qualitative research trustworthiness credibility transferability

Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy pp 1–14 Cite as

Evidence Produced While Using Qualitative Methodologies Including Research Trustworthiness

• Zachariah Jamal Nazar 2 ,
• Hamde Nazar 3 ,
• Daniel Rainkie 4 ,
• Alla El-Awaisi 2 &
• Myriam ElJaam 2  
• Living reference work entry
• First Online: 19 August 2022

99 Accesses

Qualitative research has long been challenged and criticized on issues relating to validity and objectivity. Much debate and discourse have thoroughly explored these concerns and provided coherent reasoning to allay apprehensions and provide researchers with a wealth of advice and guidance on the rigorous conduct and reporting of qualitative studies. Basic principles of trustworthiness are at the core of the evidence and include credibility, dependability, confirmability, and transferability.

Efforts to achieve these principles need to be invested from conception of the research question, through research design, conduct, reporting, and dissemination. There are validated reporting checklists which offer valuable aide-mémoires or prompts to researchers in this journey. These are also used as standards in the review of research to assess aspects of trustworthiness and subsequently quality of the research and the findings. This chapter includes a summary of primary design techniques that aim to improve “trustworthiness” of qualitative research which, if adopted, contribute toward generating evidence of greater value and potential impact.

There are other recognized strategies that can be used as tools by researchers in their endeavor to convince readers, reviewers, and potentially decision-makers of the true value of their work. It is notable that there is not a one-size-fits-all approach. Instead, researchers are urged to be cognizant of the importance of coherency and transparency in the approach, conduct, and reporting of their research to ensure it is best considered, appreciated, and utilized to inform policy and practice. Although this chapter provides an overview and description of tools and strategies to enhance trustworthiness of qualitative research, it is acknowledged that each would require a chapter in its own right to capture the theoretical evolution of these concepts and fully educate the reader. The chapter does not include examples from the pharmacy literature where the criteria have been applied, nor does it provide a comprehensive description of the competing viewpoints of establishing quality in the published literature. Therefore, it is recommended that qualitative researchers consider the following information as a research toolbox, where they are likely to need to consult more detailed manuals of the individual tools in order to fully appreciate their utility and application.

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Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, Doha, Qatar

Zachariah Jamal Nazar, Alla El-Awaisi & Myriam ElJaam

School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK

Hamde Nazar

Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada

Daniel Rainkie

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Nazar, Z.J., Nazar, H., Rainkie, D., El-Awaisi, A., ElJaam, M. (2022). Evidence Produced While Using Qualitative Methodologies Including Research Trustworthiness. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_76-1

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How to Achieve Trustworthiness in Qualitative Research

Qualitative research is, by nature, more directional than quantitative research. There is a misguided assumption that qualitative data is somehow inferior, or at least more questionable, than quantitative data derived from market research. It all comes down to rigor in qualitative research, and whether your study meets certain criteria for credibility, dependability, transferability and confirmability.

Qualitative research is, by nature, more directional than quantitative research. Rather than producing facts and figures—like the hard lines of a drawing—it gives color to your customers’ experiences and provides context by exploring the how and why behind concepts or theories in question.

As a result, there is a misguided assumption that qualitative data is somehow inferior, or at least more questionable, than the quality of quantitative data derived from market research.

However, that’s not the case. Qualitative research plays an important role in understanding consumer attitudes and behaviors, measuring brand perceptions, finessing product development efforts, and achieving other goals as you strive to keep up with shifting demands from customers, new competitors and new technologies.

It all comes down to rigor in qualitative research , and whether your study meets certain criteria for credibility, dependability, transferability and confirmability.

How is Qualitative Research Trustworthiness Measured?

Led by Qualitative Research Director, Dawn McElfresh , The Farnsworth Group has been utilizing qualitative research for over 30 years to help clients make more informed strategic decisions.

When it comes to quantitative research, trustworthiness is measured in terms of validity and reliability. You can achieve trustworthiness in qualitative market research by demonstrating that your findings are dependable, credible, confirmable and transferable. Here are how those four concepts are to be understood:

1. Dependability in Qualitative Research

Dependability is used to measure or demonstrate the consistency and reliability of your study’s results. This starts by tracking the precise methods you use for data collection, analysis and interpretation and providing adequate contextual information about each piece, so that the study could theoretically be replicated by other researchers and generate consistent results. An inquiry audit—performed by an outside person—is one tool used to examine the dependability of a qualitative study. Alternatively, screening parameters can be used to solidify research dependability.

The Farnsworth Group demonstrates the dependability of research we conduct by using specific recruitment screener parameters that allow representation from a broad range of demographics, trade criteria, experience, geographic location and so on—so the insights represent the landscape desired by our clients plus aren't representing a slanted viewpoint from one concentrated demographic.

2. Credibility in Qualitative Research

Credibility is a measure of the truth value of qualitative research, or whether the study’s findings are correct and accurate. To some degree, it relies on the credibility of the researchers themselves, as well as their research methods. Triangulation, prolonged engagement with data, persistent observation, negative case analysis, member checks, and referential adequacy are all procedures that can be used to increase the credibility of qualitative studies. 

The Farnsworth Group demonstrates the measure of truth in research we conduct by conducting senior management analysis on the data collected during the in-depth interviews or focus groups. This involves summarizing each detail and finding the overlapping themes that are consistent—which drive the key insights found in the study.  

Our team’s unique combination of decades of industry experience within manufacturing and product development allow us to formulate strategic recommendations; these insights cannot be replicated by other research firms for this reason.

3. Confirmability in Qualitative Research

In terms of confirmability, you want to prove that your qualitative research is neutral and not influenced by the assumptions or biases of the researchers. Rather, trustworthy research should produce findings that objectively reflect information collected from participants. In other words, your data should speak for itself. Confirmability is often demonstrated by providing an audit trail that details each step of data analysis and shows that your findings aren’t colored by conscious or unconscious bias but accurately portray the participants’ responses. 

Confirmability of research conducted by The Farnsworth Group is achieved by our approach of summarizing the content of each question we ask during the in-depth interview or focus group.  This showcases the overlapping themes, without bias, plus all comments heard since they all can provide value to our clients. Qualitative reporting is about the details, and we provide all the color from the interview or focus group, so that the client can view everything without researcher bias.

4. Transferability in Qualitative Research

As the name implies, transferability measures whether, or to what extent, the study’s results are applicable within other contexts, circumstances and settings. It also can be thought of in terms of generalizability. In order to demonstrate transferability in qualitative research, you can utilize thick description, which involves providing adequate details on the site, participants and methods or procedures used to collect data during your study. 

This helps other researchers evaluate whether the results are applicable for other situations. While transferability cannot be proved with 100 percent certainty, you can demonstrate that it is highly likely in order to back up the trustworthiness of your qualitative market research.

What is Thematic Analysis in Qualitative Research?

Not only must the standard trustworthiness of the data collection be high, but the standard of trustworthiness of the interpretation of results must also remain high. Thematic analysis is a foundational and widely used qualitative research method .

Thematic analysis is a flexible and accessible approach to evaluating qualitative data—such as interview transcripts, field notes or other texts—that emphasizes identifying, analyzing and interpreting patterns, meanings and themes. The challenge is that there can be different ways to interpret data, and the researcher is often relied upon to make judgements and take action when it comes to theming, coding and contextualizing the data.

Here is a brief overview of how you can establish trustworthiness within each phase of the thematic analysis process:

1. Familiarize Yourself with the Data

The first step is to establish prolonged engagement with the data and triangulate different data collection modes. Document both reflective thoughts and thoughts about potential themes in the data. Keep records of all raw data and store it in organized archives.

2. Generate Initial Codes or Tally’s

Through peer debriefing, reflexive journaling and researcher triangulation, you have the option to generate initial codes using a reliable coding framework. Alternatively, you can use response tally’s to refer to when conducting qualitative theme analysis.

In any case, be diligent to leave behind an audit trail of this work, which means having documentation of all debriefings and meetings used in the generation process. 

3. Search for Themes and Patterns

During this phase, you will once again utilize triangulation to establish trustworthiness. You can also employ diagramming to track patterns and themes in the data. Maintain detailed notes about the development of certain concepts and themes.

4. Review Your Themes

Team members can help vet themes and subthemes during this phase. You also can return to the raw data to test for referential adequacy.

5. Define and Name Themes

At this point of the process, peer debriefing and researcher triangulation are tools used to establish trustworthiness in qualitative research. Maintaining rigorous documentation is also a key component.

6. Produce the Report

For this phase, you’ll want to provide thick descriptions of the context of your study and details on the process of coding and analyzing the data. This should include justifications for all analytical and methodological choices made throughout the entire study. Here is where you’ll also conduct member checks.

Establishing Trustworthiness in Qualitative Market Research

Qualitative studies are important within the realm of market research. However, in order for the results to be useful and meaningful, you have to take a rigorous and methodical approach to the collection of qualitative data and interpretation of its themes. This is crucial to ensuring that your findings are trustworthy and reliable. 

The Farnsworth Group has the right experience and tools to help you conduct qualitative market research for the building and construction, home improvement, or lawn and ranch industries. You end up with data-driven insights supported by industry expertise that provide you with actionable recommendations.

Research Writing and Analysis

• NVivo Group and Study Sessions
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• Research Process Flow Chart
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• Step 1: Seek Out Evidence
• Step 2: Explain
• Step 3: The Big Picture
• Step 4: Own It
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• How to Synthesize and Analyze
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Trustworthiness of Qualitative Data

• Analysis and Coding Example- Qualitative Data
• Thematic Data Analysis in Qualitative Design
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Jump to DSE Guide

As noted in the dissertation template for qualitative studies, the section directly following the Chapter 4 introduction is to be labeled Trustworthiness of the Data, and in this section, qualitative researchers are required to articulate evidence of four primary criteria to ensure trustworthiness of the final study data set:

Credibility (e.g., triangulation, member checks)

Credibility of qualitative data can be assured through multiple perspectives throughout data collection to ensure data are appropriate. This may be done through data, investigator, or theoretical triangulation; participant validation or member checks; or the rigorous techniques used to gather the data.

Transferability (e.g., the extent to which the findings are generalizable to other situations)

Generalizability is not expected in qualitative research, so transferability of qualitative data assures the study findings are applicable to similar settings or individuals. Transferability can be demonstrated by clear assumptions and contextual inferences of the research setting and participants.

Dependability (e.g., an in-depth description of the methodology and design to allow the study to be repeated)

Dependability of the qualitative data is demonstrated through assurances that the findings were established despite any changes within the research setting or participants during data collection. Again, rigorous data collection techniques and procedures can assure dependability of the final data set.

Confirmability (e.g., the steps to ensure that the data and findings are not due to participant and/or researcher bias)

Confirmability of qualitative data is assured when data are checked and rechecked throughout data collection and analysis to ensure results would likely be repeatable by others. This can be documented by a clear coding schema that identifies the codes and patterns identified in analyses. Finally, a data audit prior to analysis can also ensure dependability.

For more information on these criteria, visit the Sage Research Methods database in the NU Library: https://resources.nu.edu/sagerm

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Validity, reliability, and generalizability in qualitative research

Lawrence leung.

1 Department of Family Medicine, Queen's University, Kingston, Ontario, Canada

2 Centre of Studies in Primary Care, Queen's University, Kingston, Ontario, Canada

In general practice, qualitative research contributes as significantly as quantitative research, in particular regarding psycho-social aspects of patient-care, health services provision, policy setting, and health administrations. In contrast to quantitative research, qualitative research as a whole has been constantly critiqued, if not disparaged, by the lack of consensus for assessing its quality and robustness. This article illustrates with five published studies how qualitative research can impact and reshape the discipline of primary care, spiraling out from clinic-based health screening to community-based disease monitoring, evaluation of out-of-hours triage services to provincial psychiatric care pathways model and finally, national legislation of core measures for children's healthcare insurance. Fundamental concepts of validity, reliability, and generalizability as applicable to qualitative research are then addressed with an update on the current views and controversies.

Nature of Qualitative Research versus Quantitative Research

The essence of qualitative research is to make sense of and recognize patterns among words in order to build up a meaningful picture without compromising its richness and dimensionality. Like quantitative research, the qualitative research aims to seek answers for questions of “how, where, when who and why” with a perspective to build a theory or refute an existing theory. Unlike quantitative research which deals primarily with numerical data and their statistical interpretations under a reductionist, logical and strictly objective paradigm, qualitative research handles nonnumerical information and their phenomenological interpretation, which inextricably tie in with human senses and subjectivity. While human emotions and perspectives from both subjects and researchers are considered undesirable biases confounding results in quantitative research, the same elements are considered essential and inevitable, if not treasurable, in qualitative research as they invariable add extra dimensions and colors to enrich the corpus of findings. However, the issue of subjectivity and contextual ramifications has fueled incessant controversies regarding yardsticks for quality and trustworthiness of qualitative research results for healthcare.

Impact of Qualitative Research upon Primary Care

In many ways, qualitative research contributes significantly, if not more so than quantitative research, to the field of primary care at various levels. Five qualitative studies are chosen to illustrate how various methodologies of qualitative research helped in advancing primary healthcare, from novel monitoring of chronic obstructive pulmonary disease (COPD) via mobile-health technology,[ 1 ] informed decision for colorectal cancer screening,[ 2 ] triaging out-of-hours GP services,[ 3 ] evaluating care pathways for community psychiatry[ 4 ] and finally prioritization of healthcare initiatives for legislation purposes at national levels.[ 5 ] With the recent advances of information technology and mobile connecting device, self-monitoring and management of chronic diseases via tele-health technology may seem beneficial to both the patient and healthcare provider. Recruiting COPD patients who were given tele-health devices that monitored lung functions, Williams et al. [ 1 ] conducted phone interviews and analyzed their transcripts via a grounded theory approach, identified themes which enabled them to conclude that such mobile-health setup and application helped to engage patients with better adherence to treatment and overall improvement in mood. Such positive findings were in contrast to previous studies, which opined that elderly patients were often challenged by operating computer tablets,[ 6 ] or, conversing with the tele-health software.[ 7 ] To explore the content of recommendations for colorectal cancer screening given out by family physicians, Wackerbarth, et al. [ 2 ] conducted semi-structure interviews with subsequent content analysis and found that most physicians delivered information to enrich patient knowledge with little regard to patients’ true understanding, ideas, and preferences in the matter. These findings suggested room for improvement for family physicians to better engage their patients in recommending preventative care. Faced with various models of out-of-hours triage services for GP consultations, Egbunike et al. [ 3 ] conducted thematic analysis on semi-structured telephone interviews with patients and doctors in various urban, rural and mixed settings. They found that the efficiency of triage services remained a prime concern from both users and providers, among issues of access to doctors and unfulfilled/mismatched expectations from users, which could arouse dissatisfaction and legal implications. In UK, a care pathways model for community psychiatry had been introduced but its benefits were unclear. Khandaker et al. [ 4 ] hence conducted a qualitative study using semi-structure interviews with medical staff and other stakeholders; adopting a grounded-theory approach, major themes emerged which included improved equality of access, more focused logistics, increased work throughput and better accountability for community psychiatry provided under the care pathway model. Finally, at the US national level, Mangione-Smith et al. [ 5 ] employed a modified Delphi method to gather consensus from a panel of nominators which were recognized experts and stakeholders in their disciplines, and identified a core set of quality measures for children's healthcare under the Medicaid and Children's Health Insurance Program. These core measures were made transparent for public opinion and later passed on for full legislation, hence illustrating the impact of qualitative research upon social welfare and policy improvement.

Overall Criteria for Quality in Qualitative Research

Given the diverse genera and forms of qualitative research, there is no consensus for assessing any piece of qualitative research work. Various approaches have been suggested, the two leading schools of thoughts being the school of Dixon-Woods et al. [ 8 ] which emphasizes on methodology, and that of Lincoln et al. [ 9 ] which stresses the rigor of interpretation of results. By identifying commonalities of qualitative research, Dixon-Woods produced a checklist of questions for assessing clarity and appropriateness of the research question; the description and appropriateness for sampling, data collection and data analysis; levels of support and evidence for claims; coherence between data, interpretation and conclusions, and finally level of contribution of the paper. These criteria foster the 10 questions for the Critical Appraisal Skills Program checklist for qualitative studies.[ 10 ] However, these methodology-weighted criteria may not do justice to qualitative studies that differ in epistemological and philosophical paradigms,[ 11 , 12 ] one classic example will be positivistic versus interpretivistic.[ 13 ] Equally, without a robust methodological layout, rigorous interpretation of results advocated by Lincoln et al. [ 9 ] will not be good either. Meyrick[ 14 ] argued from a different angle and proposed fulfillment of the dual core criteria of “transparency” and “systematicity” for good quality qualitative research. In brief, every step of the research logistics (from theory formation, design of study, sampling, data acquisition and analysis to results and conclusions) has to be validated if it is transparent or systematic enough. In this manner, both the research process and results can be assured of high rigor and robustness.[ 14 ] Finally, Kitto et al. [ 15 ] epitomized six criteria for assessing overall quality of qualitative research: (i) Clarification and justification, (ii) procedural rigor, (iii) sample representativeness, (iv) interpretative rigor, (v) reflexive and evaluative rigor and (vi) transferability/generalizability, which also double as evaluative landmarks for manuscript review to the Medical Journal of Australia. Same for quantitative research, quality for qualitative research can be assessed in terms of validity, reliability, and generalizability.

Validity in qualitative research means “appropriateness” of the tools, processes, and data. Whether the research question is valid for the desired outcome, the choice of methodology is appropriate for answering the research question, the design is valid for the methodology, the sampling and data analysis is appropriate, and finally the results and conclusions are valid for the sample and context. In assessing validity of qualitative research, the challenge can start from the ontology and epistemology of the issue being studied, e.g. the concept of “individual” is seen differently between humanistic and positive psychologists due to differing philosophical perspectives:[ 16 ] Where humanistic psychologists believe “individual” is a product of existential awareness and social interaction, positive psychologists think the “individual” exists side-by-side with formation of any human being. Set off in different pathways, qualitative research regarding the individual's wellbeing will be concluded with varying validity. Choice of methodology must enable detection of findings/phenomena in the appropriate context for it to be valid, with due regard to culturally and contextually variable. For sampling, procedures and methods must be appropriate for the research paradigm and be distinctive between systematic,[ 17 ] purposeful[ 18 ] or theoretical (adaptive) sampling[ 19 , 20 ] where the systematic sampling has no a priori theory, purposeful sampling often has a certain aim or framework and theoretical sampling is molded by the ongoing process of data collection and theory in evolution. For data extraction and analysis, several methods were adopted to enhance validity, including 1 st tier triangulation (of researchers) and 2 nd tier triangulation (of resources and theories),[ 17 , 21 ] well-documented audit trail of materials and processes,[ 22 , 23 , 24 ] multidimensional analysis as concept- or case-orientated[ 25 , 26 ] and respondent verification.[ 21 , 27 ]

Reliability

In quantitative research, reliability refers to exact replicability of the processes and the results. In qualitative research with diverse paradigms, such definition of reliability is challenging and epistemologically counter-intuitive. Hence, the essence of reliability for qualitative research lies with consistency.[ 24 , 28 ] A margin of variability for results is tolerated in qualitative research provided the methodology and epistemological logistics consistently yield data that are ontologically similar but may differ in richness and ambience within similar dimensions. Silverman[ 29 ] proposed five approaches in enhancing the reliability of process and results: Refutational analysis, constant data comparison, comprehensive data use, inclusive of the deviant case and use of tables. As data were extracted from the original sources, researchers must verify their accuracy in terms of form and context with constant comparison,[ 27 ] either alone or with peers (a form of triangulation).[ 30 ] The scope and analysis of data included should be as comprehensive and inclusive with reference to quantitative aspects if possible.[ 30 ] Adopting the Popperian dictum of falsifiability as essence of truth and science, attempted to refute the qualitative data and analytes should be performed to assess reliability.[ 31 ]

Generalizability

Most qualitative research studies, if not all, are meant to study a specific issue or phenomenon in a certain population or ethnic group, of a focused locality in a particular context, hence generalizability of qualitative research findings is usually not an expected attribute. However, with rising trend of knowledge synthesis from qualitative research via meta-synthesis, meta-narrative or meta-ethnography, evaluation of generalizability becomes pertinent. A pragmatic approach to assessing generalizability for qualitative studies is to adopt same criteria for validity: That is, use of systematic sampling, triangulation and constant comparison, proper audit and documentation, and multi-dimensional theory.[ 17 ] However, some researchers espouse the approach of analytical generalization[ 32 ] where one judges the extent to which the findings in one study can be generalized to another under similar theoretical, and the proximal similarity model, where generalizability of one study to another is judged by similarities between the time, place, people and other social contexts.[ 33 ] Thus said, Zimmer[ 34 ] questioned the suitability of meta-synthesis in view of the basic tenets of grounded theory,[ 35 ] phenomenology[ 36 ] and ethnography.[ 37 ] He concluded that any valid meta-synthesis must retain the other two goals of theory development and higher-level abstraction while in search of generalizability, and must be executed as a third level interpretation using Gadamer's concepts of the hermeneutic circle,[ 38 , 39 ] dialogic process[ 38 ] and fusion of horizons.[ 39 ] Finally, Toye et al. [ 40 ] reported the practicality of using “conceptual clarity” and “interpretative rigor” as intuitive criteria for assessing quality in meta-ethnography, which somehow echoed Rolfe's controversial aesthetic theory of research reports.[ 41 ]

Food for Thought

Despite various measures to enhance or ensure quality of qualitative studies, some researchers opined from a purist ontological and epistemological angle that qualitative research is not a unified, but ipso facto diverse field,[ 8 ] hence any attempt to synthesize or appraise different studies under one system is impossible and conceptually wrong. Barbour argued from a philosophical angle that these special measures or “technical fixes” (like purposive sampling, multiple-coding, triangulation, and respondent validation) can never confer the rigor as conceived.[ 11 ] In extremis, Rolfe et al. opined from the field of nursing research, that any set of formal criteria used to judge the quality of qualitative research are futile and without validity, and suggested that any qualitative report should be judged by the form it is written (aesthetic) and not by the contents (epistemic).[ 41 ] Rolfe's novel view is rebutted by Porter,[ 42 ] who argued via logical premises that two of Rolfe's fundamental statements were flawed: (i) “The content of research report is determined by their forms” may not be a fact, and (ii) that research appraisal being “subject to individual judgment based on insight and experience” will mean those without sufficient experience of performing research will be unable to judge adequately – hence an elitist's principle. From a realism standpoint, Porter then proposes multiple and open approaches for validity in qualitative research that incorporate parallel perspectives[ 43 , 44 ] and diversification of meanings.[ 44 ] Any work of qualitative research, when read by the readers, is always a two-way interactive process, such that validity and quality has to be judged by the receiving end too and not by the researcher end alone.

In summary, the three gold criteria of validity, reliability and generalizability apply in principle to assess quality for both quantitative and qualitative research, what differs will be the nature and type of processes that ontologically and epistemologically distinguish between the two.

Source of Support: Nil.

Conflict of Interest: None declared.