally avoids using select-all-that-apply questions.

It is also important to ask only one question at a time. Questions that ask respondents to evaluate more than one concept (known as double-barreled questions) – such as “How much confidence do you have in President Obama to handle domestic and foreign policy?” – are difficult for respondents to answer and often lead to responses that are difficult to interpret. In this example, it would be more effective to ask two separate questions, one about domestic policy and another about foreign policy.

In general, questions that use simple and concrete language are more easily understood by respondents. It is especially important to consider the education level of the survey population when thinking about how easy it will be for respondents to interpret and answer a question. Double negatives (e.g., do you favor or oppose  not  allowing gays and lesbians to legally marry) or unfamiliar abbreviations or jargon (e.g., ANWR instead of Arctic National Wildlife Refuge) can result in respondent confusion and should be avoided.

Similarly, it is important to consider whether certain words may be viewed as biased or potentially offensive to some respondents, as well as the emotional reaction that some words may provoke. For example, in a 2005 Pew Research Center survey, 51% of respondents said they favored “making it legal for doctors to give terminally ill patients the means to end their lives,” but only 44% said they favored “making it legal for doctors to assist terminally ill patients in committing suicide.” Although both versions of the question are asking about the same thing, the reaction of respondents was different. In another example, respondents have reacted differently to questions using the word “welfare” as opposed to the more generic “assistance to the poor.” Several experiments have shown that there is much greater public support for expanding “assistance to the poor” than for expanding “welfare.”

We often write two versions of a question and ask half of the survey sample one version of the question and the other half the second version. Thus, we say we have two  forms  of the questionnaire. Respondents are assigned randomly to receive either form, so we can assume that the two groups of respondents are essentially identical. On questions where two versions are used, significant differences in the answers between the two forms tell us that the difference is a result of the way we worded the two versions.

One of the most common formats used in survey questions is the “agree-disagree” format. In this type of question, respondents are asked whether they agree or disagree with a particular statement. Research has shown that, compared with the better educated and better informed, less educated and less informed respondents have a greater tendency to agree with such statements. This is sometimes called an “acquiescence bias” (since some kinds of respondents are more likely to acquiesce to the assertion than are others). This behavior is even more pronounced when there’s an interviewer present, rather than when the survey is self-administered. A better practice is to offer respondents a choice between alternative statements. A Pew Research Center experiment with one of its routinely asked values questions illustrates the difference that question format can make. Not only does the forced choice format yield a very different result overall from the agree-disagree format, but the pattern of answers between respondents with more or less formal education also tends to be very different.

One other challenge in developing questionnaires is what is called “social desirability bias.” People have a natural tendency to want to be accepted and liked, and this may lead people to provide inaccurate answers to questions that deal with sensitive subjects. Research has shown that respondents understate alcohol and drug use, tax evasion and racial bias. They also may overstate church attendance, charitable contributions and the likelihood that they will vote in an election. Researchers attempt to account for this potential bias in crafting questions about these topics. For instance, when Pew Research Center surveys ask about past voting behavior, it is important to note that circumstances may have prevented the respondent from voting: “In the 2012 presidential election between Barack Obama and Mitt Romney, did things come up that kept you from voting, or did you happen to vote?” The choice of response options can also make it easier for people to be honest. For example, a question about church attendance might include three of six response options that indicate infrequent attendance. Research has also shown that social desirability bias can be greater when an interviewer is present (e.g., telephone and face-to-face surveys) than when respondents complete the survey themselves (e.g., paper and web surveys).

Lastly, because slight modifications in question wording can affect responses, identical question wording should be used when the intention is to compare results to those from earlier surveys. Similarly, because question wording and responses can vary based on the mode used to survey respondents, researchers should carefully evaluate the likely effects on trend measurements if a different survey mode will be used to assess change in opinion over time.

Question order

Once the survey questions are developed, particular attention should be paid to how they are ordered in the questionnaire. Surveyors must be attentive to how questions early in a questionnaire may have unintended effects on how respondents answer subsequent questions. Researchers have demonstrated that the order in which questions are asked can influence how people respond; earlier questions can unintentionally provide context for the questions that follow (these effects are called “order effects”).

One kind of order effect can be seen in responses to open-ended questions. Pew Research Center surveys generally ask open-ended questions about national problems, opinions about leaders and similar topics near the beginning of the questionnaire. If closed-ended questions that relate to the topic are placed before the open-ended question, respondents are much more likely to mention concepts or considerations raised in those earlier questions when responding to the open-ended question.

For closed-ended opinion questions, there are two main types of order effects: contrast effects ( where the order results in greater differences in responses), and assimilation effects (where responses are more similar as a result of their order).

An example of a contrast effect can be seen in a Pew Research Center poll conducted in October 2003, a dozen years before same-sex marriage was legalized in the U.S. That poll found that people were more likely to favor allowing gays and lesbians to enter into legal agreements that give them the same rights as married couples when this question was asked after one about whether they favored or opposed allowing gays and lesbians to marry (45% favored legal agreements when asked after the marriage question, but 37% favored legal agreements without the immediate preceding context of a question about same-sex marriage). Responses to the question about same-sex marriage, meanwhile, were not significantly affected by its placement before or after the legal agreements question.

Another experiment embedded in a December 2008 Pew Research Center poll also resulted in a contrast effect. When people were asked “All in all, are you satisfied or dissatisfied with the way things are going in this country today?” immediately after having been asked “Do you approve or disapprove of the way George W. Bush is handling his job as president?”; 88% said they were dissatisfied, compared with only 78% without the context of the prior question.

Responses to presidential approval remained relatively unchanged whether national satisfaction was asked before or after it. A similar finding occurred in December 2004 when both satisfaction and presidential approval were much higher (57% were dissatisfied when Bush approval was asked first vs. 51% when general satisfaction was asked first).

Several studies also have shown that asking a more specific question before a more general question (e.g., asking about happiness with one’s marriage before asking about one’s overall happiness) can result in a contrast effect. Although some exceptions have been found, people tend to avoid redundancy by excluding the more specific question from the general rating.

Assimilation effects occur when responses to two questions are more consistent or closer together because of their placement in the questionnaire. We found an example of an assimilation effect in a Pew Research Center poll conducted in November 2008 when we asked whether Republican leaders should work with Obama or stand up to him on important issues and whether Democratic leaders should work with Republican leaders or stand up to them on important issues. People were more likely to say that Republican leaders should work with Obama when the question was preceded by the one asking what Democratic leaders should do in working with Republican leaders (81% vs. 66%). However, when people were first asked about Republican leaders working with Obama, fewer said that Democratic leaders should work with Republican leaders (71% vs. 82%).

The order questions are asked is of particular importance when tracking trends over time. As a result, care should be taken to ensure that the context is similar each time a question is asked. Modifying the context of the question could call into question any observed changes over time (see  measuring change over time  for more information).

A questionnaire, like a conversation, should be grouped by topic and unfold in a logical order. It is often helpful to begin the survey with simple questions that respondents will find interesting and engaging. Throughout the survey, an effort should be made to keep the survey interesting and not overburden respondents with several difficult questions right after one another. Demographic questions such as income, education or age should not be asked near the beginning of a survey unless they are needed to determine eligibility for the survey or for routing respondents through particular sections of the questionnaire. Even then, it is best to precede such items with more interesting and engaging questions. One virtue of survey panels like the ATP is that demographic questions usually only need to be asked once a year, not in each survey.

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• Open access
• Published: 27 April 2024

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

• Bereket Aberham Lajore 1   na1   nAff5 ,
• Yitagesu Habtu Aweke 2   na1   nAff6 ,
• Samuel Yohannes Ayanto 3   na1   nAff7 &
• Menen Ayele 4   nAff5  

BMC Health Services Research volume  24 , Article number:  542 ( 2024 ) Cite this article

142 Accesses

Metrics details

Engagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.

The purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.

Descriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.

Total of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.

The study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

Peer Review reports

Introduction

Mycobacterium tuberculosis, the infectious agent that causes multi-drug resistant tuberculosis (MDR-TB), is resistant to at least rifampicin and isoniazid. Direct infection can cause the disease to spread, or it can develop secondary to improper management of tuberculosis among drug susceptible tuberculosis cases and associated poor adherence [ 1 ].

Multidrug-resistant strains of mycobacterium tuberculosis have recently emerged, which makes achieving “End TB Strategy” more difficult [ 2 ]. Multi drug resistant tuberculosis (MDR-TB) has been found to increasingly pose a serious threat to global and Ethiopian public health sector. Despite the fact that a number of risk factors for MDR-TB have been identified through various research designs, the epidemiology of this disease is complex, contextual, and multifaceted [ 1 ]. Quantitative studies demonstrate that prior treatment history [ 3 , 4 , 5 , 6 , 7 ], interrupted drug supply [ 8 ], inappropriate treatments and poor patient compliance [ 3 , 7 , 9 ], poor quality directly observed treatment short course (DOTS), poor treatment adherence [ 10 ], age [ 5 ], and malnutrition [ 11 ] were factors associated with multi drug resistant TB.

Globally, an estimated 20% of previously treated cases and 3.3% of new cases are thought to have MDR-TB; these levels have essentially not changed in recent years. Globally, 160,684 cases of multidrug-resistant TB and rifampicin-resistant TB (MDR/RR-TB) were notified in 2017, and 139,114 cases were enrolled into treatment in 2017 [ 12 ]. A systematic review in Ethiopia reported 2% prevalence of MDR-TB [ 3 ] that is higher than what is observed in Sub-Saharan Africa, 1.5% [ 13 ]. The prevalence of MDR-TB, according to the national drug-resistant tuberculosis (DR-TB) sentinel report, was 2.3% among newly diagnosed cases of TB and 17.8% among cases of TB who had already received treatment,. This suggests a rising trend in the prevalence of TB drug resistance compared to the results of the initial drug-resistant TB survey carried out in Ethiopia from 2003 to 2005 [ 14 ].

Ethiopia has placed strategies into place that emphasize political commitment, case finding, appropriate treatment, a continuous supply of second-line anti-TB medications of high quality, and a recording system. Due to other competing health priorities, the nation is having difficulty accelerating the scale-up of the detection, enrollment and treatment of drug-resistant TB patients [ 15 , 16 ]. To address these issues, the nation switched from a hospital-based to a clinic-based ambulatory model of care, which has allowed MDR-TB services to quickly decentralize and become more accessible. Accordingly, the nation has set up health facilities to act as either treatment initiating centers (TIC) or treatment follow-up centers (TFC) or both for improved referral and communication methods [ 15 ].

One of the key components of the “End TB strategy” is engagement of health care professionals in the prevention and management of multidrug resistant tuberculosis [ 17 ]. Inadequate engagement of healthcare providers is one aspect of the healthcare system that negatively influences MDR-TB prevention and control efforts [ 17 ]. This may be manifested in a number of ways, including inadequate understanding of drug-resistant tuberculosis, improper case identification, failure to initiate treatment again, placement of the wrong regimens, improper management of side effects and poor infection prevention [ 1 ]. These contributing factors are currently being observed in Ethiopia [ 18 ], Nigeria [ 7 , 19 , 20 ] and other countries [ 21 , 22 ]. According to a study conducted in Ethiopia, MDR-TB was linked to drug side effects from first-line treatments, being not directly observed, stopping treatment for at least a day, and retreating with a category II regimen [ 17 ].

This may be the result of a synergy between previously investigated and other contextual factors that have not yet been fully explored, such as professional engagement, beliefs, and poor preventive practices. The engagement of health professionals in MDR-TB prevention and control is assessed using a number of composite indicators. Health professionals may interact primarily inside the healthcare facilities. Typically, they play a significant role in connecting healthcare services with neighborhood-based activities [ 17 ]. One of the main research areas that have not sufficiently addressed is evidence indicating the status of healthcare professionals’ engagement and contextual factors in MDR-TB prevention and management.

It is increasingly urgent to identify additional and existing factors operating in a particular context that contribute to the development of the disease in light of the epidemic of drug resistance, including multi-drug resistance (MDR-TB) and extensively drug resistant TB (XDR-TB) in both new and previously treated cases of the disease [ 23 ]. In order to develop and implement control measures, it is therefore essential to operationally identify a number of contextual factors operating at the individual, community, and health system level.

Therefore, the overall purpose of this study was to explore the level of engagement of health care providers and contextual factors hindering/enabling the prevention and provision of patient-centered care for MDR-TB in health facilities, DOTS services centers and MDR-TB treatment initiation center [TIC], in Hadiya Zone, Southern Ethiopia.

Qualitative approach and research paradigm

Descriptive phenomenological qualitative study design was employed to explore factors influencing engagement of health professionals in MDR-TB prevention and management and thematic technique was employed for the analysis of the data.

Researchers’ characteristics and reflexivity

Three Principal investigators conducted this study. Two of them had Masters of public health in Epidemiology and Reproductive health and PhD candidates and the third one had Bachelor’s degree in public health with clinical experience in the area of Tuberculosis prevention and management and MPH in Biostatistics. The principal investigators have research experience with published articles in different reputable journals. There were no prior contacts between researchers and participants before the study whereas researchers have built positive rapport with study participants during data collection to foster open communication and trust and had no any assumptions and presuppositions about the research topic and result.

Context/ study setting and period

The study was conducted between 2 and 9 May, 2019 in Hadiya Zone with more than 1.7 million people residing in the Zone. There are 300 health posts, 63 health centers, 3 functional primary hospitals and 1 comprehensive specialized hospital in the Zone. Also, there are more than 350 private clinics and 1 private hospital in the Zone. All of the public health facilities and some private health facilities provide directly observed short course treatment (DOTS) service for tuberculosis patients. There are more than eight treatment initiation centers (TICs) for MDR-TB patients in Hadiya Zone. MDR-TB (Multidrug-resistant tuberculosis) treatment initiation centers are specialized facilities that provide comprehensive care, diagnosis and treatment initiation, psychosocial support, and follow up services to individuals with MDR-TB. The linkage between MDR-TB treatment initiation centers and other healthcare facilities lies in the coordination of care, referral pathways, and collaboration to ensure comprehensive and integrated care for individuals with MDR-TB. Overall, healthcare providers play a crucial role in the management of MDR-TB by providing specialized care, ensuring treatment adherence, monitoring progress and outcomes, and supporting individuals in achieving successful treatment outcomes and improved health.

Units of study and sampling strategy

Our study participants were health care professionals working in MDR-TB TICs in both private and public health facilities, and providing DOTS services, MDR-TB program leaders in treatment initiation centers, as well as TB focal persons, disease prevention and health promotion focal person, and project partners from district health offices. The study involved four focus group discussion (FGDs) and five key informants’ interview (KII) with a total of 26 participants to gather the necessary information. Expert purposive sampling technique was employed and sample size was determined based on the saturation of idea required during data collection process.

Data collection methods and instruments

Focus group discussion and face to face key informants’ interviews were employed to collect the data. We conducted a total of four FGD and five key informants’ interviews with participants chosen from DOTS providing health facilities and MDR-TB program leaders in treatment initiation centers, as well as TB focal persons and project partners from district health offices and disease prevention and health promotion focal person. One of the FGDs was conducted among health professionals from the public MDR-TB treatment initiation centers. Three FGDs were conducted among disease prevention and health promotion focal persons, TB focal persons and DOTS providers in public health facilities (health centers).

An observation checklist was developed to assess the general infection prevention and control measures used by specific healthcare facilities in the study area. We used unstructured FGD guide, key informant interview guide, observation checklist and audio recorders to collect primary data and it was collected using local language called Amharic. Prior to data collection, three people who are not among principal investigators with at least a master’s degree in public health and prior experience with qualitative research were trained by principal investigators. Three of them acts as a tape recorder, a moderator, and as a note taker alternatively. The length of FGD ranged from 58 to 82 min and that of key informants’ interview lasted from 38 to 56 min.

Data processing and data analysis

Memos were written immediately after interviews followed by initial analysis. Transcription of audio records was performed by principal investigators. The audio recordings and notes were refined, cleaned and matched at the end of each data collection day to check for inconsistencies, correct errors, and modify the procedures in response to evolving study findings for subsequent data collection. Transcribed interviews, memos, and notes from investigator’s observation were translated to English and imported to Open Code 4.02 [ 2 ] for line by line coding of data, and categorizing important codes (sub theming). The pre-defined themes for MDR-TB prevention and control engagement were used to thematize the line-by-line codes, categories, and meanings using thematic analysis. Finally, the phenomenon being studied was explained by emerging categories and themes. Explanations in themes were substantiated by participants’ direct quotations when necessary.

Trustworthiness

Phone calls and face to face briefing were requested from study participants when some expressions in the audio seems confusing while transcripts were performed. To ensure the credibility of the study, prolonged engagement was conducted, including peer debriefing with colleagues of similar status during data analysis and inviting available study participants to review findings to ensure as it is in line with their view or not. Memos of interviews and observation were crosschecked while investigator was transcribing to ensure credibility of data as well as to triangulate investigator’s categorizing and theming procedures. For transferability, clear outlines of research design and processes were provided, along with a detailed study context for reader judgment. Dependability was ensured through careful recording and transcription of verbal and non-verbal data, and to minimize personal bias, scientific procedures were followed in all research stages. Conformability was maintained by conducting data transcription, translation, and interpretation using scientific methods. Researchers did all the best to show a range of realities, fairly and faithfully. Finally, an expert was invited to put sample of codes and categories to emerged corresponding categories and themes respectively.

Demographic characteristics of study participants

Four focus group discussions and five key informants’ interviews were conducted successfully. There were 26 participants in four focus group discussions, and key informants’ interview. Ages of participants ranges from 20 to 50 years with an average age of 33.4  ±  6.24 SD years. Participants have five to ten years of professional experience with DOTS services (Table  1 ).

Emergent themes and subthemes

The study explored how health care providers’ engagement in MDR-TB prevention and management was influenced. The investigation uncovered five major themes. These themes were the patient’s underlying causes, seeking support, perceived susceptibility, healthcare providers’ incompetence, and poor linkage between health facilities. Weak community TB prevention, health system support, and support from colleagues were identified subthemes in the search for help by health professionals whereas socioeconomic constraints, lack of awareness, and fear of discrimination were subthemes under patients underlying factors (Fig.  1 ).

Themes and subthemes emerged from the analysis of health professionals’ engagement in MDR-TB prevention and management study in Hadiya zone’s health facilities, 2019

The patient’s underlying causes

This revealed why TB/MDR-TB treatment providers believe health professionals are unable to provide standard MDR-TB services. The subthemes include TB/MDR-TB awareness, fear of discrimination, and patients’ socioeconomic constraints.

Socioeconomic constraints

According to our research, the majority of healthcare professionals who provided directly observed short-course treatment services mentioned socioeconomic constraints as barriers to engage per standard and provide MDR-TB prevention and management service. More than half of the participants stated that patients’ primary reasons include lack of money for house rental close to the treatment centers, inability to afford food and other expenses, and financial constraints to cover transportation costs.

In addition to this, patients might have additional responsibilities to provide food and cover other costs for their families’ need. The majority of health care professionals thought that these restrictions led to their poor engagement in MDR-TB prevention and management. One of the focus groups’ discussants provided description of the scenario in the following way:

“…. I have many conversations with my TB/MDR-TB patients. They fail to complete DOTS or treatment intensive care primarily as a result of the requirement of prolonged family separation. They might provide most of the family needs, including food and other expenses” (FGD-P01).

Lack of awareness about MDR-TB

This subtheme explains how MDR-TB patients’ knowledge of the illness can make it more difficult for health professionals to provide DOTS or TICs services. The majority of DOTS providers stated that few TB or MDR-TB patients were aware of how MDR-TB spreads, how it is treated, and how much medication is required. Additionally, despite the fact that they had been educated for the disease, majority of patients did not want to stop contact with their families or caregivers. A health care provider stated,

“…. I provided health education for MDR-TB patients on how the disease is transmitted and how they should care for their family members. They don’t care; however, give a damn about their families .” (FGD-P05).

Some healthcare professionals reported that some patients thought that MDR-TB could not be cured by modern medication. One medical professional described the circumstance as follows:

“…. I noticed an MDR-TB patient who was unwilling to be screened. He concluded that modern medication is not effective and he went to spiritual and traditional healers” (FGD-P02).

As a result, almost all participants agreed on the extent to which patient knowledge of TB and MDR-TB can influence a provider’s engagement to MDR-TB services. The majority suggested that in order to improve treatment outcomes and preventive measures, the media, community leaders, health development armies, one-to-five networks, non-governmental organizations, treatment supporters, and other bodies with access to information need to put a lot of efforts.

Fear of discrimination

According to our research, about a quarter of healthcare professionals recognized that patients’ fear of discrimination prevents them from offering MDR-TB patients the DOTS services they need, including counseling index cases and tracing contact histories.

HEWs, HDAs, and 1-to-5 network members allegedly failed to monitor and counsel the index cases after their immediate return to their homes, according to the opinions from eight out of twenty-six healthcare professionals. The patients began to engage in routine social and political activities with neighbors while hiding their disease status. A healthcare professional described this situation as follows:

“…. I understood from my MDR-TB patient’s words that he kept to himself and avoided social interaction. He made this decision as a result of stigmatization by locals, including health extension workers. As a result, the patient can’t attend social gatherings. …. In addition, medical professionals exclude MDR-TB patients due to fear of exposures. As a result, patients are unwilling to undergo early screening” (FGD-P04).

Professionals’ perceived risk of occupational exposure

This theme highlights the anxiety that healthcare workers experience because of MDR-TB exposure when providing patient care. Our research shows that the majority of health professionals viewed participation as “taking coupons of death.” They believed that regardless of how and where they engaged in most healthcare facilities, the risk of exposure would remain the same. According to our discussion and interview, lack of health facility’s readiness takes paramount shares for the providers’ risk of exposures and their susceptibility.

According to the opinion from the majority of FGD discussants and in-depth interviewees, participants’ self-judgment score and our observation, the majority of healthcare facilities that offer DOTS for DS-TB and MDR-TB did not create or uphold standards in infection prevention in the way that could promote better engagement. These include poor maintenance of care facilities, lack of personal protective equipment, unsuitable facility design for service provision, lack of patient knowledge regarding the method of MDR-TB transmission, and lack of dedication on the part of health care staff.

As one of our key informant interviewees [District Disease Prevention Head], described health professionals’ low engagement has been due to fear of perceived susceptibility. He shared with us what he learned from a community forum he moderated.

Community forum participant stated that “… There was a moment a health professional run-away from the TB unit when MDR-TB patient arrived. At least they must provide the necessary service, even though they are not willing to demonstrate respectful, compassionate, or caring attitude to MDR-TB patients” (KII-P01). Besides , one of the FGD discussants described the circumstance as follows:

“…. Emm…. Because most health facilities or MDR-TB TIC are not standardized, I am concerned about the risk of transmission. They are crammed together and poor ventilation is evident as well as their configuration is improper. Other medical services are causing the TICs to become overcrowded. Most patients and some medical professionals are unconcerned with disease prevention ” (FGD-P19).

Participants’ general fear of susceptibility may be a normal psychological reaction and may serve as a motivation for taking preventative actions. However, almost all participants were concerned that the main reasons for their fear were brought up by the improper application of programmatic management and MDR-TB treatment standards and infection prevention protocols in healthcare facilities.

Health care providers’ incompetence

This theme illustrates how professionalism and dedication impact participation in MDR-TB prevention and management. The use of DS-TB prevention and management by health professionals was also taken into account because it is a major factor in the development of MDR-TB. This theme includes the participants’ perspectives towards other healthcare workers involved in and connected to MDR-TB.

Nearly all of the participants were aware of the causes and danger signs of MDR-TB. The majority of the defined participants fit to the current guidelines. However, participants in focus groups and key informant interviews have brought up shortcomings in MDR-TB service delivery practice and attitude. We looked at gaps among healthcare professionals’ knowledge, how they use the national recommendations for programmatic management and prevention of MDR-TB, prevent infections, take part in community MDR-TB screenings, and collaborate with other healthcare professionals for better engagement.

More than half of the participants voiced concerns about their attitudes and skill sets when using MDR-TB prevention and management guideline. When asked about his prior experiences, one of the focus group participants said:

“…. Ok, let me tell you my experience, I was new before I attended a training on MDR-TB. I was unfamiliar with the MDR-TB definition given in the recommendations. When I was hired, the health center’s director assigned me in the TB unit. I faced difficulties until I received training” (FGD-P24). Furthermore , one of the key informant interview participants shared a story: “…. In my experience, the majority of newly graduated health professionals lack the required skill. I propose that pre-service education curricula to include TB/MDR-TB prevention and management guideline trainings” (KII-P01).

The majority of participants mentioned the skill gap that was seen among health extension workers and laboratory technicians in the majority of healthcare facilities. Some of the participants in the in-depth interviews and FGD described the gaps as follows:

“…. According to repeated quality assurance feedbacks, there are many discordant cases in our [ District TB Focal Person ] case. Laboratory technicians who received a discrepant result (KII-P01) are not given training which is augmented by shared story from FGD discussants, “According to the quality assurance system, laboratory technicians lack skill and inconsistent results are typical necessitating training for newly joining laboratory technicians” (FGD-P20).

Through our discussions, we explored the level of DOTS providers’ adherence to the current TB/MDR-TB guideline. As a result, the majority of participants pointed out ineffective anti-TB management and follow-up care. One of the participants remembered her practical experience as follows:

“…. In my experience, the majority of health professionals fail to inform patients about the drug’s side effects, follow-up procedures, and other techniques for managing the burden of treatment. Only the anti-TB drug is provided, and the patient is left alone. The national treatment recommendation is not properly implemented by them” (FGD-P04).

Many barriers have been cited as reasons that might have hindered competencies for better engagement of health professionals. Training shortage is one of the major reasons mentioned by many of the study participants. One of discussants from private health facility described the problem as

“…. We are incompetent, in my opinion. Considering that we don’t attend update trainings. Many patients who were diagnosed negative at private medical facilities turned out to be positive, and vice versa which would be risky for drug resistance” (FGD-P14) which was supported by idea from a participant in our in-depth interview: “…. We [Program managers] are running short of training for our health care providers at different health centers and revealed that four out of every five healthcare professionals who work in various health centers are unaware of the TB/MDR-TB new guideline” (KII-P02).

Seeking support

This theme focuses on the significance and effects of workplace support in the engagement of MDR-TB prevention and control. This also explains the enabling and impeding elements in the engagement condition of health professionals. Three elements make up the theme: coworkers (other health professionals) in the workplace, support from community TB prevention actors, and a healthcare system.

Support from community TB prevention actors

This subtheme includes the assistance provided to study participants by important parties such as community leaders, the health development army, and other stakeholders who were involved in a community-based TB case notification, treatment adherence, and improved patient outcomes.

Many of the study participants reported that health extension workers have been poorly participating in MDR-TB and TB-related community-based activities like contact tracing, defaulter tracing, community forums, health promotion, and treatment support. One study participant described their gap as follows:

“…. I understood that people in the community were unaware of MDR-TB. The majority of health extension workers do not prioritize raising community awareness of MDR-TB” (FGD-P13). This was supported by idea from a district disease prevention head and stated as: “…. There is no active system for contacts tracing. Health educators send us information if they find suspected cases. However, some patients might not show up as expected. We have data on three family members who tested positive for MDR-TB” (KII-P3).

Support from a health system

The prime focus of this subtheme is on the enabling elements that DOTS providers require assistance from the current healthcare system for better engagement. All study participants expressed at least two needs to be met from the health system in order for them to effectively participate in MDR-TB prevention, treatment, and management. All study participants agreed that issues with the health system had a negative impact on their engagement in the prevention, treatment, diagnosis, and management of MDR-TB in almost all healthcare facilities. Poor conditions in infrastructure, resources (supplies, equipment, guidelines, and other logistics), capacity building (training), supportive supervision, establishment of public-private partnerships, and assignment of motivated and trained health professionals are some of the barriers that needs to be worked out in order to make them engage better. One of the participants pronounces supplies and logistics problems as:

“…. The health center I worked in is listed as a DOTS provider. However, it lacks constant electricity, a working microscope, lab supplies, medications, etc, and we refer suspected cases to nearby health centers or district hospitals for AFB-examination and, “Sometimes we use a single kit for many patients and wait for the medication supply for three or more weeks and patients stops a course of therapy that might induce drug resistance” (FGD-PI04) which was augmented by statement from FGD participant who works at a treatment initiation center: “…. We faced critical shortage of supplies and hospital administrators don’t care about funding essential supplies for patient care. For instance, this hospital (the hospital in which this FGD was conducted) can easily handle N-95 masks. Why then they (hospital administrators working in some TIC) can’t do it?” (FGD-P18).”

Regarding in-service training on MDR-TB, almost all participants pointed out shortage of on-job training mechanisms. One of our FGD participants said:

“…. I missed the new training on MDRTB programmatic management guidelines. I’ve heard that new updates are available. I still work using the old standard” (FGD-PI05). A health professional working in private clinic heightens the severity of training shortage as: “…. We have not participated in TB/MDR-TB guidelines training. You know, most of for-profit healthcare facilities do not provide any training for their staff. I’m not sure if I’m following the (TB/MDR-TB) guideline” (FGD-P14). One of our key informant interview participants; MDR-TB center focal person suggested the need for training as: “…. I’ve received training on the MDR-TB services and public-private partnership strategy. It was crucial in my opinion for better engagement. It is provided for our staff [MDRTB center focal person]. However, this has not yet been expanded to other health facilities” (KII-P04).

Concerning infrastructures, transportation problem was one of the frequently mentioned obstacles by many participants that hinder engagement in MDR-TB/TB service. This factor had a negative impact to both sides (health professionals and patients). One of discussants said:

“…. I face obstacles such as transport cost to perform effective TB/MDR-TB outreach activities like health education, tracing family contacts and defaulters and community mobilization. Rural kebeles are far apart from each other. How can I support 6 rural Kebeles?” (FGD-P01). One of the participants; MDR-TB treatment centers supervisor/program partner seconded the above idea as: “…. I suggest government must establish a system to support health professionals working in remote health care facilities in addition to MDR-TB centers. I guess there are more than 30 government health centers and additional private clinics. We can’t reach them all due to transportation challenges” (KII-P05). One of the participants , a district disease prevention head added: “…. Our laboratory technicians take sample from MDR-TB suspects to the post office and then, the post office sends to MDR-TB site. Sometimes, feedback may not reach timely. There is no any system to cover transportation cost. That would make case detection challenging” (FGD-P02).

Support from colleagues

Study participants stated the importance of having coworker with whom they could interconnect. However, eight participants reported that they were discriminated by their workmates for various reasons, such as their perceived fear of exposure to infection and their perception as if health professionals working in TB/MDR-TB unit get more training opportunities and other incentives. One of the focus group discussants said:

“…. My colleagues [health professional working out of MDR-TB TICs] stigmatize us only due to our work assignment in MDR-TB clinic. I remember that one of my friends who borrowed my headscarf preferred to throw it through a window than handing-over it back safely. Look, how much other health professionals are scared of working in MDR-TB unit. This makes me very upset. I am asking myself that why have I received such training on MDR-TB?” (FGD-P04).

Some of the participants also perceived that, health professionals working in MDR-TB/TB unit are the only responsible experts regarding MDR-TB care and treatment. Because, other health professionals consider training as if it is an incentive to work in such units. One of the FGD discussants described:

“… Health professionals who work in other service units are not volunteer to provide DOTS if TB focal person/previously trained staffs are not available. Patients wait for longer time” (FGD-P11).

Health facilities’ poor linkage

This theme demonstrates how various healthcare facilities, including private and public healthcare facilities such as, health posts, health care centers and hospitals, and healthcare professionals working at various levels of the healthcare system in relation to TB/MDR-TB service, are inter-linked or communicating with one another.

Many study participants noted a lack of coordination between higher referral hospitals, TB clinics, health posts, and health centers. Additionally, the majority of the assigned healthcare professionals had trouble communicating with patients and their coworkers. A focus group discussant also supported this idea as

“…. There is a lack of communication between us [DOTS providers at treatment initiation centers] and health posts, health centers, and private clinics. We are expected to support about 30 public health facilities. It’s of too much number, you know. They are out of our reach. We only took action when a problem arose” (FGD-P16).

Significant number of participants had raised the problem of poor communication between health facilities and treatment initiation centers. One of the interviewees [program manager] said:

“…. I see that one of our challenges is the weak referral connections between treatment initiation centers and health centers. As a result, improper sample transfer to Gene- Xpert sites and irregular postal delivery are frequent” . “Our; DOTS staff at the MDR-TB center, DOTS staff at the health center, and health extension workers are not well connected to one another. Many patients I encountered came to this center [MDR-TB center] after bypassing both health post and health center. Poor linkage and communication, in my opinion, could be one of the causes. The same holds true for medical facilities that are both public and private ” (KII-P02).

Engagement of individual healthcare providers is one of the peculiar interventions to achieve the goal of universal access to drug resistance tuberculosis care and services [ 17 ]. Healthcare providers engagement in detecting cases, treating and caring for multidrug resistant tuberculosis (MDR-TB) may be influenced by various intrinsic (individual provider factors) and extrinsic (peer, health system, political and other factors) [ 15 ]. Our study explored engagement of individual DOTS providers and factors that influence their engagement in MDR-TB prevention and management service. This is addressed through five emergent themes and subthemes as clearly specified in our results section.

The findings showed patients’ socioeconomic constraints were important challenges that influence health professionals’ engagement, and provision of MDR-TB prevention and management services. Although approaches differ, studies in Ethiopia [ 24 ], South Africa [ 25 ] and India [ 26 , 27 ] documented that such factors influence health providers’ engagement in the prevention and management of multi drug resistant tuberculosis. Again, the alleviation of these factors demands the effort from patients, stakeholders working on TB, others sectors, and the healthcare system so that healthcare providers can deliver the service more effectively in their day-to-day activities and will be more receptive to the other key factors.

We explored participants’ experiences on how patients’ awareness about drug sensitive or multi drug resistant tuberculosis influenced their engagement. Accordingly, participants encountered numerous gaps that restricted their interactions with TB/MDR-TB patients. In fact, our study design and purposes vary, studies [ 28 , 29 , 30 ] indicated that patients awareness influenced providers decision in relation to MDR-TB services and patients’ awareness status is among factors influencing healthcare providers’ decision making about the care the MDR-TB patient receives. As to our knowledge, patients’ perceived fear of discrimination was not documented whether it had direct negative impact on reducing providers’ engagement. Therefore, patients’ awareness creation is an important responsibility that needs to be addressed by the community health development army, health extension workers, all other healthcare providers and stakeholder for better MDR-TB services and patient outcomes.

Our study indicates that healthcare providers perceived that they would be exposed to MDR-TB while they are engaged. Some of the participants were more concerned about the disadvantages of engagement in providing care to MDR-TB patients which were predominantly psychological and physical pressure. In this context, the participants emphasized that engagement in MDR-TB patient care is “always being at risk” and expressed a negative attitude. This finding is similar to what has been demonstrated in a cross-sectional study conducted in South Africa in which majority of healthcare providers believed their engagement in MDR-TB services would risk their health [ 21 ].

However, majority of the healthcare providers demonstrated perceived fear of exposures mainly due to poor infection prevention practices and substandard organization of work environment in most TB/MDR-TB units. This is essentially reasonable fear, and needs urgent intervention to protect healthcare providers from worsening/reducing their effective engagement in MDR-TB patient care. On the other side of the coin, perceived risk of occupational exposure to infection could be source for taking care of oneself to combat the spread of the infection.

In our study, healthcare provider’s capability (competence) also had an impact on their ability to engage in prevention and management of MDR-TB. Here, participants had frequently raised their and other healthcare providers’ experience regarding skill gaps, negative attitude towards the service unit they were working in, ineffective use of MDR-TB guideline, poor infection prevention practices and commitment. In addition, many health professionals report serious problems regarding case identification and screening, drug administration, and side effect management. These findings were supported by other studies in Ethiopia [ 7 ] and in Nigeria [ 19 , 20 ]. This implies an urgent need for training of health care worker on how to engage in prevention and management of multidrug resistant TB.

Moreover, our findings provide insights into the role of community TB prevention actors, currently functioning health system, and colleagues and other stakeholders’ regarding healthcare providers’ engagement. Participants emphasized that support from community TB prevention actors is a key motivation to effectively engage on management and prevention roles towards MDR-TB. Evidence shows that community TB prevention is one of the prominent interventions that study participants would expect in DOTS provision as community is the closest source of information regarding the patients [ 31 , 32 ].

Similarly, all participants had pointed out the importance of support from a health system directly or indirectly influence their engagement in the prevention, diagnosis, treatment, and management of MDR-TB. Researches indicated that health system supports are enabling factors for healthcare providers in decision making regarding TB/MDR-TB prevention and treatment [ 33 ]. This problem is documented by the study done in Ethiopia [ 22 ]. In addition, support from colleagues and other stakeholders was also a felt need to engage in MDR-TB which was supported by the World Health Organization guideline which put engagement in preventing MDR-TB and providing patients centered care needs collaborative endeavor among healthcare providers, patients, and other stakeholders [ 17 ].

Participants showed that there were poor linkage among/within DOTS providers working in health post (extension workers), health centers, hospitals and MDRTB treatment initiation centers. Our finding is consistent with a research in South Africa which shows poor health care attitude is linked to poor treatment adherence [ 34 ]. Our study implies the need for further familiarization especially on clinical programmatic management of drug resistant tuberculosis. Moreover, program managers need to follow health professionals’ engagement approaches recommended by the World Health Organization: End TB strategy [ 17 ].

Limitations of the study

There are some limitations that must be explicitly acknowledged. First, participants from private health facilities were very few, which might have restricted the acquisition and incorporation of perspectives from health care providers from private health care facilities. Second, healthcare providers’ engagement was not measured from patient side given that factors for engagement may differ from what has been said by the healthcare provides. Third, power relationships especially among focus group discussant in MDR-TB treatment initiation centers might have influenced open disclosures of some sensitive issues.

The study showed how healthcare provider’s engagement in MDR-TB management and prevention was influenced. Accordingly, patient’s underlying causes, seeking support, perceived occupational exposure, healthcare provider’s incompetence and health facilities poor linkage were identified from the analysis. Weak community TB prevention efforts, poor health system support and support from colleagues, health care providers’ incompetence and health facilities poor linkage were among identified factors influencing engagement in MDR – TB prevention and management. Therefore, measures need to be in place that avert the observed obstacles to health professionals’ engagement including further quantitative studies to determine the effects of the identified reasons and potential factors in their engagement status.

Furthermore, our findings pointed out the need for additional training of service providers, particularly in clinical programmatic management of drug-resistant tuberculosis. Besides, program managers must adhere to the World Health Organization’s recommendations for health professional engagement. Higher officials in the health sector needs to strengthen the linkage between health facilities and service providers at different levels. Community awareness creation to avoid fear of discrimination including provision of support for those with MDR-TB is expected from health experts through implementation of social behavioral change communication activities.

Abbreviations

Directly observed treatment short-course

Drug susceptible tuberculosis

Millennium development goals

Multidrug resistant tuberculosis

Sustainable development goals

Tuberculosis

Treatment initiation center

World Health Organization

Extensively drug resistant TB

WHO. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. WHO; Geneva, Switherland. 2014.

WHO. Implementing the end TB Strategy: The Essentials. WHO, Geneva. Switherland; 2015.

Eshetie S, Gizaw M, Dagnew M, Kumera G, Woldie H, Fikadu A. et.al. Multidrug-resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis Ethiopia: efforts to expand diagnostic services, treatment and care. BMC Antimicrobial Resist Infect Control. 2014;3:31.

Biadglegne F, Sack U, Rodloff AC. Multidrug-resistant tuberculosis in Ethiopia: efforts to expand diagnostic services, treatment and care. BMC Antimicro Resist Infect Control. 2014;3:31.

Lema NA, Majigo M, Mbelele PM, Abade AMIM. Risk factors associated with multidrug resistant tuberculosis among patients referred to Kibong’oto Infectious Disease Hospital in northern Tanzania. Tanzania J Health Res. 2016;18:4.

Mekonnen F, Tessema B, Moges F, Gelaw A, Eshetie S. G. K. Multidrug resistant tuberculosis: prevalence and risk factors in districts of metema and west armachiho, Northwest Ethiopia. BMC Infect Dis. 2015;15:461.

Selamawit H, Girmay M, Belaineh G, Muluken M, Alemayehu M, et al. PS. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study. BMC Public Health 2013. 2013;13:782.

Google Scholar  

Safwat TM, Elmasry AA, Mohamed A. Prevalence of multi-drug resistant tuberculosis in abbassia Chest hospital from july 2006 to december 2009. Egyptian J Bronchol. 2011;5(2):124–30.

World Health Organization. WHO Global tuberculosis report 2015. Geneva: WHO. 2015.

Rifat M, Hall J, Oldmeadow C, Husain A, Hinderaker SG. AH. M. Factors related to previous tuberculosis treatment of patients with multidrug resistant tuberculosis in Bangladesh. BMJ Open. 2015;5.

Gupta KB, Gupta R, Atreja A, Verma MSV. Tuberculosis and nutrition. Lung India: Offic Organ of Indian Chest Soc. 2009;26(1):9–16. https://doi.org/10.4103/0970-2113.45198 . 2009.

World Health Organization. WHO Global tuberculosis report 2018. Geneva: WHO. 2018.

Deus L, Willy S, Kenneth M, George WK, Frank JCMJ. et al. Variation and risk factors of drug resistant tuberculosis in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2015;15.

Federal Ministry of Health. Guidelines for Clinical and Programmatic Management of TB, TB/HIV and Leprosy in Ethiopia. Fifth Edition. Addis Ababa. March, 2013.

FDRE/MOH. Guidelines on programmatic management of drug resistant tuberculosis in Ethiopia. 2ND ED.2014 ADDIS ABABA. 2014.

CSIS. Center for Strategic and International Studies. As Ethiopia moves toward tuberculosis elimination, success requires higher investment: A report of CSIS global health policy center. CSIS, Washinton DC, America. 2016.

World Health organization. Framework for the engagement of all health care providers in the management of drug resistant tuberculosis. Geneva; Switherland. WHO 2015.

Vries G, Tsolova S, Anderson LF, Gebhard AC, Helda E, Hollo V. Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences. BMC Public Health. 2017;17:334.

Isara AR, Akpodiete A. Concerns about the knowledge and attitude of multidrug resistant tuberculosis among health care workers and patients in Delta State, Nigeria. Nigerian J Clin Pract. 2015;18:5.

Luka MI, Idris SH, Patrick N, Ndadilnasiya EW, Moses OA, Phillip P., et al. Health care workers’ knowledge and attitude towards TB patients under Direct Observation of Treatment in Plateau state Nigeria, 2011. Pan Afr Med J. 2014;18 (Supp1):8.

Malangu N, Adebanjo OD. Knowledge and practices about multidrug-resistant tuberculosis amongst healthcare workers in Maseru. Afr J Prm Health Care Fam Med. 2015;7:1.

Molla Y, Jerene D, Jema I, Nigussie G, Kebede T, Kassie Y. et.al. The experience of scaling up a decentralized, ambulatory model of care for management of multidrug-resistant tuberculosis in two regions of Ethiopia. J Clinic Tubercul Other Mycobacter Dis. 2017;7:28–33.

Merza MA, Farnia P, Tabarsi P, Khazampour M, Masjedi MR. AA. V. Anti-tuberculosis drug resistance and associated risk factors in a tertiary level TB centre in Iran: a retrospective analysis. J Infect Dev Ctries. 2011;5(7):511–19.

Gebremariam MK, Bjune GA. FJ. Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health. 2010;10:651.

Suri AGK. S. C. Voices from the Field: Perspectives from Community Health Workers on Health Care Delivery in Rural KwaZulu-Natal, South Africa. J Infect Dis. 2007;196:S505–11.

Deshmukh RD, Dhande DJ, Sachdeva KS, Sreenivas AN, Kumar AMV. M. P. Social support a key factor for adherence to multidrug-resistant tuberculosis treatment. Indian J Tubercul. 2017.

Samuel B, Volkmann T, Cornelius S, Mukhopadhay S, Mitra K, Kumar AM., et al. Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India. J Tuberc Res. 2016;4(4):213–19.

NC. E. The making of a public health problem: multi-drug resistant tuberculosis in India. Health Policy Plan 2013;28:375–85.

Gler MT, Podewils LJ, Munez N, Galipot M, Quelapio MID, Tupasi TE. Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012;16(7):955–60. https://doi.org/10.5588/ijtld.11.0502 .

Article   CAS   Google Scholar  

Horter S, Stringer B, Greig J, Amangeldiev A, Tillashaikhov MN, Parpieva N., et al. Where there is hope: a qualitative study examining patients’ adherence to multidrug resistant tuberculosis treatment in Karakalpakstan, Uzbekistan. BMC Infect Dis. 2016;16:362.

Naidoo P, Niekerk MV, Toit ED, Beyers N, Leon N. Pathways to multidrug-resistant tuberculosis diagnosis and treatment initiation: a qualitative comparison of patients’ experiences in the era of rapid molecular diagnostic tests. BMC Health Serv Res. 2015;15:488.

WHO. ENGAGE-TB. Training of community health workers and community volunteers. Integrating community-based tuberculosis activities into the work of nongovernmental and other civil society organizations. 2015.

Gerard de Vries S, Tsolova FL, Anderson AC, Gebhard E, Heldal et al. Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences BMC Public Health. 2017;17:334. https://doi.org/10.1186/s12889-017-4216-9 .

Finlay A, Lancaster JHT, Weyer K, Miranda A. M. W. Patient- and Provider level risk factors associated with default from tuberculosis treatment, South Africa: a case control study. BMC Publich Health. 2012;12:56.

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Acknowledgements

We would like to acknowledge Hosanna College of Health Sciences Research and community service directorate for providing us the opportunity and necessary fund to conduct this research. Our appreciation also goes to heads of various health centers, hospitals, district health and Hadiya Zone Health office for unreserved cooperation throughout data collection.

The authors declare that this study received funding from Hosanna College of Health Sciences. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

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Bereket Aberham Lajore & Menen Ayele

Present address: Hossana College of Health Sciences, Hosanna, SNNPR, Ethiopia

Yitagesu Habtu Aweke

Present address: College of Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

Samuel Yohannes Ayanto

Present address: College of Health Sciences, Institute of Public Health, Department of -Population and Family Health, Jimma University, Jimma, Ethiopia

Bereket Aberham Lajore, Yitagesu Habtu Aweke and Samuel Yohannes Ayanto contributed equally to this work.

Authors and Affiliations

Department of Family Health, Hossana College of health sciences, Hossana, Ethiopia

Bereket Aberham Lajore

Department of Health informatics, Hossana College of Health Sciences, Hossana, Ethiopia

Department of Midwifery, Hossana College of Health Sciences, Hossana, Ethiopia

Department of Clinical Nursing, Hossana College of Health Sciences, Hossana, Ethiopia

Menen Ayele

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Bereket Aberham Lajore, Yitagesu Habtu Aweke, and Samuel Yohannes Ayanto conceived the idea and wrote the proposal, participated in data management, analyzed the data and drafted the paper and revised the analysis and subsequent draft of the paper. Menen Ayele revised and approved the proposal, revised the analysis and subsequent draft of the paper. Yitagesu Habtu and Bereket Aberham Lajore wrote the main manuscript text and prepared all tables. All authors reviewed and approved the final manuscript.

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Correspondence to Bereket Aberham Lajore .

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Ethical approval was obtained from Institutional review board [IRB] of Hossana College of health sciences after reviewing the protocol for ethical issues and provided a formal letter of permission to concerned bodies in the health system. Accordingly, permission to conduct this study was granted by respective health facilities in Hadiya zone. Confidentiality of the information was assured and participants’ autonomy not to participate or to opt-out at any stage of the interview were addressed. Finally, informed consent was obtained from the study participants after detailed information.

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Lajore, B.A., Aweke, Y.H., Ayanto, S.Y. et al. Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study. BMC Health Serv Res 24 , 542 (2024). https://doi.org/10.1186/s12913-024-10911-6

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“Holy cow, where do I sign up?” Attitudes of Military Veterans toward Epigenomic Biomarker Toxic Exposure Testing

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Background With the signing of the PACT Act in 2022, there is great interest and investment in studying toxic exposures encountered during military service. One way to address this is through the identification of epigenomic biomarkers associated with exposures. There is increasing evidence suggesting that exposure to toxic substances may result in alterations to DNA methylation and resultant gene expression. These epigenomic changes may lead to adverse health effects for exposed individuals and their offspring. While the development of epigenomic biomarkers for exposures could facilitate understanding of these exposure-related health effects, such testing could also provide unwanted information.

Objectives Explore Veterans’ attitudes toward epigenomic biomarker research and the potential to test for past exposures that could pose intergenerational risk.

Methods Semi-structured interviews with Veterans (n=22) who experienced potentially harmful exposures during their military service.

Results Twenty Veterans said they would hypothetically want to receive epigenomic information related to their toxic exposures and potential health impacts as part of a research study. Veterans identified nine potential benefits of this research, including promoting insights concerning intergenerational health, identification of early health interventions to mitigate the impact of exposures, and additional knowledge or explanation for their experiences. At the same time, 16 participants noted potential risks, including psychological distress in response to results, concerns about receiving non-actionable, uncertain, or inaccurate results, and issues related to privacy and discrimination. Ten participants also identified at least one condition in their children that they thought could be related to their exposure and most said they would be interested in receiving research results related to their children’s and grandchildren’s risk of developing a health condition associated with their exposure.

Discussion Results suggest that Veterans might welcome benefits of epigenomic research related to military exposures yet have some concerns about potential negative impacts.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Funding for this research was provided by the Gulf Coast Center for Precision Environmental Health (NIH P30 ES030285) through a National Institute of Environmental Health Sciences Center Pilot Project grant. This research was also supported in part by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Services at the Center for Innovations in Quality, Effectiveness and Safety (IQuESt; CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The IRB of Baylor College of Medicine gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

C onflicts of I nterest The authors declare they have nothing to disclose.

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Aggregated qualitative data are available from the corresponding author upon reasonable request in accordance with VA privacy requirements.

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Students’ Sense of Belonging Matters: Evidence from Three Studies

On Thursday, February 16, we hosted Dr. Maithreyi Gopalan to discuss her latest research on how students’ sense of belonging matters.

• Evidence has shown that in certain contexts, a student’s sense of belonging improves academic outcomes, increases continuing enrollment, and is protective for mental health. In some of the studies presented, these correlations were still present beyond the time frame of the analysis, suggesting that belonging might have a longitudinal effect.
• Providing a more adaptive interpretation of challenge seemed to help students in a belonging intervention make alternative and more adaptive attributions for their struggles, forestalling a potential negative impact on their sense of belonging.

Professor Gopalan began her talk by discussing how the need for “a sense of belonging” has been identified as a universal and fundamental human motivation in the field of psychology. John Bowlby, one of the first to conduct formal scientific research on belonging, examined the effects on children who had been separated from their parents during WWII (Baumeister & Leary, 1995). From his pioneering work, Bowlby and colleagues proposed that humans are driven to form lasting and meaningful interpersonal relationships, and the inability to meet this need results in loneliness and mental distress. Educational psychologists adapted the concept of belonging to indicate how students’ sense of fit with themselves and with their academic context can affect how they perceive whether they can thrive within it (Eccles & Midgley, 1989; Eccles & Roeser, 2011).

After providing this brief overview of what belonging means more broadly, Dr. Gopalan introduced the concept of “belonging uncertainty” pioneered by social psychologists Geoffrey Cohen and Gregory Walton at Stanford University (Walton & Cohen, 2007) to describe the uncertainty students might feel about their belonging when entering a new social and academic situation , which is most pronounced during times of transition (e.g., entering college). Research has shown that belonging uncertainty affects how students make sense of daily adversities, often interpreting negative events as evidence for why they do not belong. Belonging uncertainty may result in disengagement and poor academic outcomes. In contrast, a sense of belonging is associated with academic achievement, persistence in the course, major, and college (Walton & Cohen, 20011, Yeager & Walton, 2011). It is the concept of belonging uncertainty that is the focus of Dr. Gopalan’s presentation, with emphasis on the findings from the following key research questions:

• How do students’ sense of belonging in the first year correlate with academic persistence and outcomes at a national level?
• Can belonging interventions during the first semester of college lead to increased persistence and academic achievement in a diverse educational setting?
• How does a student’s sense of belonging amidst the COVID-19 pandemic correlate with mental health?

Study 1: College Students’ Sense of Belonging: A National Perspective (Gopalan & Brady, 2019)

Most research examining college students’ sense of belonging has come from studies looking at one or a few single four-year institutions. To examine how belonging differs across student identities and institutions, Professor Gopalan and colleagues looked at the responses from the only nationally representative survey of college students to date that had measured belonging. The Beginning Postsecondary Students Longitudinal Study (BPS) (Dudley et al ., 2020) sampled first-time beginning college students from 4070 eligible two- and four-year institutions (N= 23, 750 students), surveyed during their first year and subsequently two years later.

Professor Gopalan examined average measurements of belonging across institution type and student characteristics (Gopalan & Brady, 2019) and associations between belonging measurements and measurements of academic achievement, including GPA and persistence (continued enrollment), self-reported mental health, and self-reported use of campus services. The results, Dr. Gopalan explained, were striking: underrepresented racial and ethnic minority students (URMs) and first-generation/low-income students (FGLIs) reported a lower sense of belonging in four-year colleges than their non-URM and non-FGLI counterparts. 1 Importantly, they also found that having a greater sense of belonging is associated with higher academic performance, persistence, and is protective for mental health in year three of students’ undergraduate trajectory, suggesting that belonging might have a longitudinal effect (Gopalan & Brady, 2019). These findings were consistent with previous results from smaller studies involving single institutions. Sense of belonging is important not just in specific institutions but nationally, and social identity and context matter . One practical and policy-driven takeaway from this study is that only one national data set currently measures students’ sense of belonging using a single item. More robust measurements and large data sets might reveal additional insights into the importance of belonging for students’ educational experiences.

1 At two-year colleges, first-year belonging is not associated with persistence, engagement, or mental health. This suggests that belonging may function differently in two-year settings. More work is ongoing to try to understand the context that might be driving the difference. (Deil-Amen, 2011).

Study 2: A customized belonging intervention improves retention of socially disadvantaged students at a broad-access university (Murphy et al ., 2020)

Professor Gopalan and colleagues wanted to understand how to adapt existing belonging interventions to different educational contexts and dig deeper into underlying psychological processes underpinning belonging uncertainty. Because previous social-belonging interventions were conducted in well-resourced private or public institutions, Professor Gopalan was interested in examining whether the positive effects of belonging interventions could be extended to a broader-access context (context matters as not all extensions of belonging interventions have been shown to reproduce persistent changes in enrollment and academic outcomes). For this purpose, the traditional belonging interventions were customized for a four-year, Hispanic-serving public university with an 85% commuter enrollment using focus groups and surveys. Based on prior research, belonging interventions provide an adaptive lay theory for why students encounter challenges during transition times (Yeager et al ., 2016). Students, particularly those with little knowledge of how college works or those who have experienced discrimination, or are aware of negative stereotypes about their social group, may make global interpretations of why college can be challenging and may even associate challenges as evidence that they and students like them don’t belong. With belonging interventions, the lay theory provided to students aims to frame the experience of challenge in more adaptive ways—challenge and adversity are typical experiences, particularly during transitional moments, and should be expected; adapting academically and socially takes time—students will be more likely to persist, seek out campus resources and develop social relationships.

• They acknowledge that challenges are expected during transitions and that these are varied.
• They communicate to students that most students, including students from non-minority groups, experience similar challenges and feelings about them.
• They communicate that belonging is a process that takes time and tends to increase over time
• They use student examples of challenges and resolutions.

The Intervention

All students in the first-year writing class were randomly assigned to either the belonging group or an active control group. The intervention was provided to first-year students in their writing class and consisted of a reading and writing assignment about social and academic belonging. The control group was given the same assignment but with a different topic, study skills. In the intervention group, students read several stories from a racially diverse set of upper-level students who reflected on the challenges of making friends and adjusting to a new academic context. The hypothetical students reflected on the strategies they used, the resources they accessed, and how the challenge dissipated over time. After the reading exercise, the students in the intervention group were instructed to write about how the readings echoed their own first-year experiences. Then, they were asked to write a letter to future students who might question their belonging during their transition to college. Research has shown that written reflections help students internalize the main messages of the belonging intervention (Yeager & Walton, 2011).

Similar to previously published belonging interventions, results in persistence and academic achievement were significant for minoritized groups in the belonging cohort:

• Persistence. Compared to the control group, continuous enrollment for URM & FGLI students increased by 10% one year after and 9% two years after the intervention.
• Performance. The non-cumulative GPA from the URM & FGLI students increased by 0.19 points the semester immediately following the intervention and by 0.11 over the next two years compared to students in the control group.

Immediately following the intervention, a selected sub-sample of students in both conditions was invited to take a daily diary survey for nine consecutive days. The daily diary survey assessed students’ daily positive and negative academic and social experiences (students were asked to report and describe three negative and three positive events that they faced daily and to rate how positive and negative the events were), as well as their daily sense of social and academic belonging. The daily-diary assignment revealed another interesting finding: the intervention did not change the overall perception of negative events. URM & FGLI students in both groups had a statistically similar daily-adversity index and reported the same number of daily adverse events on average. However, there was no connection between the adversity index and sense of belonging for students in the belonging cohort. In contrast, students in the control group evidenced a negative correlation between daily adversities and belonging: “the greater adversity disadvantaged students experienced on a day, the lower their sense of social and academic fit” (Murphy et al ., 2020).

Providing a more adaptive interpretation of challenge seemed to help students in the belonging condition make alternative and more adaptive attributions for their struggles that did not connect to their sense of belonging. A follow-up survey one year after the intervention showed that minoritized students in the belonging intervention continued to report a higher sense of belonging in comparison to their counterparts in the control group.

Study 3: College Student’s Sense of Belonging and Mental Health Amidst the COVID-19 Pandemic (Gopalan et al ., 2022)

Dr. Gopalan presented the third study, which turned out to provide a unique opportunity to assess whether sense of belonging had predictive effects on mental health. In the fall of 2019, researchers sent a survey to students at a large, multicampus Northeastern public university called the College Relationship and Experience survey (CORE), which included two questions about belonging, among other items. In the Spring of 2020, after students were sent home due to the COVID-19 pandemic, a variation of the same survey was sent to students who had taken the CORE survey. After controlling for pre-COVID depression and anxiety, Dr. Gopolan and colleagues found that students who reported a higher sense of belonging in the fall of 2019 had lower rates of depression and anxiety midst-COVID pandemic , with the effects on depression more strongly predictive than those for anxiety. The correlation between a lower sense of belonging and higher rates of depression and anxiety was also found to be strongest for first-year students, who had little time during their first year to build community and adjust to college before the pandemic hit.

Dr. Gopalan concluded with some practical advice for instructors: “Stop telling students they belong, show them instead that they belong,” citing a recent op-ed from Greg Walton . We do this by modeling the idea that belonging is a process that takes time and by communicating to students that they are not alone , which can be done through sharing our own experiences with belonging, and by allowing students space to hear the experiences of their peers and learn from one another.

• Classroom Practices Library which includes Overview: Effective Social Belonging Messages are more.
• The Project for Education Research That Scales (PERTS) : a free belonging intervention for four-year colleges and universities.
• Research library on belonging
• Article on Structures for Belonging: A Synthesis of Research on Belonging-Supportive Learning Environments
• “Stop telling students ‘You Belong!’”
• Everyone is talking about belonging: What does it really mean?
• Post-secondary
• Academic Belonging : introduction to the concept and practices that support it.
• Flipping Failure : a campus-wide initiative to help students feel less alone by hearing stories about how their peers coped with academic challenges

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117 (3), 497–529. https://doi.org/10.1037/0033-2909.117.3.497

Deil-Amen, R. (2011). Socio-academic integrative moments: Rethinking academic and social integration among two-year college students in career-related programs. The Journal of Higher Education , 82(1), 54-91. https://doi.org/10.1080/00221546.2011.11779085  

Dudley, K., Caperton, S.A., and Smith Ritchie, N. (2020). 2012 Beginning Postsecondary Students Longitudinal Study (BPS:12) Student Records Collection Research Data File Documentation (NCES 2021-524). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved 2/27/2023 from https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid-2021524

Eccles, J. S., & Midgley, C. (1989). Stage/Environment Fit: Developmentally Appropriate Classrooms for Early Adolescence. In R. E. Ames, & Ames, C. (Eds.), Research on Motivation in Education , 3, 139-186. New York: Academic Press.

Eccles, J. S., & Roeser, R. W. (2011). Schools as developmental contexts during adolescence. Journal of Research on Adolescence, 21 (1), 225–241. https://doi.org/10.1111/j.1532-7795.2010.00725.x

Gopalan, M., & Brady, S. T. (2020). College Students’ Sense of Belonging: A National Perspective. Educational Researcher , 49(2), 134–137. https://doi.org/10.3102/0013189X19897622

Gopalan, M., Linden-Carmichael, A. Lanza, S. (2022). College Students’ Sense of Belonging and Mental Health Amidst the COVID-19 Pandemic, Journal of Adolescent Health , 70(2), 228-233. https://doi.org/10.1016/j.jadohealth.2021.10.010

Murphy, M.C., Gopalan, M., Carter, E. R., Emerson, K. T. U., Bottoms, B. L., and Walton, G.M., (2020). A customized belonging intervention improves retention of socially disadvantaged students at a broad-access university Science Advances, 6(29). DOI: 10.1126/sciadv.aba4677

Walton, & Cohen. (2007). A question of belonging: Race, social fit, and achievement. Journal of Personality and Social Psychology, 92(1), 82. https://doi.org/10.1037/0022-3514.92.1.82

Walton, G.M., & Cohen, G.L. (2011). A Brief Social-Belonging Intervention Improves Academic and Health Outcomes of Minority Students. Science,  331(6023), 1447-1451.  DOI: 10.1126/science.1198364

Yeager, D. S., & Walton, G. M. (2011). Social-Psychological Interventions in Education They’re Not Magic. Review of Educational Research, 81(2), 267–301. http://doi.org/10.3102/0034654311405999

Yeager, D.S., Walton G.M., Brady, S.T., Dweck, C.S.,(2016). Teaching a lay theory before college narrows achievement gaps at scale, Psychological and Cognitive Sciences , 113(24), E3341-E3348. https://doi.org/10.1073/pnas.1524360113

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Technology as a Tool for Improving Patient Safety

Introduction .

In the past several decades, technological advances have opened new possibilities for improving patient safety. Using technology to digitize healthcare processes has the potential to increase standardization and efficiency of clinical workflows and to reduce errors and cost across all healthcare settings. 1 However, if technological approaches are designed or implemented poorly, the burden on clinicians can increase. For example, overburdened clinicians can experience alert fatigue and fail to respond to notifications. This can lead to more medical errors. As a testament to the significance of this topic in recent years, several government agencies [(e.g. the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid services (CMS)] have developed resources to help healthcare organizations integrate technology, such as the Safety Assurance Factors for EHR Resilience (SAFER) guides developed by the Office of the National Coordinator for Health Information Technology (ONC). 2,3,4  However, there is some evidence that these resources have not been widely used.5 Recently, the Centers for Medicare & Medicaid Services (CMS) started requiring hospitals to use the SAFER guides as part of the FY 2022 Hospital Inpatient Prospective Payment Systems (IPPS), which should raise awareness and uptake of the guides. 6

During 2022, research into technological approaches was a major theme of articles on PSNet. Researchers reviewed all relevant articles on PSNet and consulted with Dr. A Jay Holmgren, PhD, and Dr. Susan McBride, PhD, subject matter experts in health IT and its role in patient safety. Key topics and themes are highlighted below.  

Clinical Decision Support  

The most prominent focus in the 2022 research on technology, based on the number of articles published on PSNet, was related to clinical decision support (CDS) tools. CDS provides clinicians, patients, and other individuals with relevant data (e.g. patient-specific information), purposefully filtered and delivered through a variety of formats and channels, to improve and enhance care. 7   

Computerized Patient Order Entry  

One of the main applications of CDS is in computerized patient order entry (CPOE), which is the process used by clinicians to enter and send treatment instructions via a computer application. 8 While the change from paper to electronic order entry itself can reduce errors (e.g., due to unclear handwriting or manual copy errors), research in 2022 showed that there is room for improvement in order entry systems, as well as some promising novel approaches. 

Two studies looked at the frequency of and reasons for medication errors in the absence of CDS and CPOE and demonstrated that there was a clear patient safety need. One study found that most medication errors occurred during the ordering or prescribing stage, and both this study and the other study found that the most common medication error was incorrect dose. Ongoing research, such as the AHRQ Medication Safety Measure Development project, aims to develop and validate measure specifications for wrong-patient, wrong-dose, wrong-medication, wrong-route, and wrong-frequency medication orders within EHR systems, in order to better understand and capture health IT safety events.9 Errors of this type could be avoided or at least reduced through the use of effective CPOE and CDS systems. However, even when CPOE and CDS are in place, errors can still occur and even be caused by the systems themselves. One study reviewed duplicate medication orders and found that 20% of duplicate orders resulted from technological issues, including alerts being overridden, alerts not firing, and automation issues (e.g., prefilled fields). A case study last year Illustrated one of the technological issues, in this case a manual keystroke error, that can lead to a safety event. A pharmacist mistakenly set the start date for a medication to the following year rather than the following day , which the CPOE system failed to flag. The authors recommended various alerts and coding changes in the system to prevent this particular error in the future.  

There were also studies in 2022 that showed successful outcomes of well-implemented CPOE systems. One in-depth pre-post, mixed-methods study showed that a fully implemented CPOE system significantly reduced specific serious and commonly occurring prescribing and procedural errors. The authors also presented evidence that it was cost-effective and detailed implementation lessons learned drawn from the qualitative data collected for the study. A specific CPOE function that demonstrated statistically significant improvement in 2022 was automatic deprescribing of medication orders and communication of the relevant information to pharmacies. Deprescribing is the planned and supervised process of dose reduction or stopping of a medication that is no longer beneficial or could be causing harm. That study showed an immediate and sustained 78% increase in successful discontinuations after implementation of the software. A second study on the same functionality determined that currently only one third to one half of medications are e-prescribed, and the study proposed that e-prescribing should be expanded to increase the impact of the deprescribing software. It should be noted, however, that the systems were not perfect and that a small percentage of medications were unintentionally cancelled. Finally, an algorithm to detect patients in need of follow-up after test results was developed and implemented in another study . The algorithm showed some process improvements, but outcome measures were not reported. 

Usability  

Usability of CDS systems was a large focus of research in 2022. Poorly designed systems that do not fit into existing workflows lead to frustrated users and increase the potential for errors. For example, if users are required to enter data in multiple places or prompted to enter data that are not available to them, they could find ways to work around the system or even cease to use it, increasing the potential for patient safety errors. The documentation burden is already very high on U.S. clinicians, 10 so it is important that novel technological approaches do not add to this burden but, if possible, alleviate it by offering a high level of usability and interoperability.  

One study used human-factored design in creating a CDS to diagnose pulmonary embolism in the Emergency Department and then surveyed clinician users about their experiences using the tool. Despite respondents giving the tool high usability ratings and reporting that the CDS was valuable, actual use of the tool was low. Based on the feedback from users, the authors proposed some changes to increase uptake, but both users and authors mentioned the challenges that arise when trying to change the existing workflow of clinicians without increasing their burden. Another study gathered qualitative feedback from clinicians on a theoretical CDS system for diagnosing neurological issues in the Emergency Department. In this study too, many clinicians saw the potential value in the CDS tool but had concerns about workflow integration and whether it would impact their ability to make clinical decisions. Finally, one study developed a dashboard to display various risk factors for multiple hospital-acquired infections and gathered feedback from users. The users generally found the dashboard useful and easy to learn, and they also provided valuable feedback on color scales, location, and types of data displayed. All of these studies show that attention to end user needs and preferences is necessary for successful implementation of CDS.  However, the recent market consolidation in Electronic Health Record vendors may have an impact on the amount of user feedback gathered and integrated into CDS systems. Larger vendors may have more resources to devote to improving the usability and design of CDS, or their near monopolies in the market may not provide an incentive to innovate further. 11 More research is needed as this trend continues.  

Alerts and Alarms 

Alerts and alarms are an important part of most CDS systems, as they can prompt clinicians with important and timely information during the treatment process. However, these alerts and alarms must be accurate and useful to elicit an appropriate response. The tradeoff between increased safety due to alerts and clinician alert fatigue is an important balance to strike. 12

Many studies in 2022 looked at clinician responses to medication-related alerts, including override and modification rates. Several of the studies found a high alert override rate but questioned the validity of using override rates alone as a marker of CDS effectiveness and usability. For example, one study looked at drug allergy alerts and found that although 44.8% of alerts were overridden, only 9.3% of those were inappropriately overridden, and very few overrides led to an adverse allergic reaction. A study on “do not give” alerts found that clinicians modified their orders to comply with alert recommendations after 78% of alerts but only cancelled orders after 26% of alerts. A scoping review looked at drug-drug interaction alerts and found similar results, including high override rates and the need for more data on why alerts are overridden. These findings are supported by another study that found that the underlying drug value sets triggering drug-drug interaction alerts are often inconsistent, leading to many inappropriate alerts that are then appropriately overridden by clinicians. These studies suggest that while a certain number of overrides should be expected, the underlying criteria for alert systems should be designed and regularly reviewed with specificity and sensitivity in mind. This will increase the frequency of appropriate alerts that foster indicated clinical action and reduce alert fatigue. 

There also seems to be variability in the effectiveness of alert systems across sites. One study looked at an alert to add an item to the problem list if a clinician placed an order for a medication that was not indicated based on the patient’s chart. The study found about 90% accuracy in alerts across two sites but a wide difference in the frequency of appropriate action between the sites (83% and 47%). This suggests that contextual factors at each site, such as culture and organizational processes, may impact success as much as the technology itself.  

A different study looked at the psychology of dismissing alerts using log data and found that dismissing alerts becomes habitual and that the habit is self-reinforcing over time. Furthermore, nearly three quarters of alerts were dismissed within 3 seconds. This indicates how challenging it can be to change or disrupt alert habits once they are formed. 

Artificial Intelligence and Machine Learning  

In recent years, one of the largest areas of burgeoning technology in healthcare has been artificial intelligence (AI) and machine learning. AI and machine learning use algorithms to absorb large amounts of historical and real-time data and then predict outcomes and recommend treatment options as new data are entered by clinicians. Research in 2022 showed that these techniques are starting to be integrated into EHR and CDS systems, but challenges remain. A full discussion of this topic is beyond the scope of this review. Here we limit the discussion to several patient-safety-focused resources posted on PSNet in 2022.  

One of the promising aspects of AI is its ability to improve CDS processes and clinician workflow overall. For example, one study last year looked at using machine learning to improve and filter CDS alerts. They found that the software could reduce alert volume by 54% while maintaining high precision. Reducing alert volume has the potential to alleviate alert fatigue and habitual overriding. Another topic explored in a scoping review was the use of AI to reduce adverse drug events. While only a few studies reviewed implementation in a clinical setting (most evaluated algorithm technical performance), several promising uses were found for AI systems that predict risk of an adverse drug event, which would facilitate early detection and mitigate negative effects.  

Despite enthusiasm for and promising applications of AI, implementation is slow. One of the challenges facing implementation is the variable quality of the systems. For example, a commonly used sepsis detection model was recently found to have very low sensitivity. 13 Algorithms also drift over time as new data are integrated, and this can affect performance, particularly during and after large disturbances like the COVID-19 pandemic. 14 There is also emerging research about the impact of AI algorithms on racial and ethnic biases in healthcare; at the time of publication of this essay, an AHRQ EPC was conducting a review of evidence on the topic. 15  These examples highlight the fact that AI is not a “set it and forget it” application; it requires monitoring and customization from a dedicated resource to ensure that the algorithms perform well over time. A related challenge is the lack of a strong business case for using high-quality AI. Because of this, many health systems choose to use out-of-the-box AI algorithms, which may be of poor quality overall (or are unsuited to particular settings) and may also be “black box” algorithms (i.e., not customizable by the health system because the vendor will not allow access to the underlying code). 16 The variable quality and the lack of transparency may cause mistrust by clinicians and overall aversion to AI interventions.  

In an attempt to address these concerns, one article in 2022 detailed best practices for AI implementation in health systems, focusing on the business case. Best practices include using AI to address a priority problem for the health system rather than treating it as an end itself. Additionally, testing the AI using the health system’s patients and data to demonstrate applicability and accuracy for that setting, confirming that the AI can provide a return on investment, and ensuring that the AI can be implemented easily and efficiently are also important. Another white paper described a human-factors and ergonomics framework for developing AI in order to improve the implementation within healthcare systems, teams, and workflows. The federal government and international organizations have also published AI guidelines, focusing on increasing trustworthiness (National Artificial Intelligence Initiative) 17 and ensuring ethical governance (World Health Organization). 18   

Conclusion and Next Steps 

As highlighted in this review, the scope and complexity of technology and its application in healthcare can be intimidating for healthcare systems to approach and implement. Researchers last year thus created a framework that health systems can use to assess their digital maturity and guide their plans for further integration.  

The field would benefit from more research in several areas in upcoming years. First and foremost, high-quality prospective outcome studies are needed to validate the effectiveness of the new technologies. Second, more work is needed on system usability, how the systems are integrated into workflows, and how they affect the documentation burden placed on clinicians. For CDS specifically, more focus is needed on patient-centered CDS (PC CDS), which supports patient-centered care by helping clinicians and patients make the best decisions given each individual’s circumstances and preferences. 19 AHRQ is already leading efforts in this field with their CDS Innovation Collaborative project. 20 Finally, as it becomes more common to incorporate EHR scribes to ease the documentation burden, research on their impact on patient safety will be needed, especially in relation to new technological approaches. For example, when a scribe encounters a CDS alert, do they alert the clinician in all cases? 

In addition to the approaches mentioned in this article, other emerging technologies in early stages of development hold theoretical promise for improving patient safety. One prominent example is “computer vision,” which uses cameras and AI to gather and process data on what physically happens in healthcare settings beyond what is captured in EHR data, 21 including being able to detect immediately that a patient fell in their room. 22  

As technology continues to expand and improve, researchers, clinicians, and health systems must be mindful of potential stumbling blocks that could impede progress and threaten patient safety. However, technology presents a wide array of opportunities to make healthcare more integrated, efficient, and safe.  

• Cohen CC, Powell K, Dick AW, et al. The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents . J Appl Gerontol . 2022;41(7):1695-1701. doi: 10.1177/07334648221082024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9232878/
• https://www.healthit.gov/topic/safety/safer-guides
• https://cds.ahrq.gov/cdsconnect/repository
• https://www.cms.gov/about-cms/obrhi
• McBride S, Makar E, Ross A, et al. Determining awareness of the SAFER guides among nurse informaticists. J Inform Nurs. 2021;6(4). https://library.ania.org/ania/articles/713/view
• Sittig DF, Sengstack P, Singh H. Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. J ama . 2022;327:719-720.
• https://library.ahima.org/doc?oid=300027#.Y-6RhXbMKHt
• https://www.healthit.gov/faq/what-computerized-provider-order-entry#:~:text=Computerized%20provider%20order%20entry%20(CPOE,paper%2C%20fax%2C%20or%20telephone
• https://digital.ahrq.gov/2018-year-review/research-spotlights/leveragin…
• Holmgren AJ, Downing NL, Bates DW, et al. Assessment of electronic health record use between US and non-US health systems. JAMA Intern Med. 2021;181:251-259. https://doi.org/10.1001/jamainternmed.2020.7071
• Holmgren AJ, Apathy NC. Trends in US hospital electronic health record vendor market concentration, 2012–2021. J Gen Intern Med. 2022. https://link.springer.com/article/10.1007/s11606-022-07917-3#citeas
• Co Z, Holmgren AJ, Classen DC, et al. The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. J Am Med Inform Assoc. 2020;27:1252-1258. https://pubmed.ncbi.nlm.nih.gov/32620948/
• Wong A, Otles E, Donnelly JP, et al. External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Intern Med. 2021;181:1065-1070. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781307
• Parikh RB, Zhang Y, Kolla L, et al. Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic. J Am Med Inform Assoc. 2022;30:348-354. https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocac221/6835770?login=false
• https://effectivehealthcare.ahrq.gov/products/racial-disparities-health…
• https://www.statnews.com/2022/05/24/market-failure-preventing-efficient-diffusion-health-care-ai-software/
• https://www.ai.gov/strategic-pillars/advancing-trustworthy-ai/
• Ethics and governance of artificial intelligence for health (WHO guidance). Geneva: World Health Organization; 2021. https://www.who.int/publications/i/item/9789240029200
• Dullabh P, Sandberg SF, Heaney-Huls K, et al. Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan. J Am Med Inform Assoc. 2022: 29(7):1233-1243. doi: 10.1093/jamia/ocac059. PMID: 35534996; PMCID: PMC9196686.
• https://cds.ahrq.gov/cdsic
• Yeung S, Downing NL, Fei-Fei L, et al. Bedside computer vision: moving artificial intelligence from driver assistance to patient safety. N Engl J Med. 2018;387:1271-1273. https://www.nejm.org/doi/10.1056/NEJMp1716891
• Espinosa R, Ponce H, Gutiérrez S, et al. A vision-based approach for fall detection using multiple cameras and convolutional neural networks: a case study using the UP-Fall detection dataset. Comput Biol Med. 2019;115:103520. https://doi.org/10.1016/j.compbiomed.2019.103520

This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers

Perspective

Perspectives on Safety

Annual Perspective

Patient Safety Innovations

Suicide Prevention in an Emergency Department Population: ED-SAFE

WebM&M Cases

The Retrievals. August 9, 2023

Agent of change. August 1, 2018

Amid lack of accountability for bias in maternity care, a California family seeks justice. August 16, 2023

Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens. April 12, 2006

Improving patient safety by shifting power from health professionals to patients. October 25, 2023

Patient Safety Primers

Discharge Planning and Transitions of Care

Medicines-related harm in the elderly post-hospital discharge. March 27, 2019

Emergency department crowding: the canary in the health care system. November 3, 2021

Advancing Patient Safety: Reviews From the Agency for Healthcare Research and Quality's Making Healthcare Safer III Report. September 2, 2020

Exploring Alternatives To Malpractice Litigation. January 15, 2014

Making Healthcare Safer III. March 18, 2020

Special Section: Patient Safety. May 24, 2006

The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise. November 19, 2008

Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014. September 1, 2014

Quality, Safety, and Noninterpretive Skills. November 11, 2015

Patient Safety. November 21, 2018

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote response team and customized alert settings help improve management of sepsis.

Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. May 24, 2023

Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: a systematic review. May 17, 2023

Journal Article

Reducing hospital harm: establishing a command centre to foster situational awareness.

The potential for leveraging machine learning to filter medication alerts. May 4, 2022

Improving the specificity of drug-drug interaction alerts: can it be done? April 6, 2022

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system. December 23, 2020

The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. July 29, 2020

Assessment of health information technology-related outpatient diagnostic delays in the US Veterans Affairs health care system: a qualitative study of aggregated root cause analysis data. July 22, 2020

Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting. August 21, 2019

Improving medication-related clinical decision support. March 7, 2018

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting. April 6, 2016

The effect of provider characteristics on the responses to medication-related decision support alerts. July 15, 2015

Best practices: an electronic drug alert program to improve safety in an accountable care environment. July 1, 2015

Impact of computerized physician order entry alerts on prescribing in older patients. March 25, 2015

Differences of reasons for alert overrides on contraindicated co-prescriptions by admitting department. December 17, 2014

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