qualitative analysis of education

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In This Article Expand or collapse the "in this article" section Qualitative Data Analysis Techniques

Introduction, general overviews.

• Semiotic Analysis
• Text Mining
• Discourse Analysis
• Classical Content Analysis
• Schema Analysis
• Latent Content Analysis
• Manifest Content Analysis
• Keywords-in-context
• Constant Comparison Analysis
• Membership Categorization Analysis
• Narrative Analysis
• Conversation Analysis
• Ethnographic Decision Model Analysis
• Critical Discourse Analysis
• Frame or Framing Analysis
• Social Semiotic Analysis
• Domain Analysis
• Taxonomic Analysis
• Componential Analysis
• Theme Analysis
• Dialogical Narrative Analysis
• Qualitative Comparative Analysis
• Multimodal Discourse Analysis (MDA)
• Dimensional Analysis
• Framework Analysis
• Secondary Data Analysis
• Interpretative Phenomenological Analysis (IPA)
• Consensual Qualitative Research
• Situational Analysis
• Micro-Interlocutor Analysis
• Rhetorical Analysis
• Systematic Data Integration
• Nonverbal Communication Analysis

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Qualitative Data Analysis Techniques by Anthony J. Onwuegbuzie , Magdalena Denham LAST REVIEWED: 05 August 2020 LAST MODIFIED: 30 June 2014 DOI: 10.1093/obo/9780199756810-0078

Qualitative research can be traced back to ancient times; however, the use of qualitative methods began to be formalized in certain disciplines (e.g., sociology, anthropology) only in the 19th century. Broadly speaking, qualitative research involves an in-depth examination of human experiences and human behavior, with the goal of obtaining insights into everyday experiences and meaning attached to these experiences of individuals (via qualitative methodologies such as biography, autobiography, life history, oral history, autoethnography, case study) and groups (via qualitative methodologies such as phenomenology, ethnography, grounded theory), which, optimally, can lead to understanding the meaning of behaviors from the study participant’s/group’s perspective. Qualitative researchers tend to investigate not just what, where , and when , but more importantly the why and how of events, experiences, and behaviors. Thus, qualitative researchers are much more likely to study smaller but focused samples than large samples. In general, qualitative research studies primarily involve the collection, analysis, and interpretation of data (i.e., information) that naturally occur. Of these steps, the analysis of data arguably represents one of the most difficult steps—if not the most difficult step—of the qualitative research process because it involves a systematic exploration of meaning and the achievement of verstehen (i.e., understanding). More specifically, qualitative data analysis is a process that comprises multiple phases, and from which findings are extracted or emerge. These phases include examining, cleaning, organizing, reducing, exploring, describing, explaining, displaying, interrogating, categorizing, pattern finding, transforming, correlating, consolidating, comparing, integrating, synthesizing, and interpreting data, in ways that allow researchers to see patterns, to identify categories and themes, to develop typologies, to discover relationships, to cultivate explanations, to extract interpretations, to develop critiques, to generate or to advance theories, and/or the like, with the goal of meaning making. A criticism of qualitative data analysis is that because it typically involves examination of data extracted from small, nonrandom samples, findings stemming from any qualitative analysis usually are not generalizable beyond the local research participants. However, what is a limitation for one purpose (i.e., generalization of findings to the population the sample was drawn from), is a strength for another purpose. Specifically, the examination of relatively small samples allows qualitative researchers to collect (maximally) rich data (e.g., via in-depth interviews, focus groups, observations, images, nonverbal communication). This, in turn, makes it more likely that as a result of the qualitative data analysis, verstehen will be achieved.

The analysis of data represents the most important and difficult step in the qualitative research process. Therefore, the purpose of this entry is to document the history and development of qualitative analytical approaches. In particular, described here are thirty-four formal qualitative data-analysis approaches that were identified from an exhaustive search of the literature. This OBO entry not only extends the work of Onwuegbuzie, et al. 2011 —which identified twenty-three analysis approaches—but by adding numerous other qualitative data analysis approaches, it also extends these works by documenting the origin of each analysis approach, mapping it onto the nine moments described in Denzin and Lincoln 2011 and outlining the sources of qualitative data that it can analyze. With respect to the latter, see Leech and Onwuegbuzie 2008 with typology wherein the following four major sources of qualitative data prevail: talk, observations, images, and documents. Specifically, talk represents data that are extracted directly from the voices of the participants using data collection techniques such as individual interviews and focus groups. Observations involve the collection of data by systematically watching or perceiving one or more events, interactions, or nonverbal communication to address or to inform the research question(s). Images represent still (e.g., drawings, photographs) or moving (e.g., videos) visual data that are observed or perceived. Documents represent the collection of text that exists either in printed or digital form. As Miles and Huberman 1994 declared: “The strengths of qualitative data rest on the competence with which their analysis is carried out” (p. 10). By only being aware of a few qualitative data-analysis approaches, a qualitative researcher might make the data fit the analysis rather than select the most appropriate data-analysis approach given the underlying research elements such as the research question, researcher’s lens, and sampling and design characteristics. In contrast, by being aware of the array of qualitative data-analysis approaches, as well as how and when to conduct them, a qualitative researcher is in a better position not only to conduct analyses that have integrity but also to conduct analyses that emerge as findings emerge. Thus, qualitative researchers likely would put themselves in a better position for making meaning if they adopt a constructivist approach to qualitative data analysis. However, this can only occur if they have an awareness of multiple ways of analyzing qualitative data. This goal helps to establish the significance of the current work in this field.

Denzin, Norman K., and Yvonna S. Lincoln. 2011. Introduction: The discipline and practice of qualitative research. In Sage handbook of qualitative research . 4th ed. Edited by Norman K. Denzin and Yvonna S. Lincoln, 1–25. Thousand Oaks, CA: SAGE.

The authors document the history of qualitative research. This history spans nine moments, starting with they call the “traditional” moment and continuing through to the ninth moment, which they call the “fractured future,” which is the present moment.

Leech, Nancy L., and Anthony J. Onwuegbuzie. 2008. Qualitative data analysis: A compendium of techniques and a framework for selection for school psychology research and beyond. School Psychology Quarterly 23:587–604.

DOI: 10.1037/1045-3830.23.4.587

The authors describe the following eighteen qualitative analysis techniques: method of constant comparison analysis, keywords-in-context, word count, classical content analysis, domain analysis, taxonomic analysis, componential analysis, conversation analysis, discourse analysis, secondary analysis, membership categorization analysis, narrative analysis, qualitative comparative analysis, semiotics, manifest content analysis, latent content analysis, text mining, and micro-interlocutor analysis.

Miles, Matthew B., and A. Michael Huberman. 1994. Qualitative data analysis: An expanded sourcebook . 2d ed. Thousand Oaks, CA: SAGE.

In this groundbreaking book, the authors conceptualize and describe nineteen within-case analyses (i.e., partially ordered display, time-ordered display, role-ordered display, and conceptually ordered display) and eighteen cross-case analyses (i.e., partially ordered display, case-ordered display, time-ordered display, and conceptually ordered display. Thus, this work is the most comprehensive guidebook to qualitative analysis to date.

Onwuegbuzie, Anthony J., Nancy L. Leech, and Kathleen M. T. Collins. 2011. Toward a new era for conducting mixed analyses: The role of quantitative dominant and qualitative dominant crossover mixed analyses. In The Sage handbook of innovation in social research methods . Edited by Malcolm Williams and Paul W. Vogt, 353–384. Thousand Oaks, CA: SAGE.

In this book chapter, the authors introduce a unified framework for combining qualitative analysis and quantitative analysis—which they call a mixed analysis—regardless of whether the researcher is oriented toward quantitative research or mixed research.

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on June 22, 2023.

Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analyzing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, history, etc.

• How does social media shape body image in teenagers?
• How do children and adults interpret healthy eating in the UK?
• What factors influence employee retention in a large organization?
• How is anxiety experienced around the world?
• How can teachers integrate social issues into science curriculums?

Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, other interesting articles, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography , action research , phenomenological research, and narrative research. They share some similarities, but emphasize different aims and perspectives.

Note that qualitative research is at risk for certain research biases including the Hawthorne effect , observer bias , recall bias , and social desirability bias . While not always totally avoidable, awareness of potential biases as you collect and analyze your data can prevent them from impacting your work too much.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

• Observations: recording what you have seen, heard, or encountered in detailed field notes.
• Interviews:  personally asking people questions in one-on-one conversations.
• Focus groups: asking questions and generating discussion among a group of people.
• Surveys : distributing questionnaires with open-ended questions.
• Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
• You take field notes with observations and reflect on your own experiences of the company culture.
• You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
• You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves “instruments” in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analyzing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

• Prepare and organize your data. This may mean transcribing interviews or typing up fieldnotes.
• Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
• Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorize your data.
• Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
• Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analyzing qualitative data. Although these methods share similar processes, they emphasize different concepts.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

• Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

• Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

• Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

• Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

Researchers must consider practical and theoretical limitations in analyzing and interpreting their data. Qualitative research suffers from:

• Unreliability

The real-world setting often makes qualitative research unreliable because of uncontrolled factors that affect the data.

• Subjectivity

Due to the researcher’s primary role in analyzing and interpreting data, qualitative research cannot be replicated . The researcher decides what is important and what is irrelevant in data analysis, so interpretations of the same data can vary greatly.

• Limited generalizability

Small samples are often used to gather detailed data about specific contexts. Despite rigorous analysis procedures, it is difficult to draw generalizable conclusions because the data may be biased and unrepresentative of the wider population .

• Labor-intensive

Although software can be used to manage and record large amounts of text, data analysis often has to be checked or performed manually.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Chi square goodness of fit test
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

There are five common approaches to qualitative research :

• Grounded theory involves collecting data in order to develop new theories.
• Ethnography involves immersing yourself in a group or organization to understand its culture.
• Narrative research involves interpreting stories to understand how people make sense of their experiences and perceptions.
• Phenomenological research involves investigating phenomena through people’s lived experiences.
• Action research links theory and practice in several cycles to drive innovative changes.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organizations.

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

• Prepare and organize your data.
• Review and explore your data.
• Develop a data coding system.
• Assign codes to the data.
• Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

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Using Qualitative Data in Education For Better Student Outcomes

Qualitative data in education is a powerful tool that can be used to enhance instructional practices and improve student outcomes. By understanding and effectively utilizing qualitative data, educators can gain valuable insights into their students’ experiences, perceptions, and needs.

In this article, we’ll uncover the importance of qualitative data in education, discuss different techniques for gathering and analyzing data, and provide strategies for applying this knowledge to make data-informed decisions to benefit students.

• What is Qualitative Data in Education?
• The Importance of Qualitative Data in Education
• Gathering Qualitative Data in the Classroom
• Analyzing Qualitative Data for Educational Insights
• Tools for Qualitative Data Analysis
• Applying Qualitative Data to Improve Student Outcomes
• Overcoming Challenges in Using Qualitative Data

1.  What is Qualitative Data in Education?

When it comes to understanding qualitative data in education, it’s important to have a clear definition. Qualitative data encompasses a wide range of information that is gathered through various methods, including observations, interviews, focus groups, and written documents. These methods include observing students in their natural learning environments, conducting interviews to gather their perspectives, engaging in focus groups to explore shared experiences, and analyzing written documents such as essays or reflective journals.

By using these methods, educators can gather rich and detailed information about students’ experiences, allowing them to gain insights into their thoughts, emotions, and motivations. This type of data is often subjective in nature, as it is influenced by the unique perspectives and interpretations of the individuals involved.

2.  The Importance of Qualitative Data in Education

Qualitative data plays a crucial role in education as it provides insights into complex phenomena that quantitative data alone cannot capture. While quantitative data can provide information about student performance and achievement, it does not provide a complete picture of the factors that influence these outcomes.

Read next: A guide to the different types of data in education

By gathering qualitative data, teachers can gain a holistic understanding of their students’ learning environments. They can uncover factors that may influence their academic performance, such as classroom dynamics, instructional approaches, and socio-cultural factors. For example, qualitative data can reveal how students’ cultural backgrounds impact their learning experiences and how their interactions with peers and teachers shape their attitudes towards education.

Moreover, qualitative data allows educators to explore the why and how behind students’ behaviors, attitudes, and outcomes. It enables them to identify patterns, themes, and trends that can guide instructional practices, curriculum development, and overall school improvement strategies.

By analyzing qualitative data, educators can gain valuable insights into the effectiveness of their teaching methods and make informed decisions to enhance student learning. They can also use this data to tailor their instruction to meet the diverse needs of their students, ensuring that every learner has the opportunity to succeed.

3.  Gathering Qualitative Data in the Classroom

Gathering qualitative data in the classroom involves using various methods to collect and document students’ experiences and perspectives. By employing a range of techniques, educators can gather a rich and diverse set of qualitative data that represents various dimensions of students’ educational journey.

Qualitative data in education can take different forms, including:

• Written reflections
• Classroom observations
• Focus groups, and
• Student work samples.

Each type of data collection method offers unique insights into students’ thoughts, feelings, and attitudes. For example, interviews can provide in-depth information about individual students’ experiences and perceptions. Educators can sit down with students one-on-one and ask open-ended questions to delve into their thoughts and emotions regarding their learning experiences. This method allows for a deeper understanding of the student’s perspective and allows them to express their thoughts freely.

Focus groups, on the other hand, allow for group discussions and the exploration of shared perspectives and experiences. Educators can gather a small group of students and facilitate a conversation around a specific topic or theme. This method encourages students to share their thoughts and engage in meaningful dialogue with their peers, providing valuable insights into their collective experiences.

By employing these techniques, educators can engage students directly in the data collection process, offering them the opportunity to have their voices heard. This participatory approach not only promotes student engagement but also provides a more accurate representation of their experiences and perspectives.

4.  Analyzing Qualitative Data for Educational Insights

Once qualitative data has been collected, the next step is to analyze it to derive meaningful insights. Analyzing qualitative data involves a systematic and rigorous examination of the gathered information to identify patterns, themes, and trends.

Qualitative data analysis is a crucial step in the research process, as it allows educators to gain a deeper understanding of the experiences, perspectives, and behaviors of their students. By analyzing qualitative data, educators can uncover valuable insights that can inform their teaching practices and decision-making processes.

The process of qualitative data analysis typically involves several key steps. These include transcribing interviews or observations, identifying codes or themes, categorizing data, and interpreting the findings.

Transcribing interviews or observations is an essential step in qualitative data analysis. It involves converting audio or video recordings into written text, ensuring that every detail and nuance is captured accurately. This transcription process allows educators to review and analyze the data more effectively.

Identifying codes or themes is another crucial aspect of qualitative data analysis. Codes are labels or tags that are assigned to specific segments of data, representing concepts or ideas that emerge from the analysis. By identifying codes, educators can organize the data and make it more manageable for further analysis.

Categorizing data is the process of grouping similar codes or themes together. This step helps educators identify patterns and connections within the data. By categorizing data, educators can gain a holistic view of the information and draw meaningful conclusions.

Interpreting the findings is the final step in qualitative data analysis. It involves making sense of the data and extracting meaningful insights. Educators need to critically analyze the data, considering the context, participants’ perspectives, and their own experiences and knowledge. By interpreting the findings, educators can generate valuable knowledge that can be applied to their teaching practices.

5.  Tools for Qualitative Data Analysis

There are various software tools available that can facilitate the analysis of qualitative data. These tools provide features for coding, organizing, and visualizing data, making the analysis process more efficient and manageable.

One popular qualitative data analysis software is NVivo. NVivo offers a range of features that allow educators to organize and analyze their qualitative data effectively. It provides tools for coding, annotating, and visualizing data, making it easier to identify patterns and themes. NVivo also allows for collaboration, enabling educators to work together on analyzing the data and deriving insights.

Another widely used software for qualitative data analysis is ATLAS.ti. ATLAS.ti provides a comprehensive set of tools for coding, organizing, and analyzing qualitative data. It allows educators to create networks and visual representations of their data, helping them to identify relationships and connections. ATLAS.ti also offers advanced text search capabilities, making it easier to locate specific information within the data.

Overall, the availability of these software tools has revolutionized the process of qualitative data analysis. Educators now have access to powerful and user-friendly tools that can enhance their ability to analyze and derive insights from qualitative data. By utilizing these tools, educators can make more informed decisions and improve their teaching practices based on a deeper understanding of their students’ experiences and perspectives.

6.  Applying Qualitative Data to Improve Student Outcomes

Using qualitative data effectively can lead to tangible improvements in student outcomes. By applying insights gained from qualitative data analysis, educators can tailor their instructional practices and interventions to better support students’ needs.

Strategies for Data-Informed Decision Making

Data-informed decision making involves using qualitative data as a basis for making informed choices about teaching strategies, curriculum development, and student support services. Educators can use qualitative data to identify areas for improvement, monitor student progress, and evaluate the effectiveness of interventions or instructional approaches.

For example, qualitative data might highlight areas where students are experiencing difficulties or disengagement. Based on this information, educators can implement targeted interventions or adapt teaching methods to better meet students’ needs.

Read next: How student data can improve your teaching strategy

Monitoring and Evaluating the Impact of Data-Driven Changes

Once changes have been implemented based on qualitative data findings, it is essential to monitor and evaluate their impact. Ongoing assessment ensures that interventions are effective and responsive to students’ needs.

Regularly reviewing the outcomes of data-driven changes allows educators to gather additional qualitative data to inform and refine their practices. This cyclical process of data collection, analysis, implementation, and evaluation enables continuous improvement and better student outcomes.

7.  Overcoming Challenges in Using Qualitative Data

While qualitative data can provide valuable insights, there are challenges to consider when collecting and analyzing this type of data in education. By addressing these obstacles, educators can maximize the benefits of using qualitative data.

One common challenge is ensuring data reliability and validity. To address this, educators should use established research methodologies, such as triangulation, where multiple methods and data sources are used to support or validate findings. Additionally, educators may face time constraints and limited resources when collecting qualitative data. Planning and prioritizing data collection activities, as well as leveraging technology tools for data analysis, can help overcome these challenges.

When working with qualitative data, it is essential to prioritize ethical considerations. Educators must obtain informed consent from participants, protect their privacy and confidentiality , and ensure that the data is used only for educational purposes. By nurturing a culture of ethical data use, educators can build trust with their students and maintain the integrity of their research and decision-making processes.

Final Thoughts

In summary, qualitative data in education is a valuable resource that can enhance and improve student outcomes. Understanding qualitative data, employing effective data collection techniques, and analyzing the gathered information can provide educators with insights into students’ experiences and needs.

While qualitative data provides rich, in-depth insights into student experiences and needs, it’s essential to visualize and interpret this information for maximum impact. Our Inno™ Starter Kits are designed precisely for this purpose. By offering educators a comprehensive platform to easily plug in and showcase qualitative student data, the kits empower you to derive actionable strategies for enhanced student outcomes. Don’t just gather data—transform it into meaningful change with Inno™ Starter Kits.

Thank you for sharing!

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Examples of Qualitative Data in Education: How to Use

The phrase “Examples of Qualitative Data in Education” reveals rich and detailed knowledge in the field of education, where understanding fuels creativity and insights drive advancement. While quantitative data frequently grabs the spotlight, its qualitative counterpart is just as important for understanding how complicated learning environments work.

In this blog, we will delve into the significance of qualitative data in education and provide a range of examples showcasing its applications in fostering educational excellence.

What is qualitative data?

Qualitative data is a type of data that is open to interpretation and can be used in a variety of ways- both as a measure of quality and as the basis for analysis. 

It describes the way things are and tells you why something is happening, rather than what is happening (for example, if a student isn’t doing well in math, qualitative data would tell you their reasons for this), rather than describing its characteristics or how much of it there is. 

Qualitative data is not numerical and does not have a set meaning, which makes it difficult to analyze. Understanding how to use qualitative data collection in education effectively can be crucial for educational institutions.

LEARN ABOUT: Qualitative Interview

Using qualitative data in educational settings

Qualitative data provides insight into the learning experience that cannot always be expressed through numbers. It allows you to better understand how students learn by asking open-ended questions and listening carefully to their answers. 

When you use qualitative data, you can investigate particular areas of concern for your organization and formulate action plans as needed. Also, qualitative data addresses a number of the shortcomings of quantitative research. 

For instance, quantitative data can indicate that a particular school district’s test scores have outperformed those of other regional school districts but cannot explain why this is the case.

Examples of qualitative data in education

Here are some examples of qualitative data in education:

Field observations

Teachers and administrators could observe the classroom during different times of day, at different points during the year, or when a special event is happening.

Documentary research

School organizations can spend time looking closely at their current documents to learn more about students.

Focus groups

Conducting focus group discussions with students, teachers, or parents can provide qualitative insights into their perceptions, experiences, and opinions related to educational practices and policies.

Student portfolios

Reviewing student portfolios that showcase their work, assignments, and projects over time offers qualitative data on their progress, growth, and learning journey.

Peer review and feedback

Encouraging students to provide peer reviews and feedback on each other’s work generates qualitative data on their ability to critically assess and provide constructive input.

Learning diaries

Similar to journals, learning diaries encourage students to document their daily experiences, challenges, and triumphs, offering qualitative insights into their engagement and progress.

Parent-teacher conferences

Conversations during parent-teacher conferences provide qualitative data about a student’s strengths, weaknesses, and overall development from both home and school perspectives.

Online discussion forums

Analyzing interactions on online platforms where students and educators discuss topics related to coursework offers qualitative insights into their understanding, questions, and collaboration and is one of the best examples of qualitative data in education.

Classroom artifacts

Examining classroom artifacts like bulletin boards, student artwork, and project displays provides qualitative data on the learning environment, student creativity, and the integration of various subjects.

Audio and video recordings

Recording classroom discussions, presentations, or group activities captures qualitative data on communication skills, collaboration, and the depth of student understanding.

Student surveys with open-ended questions

Incorporating open-ended questions into student surveys enables them to express their thoughts, opinions, and suggestions in their own words, yielding qualitative data that complements quantitative results.

Teacher reflective journals

Teachers maintaining reflective journals about their teaching experiences, challenges, and innovative approaches generate qualitative data on professional growth and instructional strategies.

Student interviews

One-on-one interviews with students are one of the most common examples of qualitative data in education. It can provide qualitative insights into their learning experiences, interests, and motivations, helping educators tailor instruction to individual needs.

How can a survey tool help with qualitative data analysis in education?

A survey tool is a useful research tool that can help with qualitative data analysis in education. Qualitative data is best analyzed through close inspection and asking questions to understand the root causes of phenomena, but this is a time-consuming process. 

A well-designed survey questionnaire can simplify the qualitative analysis by giving you insight into what most concerns your group and helping you to prioritize your responses.

Key steps to using a survey tool: In order to successfully use a survey tool, you’ll need to:

Define your goal

What are you trying to accomplish? If you don’t know where you want the findings of your Qualitative research project to lead, it will be difficult for people to provide feedback and difficult for you to analyze the results.

Choose your qualitative research method

What are your options? How will people be invited to give feedback, and where will this feedback come from? Identifying how participants/respondents/users will be asked about their experiences is an important first step.

Design survey questions

Craft thoughtful and relevant survey questions that align with your research goals. Ensure a mix of closed-ended questions to gather quantitative data and open-ended questions to gather qualitative insights. 

Use clear and concise language to avoid ambiguity, and consider using skip logic or branching to tailor the survey experience based on participants’ responses. Well-designed questions will make the data analysis process smoother.

Distribute and collect responses

Utilize the survey tool to distribute the survey to your target audience, whether it’s students, teachers, parents, or administrators. You can use various distribution channels such as email, social media, or school websites. 

Track the responses as they come in and monitor the data collection process. Keep the survey open for an appropriate amount of time to ensure a diverse range of responses.

Analyze qualitative data

Once you’ve collected a sufficient number of responses, begin the qualitative data analysis process. Start by categorizing and coding open-ended responses. Look for recurring themes, patterns, and trends within the qualitative data. 

You can use tools like thematic analysis to identify key themes that emerge from participants’ responses. Software like NVivo or even Excel can help organize and analyze qualitative data effectively.

Triangulate with quantitative data

If your survey included closed-ended questions with quantitative responses (e.g., Likert scales), you can enrich your analysis by comparing qualitative insights with quantitative data. This triangulation can provide a more comprehensive understanding of the research topic. 

For example, if participants express negative sentiments about a particular aspect of education, you can cross-reference this sentiment with the corresponding quantitative rating to see if there’s a correlation.

LEARN ABOUT: Steps in Qualitative Research

Methods to analyze qualitative data

Qualitative research methods form the cornerstone of understanding human experiences, utilizing an array of data collection methods to delve into the nuances of perspectives. From interviews and focus groups to ethnographic studies and content analysis, these qualitative methods harmonize to reveal the intricate tapestry of human narratives. 

Now, we will unveil how these methods converge, creating a symphony of insights that deepen our comprehension of the human condition.

Content analysis

The content of the data is analyzed by scrutinizing and interpreting texts, pictures, video, audio, and other materials. This involves looking at the words in a document, for example, and deciding their meaning.

Grounded theory

To create a grounded theory, you study what is happening in a particular situation and try to formulate a theory about why it happens. This process often begins with an initial assumption or question, which will be tested out over time. For example: “How do we know when this analysis process is finished?”

Phenomenology

Phenomenology looks at experiences from the perspective of those who experience them. It tries to understand what these experiences mean to people rather than the events themselves. This is relevant for understanding students’ learning experiences in an educational setting.

Framework analysis

Framework analysis is a conversation with participants and then using the content of that discussion to analyze the data. It could involve asking individuals, “What was the knowledge you gained from this project?” and then anonymizing their answers in order to avoid starting your article with personal stories.

Discourse analysis

Discourse analysis looks at how individuals use language and what the implications of those uses are. This can be helpful in a classroom setting where students use their voices to express themselves about their learning process within the walls of academia.

Interpretative phenomenological analysis

Interpretive phenomenological analysis (IPA) helps you understand that qualitative data is a type of open-ended and interpretable data that can be used in various ways. Whether you’re trying to learn more about your customer’s experiences or the educational process, qualitative analysis will help get insights into what’s important for your project.

Learn more about academic surveys here

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Qualitative data in education is a treasure trove of insights that empowers educators and administrators to create holistic learning experiences. 

By leveraging methods such as interviews, observations, and reflections, educational institutions can gain a deeper understanding of student needs, teaching strategies, and program effectiveness. The fusion of quantitative and qualitative data enriches decision-making processes and paves the way for continuous improvement in education.

If you want help analyzing the qualitative aspects of your research projects, we’re here to provide assistance with our survey tool ! Let us know if there are any other information needs, and we’ll work on providing an answer as soon as possible.

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• v.29(2); 2017 Jun

The qualitative orientation in medical education research

Qualitative research is very important in educational research as it addresses the “how” and “why” research questions and enables deeper understanding of experiences, phenomena and context. Qualitative research allows you to ask questions that cannot be easily put into numbers to understand human experience. Getting at the everyday realities of some social phenomenon and studying important questions as they are really practiced helps extend knowledge and understanding. To do so, you need to understand the philosophical stance of qualitative research and work from this to develop the research question, study design, data collection methods and data analysis. In this article, I provide an overview of the assumptions underlying qualitative research and the role of the researcher in the qualitative process. I then go on to discuss the type of research objectives which are common in qualitative research, then introduce the main qualitative designs, data collection tools, and finally the basics of qualitative analysis. I introduce the criteria by which you can judge the quality of qualitative research. Many classic references are cited in this article, and I urge you to seek out some of these further reading to inform your qualitative research program.

Introduction

When we speak of “quantitative” or “qualitative” methodologies, we are in the final analysis speaking about an interrelated set of assumptions about the social world which are philosophical, ideological, and epistemological. They encompass more than just data collection methodologies [ 1 ].

It is easy to assume that the differences between quantitative and qualitative research are solely about how data is collected—the randomized controlled trial versus ethnographic fieldwork, the cohort study versus the semi-structured interview. However, quantitative and qualitative approaches make different assumptions about the world [ 2 ], about how science should be conducted, and about what constitutes legitimate problems, solutions and criteria of “proof” [ 3 ].

Why is it important to understand differences in assumptions, or philosophies, of research? Why not just go ahead and do a survey or carry out some interviews? First, the assumptions behind the research tools you choose provide guidance for conducting your research. They indicate whether you should be an objective observer or whether you have a contributory role in the research process. They guide whether or not you must slavishly ask each person in a study the same questions or whether your questions can evolve as the study progresses. Second, you may wish to submit your work as a dissertation or as a research paper to be considered for publication in a journal. If so, the chances are that examiners, editors, and reviewers might have knowledge of different research philosophies from yours and may be unwilling to accept the legitimacy of your approach unless you can make its assumptions clear. Third, each research paradigm has its own norms and standards, its accepted ways of doing things. You need to “do things right”. Finally, understanding the theoretical assumptions of the research approach helps you recognize what the data collection and analysis methods you are working with do well and what they do less well, and lets you design your research to take full advantage of their strengths and compensate for their weaknesses.

In this short article, I will introduce the assumptions of qualitative research and their implications for research questions, study design, methods and tools, and analysis and interpretation. Readers who wish a comparison between qualitative and quantitative approaches may find Cleland [ 4 ] useful.

Ontology and epistemology

We start with a consideration of the ontology (assumptions about the nature of reality) and epistemology (assumptions about the nature of knowledge) of qualitative research.

Qualitative research approaches are used to understand everyday human experience in all its complexity and in all its natural settings [ 5 ]. To do this, qualitative research conforms to notions that reality is socially constructed and that inquiry is unavoidably value-laden [ 6 ]. The first of these, reality is socially constructed, means reality cannot be measured directly—it exists as perceived by people and by the observer. In other words, reality is relative and multiple, perceived through socially constructed and subjective interpretations [ 7 ]. For example, what I see as an exciting event may be seen as a threat by other people. What is considered a cultural ritual in my country may be thought of as quite bizarre elsewhere. Qualitative research is concerned with how the social world is interpreted, understood, experienced, or constructed. Mann and MacLeod [ 8 ] provide a very good overview of social constructivism which is a excellent starting point for understanding this.

The idea of people seeing things in diverse ways also holds true in research process, hence inquiry being valued-laden. Different people have different views of the same thing depending on their upbringing and other experiences, their training, and professional background. Someone who has been trained as a social scientist may “see” things differently from someone who has been medically trained. A woman may see things differently to a man. A more experienced researcher will see things differently from a novice. A qualitative researcher will have very different views of the nature of “evidence” than a quantitative researcher. All these viewpoints are valid. Moreover, different researchers can study the same topic and try to find solutions to the same challenges using different study designs—and hence come up with different interpretations and different recommendations. For example, if your position is that learning is about individual, cognitive, and acquisitive processes, then you are likely to research the use of simulation training in surgery in terms of the effectiveness and efficacy of training related to mastery of technical skills [ 9 , 10 ]. However, if your stance is that learning is inherently a social activity, one which involves interactions between people or groups of people, then you will look to see how the relationships between faculty members, participants and activities during a simulation, and the wider social and cultural context, influence learning [ 11 , 12 ].

Whether researchers are explicit about it or not, ontological and epistemological assumptions will underpin how they study aspects of teaching and learning. Differences in these assumptions shape not only study design, but also what emerges as data, how this data can be analysed and even the conclusions that can be drawn and recommendations that can be made from the study. This is referred to as worldview, defined by Creswell [ 13 ] as “a general orientation about the world and the nature of research that a researcher holds.” McMillan [ 14 ] gives a very good explanation of the importance of this phenomenon in relation to medical education research. There is increasing expectation that researchers make their worldview explicit in research papers.

The research objective

Given the underlying premise that reality is socially constructed, qualitative research focuses on answering “how” and “why” questions, of understanding a phenomena or a context. For example, “Our study aimed to answer the research question: why do assessors fail to report underperformance in medical students? [ 15 ]”, “The aim of this work was to investigate how widening participation policy is translated and interpreted for implementation at the level of the individual medical school [ 4 ].”

Common verbs in qualitative research questions are identify, explore, describe, understand, and explain. If your research question includes words like test or measure or compare in your objectives, these are more appropriate for quantitative methods, as they are better suited to these types of aims. Bezuidenhout and van Schalkwyk [ 16 ] provide a good guide to developing and refining your research question. Lingard [ 17 ]’s notion of joining the conversation and the problem-gap-hook heuristic are also very useful in terms of thinking about your question and setting it out in the introduction to a paper in such a way as to interest journal editors and readers.

Do not think formulating a research question is easy. Maxwell [ 18 ] gives a good overview of some of the potential issues including being too general, making assumptions about the nature of the issue/problem and using questions which focus the study on difference rather than process. Developing relevant, focused, answerable research questions takes time and generating good questions requires that you pay attention not just to the questions themselves but to their connections with all the other components of the study (the conceptual lens/theory, the methods) [ 18 ].

Theory can be applied to qualitative studies at different times during the research process, from the selection of the research phenomenon to the write-up of the results. The application of theory at different points can be described as follows [ 19 , 20 , 21 ]: (1) Theory frames the study questions, develops the philosophical underpinnings of the study, and makes assumptions to justify or rationalize the methodological approach. (2) Qualitative investigations relate the target phenomenon to the theory. (3) Theory provides a comparative context or framework for data analysis and interpretation. (4) Theory provides triangulation of study findings.

Schwartz-Barcott et al. [ 20 ] characterized those processes as theoretical selectivity (the linking of selected concepts with existing theories), theoretical integration (the incorporation and testing of selected concepts within a particular theoretical perspective), and theory creation (the generation of relational statements and the development of a new theory). Thus, theory can be the outcome of the research project as well as the starting point [ 22 ].

However, the emerging qualitative researcher may wish a little more direction on how to use theory in practice. I direct you to two papers: Reeves et al. [ 23 ] and Bordage [ 24 ]. These authors clearly explain the utility of theory, or conceptual frameworks, in qualitative research, how theory can give researchers different “lenses” through which to look at complicated problems and social issues, focusing their attention on different aspects of the data and providing a framework within which to conduct their analysis. Bordage [ 24 ] states that “conceptual frameworks represent ways of thinking about a problem or a study, or ways of representing how complex things work the way they do. Different frameworks will emphasise different variables and outcomes.” He presents an example in his paper and illustrates how different lens highlight or emphasise different aspects of the data. Other authors suggest that two theories are potentially better than one in exploring complex social issues [ 25 ]. There is an example of this in one of my papers, where we used the theories of Bourdieu [ 26 ] and Engestrom [ 27 , 28 ] nested within an overarching framework of complexity theory [ 29 ] to help us understand learning at a surgical bootcamp. However, I suggest that for focused studies and emerging educational researchers, one theoretical framework or lens is probably sufficient.

So how to identify an appropriate theory, and when to use it? It is crucially important to read widely, to explore lots of theories, from disciplines such as (but not only) education, psychology, sociology, and economics, to see what theory is available and what may be suitable for your study. Carefully consider any theory, check its assumptions [ 30 ] are congruent with your approach, question, and context before final selection [ 31 ] before deciding which theory to use. The time you spend exploring theory will be time well spent in terms not just of interpreting a specific data set but also to broadening your knowledge. The second question, when to use it, depends on the nature of the study, but generally the use of theory in qualitative research tends to be inductive; that is, building explanations from the ground up, based on what is discovered. This typically means that theory is brought in at the analysis stage, as a lens to interpret data.

In the qualitative approach, the activities of collecting and analyzing data, developing and modifying theory, and elaborating or refocusing the research questions, are usually going on more or less simultaneously, each influencing all of the others for a useful model of qualitative research design [ 18 ]. The researcher may need to reconsider or modify any design decision during the study in response to new developments. In this way, qualitative research design is less linear than quantitative research, which is much more step-wise and fixed.

This is not the same as no structure or plan. Most qualitative projects are pre-structured at least in terms of the equivalent of a research protocol, setting out what you are doing (aims and objectives), why (why is this important), and how (theoretical underpinning, design, methods, and analysis). I have provided a brief overview of common approaches to qualitative research design below and direct you to the numerous excellent textbooks which go into this in more detail [ 32 , 33 , 34 , 35 ].

There are five basic categories of qualitative research design: ethnography, narrative, phenomenological, grounded theory, and case study [ 13 , 32 ].

2. Ethnography

In ethnography, you immerse yourself in the target participants’ environment to understand the goals, cultures, challenges, motivations, and themes that emerge. Ethnography has its roots in cultural anthropology where researchers immerse themselves within a culture, often for years. Through multiple data collection approaches—observations, interviews and documentary data, ethnographic research offers a qualitative approach with the potential to yield detailed and comprehensive accounts of different social phenomenon (actions, behavior, interactions, and beliefs). Rather than relying on interviews or surveys, you experience the environment first hand, and sometimes as a “participant observer” which gives opportunity to gather empirical insights into social practices which are normally “hidden” from the public gaze. Reeves et al. [ 36 ] give an excellent guide to ethnography in medical education which is essential reading if you are interested in using this approach.

3. Narrative

The narrative approach weaves together a sequence of events, usually from just one or two individuals to form a cohesive story. You conduct in-depth interviews, read documents, and look for themes; in other words, how does an individual story illustrate the larger life influences that created it. Often interviews are conducted over weeks, months, or even years, but the final narrative does not need to be in chronological order. Rather it can be presented as a story (or narrative) with themes, and can reconcile conflicting stories and highlight tensions and challenges which can be opportunities for innovation.

4. Phenomenology

Phenomenology is concerned with the study of experience from the perspective of the individual, “bracketing” taken-for-granted assumptions and usual ways of perceiving. Phenomenological approaches emphasise the importance of personal perspective and interpretation. As such they are powerful for understanding subjective experience, gaining insights into people’s motivations and actions, and cutting through the clutter of taken-for-granted assumptions and conventional wisdom.

Phenomenological approaches can be applied to single cases or to selected samples. A variety of methods can be used in phenomenologically-based research, including interviews, conversations, participant observation, action research, focus meetings, and analysis of personal texts. Beware though—phenomenological research generates a large quantity data for analysis.

The phenomenological approach is used in medical education research and there are some good articles which will familiarise you with this approach [ 37 , 38 ].

5. Grounded theory

Whereas a phenomenological study looks to describe the essence of an activity or event, grounded theory looks to provide an explanation or theory behind the events. Its main thrust is to generate theories regarding social phenomena: that is, to develop higher level understanding that is “grounded” in, or derived from, a systematic analysis of data [ 39 ]. Grounded theory is appropriate when the study of social interactions or experiences aims to explain a process, not to test or verify an existing theory. Rather, the theory emerges through a close and careful analysis of the data.

The key features of grounded theory are its iterative study design, theoretical (purposive) sampling, and cycles of simultaneous data collection and analysis, where analysis informs the next cycle of data collection. In keeping with this iterative design, the sample is not set at the outset but is selected purposefully as the analysis progresses; participants are chosen for their ability to confirm or challenge an emerging theory. As issues of interest are noted in the data, they are compared with other examples for similarities and differences.

Grounded theory was first proposed by Glaser and Strauss [ 40 ] in 1967 but since then there have been many interpretations of this approach, each with their own processes and norms [ 41 , 42 , 43 ].

Beware—grounded theory is often done very badly, and numerous studies are rejected by journals because they claim to use grounded theory but do not actually do so, or do so badly.

6. Case study

Researcher Yin [ 44 ] defines the case study research method as an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used. The case study method enables a researcher to closely examine the data within a specific context—for example, in a small geographical area or a very limited number of individuals as the subjects of study. Case studies explore and investigate contemporary real-life phenomenon through detailed contextual analysis of a limited number of events or conditions, and their relationships. A case study involves a deep understanding through multiple types of data sources. For example, we used case study methodology recently to explore the nature of the clinical learning environment in a general surgical unit, and used both documents and interviews as data sources. Case studies can be explanatory, exploratory, or describing an event [ 44 ] and case study design can be very open or more structured [ 45 ]. Case studies are a useful approach where the focus is to explain the complexities of real life situations.

While the five methods generally use similar data collection techniques (observation, interviews, and reviewing text—see below), the purpose of the study differentiates them.

Data collection methods

The qualitative methods most commonly used for research purposes can be classified in three broad categories: (1) interviews (individual or group), (2) observation methods, and (3) document review.

The qualitative research interview seeks to describe and gain understanding of certain themes in the life world of the subjects. Interviews can be organised one-to-one or group (focus groups) depending on the topic under study, the cultural context, and the aims of the project. Observational data collection in qualitative research involves the detailed observation of people and events to learn about behaviors and interactions in natural settings [ 46 ]. Such study designs are useful when the study goal is to understand cultural aspects of a setting or phenomenon [ 47 ], when the situation of interest is hidden, (tacit), or when subjects in the setting appear to have notably different views to other groups. Written materials or documents such as institutional records, personal diaries, and historical public documents may also serve as a valuable source of secondary data, providing insight into the lives and experiences of the group under study. For example, in one of my recent studies we used document analysis to uncover the thinking behind the design of a new medical school, then carried out interviews with “users” of the new building to explore how the intentions of the planners played out in reality. However, this is only one way of incorporating document analysis into a study: see Bowen [ 48 ] for an excellent introduction to the purpose and practicalities of document review within qualitative research.

See Dicicco-Bloom and Crabtree [ 49 ] for a useful summary of the content and process of the qualitative research interview, Creswell [ 50 ] for further discussion of the many different approaches in qualitative research and their common characteristics.

1. Data management

Qualitative research may use some form of quantification, but statistical forms of analysis are not central [ 51 ]. Instead, qualitative data analysis aims to uncover emerging themes, patterns, concepts, insights, and understandings [ 52 ]. The data are allowed to “speak for themselves” by the emergence of conceptual categories and descriptive themes. Trying to squeeze narratives into boxes (like “0” and “1”) would result in the loss of contextualisation and narrative layering. The researcher must immerse themselves in the data in order to be able to see meaningful patterns and themes, making notes as they go through the processes of data collection and analysis, and then using these notes to guide the analysis strategy.

Qualitative data has to be managed before it can be analysed—you can generate a lot of data from just a few interviews or observations! You may want to use a specialist qualitative database to facilitate data management and analysis. NVivo is a well-known qualitative data analysis software package (note that qualitative software packages enable you to make and store notes, and explanations of your codes, so you do not need to juggle bits of paper and electronic data files). These and similar databases are available commercially (i.e., at a cost) and are used widely by universities. The choice of database may be dictated by the resources of your institution, your personal preference, and/or what technical support is available locally. However, if you do not have access to qualitative data management software, then use paper and pencil: read and re-read transcripts, take notes on specifics and the bigger patterns, and label different themes with different coloured pen. You do all this in a software package anyway, as data management software does not describe or analyse your data for you. See Cleland et al. [ 53 ] for comprehensive guidance on how to use qualitative databases in education research.

Data analysis

While bearing in mind that qualitative data collection and analysis are iterative rather than linear (see earlier), Miles and Huberman [ 54 ] explain the process of qualitative data analysis as (1) data reduction (extracting the essence), (2) data display (organizing for meaning), and (3) drawing conclusions (explaining the findings).

Data analysis usually follows an inductive approach where the data are allowed to “speak for themselves” by the emergence of conceptual categories and descriptive themes. The researcher must be open to multiple possibilities or ways to think about a problem, engaging in “mental excursions” using multiple stimuli, “side-tracking” or “zigzagging,” changing patterns of thinking, making linkages between the “seemingly unconnected,” and “playing at it,” all with the intention of “opening the world to us in some way” [ 52 ]. The researcher must immerse themselves in the data in order to be able to see meaningful patterns and themes, making notes as they go through the processes of data collection and analysis, and then using these notes to guide the analysis strategy and the development of a coding framework.

In this way, good qualitative research has a logical chain of reasoning, multiple sources of converging evidence to support an explanation, and rules out rival hypotheses with convincing arguments and solid data. The wider literature and theory are used to derive analytical frameworks as the process of analysis develops and different interpretations of the data are likely to be considered before the final argument is built. For example, one of our own studies aimed to explore how widening access policy is translated and implemented at the level of individual medical schools [ 4 ]. Data was collected via individual interviews with key personnel. We initially conducted a primary level thematic analysis to determine themes. After the themes emerged, and following further team discussion, we explored the literature, identified and considered various theories, in some depth, before identifying the most appropriate theory or conceptual lens for a secondary, theory-driven analysis.

There are some excellent text books which discuss qualitative data analysis in detail [ 35 , 55 ].

Judging the quality of research

There are various criteria by which you can judge the quality of qualitative research. These link to efforts by the research team to consider their findings. The most common ways of doing so are triangulation, respondent validation, reflexivity, detail and process, and fair dealing [ 56 ] (but see also Varpio et al. [ 57 ] for a detailed discussion of the limitations of some of these methods).

Triangulation compares the results from either two or more different methods of data collection (for example, interviews and observation) or, more simply, two or more data sources (for example, interviews with different people). The researcher looks for patterns of convergence to develop or corroborate an overall interpretation. This is as a way of ensuring comprehensiveness. Respondent validation, or “member checking,” includes techniques in which the investigator’s account is compared with those of the research subjects to establish the level of correspondence between the two sets. Study participants’ reactions to the analyses are then incorporated into the study findings. Providing a clear account of the process of data collection and analysis is important. By the end of the study, it should be possible to provide a clear account of how early, simple coding evolved into more sophisticated coding structures and thence into clearly defined concepts and explanations for the data collected. Reflexivity is discussed earlier but in terms of analysis reflexivity means sensitivity to the ways in which the researcher and the research process have shaped the collected data, including the role of prior assumptions and experience. These two points address credibility, whether the study has been conducted well and the findings seem reasonable. It is important to pay attention to “negative cases,” data that contradict, or seem to contradict, the emerging explanation of the phenomena under study. These can be a very useful source of information in terms of refining the analysis and thinking beyond the obvious. The final technique is to ensure that the research design explicitly incorporates a wide range of different perspectives. In practice this can mean presenting data from a wide range of diverse participants. A very practical point is worth mentioning here—any reviewer will want to see quotes labelled in some way; for example, P11FFG2 would be participant 11, female, focus group 2). This helps the reader see that your data does not just represent the view of one or two people, but that there is indeed some sort of pattern or commonality to report.

Guba and Lincoln [ 58 ] provide the following criteria for judging qualitative research: credibility, transferability, dependability, and confirmability. I direct you to the original resource and to a very good explanation of these criteria in Mann and MacLeod [ 8 ].

Qualitative research is very important in educational research as it addresses the “how” and “why” research questions and enables deeper understanding of experiences, phenomena, and context. Qualitative research allows you to ask questions that cannot be easily put into numbers to understand human experience. Getting at the everyday realities of some social phenomenon and studying important questions as they are really practiced helps answer big questions. To do so, you need to understand the philosophical stance of qualitative research and work from this to develop the research question, study design, data collection methods, and data analysis.

• Author Rights
• Diversity, Equity & Inclusion

• JOLE 2023 Special Issue
• Editorial Staff
• 20th Anniversary Issue
• A Qualitative Analysis of How Students Construct their Leadership Learning from a High-Impact Leadership Program

Summer F. Odom, Tearney Woodruff, Melissa R. Shehane, Kim E. Dooley, Megan Stein 10.12806/V20/I1/R3

Introduction

Leadership development is often a cited outcome for higher education institutions (Astin & Astin, 2000; Zimmerman-Oster & Burkhardt, 1999) and there is evidence that students can increase their leadership skills during college (Pascarella & Terenzini, 2005). Furthermore, leadership is often cited as an outcome in mission statements of many colleges and universities as these institutions seek to develop students to be contributing members of society and employ leadership skills (Astin & Astin, 2000; Council for the Advancement of Standards in Higher Education, 2012). The process of learning and developing leadership can occur at many stages of a student’s college journey as curricular and co-curricular leadership initiatives exist on college campuses to address the leadership needs of students.  These efforts can sometimes seem disjointed as they are offered by various departments within colleges and universities that differ in their goals, aims, budgets, and resources (Allen & Shehane, 2016). There is a call for healthy curricular/co-curricular partnerships between institutional units that allow for scholarship to progress.

The Maroon & White Leadership Program at Texas A&M University is what could be defined as a formal leadership program or a program that is an “intentional collection of leadership experiences that are integrated into an overall experience designed with the purpose of developing or enhancing leadership skills, knowledge, and capacity” (Haber, 2011, p. 232). These formal leadership programs usually involve academic courses along with co-curricular experiences like retreats, service-learning, or even ropes courses. The purpose of the Maroon & White Leadership Program is to guide participants in developing their identity as leaders by engaging in leadership development, education, and training opportunities while at the university (Allen & Roberts, 2011; Komives et al., 2006; Komives et al., 2007).  The curricular piece consists of the fact that students complete leadership learning experiences that are led by faculty members in leadership courses across campus.  Students also complete cocurricular experiences as they are involved in workshops, student organizations, and other leadership activities not related to course credit.

Participants of the Maroon & White Leadership Program are committed to honing skills, developing an appreciation for lifelong learning, and striving to be an engaged citizen post-graduation. Fundamental components of the program are that students engage in and reflect on, both in oral or written form, at least eight different leadership experiences which exhibit a balance of leadership training, education, and development experiences.  Each student is paired with a leadership coach who facilitates this critical reflection process and supports the student’s intentional, individualized, and holistic development as a leader. Komives et al., (2006) shared that “students need a safe place to reflect and make meaning of their experiences” (p. 415). Leadership coaches guide participants in reflecting about how they work within group contexts and what they are learning from these interactions, which is emphasized in the LID model. Coaches are critical to the affirmation and support needed to develop self-confidence and shape a leadership identity (Komives et al., 2006).

The Maroon & White Leadership Program is led by members of the Division of Student Affairs and is open to any Texas A&M University student who is interested in leadership development, education, and training experiences, and students do not need to be involved in leadership organizations, positions, or programs to participate.  There are no prerequisites to join the program. To become a Maroon & White Leadership Fellow, students do need to have a 2.25 GPA, complete the program within 2-5 semesters, meet with their leadership coach at least two times per semester, complete the eight designators of leadership training, development, and education, complete their leadership engagement project, and attend the induction ceremony. As of March 2019, there were 180 students actively participating in the program and 81 students have been inducted into the Maroon & White Leadership Society since the start of the program in 2014. There have been a total of 298 students who have participated at some level with the Maroon & White Leadership Program and 241 leadership coaches who have been involved.

Literature Review

The Maroon & White Leadership Program is highlighted as a high-impact experience for students. High-impact practices are those experiences designed by colleges and universities which lead to deeper engaged learning among other reticent outcomes.  According to the work of Kuh et al. (2013, p. 10), key elements of high-impact practices include those experiences where (a) performance expectations are set at appropriately high levels, (b) there is a significant investment of time and effort by students over an extended period of time, (c) there are interactions with faculty and peers about substantive matters, (d) students are exposed to and must contend with people and circumstances that differ from those with which students are familiar,(e) there is frequent, timely, and constructive feedback, (f) students have periodic, structured opportunities to reflect and integrate learning, (g) students have opportunities to discover relevance of learning through real-world applications, and (h)) students produce a public demonstration of competence. Higher education has challenged educators to develop courses, programs, and experiences that meet the aforementioned criteria (American Association of Colleges & Universities, 2007; Kuh, 2008). One way colleges and universities have set out to develop essential skills or learning outcomes of students is through high-impact educational practices. Leadership experiences often overlap with characteristics of high-impact educational practices (Priest & Clegorne, 2015). Leadership educators should recognize the opportunity to engage students in high-impact educational experiences through the experiences they design for their students. While evidence of the impact of high-impact practices has been documented (Kuh et al., 2013), more research is needed to examine the outcomes of these experiences in leadership.

As with many aspects of leadership, clear boundaries of experiences are challenging to articulate. The terms leadership education, leadership studies, learning, skill development often yield conflicting answers (Sowcik & Allen, 2013). Allen and Shehane (2016) contend that in order to effectively assess leadership, a balanced approach to leadership education and learning is needed. Furthermore, clarifying language like defining the type of leadership program is seen as one of the most critical and often overlooked components of being able to assess leadership.  Allen and Shehane (2016) classify experiences into three types: curricular, cocurricular, and hybrid experiences.  Curricular refers to those experiences that are part of an academic curriculum and are credit bearing; they would also be listed on a student transcript.  Cocurricular refers to experiences outside the classroom for which students do not receive academic credit.  And, hybrid experiences are a blend of the two experiences.  A formal leadership program would be a hybrid program and is defined as an “intentional collection of leadership experiences that are integrated into an overall experience designed with the purpose of developing or enhancing leadership skills, knowledge, and capacity” (Haber, 2011, p. 232).

Learning should be introduced as an outcome for leadership programs so they can be more intentionally designed, assessed, and evaluated (Allen & Shehane, 2016). Learning has been approached using five primary theories including cognitivism, behaviorism, humanism, social learning, and constructivism (Merriam & Caffarella, 1999).  Allen and Shehane (2016) outlined instructional strategies for each learning approach as well as ways to assess learning in each area.  The constructivist orientation to learning involves the learner taking on new and meaningful experiences while the educator helps the learners make sense of these experiences following an activity.  Learning is assessed and measured primarily through a qualitative framework using reflections or interviews (see Lahey et al., 1988).  However, a challenge exists with programs that are more experiential in that there is usually little opportunity for real-time feedback, coaching, and repetition which are essential for deliberate practice (Ericsson et al., 1993).  While programs designed for a constructivist approach might be ideal, these programs are difficult to design to ensure that learning has occurred and connections have been made.

The Maroon & White Leadership Program at Texas A&M University takes a constructivist approach to learning and is an opportunity for students to achieve learning by taking on new and meaningful experiences and make sense of these experiences through reflection. Students in the program participate in eight different leadership experiences among all three different leadership designators including leadership training (mostly focused at the behaviorism approach), leadership education (mostly focused on the cognitivism approach), and leadership development (mostly focused on the humanist orientation).  Ultimately, the measure of learning is a constructivist approach because they are measured through the reflections they complete after each experience with the guidance of a leadership coach to help them make sense of their learning.

Students in the Maroon & White Leadership Program complete leadership experiences in the categorizations of leadership training, leadership education, and leadership development. Leadership learning is the outcome of all three components.  Leadership training is defined as, “proficiency in demonstrating specific skills associated with the activity of leadership” (Allen & Shehane, 2016, p. 43). Even though there is a lack of agreement of which skills should be focused on, skills including time management and conflict management are examples of skills that can be developed through training exercises. Activities that fall under the training designator include conferences, workshops, and online webinars.

Leadership education is defined as “the process of facilitating learning via planned and naturalistic experiences associated with the activity of leadership” and encompasses “formal/structured to informal/unstructured interventions” (Allen & Shehane, 2016, p. 41). Programming included in leadership education ranges from study abroad to learning communities and classroom education.  Leadership education is what we typically think of for students enrolled in collegiate leadership courses, but it could also be leadership seminars and talks about leadership.

In contrast to the group dynamic attributed to leadership education, leadership development is solely focused on individual growth. Leadership development is defined as, “new insights and progression, which can include an individual’s motivations, values, identity, emotions, and potential in relation to the activity of leadership” (Allen & Shehane, 2016, p. 43). Activities that relate to leadership development include, “reflection, small group dialogue, and journaling” (Allen & Shehane, 2016, p. 43) and programming included in leadership development includes elected leadership positions, organizational roles, and involvement in organizations. According to Avolio and Gardner (2005), leadership development is aimed at many levels including the individual, dyadic, group, and strategic levels.

Student leadership learning opportunities include a variety of different formats including courses, multi-year programs, national leadership experiences such as LeaderShape, study abroad, and leadership workshops. Leadership training, education, and development experiences complement each other and contribute differently to how students learn leadership.  Rarely do leadership learning opportunities offer combined training, education, and development components into one experience. One could purport that the combination of all of these learning opportunities would enhance students’ leadership learning. The purpose of this study was to examine how students construct their leadership learning from a high-impact leadership experience that purposefully involves leadership training, education, and development experiences and uses the guidance of a leadership coach as measured by student reflections and focuses on the constructivist approach to learning.  A challenge to leadership programming is measuring the impact it has on the population it seeks to develop. It is important to examine the outcomes of leadership experiences of college students so that universities can continue to develop leadership skills of students that are important for the workforce and society (National Association of Colleges and Employers, 2017).

Theoretical/Conceptual Framework

The Leadership Identity Development (LID) model serves as the theoretical framework for the Maroon & White Leadership Program and for this study.  This theoretical foundation affords the program an opportunity to offer intensive and purposeful leadership mentorship, to gather rich qualitative data about leadership learning across campus, and to integrate theory and assessment seamlessly throughout the program.  Researchers who developed this model were initially interested in how leadership identity developed over time, “specifically in terms of how one comes to the self-acceptance of knowing one can work effectively with others to accomplish shared goals from any place in an organization—that is, to engage in leadership and see oneself as a leader” (Komives et al., 2007, p. 393). A key finding from the study focused on developing the self, which includes “deepening self-awareness, building self-confidence, establishing interpersonal efficacy in working with others, applying new skills, and expanding one’s motivations—from joining groups just to make friends to being involved in groups to make a valuable contribution” (Komives et al., 2007, p. 394).  Furthermore, group influences and the importance of engaging meaningfully in groups are central to developing a leadership identity. Individuals who stay with the group over time see the value in learning from the continuity of group membership, and more importantly, see the group as an organization with structure and purpose rather than a collection of friends. As such, the students’ perceptions change over time. Initially, they see themselves as dependent on others, then they moved to an independent view from others, and finally they see the need for interdependence with others.

The educational setting can create an environment that supports and facilitates learning for both students and groups. Education cannot force people to change, but it can help students reflect and make meaning of their lives (Zimmerman-Oster & Burkhardt, 1999).  Identity development is connected to the changing nature of relationships with others. Day (2001) proclaimed that “the primary emphasis in leadership development is on building and using interpersonal competence” (p. 585). As such, a central component of the program for this study is the development of self as leaders.  Understanding oneself as a leader does not equate to being able to lead others. Students must also engage in leadership with others to further understand the relational aspect of working in groups and organizations. Because students are engaging in eight leadership experiences, reflecting on those experiences, and gaining feedback from a leadership coach, we would expect there to be growth and progression among the stages (Awarenessà Integration/Synthesis) of the leadership identity development model (Komives et al., 2007; See Figure 1).

Reflection, or reflective thought, as defined by Dewey (1910), is the “active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends” (p. 6).  A valuable experience is without meaning unless the experience is connected and applied. Student learning is deepened and strengthened when the abstract becomes concrete (Bringle & Hatcher, 1999). Structured self-reflection has been found to increase students’ knowledge of personal values (Branson, 2007). Reflection has been suggested as a way to measure learning in the constructivist approach (Merriam & Caffarella, 1999).

Huba and Freed (2000) determined that short writing assignments serve as an appropriate way to measure changes in knowledge, attitudes, and skills.  When a learner reflects upon their thoughts and emotions because of an educational experience or training program, the nature of the learning process helps the learner to construct meaning from information and experiences. Boud and Walker (1985) define reflection as “those intellectual and affective activities in which individuals engage to explore their experiences to lead to new understanding and appreciation” (p. 19).  Reflection may include the sharing of feelings, observations, ideas, and reactions regarding a learning activity.  While reflection can take many forms, reflective writing is often used to get students to delve into subject matter at a deeper level.  Students in the program for this study utilized reflection after each of their leadership experiences.  Reflection could have occurred in written form or in oral form and then feedback provided by their leadership coach.  Since students completed eight reflections as part of completing the Maroon & White Leadership Program requirements, there was a potential for all of these reflections to be reviewed for this study.  Reflections were from various leadership designators (education, training, or development) as students in the program need to complete experiences from each of them to complete the program.

Examples of leadership education experiences include taking a leadership course, spending a semester at sea, participating in a student affairs conference, being a LeaderShape catalyst, studying abroad, and international excursions.  Leadership training experiences consisted of things like a leadership summit difficult dialogue program, an orientation leader program, training program, being on a diversity panel, participating in a StrengthsQuest workshop, attending a leadership conference, participating in a gender specific leadership conference, and completing an internship. Examples of leadership development experiences include being on an advisory board of an organization, being a commander of a squadron, being in the band, serving as a camp counselor for a student-led organization, serving as an officer in an organization, being a director of a student organization, being a student worker, and completing an internship.  Some experiences may overlap in each designator depending on the focus of the experience; the determination was made through the advisor of the Maroon & White Leadership Program and the student’s leadership coach.  It should also be noted that there were certain experiences in each designator that were further designated as signature or premiere.  A signature program is a program that (a) is open to all or a large proportion of students, (b) relates to university learning outcomes and leadership common language and (c) has academic ties.  Any program already approved as a high impact practice at the university would be a signature program by default. A premiere program is identified as those programs and organizations that are advised by a Division of Student Affairs staff member or are hosted by a Division sub-area.  Students were required to complete at least four experiences that meet the criteria of premiere or signature among their eight total experiences.

This study used content analysis within the qualitative research paradigm. Content analysis has been defined as “a technique that enables researchers to study human behavior in an indirect way, through an analysis of their communications” (Fraenkel et al., 1999, p. 405).   Content analysis allows the researchers to examine written documents unobtrusively to provide “a passport to listening to the words of the text, and understanding better the perspective(s) of the producer of these words” (Berg, 2001, p. 242).  The unit of analysis was words, phrases, sentences, and paragraphs within the reflective writing samples of undergraduate students who participated and earned exemplary status in the Maroon & White Leadership Program.  Abrahamson (1983) suggest that researchers begin by immersing themselves in the documents to identify the themes (inductive) and use some categorical scheme or theoretical/social construct for assessment (deductive). For this study, the five-member research team incorporated independent corroborative techniques (like inter-rater reliability) and detailed excerpts from relevant statements to document interpretations of patterns and themes during a peer debriefing session. After open coding (Strauss, 1987), the constant comparative method was used to integrate data (reflective writing samples) and theory using joint coding and analysis (Lincoln & Guba, 1985).

A purposive sample consisting of reflections from students noted as exemplary from the population of students enrolled in the Maroon & White Leadership Program were used in this study.  The units of analysis for this study were reflections from exemplary students.  Exemplary students were determined by a panel of evaluators who assessed students through an exit interview and capstone presentation. Evaluators used a rubric grounded in critical reflection and the leadership identity development model (Komives et al., 2006) to determine exemplary status. At the time of this data analysis, there were 17 exemplary students. 134 reflections from 17 exemplary students were analyzed for this study.  Students were assigned a pseudonym to maintain confidentiality of their reflections.  IRB approval was obtained for this study and it was determined to be exempt.

We will discuss the results by the themes that emerged from each of the three leadership experience designators of leadership training, leadership development, and leadership education. Outcomes of student learning from their leadership training reflections revealed two themes: skill development and process of leadership. Outcomes of student learning from their leadership development reflections revealed four themes: value of experiences, self-discovery, knowledge of leadership, and leadership skills. Outcomes of student learning from their leadership education reflections revealed three themes: knowledge of leadership, understanding and value of diversity, and confidence in leadership abilities.

Leadership Training.  Learning within the leadership training designator can be categorized into two themes including skill development and process of leadership.

Skill development.   This theme includes students learning about and valuing skills in conflict/risk management, working with others who are different/diverse, networking, volunteer strategies, listening/recognition, developing and executing lessons, problem solving, and communication skills for leadership. Logan stated this in his reflection regarding listening:

  This experience contributed to my listening and recognition skills. I realized that in order to benefit others, I have to be willing to hear their stories and recognize their needs. It helped me understand that listening is an active skill that requires effort and an open mind…this directly translates to leadership.

Students expressed both learning skills and learning to value certain skills of leadership. Liliana specifically reflected about valuing the skills of building respect with others as important in the world today:

The world is constantly changing; people from different cultures are continuously forming a variety of relationships.  Leaders can be found everywhere by anyone, and as the world evolves, leaders must be ready at all times. When leaders know how to respect others, work can be done effectively, and respect can be gained in return.

Furthermore, Lauren expressed learning about the value of gaining knowledge of different cultures:

As a leader, and especially in the world right now, we will be expected to interact with people from different cultures who have known different ways of life…a well-adjusted person can thrive anywhere, and that applies to interacting in different cultural contexts as well…I am now more conscious of international trade agreements, international slavery issues, and all sorts of international legality issues that affect the United States as well as Southeastern Asian countries.

Process of Leadership.   This theme includes student learning about leadership as a process not just a position, a willingness to try new things and get out of their comfort zone, reaffirming the mission and vision for an organization, and strengths and decisions as a leader.  Lauren discussed about how leadership is a process and that anyone can be a leader as she stated:

Leadership is not just about having the right morals and ideals.  It’s first and foremost about accepting personal responsibility for the problems that are going on around you, and taking steps to actively change them.

Meredith reflected on the leadership process and specifically the focus on leaders’ strengths:

I have always thought that leadership developed solely from the personality of the individual, not that it doesn’t play a huge part, but I feel that the true form of leadership comes from the strengths the individual uses to lead.

And, Meghan reflected about wanting to learn more about other people, because she believed this would help unlock her strengths as a leader:

Over the next few months I started meeting people from all different walks of life trying to connect with them and understand them better.  I had realized that coming from a small town in Texas, I knew very little about other cultures and I wanted to completely eradicate this aspect of my personality.  This mindset led me to study abroad in the middle east…by taking on so many diverse opportunities, I unlocked strengths which have completely shaped who I am as a person.

Leadership Development.  Learning from within the leadership development area could be categorized into three themes: value of experiences, self-discovery, knowledge of leadership, and leadership skills.

Value of Experiences.   This theme is characterized by students discussing how their leadership development experience was a catalyst for other leadership opportunities and how they have overcome personal leadership obstacles. Kisha reflected about stepping outside her comfort zone:

I was given the freedom to be creative and put my visions in action. I think if given the opportunity that every leader should exercise these. If you don’t learn how to take chances and put yourself out there, you will miss many opportunities for development.

And, Kayla reflected on the value of failure and negative experiences:

I see myself as a stronger individual and leader as a result of this experience. I often try to block out this part of my leadership journey because there are very few positive aspects to it. However, I see now that it was essential in becoming the woman that I am today.

Meghan said she would take advantage of opportunities differently:

Something else that I plan to do differently because of this experience is to continuously take on challenges. Sometimes I underestimate my abilities and lose out on opportunities that could have been transformational.

Will learned about the value of picking an effective team as he stated:

I also have a newfound appreciation for picking an effective team. This does not mean picking only people who have the same personality or conflict resolution type; rather, it means only picking people who respect other points of view and are willing to prioritize picking the best solution over picking their solution.

Self-discovery.   Within this theme, students reflected about discovering their personal leadership motivations, how their actions affected others, gaining knowledge of self, and confidence in themselves as a leader. Lily specifically discussed the characteristic of passion:

This experience has taught me that passion has a lot to do with your development as a leader. Being more passionate about what you do will get you further in anything you attempt. It might even be your motivation that will push you through in the long run.

Lesley wrote about the importance of recognizing and developing areas of weaknesses and blind spots:

I have also learned that my perfectionism sometimes causes difficulty when working with others. For instance, when working with my partner, we had to make many decisions about how we would spend our time with the freshmen.  I struggled with compromising even on small details, because I wanted everything to be perfect in the way I envisioned. However, I have come to understand that my vision is often far from perfect and it is often better to work with the ideas of others instead of wasting time arguing over small decisions.

Meghan discussed the realization of how actions and modeling the way as a leader inspired others to be more involved:

“…leading by example was the most effective way of keeping members involved and on track.  I realized that the more passionate I was, the more inspired my members were; the earlier I was to meetings, the more likely they were to be on-time; the more prepared I was for meetings, the more involved my members were; the more I signed up for volunteer events, the more members I had volunteer.”

Jessica further illustrated this realization of the importance of modeling the way by stating “Being genuine and transparent with those around you and modeling the way is necessary to establish strong, trustworthy relationships with others.” Sarah felt like her confidence in leadership grew through her leadership development experience:

I see myself as capable of building better organizations out of existing ones. I know that it is possible for me to improve an organization from inside it through critically examining the organization’s activities in comparison to its purpose. I am also more confident of my intuition in undefined circumstances—I can create a purpose where one is lacking, and seek guidance when I get too little. After having to find my own purpose in leadership last year, it was much easier than it would otherwise have been for me to take on executive leadership in First Wing this year. I am also much more comfortable about the idea of being in charge of the [program] this summer than I would have been without this exercise in autonomy.

Lily further reflected on how her confidence as a leader has grown:

From this experience I am not certain that I will completely act different, but my confidence about going into leadership positions has grown so much.  I have so much more faith in what I am capable of accomplishing and that I can get there despite the fact that more people had experience.  I hope to use this experience as something that will carry my confidence in the professional world when I feel like people are doubting my abilities or I start to question whether a leadership role was the right thing for me to do.

Knowledge of leadership.   In the knowledge of leadership theme, students discussed gaining knowledge of leadership styles and approaches and a changing view of leadership. Sarah reflected on the value of being a relational leader:

I also know how much stronger a team is when they are brought together by social as well as occupational ties.  As a leader in the future, I will value relationships above tasks.  My first goal upon entering a new organization will be to establish relationships with each of my direct subordinates and with my coworkers.  I know that with relationships of mutual trust established, common goals become important to both people.  It hurts more to disappoint a friend than a colleague.

Other students reflected about the changing view of positional leaders as with Christine who said “…a role can still be leadership despite the title” or Chesney who stated “…To be a good leader, you also need to be a good follower.” Chesney also learned that “It’s not always about the goal…it’s also about how you get there.” Jessica reflected about the importance of trust to leadership: “By being transparent and genuine, a leader can establish a foundation of trust that the group can build on. This trust can make discussion and disagreement be received differently…”

Meghan described her learning in the following way:

I now view leadership in a more holistic sense. I understand, now, that leading a team of your peers to a common goal involves many moving parts and the success of your team depends mainly on the environment that you create .

Leadership Skills.   While students reflected on actual leadership skills learned, they also reflected on the value of these skills to leadership. Specific leadership skills mentioned in the student reflections include communication, addressing conflict/compromise, understanding others, responsibility, ethics/character, establishing a shared vision, and adaptability through their leadership development experiences.

Jessica reflected on how her leadership development experience taught her about compromise:

The first was learning how to compromise.  In all of my previous leadership positions, my ideas were usually met with enthusiasm and agreement.  This did not often happen in our committee meetings.  I always thought that I took criticism well, but being told flat-out that my idea would not work or that it would not meet a certain goals was tough to handle.  I really had to take a step back and say to myself that it wasn’t “my way or the highway.”  Compromise was a big part of our committee decisions and, now that I think back on our decisions, the success of our workshops was due to our, and my, ability to compromise.

In regards to establishing a shared vision, Samantha talked about learning to “see a vision to fruition.” She also stated, “It was a very new experience being the final decision maker.  With the freedom came responsibility, as the success or failure of the event would fall on me.”

Leadership Education.  Learning within the leadership education designator can be categorized into three themes: knowledge of leadership, understanding and value of diversity, and confidence in leadership abilities.

  Knowledge of leadership.   Specific to knowledge of leadership, students discussed autocratic vs. democratic leadership styles, values, changing views of leadership, and the importance of assessment and reflection as a leader.  Two students specifically mentioned gaining knowledge of leadership styles. Kirsten discussed the importance of knowing when to use which leadership style:

Knowing when to be more or less authoritative in decision making is extremely important for a leader.  A leader who does not know what leadership model is appropriate for a situation can be one of two extremes if the wrong style is picked for too long.  If the leader is not willing to make difficult decisions to motivate an ambivalent group, the group can suffer from taking far too long to make a decision or might not make a decision at all.

Jessica discussed the importance of adapting her leadership style to a situation:

Being able to adapt to situations and recognize that a person’s leadership style and approach will be different for each situation is something that is really important.  If a person is stuck in a certain mindset about leadership, they may not be able to see past that and do what is best in each unique situation. I have learned to better recognize different situations and adapt my leadership style to that situation.

Understanding and value of diversity.   Within this theme, students reflected on how diversity broadens one’s perspective, productivity increases, value in seeking diverse groups, the fact that diversity is still an obstacle in society and without it we risk making errors in social and cultural settings.  Payton reflected on having a better understanding of diversity and inclusivity:

Inclusivity and diversity doesn’t mean everyone walking around on eggshells trying to avoid offending anyone.  They mean coming to a place intellectually and emotionally where you can understand and appreciate the differences in where people come from and how they live.

Kisha reflected about the importance of understanding others’ value systems:

I learned that every person’s unique upbringing is what helps define the way they think. At first, I thought that when some students especially at Texas A&M University weren’t being inclusive in their actions it was because they didn’t care to.  Now, I know that most just never thought that their actions were offensive and by simply being educated on the matter, it prevents them from doing these things in the future.

Yet, Samantha reflected on how she has grown to value the differences of others:

I have developed a sense of not only acceptance of people of different backgrounds or cultures, but I have tried to embrace a philosophy which allows me to truly appreciate the input of people from all different walks of life…Latinos have unique experiences which can serve as an asset to our society, an asset that needs to be acknowledged and cultivated.

Confidence in leadership abilities.   Under this theme, it appeared that students gained confidence in their leadership abilities by going through a leadership education experience.  Students mentioned gaining confidence in their skills of dealing with change, debate and civil discourse, leadership styles, and trust in themselves.  Specifically, Kirsten mentioned: “I am more confident taking a more authoritative position as a leader. …I think the biggest change in how I viewed my leadership ability is in my self-confidence.” Samantha further reflected on her experience in the classroom with discussing controversial topics and how she will use this in working with another group:

My own experiences abroad will be helpful, but having taken this course I have experience openly discussing controversial topics. Day to day I never discussed hot button issues with people abroad unless I already knew them quite well. In contrast, during class I was able to observe and engage in extremely open and frank discussions. I will be certain to impress upon the participants that the rhetoric, body language, and tone we use is important. It is one hundred percent okay to be hesitant about new cultures.

Will reflected on a course that he took that involved a group project and how he gained confidence in his abilities:

I think the biggest change in how I viewed my leadership ability is in my self-confidence. I had served in leadership positions before that project, but I had either been put in a leadership position or had been lead by a competent leader with adult support. This was the first time I had ever been in a position where I had to figure out what authority I had within the group, and it definitely gave me confidence for the future.

Discussion/Conclusions/Recommendations

College students have opportunities for leadership learning through leadership training, education, and development experiences in the Maroon & White Leadership Program. As we would somewhat expect, reflections from students in the Maroon & White Leadership Program exhibited outcomes characterized by the LID model (Komives et al., 2007).  Specifically in the “developing self” component of the LID model, students appeared to exhibit aspects of deepening self-awareness, building self-confidence, establish interpersonal efficacy in working with others, applying new skills, and expanding one’s motivations.

From the leadership training experiences, students learned about skill development and the process of leadership.  Within the skill development area, students reflected on skills of working with others, which could also be considered as establishing interpersonal efficacy in working with others. Students talked about expanding one’s motivations as we see that Meghan was going to study abroad because she wanted to think differently after having gone through a leadership training.

Within the leadership education designation, student reflections were characterized as learning knowledge of leadership, understanding and valuing diversity, and confidence in their leadership abilities.  The understanding and valuing of diversity theme fits in with the LID model in terms of the establishing interpersonal efficacy in working with others.  Students reflected on how they now recognize the importance of working with others who are different than them and can value their unique experiences.  Students also discussed confidence in their leadership abilities.  Part of the LID model of developing self indicates that students should build self-confidence.  From the leadership training and leadership education reflections, students did discuss gaining confidence in their leadership abilities.

In the reflection about students’ leadership development experiences, students reflected on value of experiences and self-discovery.  Kayla specifically had a deepening self-awareness as she discussed her failures, but can now see how these failures shaped her as a person. Lesley reflected on a deepening self-awareness for recognizing blind spots and the importance of working with others to overcome them. We also see within the leadership experience designator, students reflected on leadership as a process and identifying leadership as more than just a position as in Christine’s statement that you can be a leader despite your title.

The one part of the LID model that may not have been as evident from the reflections about student leadership experiences is in applying new skills.  The LID model is a framework for helping us understand how students develop as leaders.  It is a cyclical model that would assert students should be able to apply new skills as they develop as a leader.  This may be an area where the Maroon & White Leadership Program could focus on building within their program.  Students complete a combination of eight leadership experiences as part of the program.  Leadership educators within the program should formulate ways to better equip coaches to help students apply their new skills as a leader or help students better articulate how they are applying those new skills.

The theoretical framework worked well for this analysis and demonstrates the importance of formal education, training programs, and student development in the process to becoming authentic leaders.  The oral and written reflections provide evidence of student leadership learning and progression through the leadership identity stages as a result of this leadership program.  It should be noted; however, that the student reflections analyzed for this study were those that were considered “exemplary.”  The constructed learning of these individuals reflects those that were rated highly by a panel of judges. More research should be conducted to examine the learning of those students who did not rate as exemplary to see whether similar constructed learning occurs.

More research is needed to examine how the type of leadership experience (training, education, or development) impacts the leadership identity development of students.  Also, the Maroon & White Leadership Program is a purposeful program designed to get students to reflect both orally and in written form about their leadership experiences and with the guidance of a leadership coach.  To truly examine the impact of the program, more research should be conducted to compare students who are only doing leadership development, leadership education, or leadership training experiences without the added requirements of reflection and guidance of a leadership coach.  Furthermore, research should also be focused on the impact of a leadership coach on a student’s leadership journey. Given the impact of a leadership mentor or coach on a student’s leadership identity development (Komives et al., 2006), more research should be conducted to examine the behaviors and characteristics of the leadership coach and the factors that affect the impact of their role in a student’s leadership journey.

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Qualitative Data Analysis: Step-by-Step Guide (Manual vs. Automatic)

When we conduct qualitative methods of research, need to explain changes in metrics or understand people's opinions, we always turn to qualitative data. Qualitative data is typically generated through:

• Interview transcripts
• Surveys with open-ended questions
• Contact center transcripts
• Texts and documents
• Audio and video recordings
• Observational notes

Compared to quantitative data, which captures structured information, qualitative data is unstructured and has more depth. It can answer our questions, can help formulate hypotheses and build understanding.

It's important to understand the differences between quantitative data & qualitative data . But unfortunately, analyzing qualitative data is difficult. While tools like Excel, Tableau and PowerBI crunch and visualize quantitative data with ease, there are a limited number of mainstream tools for analyzing qualitative data . The majority of qualitative data analysis still happens manually.

That said, there are two new trends that are changing this. First, there are advances in natural language processing (NLP) which is focused on understanding human language. Second, there is an explosion of user-friendly software designed for both researchers and businesses. Both help automate the qualitative data analysis process.

In this post we want to teach you how to conduct a successful qualitative data analysis. There are two primary qualitative data analysis methods; manual & automatic. We will teach you how to conduct the analysis manually, and also, automatically using software solutions powered by NLP. We’ll guide you through the steps to conduct a manual analysis, and look at what is involved and the role technology can play in automating this process.

More businesses are switching to fully-automated analysis of qualitative customer data because it is cheaper, faster, and just as accurate. Primarily, businesses purchase subscriptions to feedback analytics platforms so that they can understand customer pain points and sentiment.

We’ll take you through 5 steps to conduct a successful qualitative data analysis. Within each step we will highlight the key difference between the manual, and automated approach of qualitative researchers. Here's an overview of the steps:

The 5 steps to doing qualitative data analysis

• Gathering and collecting your qualitative data
• Organizing and connecting into your qualitative data
• Coding your qualitative data
• Analyzing the qualitative data for insights
• Reporting on the insights derived from your analysis

What is Qualitative Data Analysis?

Qualitative data analysis is a process of gathering, structuring and interpreting qualitative data to understand what it represents.

Qualitative data is non-numerical and unstructured. Qualitative data generally refers to text, such as open-ended responses to survey questions or user interviews, but also includes audio, photos and video.

Businesses often perform qualitative data analysis on customer feedback. And within this context, qualitative data generally refers to verbatim text data collected from sources such as reviews, complaints, chat messages, support centre interactions, customer interviews, case notes or social media comments.

How is qualitative data analysis different from quantitative data analysis?

Understanding the differences between quantitative & qualitative data is important. When it comes to analyzing data, Qualitative Data Analysis serves a very different role to Quantitative Data Analysis. But what sets them apart?

Qualitative Data Analysis dives into the stories hidden in non-numerical data such as interviews, open-ended survey answers, or notes from observations. It uncovers the ‘whys’ and ‘hows’ giving a deep understanding of people’s experiences and emotions.

Quantitative Data Analysis on the other hand deals with numerical data, using statistics to measure differences, identify preferred options, and pinpoint root causes of issues.  It steps back to address questions like "how many" or "what percentage" to offer broad insights we can apply to larger groups.

In short, Qualitative Data Analysis is like a microscope,  helping us understand specific detail. Quantitative Data Analysis is like the telescope, giving us a broader perspective. Both are important, working together to decode data for different objectives.

Qualitative Data Analysis methods

Once all the data has been captured, there are a variety of analysis techniques available and the choice is determined by your specific research objectives and the kind of data you’ve gathered.  Common qualitative data analysis methods include:

Content Analysis

This is a popular approach to qualitative data analysis. Other qualitative analysis techniques may fit within the broad scope of content analysis. Thematic analysis is a part of the content analysis.  Content analysis is used to identify the patterns that emerge from text, by grouping content into words, concepts, and themes. Content analysis is useful to quantify the relationship between all of the grouped content. The Columbia School of Public Health has a detailed breakdown of content analysis .

Narrative Analysis

Narrative analysis focuses on the stories people tell and the language they use to make sense of them.  It is particularly useful in qualitative research methods where customer stories are used to get a deep understanding of customers’ perspectives on a specific issue. A narrative analysis might enable us to summarize the outcomes of a focused case study.

Discourse Analysis

Discourse analysis is used to get a thorough understanding of the political, cultural and power dynamics that exist in specific situations.  The focus of discourse analysis here is on the way people express themselves in different social contexts. Discourse analysis is commonly used by brand strategists who hope to understand why a group of people feel the way they do about a brand or product.

Thematic Analysis

Thematic analysis is used to deduce the meaning behind the words people use. This is accomplished by discovering repeating themes in text. These meaningful themes reveal key insights into data and can be quantified, particularly when paired with sentiment analysis . Often, the outcome of thematic analysis is a code frame that captures themes in terms of codes, also called categories. So the process of thematic analysis is also referred to as “coding”. A common use-case for thematic analysis in companies is analysis of customer feedback.

Grounded Theory

Grounded theory is a useful approach when little is known about a subject. Grounded theory starts by formulating a theory around a single data case. This means that the theory is “grounded”. Grounded theory analysis is based on actual data, and not entirely speculative. Then additional cases can be examined to see if they are relevant and can add to the original grounded theory.

Challenges of Qualitative Data Analysis

While Qualitative Data Analysis offers rich insights, it comes with its challenges. Each unique QDA method has its unique hurdles. Let’s take a look at the challenges researchers and analysts might face, depending on the chosen method.

• Time and Effort (Narrative Analysis): Narrative analysis, which focuses on personal stories, demands patience. Sifting through lengthy narratives to find meaningful insights can be time-consuming, requires dedicated effort.
• Being Objective (Grounded Theory): Grounded theory, building theories from data, faces the challenges of personal biases. Staying objective while interpreting data is crucial, ensuring conclusions are rooted in the data itself.
• Complexity (Thematic Analysis): Thematic analysis involves identifying themes within data, a process that can be intricate. Categorizing and understanding themes can be complex, especially when each piece of data varies in context and structure. Thematic Analysis software can simplify this process.
• Generalizing Findings (Narrative Analysis): Narrative analysis, dealing with individual stories, makes drawing broad challenging. Extending findings from a single narrative to a broader context requires careful consideration.
• Managing Data (Thematic Analysis): Thematic analysis involves organizing and managing vast amounts of unstructured data, like interview transcripts. Managing this can be a hefty task, requiring effective data management strategies.
• Skill Level (Grounded Theory): Grounded theory demands specific skills to build theories from the ground up. Finding or training analysts with these skills poses a challenge, requiring investment in building expertise.

Benefits of qualitative data analysis

Qualitative Data Analysis (QDA) is like a versatile toolkit, offering a tailored approach to understanding your data. The benefits it offers are as diverse as the methods. Let’s explore why choosing the right method matters.

• Tailored Methods for Specific Needs: QDA isn't one-size-fits-all. Depending on your research objectives and the type of data at hand, different methods offer unique benefits. If you want emotive customer stories, narrative analysis paints a strong picture. When you want to explain a score, thematic analysis reveals insightful patterns
• Flexibility with Thematic Analysis: thematic analysis is like a chameleon in the toolkit of QDA. It adapts well to different types of data and research objectives, making it a top choice for any qualitative analysis.
• Deeper Understanding, Better Products: QDA helps you dive into people's thoughts and feelings. This deep understanding helps you build products and services that truly matches what people want, ensuring satisfied customers
• Finding the Unexpected: Qualitative data often reveals surprises that we miss in quantitative data. QDA offers us new ideas and perspectives, for insights we might otherwise miss.
• Building Effective Strategies: Insights from QDA are like strategic guides. They help businesses in crafting plans that match people’s desires.
• Creating Genuine Connections: Understanding people’s experiences lets businesses connect on a real level. This genuine connection helps build trust and loyalty, priceless for any business.

How to do Qualitative Data Analysis: 5 steps

Now we are going to show how you can do your own qualitative data analysis. We will guide you through this process step by step. As mentioned earlier, you will learn how to do qualitative data analysis manually , and also automatically using modern qualitative data and thematic analysis software.

To get best value from the analysis process and research process, it’s important to be super clear about the nature and scope of the question that’s being researched. This will help you select the research collection channels that are most likely to help you answer your question.

Depending on if you are a business looking to understand customer sentiment, or an academic surveying a school, your approach to qualitative data analysis will be unique.

Once you’re clear, there’s a sequence to follow. And, though there are differences in the manual and automatic approaches, the process steps are mostly the same.

The use case for our step-by-step guide is a company looking to collect data (customer feedback data), and analyze the customer feedback - in order to improve customer experience. By analyzing the customer feedback the company derives insights about their business and their customers. You can follow these same steps regardless of the nature of your research. Let’s get started.

Step 1: Gather your qualitative data and conduct research (Conduct qualitative research)

The first step of qualitative research is to do data collection. Put simply, data collection is gathering all of your data for analysis. A common situation is when qualitative data is spread across various sources.

Classic methods of gathering qualitative data

Most companies use traditional methods for gathering qualitative data: conducting interviews with research participants, running surveys, and running focus groups. This data is typically stored in documents, CRMs, databases and knowledge bases. It’s important to examine which data is available and needs to be included in your research project, based on its scope.

Using your existing qualitative feedback

As it becomes easier for customers to engage across a range of different channels, companies are gathering increasingly large amounts of both solicited and unsolicited qualitative feedback.

Most organizations have now invested in Voice of Customer programs , support ticketing systems, chatbot and support conversations, emails and even customer Slack chats.

These new channels provide companies with new ways of getting feedback, and also allow the collection of unstructured feedback data at scale.

The great thing about this data is that it contains a wealth of valubale insights and that it’s already there! When you have a new question about user behavior or your customers, you don’t need to create a new research study or set up a focus group. You can find most answers in the data you already have.

Typically, this data is stored in third-party solutions or a central database, but there are ways to export it or connect to a feedback analysis solution through integrations or an API.

Utilize untapped qualitative data channels

There are many online qualitative data sources you may not have considered. For example, you can find useful qualitative data in social media channels like Twitter or Facebook. Online forums, review sites, and online communities such as Discourse or Reddit also contain valuable data about your customers, or research questions.

If you are considering performing a qualitative benchmark analysis against competitors - the internet is your best friend. Gathering feedback in competitor reviews on sites like Trustpilot, G2, Capterra, Better Business Bureau or on app stores is a great way to perform a competitor benchmark analysis.

Customer feedback analysis software often has integrations into social media and review sites, or you could use a solution like DataMiner to scrape the reviews.

Step 2: Connect & organize all your qualitative data

Now you all have this qualitative data but there’s a problem, the data is unstructured. Before feedback can be analyzed and assigned any value, it needs to be organized in a single place. Why is this important? Consistency!

If all data is easily accessible in one place and analyzed in a consistent manner, you will have an easier time summarizing and making decisions based on this data.

The manual approach to organizing your data

The classic method of structuring qualitative data is to plot all the raw data you’ve gathered into a spreadsheet.

Typically, research and support teams would share large Excel sheets and different business units would make sense of the qualitative feedback data on their own. Each team collects and organizes the data in a way that best suits them, which means the feedback tends to be kept in separate silos.

An alternative and a more robust solution is to store feedback in a central database, like Snowflake or Amazon Redshift .

Keep in mind that when you organize your data in this way, you are often preparing it to be imported into another software. If you go the route of a database, you would need to use an API to push the feedback into a third-party software.

Computer-assisted qualitative data analysis software (CAQDAS)

Traditionally within the manual analysis approach (but not always), qualitative data is imported into CAQDAS software for coding.

In the early 2000s, CAQDAS software was popularised by developers such as ATLAS.ti, NVivo and MAXQDA and eagerly adopted by researchers to assist with the organizing and coding of data.  

The benefits of using computer-assisted qualitative data analysis software:

• Assists in the organizing of your data
• Opens you up to exploring different interpretations of your data analysis
• Allows you to share your dataset easier and allows group collaboration (allows for secondary analysis)

However you still need to code the data, uncover the themes and do the analysis yourself. Therefore it is still a manual approach.

Organizing your qualitative data in a feedback repository

Another solution to organizing your qualitative data is to upload it into a feedback repository where it can be unified with your other data , and easily searchable and taggable. There are a number of software solutions that act as a central repository for your qualitative research data. Here are a couple solutions that you could investigate:  

• Dovetail: Dovetail is a research repository with a focus on video and audio transcriptions. You can tag your transcriptions within the platform for theme analysis. You can also upload your other qualitative data such as research reports, survey responses, support conversations, and customer interviews. Dovetail acts as a single, searchable repository. And makes it easier to collaborate with other people around your qualitative research.
• EnjoyHQ: EnjoyHQ is another research repository with similar functionality to Dovetail. It boasts a more sophisticated search engine, but it has a higher starting subscription cost.

Organizing your qualitative data in a feedback analytics platform

If you have a lot of qualitative customer or employee feedback, from the likes of customer surveys or employee surveys, you will benefit from a feedback analytics platform. A feedback analytics platform is a software that automates the process of both sentiment analysis and thematic analysis . Companies use the integrations offered by these platforms to directly tap into their qualitative data sources (review sites, social media, survey responses, etc.). The data collected is then organized and analyzed consistently within the platform.

If you have data prepared in a spreadsheet, it can also be imported into feedback analytics platforms.

Once all this rich data has been organized within the feedback analytics platform, it is ready to be coded and themed, within the same platform. Thematic is a feedback analytics platform that offers one of the largest libraries of integrations with qualitative data sources.

Step 3: Coding your qualitative data

Your feedback data is now organized in one place. Either within your spreadsheet, CAQDAS, feedback repository or within your feedback analytics platform. The next step is to code your feedback data so we can extract meaningful insights in the next step.

Coding is the process of labelling and organizing your data in such a way that you can then identify themes in the data, and the relationships between these themes.

To simplify the coding process, you will take small samples of your customer feedback data, come up with a set of codes, or categories capturing themes, and label each piece of feedback, systematically, for patterns and meaning. Then you will take a larger sample of data, revising and refining the codes for greater accuracy and consistency as you go.

If you choose to use a feedback analytics platform, much of this process will be automated and accomplished for you.

The terms to describe different categories of meaning (‘theme’, ‘code’, ‘tag’, ‘category’ etc) can be confusing as they are often used interchangeably.  For clarity, this article will use the term ‘code’.

To code means to identify key words or phrases and assign them to a category of meaning. “I really hate the customer service of this computer software company” would be coded as “poor customer service”.

How to manually code your qualitative data

• Decide whether you will use deductive or inductive coding. Deductive coding is when you create a list of predefined codes, and then assign them to the qualitative data. Inductive coding is the opposite of this, you create codes based on the data itself. Codes arise directly from the data and you label them as you go. You need to weigh up the pros and cons of each coding method and select the most appropriate.
• Read through the feedback data to get a broad sense of what it reveals. Now it’s time to start assigning your first set of codes to statements and sections of text.
• Keep repeating step 2, adding new codes and revising the code description as often as necessary.  Once it has all been coded, go through everything again, to be sure there are no inconsistencies and that nothing has been overlooked.
• Create a code frame to group your codes. The coding frame is the organizational structure of all your codes. And there are two commonly used types of coding frames, flat, or hierarchical. A hierarchical code frame will make it easier for you to derive insights from your analysis.
• Based on the number of times a particular code occurs, you can now see the common themes in your feedback data. This is insightful! If ‘bad customer service’ is a common code, it’s time to take action.

We have a detailed guide dedicated to manually coding your qualitative data .

Using software to speed up manual coding of qualitative data

An Excel spreadsheet is still a popular method for coding. But various software solutions can help speed up this process. Here are some examples.

• CAQDAS / NVivo - CAQDAS software has built-in functionality that allows you to code text within their software. You may find the interface the software offers easier for managing codes than a spreadsheet.
• Dovetail/EnjoyHQ - You can tag transcripts and other textual data within these solutions. As they are also repositories you may find it simpler to keep the coding in one platform.
• IBM SPSS - SPSS is a statistical analysis software that may make coding easier than in a spreadsheet.
• Ascribe - Ascribe’s ‘Coder’ is a coding management system. Its user interface will make it easier for you to manage your codes.

Automating the qualitative coding process using thematic analysis software

In solutions which speed up the manual coding process, you still have to come up with valid codes and often apply codes manually to pieces of feedback. But there are also solutions that automate both the discovery and the application of codes.

Advances in machine learning have now made it possible to read, code and structure qualitative data automatically. This type of automated coding is offered by thematic analysis software .

Automation makes it far simpler and faster to code the feedback and group it into themes. By incorporating natural language processing (NLP) into the software, the AI looks across sentences and phrases to identify common themes meaningful statements. Some automated solutions detect repeating patterns and assign codes to them, others make you train the AI by providing examples. You could say that the AI learns the meaning of the feedback on its own.

Thematic automates the coding of qualitative feedback regardless of source. There’s no need to set up themes or categories in advance. Simply upload your data and wait a few minutes. You can also manually edit the codes to further refine their accuracy.  Experiments conducted indicate that Thematic’s automated coding is just as accurate as manual coding .

Paired with sentiment analysis and advanced text analytics - these automated solutions become powerful for deriving quality business or research insights.

You could also build your own , if you have the resources!

The key benefits of using an automated coding solution

Automated analysis can often be set up fast and there’s the potential to uncover things that would never have been revealed if you had given the software a prescribed list of themes to look for.

Because the model applies a consistent rule to the data, it captures phrases or statements that a human eye might have missed.

Complete and consistent analysis of customer feedback enables more meaningful findings. Leading us into step 4.

Step 4: Analyze your data: Find meaningful insights

Now we are going to analyze our data to find insights. This is where we start to answer our research questions. Keep in mind that step 4 and step 5 (tell the story) have some overlap . This is because creating visualizations is both part of analysis process and reporting.

The task of uncovering insights is to scour through the codes that emerge from the data and draw meaningful correlations from them. It is also about making sure each insight is distinct and has enough data to support it.

Part of the analysis is to establish how much each code relates to different demographics and customer profiles, and identify whether there’s any relationship between these data points.

Manually create sub-codes to improve the quality of insights

If your code frame only has one level, you may find that your codes are too broad to be able to extract meaningful insights. This is where it is valuable to create sub-codes to your primary codes. This process is sometimes referred to as meta coding.

Note: If you take an inductive coding approach, you can create sub-codes as you are reading through your feedback data and coding it.

While time-consuming, this exercise will improve the quality of your analysis. Here is an example of what sub-codes could look like.

You need to carefully read your qualitative data to create quality sub-codes. But as you can see, the depth of analysis is greatly improved. By calculating the frequency of these sub-codes you can get insight into which  customer service problems you can immediately address.

Correlate the frequency of codes to customer segments

Many businesses use customer segmentation . And you may have your own respondent segments that you can apply to your qualitative analysis. Segmentation is the practise of dividing customers or research respondents into subgroups.

Segments can be based on:

• Demographic
• And any other data type that you care to segment by

It is particularly useful to see the occurrence of codes within your segments. If one of your customer segments is considered unimportant to your business, but they are the cause of nearly all customer service complaints, it may be in your best interest to focus attention elsewhere. This is a useful insight!

Manually visualizing coded qualitative data

There are formulas you can use to visualize key insights in your data. The formulas we will suggest are imperative if you are measuring a score alongside your feedback.

If you are collecting a metric alongside your qualitative data this is a key visualization. Impact answers the question: “What’s the impact of a code on my overall score?”. Using Net Promoter Score (NPS) as an example, first you need to:

• Calculate overall NPS
• Calculate NPS in the subset of responses that do not contain that theme
• Subtract B from A

Then you can use this simple formula to calculate code impact on NPS .

You can then visualize this data using a bar chart.

You can download our CX toolkit - it includes a template to recreate this.

Trends over time

This analysis can help you answer questions like: “Which codes are linked to decreases or increases in my score over time?”

We need to compare two sequences of numbers: NPS over time and code frequency over time . Using Excel, calculate the correlation between the two sequences, which can be either positive (the more codes the higher the NPS, see picture below), or negative (the more codes the lower the NPS).

Now you need to plot code frequency against the absolute value of code correlation with NPS. Here is the formula:

The visualization could look like this:

These are two examples, but there are more. For a third manual formula, and to learn why word clouds are not an insightful form of analysis, read our visualizations article .

Using a text analytics solution to automate analysis

Automated text analytics solutions enable codes and sub-codes to be pulled out of the data automatically. This makes it far faster and easier to identify what’s driving negative or positive results. And to pick up emerging trends and find all manner of rich insights in the data.

Another benefit of AI-driven text analytics software is its built-in capability for sentiment analysis, which provides the emotive context behind your feedback and other qualitative textual data therein.

Thematic provides text analytics that goes further by allowing users to apply their expertise on business context to edit or augment the AI-generated outputs.

Since the move away from manual research is generally about reducing the human element, adding human input to the technology might sound counter-intuitive. However, this is mostly to make sure important business nuances in the feedback aren’t missed during coding. The result is a higher accuracy of analysis. This is sometimes referred to as augmented intelligence .

Step 5: Report on your data: Tell the story

The last step of analyzing your qualitative data is to report on it, to tell the story. At this point, the codes are fully developed and the focus is on communicating the narrative to the audience.

A coherent outline of the qualitative research, the findings and the insights is vital for stakeholders to discuss and debate before they can devise a meaningful course of action.

Creating graphs and reporting in Powerpoint

Typically, qualitative researchers take the tried and tested approach of distilling their report into a series of charts, tables and other visuals which are woven into a narrative for presentation in Powerpoint.

Using visualization software for reporting

With data transformation and APIs, the analyzed data can be shared with data visualisation software, such as Power BI or Tableau , Google Studio or Looker. Power BI and Tableau are among the most preferred options.

Visualizing your insights inside a feedback analytics platform

Feedback analytics platforms, like Thematic, incorporate visualisation tools that intuitively turn key data and insights into graphs.  This removes the time consuming work of constructing charts to visually identify patterns and creates more time to focus on building a compelling narrative that highlights the insights, in bite-size chunks, for executive teams to review.

Using a feedback analytics platform with visualization tools means you don’t have to use a separate product for visualizations. You can export graphs into Powerpoints straight from the platforms.

Conclusion - Manual or Automated?

There are those who remain deeply invested in the manual approach - because it’s familiar, because they’re reluctant to spend money and time learning new software, or because they’ve been burned by the overpromises of AI.  

For projects that involve small datasets, manual analysis makes sense. For example, if the objective is simply to quantify a simple question like “Do customers prefer X concepts to Y?”. If the findings are being extracted from a small set of focus groups and interviews, sometimes it’s easier to just read them

However, as new generations come into the workplace, it’s technology-driven solutions that feel more comfortable and practical. And the merits are undeniable.  Especially if the objective is to go deeper and understand the ‘why’ behind customers’ preference for X or Y. And even more especially if time and money are considerations.

The ability to collect a free flow of qualitative feedback data at the same time as the metric means AI can cost-effectively scan, crunch, score and analyze a ton of feedback from one system in one go. And time-intensive processes like focus groups, or coding, that used to take weeks, can now be completed in a matter of hours or days.

But aside from the ever-present business case to speed things up and keep costs down, there are also powerful research imperatives for automated analysis of qualitative data: namely, accuracy and consistency.

Finding insights hidden in feedback requires consistency, especially in coding.  Not to mention catching all the ‘unknown unknowns’ that can skew research findings and steering clear of cognitive bias.

Some say without manual data analysis researchers won’t get an accurate “feel” for the insights. However, the larger data sets are, the harder it is to sort through the feedback and organize feedback that has been pulled from different places.  And, the more difficult it is to stay on course, the greater the risk of drawing incorrect, or incomplete, conclusions grows.

Though the process steps for qualitative data analysis have remained pretty much unchanged since psychologist Paul Felix Lazarsfeld paved the path a hundred years ago, the impact digital technology has had on types of qualitative feedback data and the approach to the analysis are profound.  

If you want to try an automated feedback analysis solution on your own qualitative data, you can get started with Thematic .

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Qualitative vs Quantitative Research Methods & Data Analysis

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What is the difference between quantitative and qualitative?

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

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

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

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

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

What Is Qualitative Research?

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

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

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

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

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

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

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

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

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

Qualitative Methods

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

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

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

Here are some examples of qualitative data:

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

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

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

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

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

Qualitative Data Analysis

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

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

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

Key Features

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

Limitations of Qualitative Research

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

Advantages of Qualitative Research

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

What Is Quantitative Research?

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

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

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

Quantitative Methods

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

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

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

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

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

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

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

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

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

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

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

Quantitative Data Analysis

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

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

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

Limitations of Quantitative Research

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

Advantages of Quantitative Research

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

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

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

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

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

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

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

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

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

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

Further Information

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

Followers, customers, or partners? Comparing conceptualisations of students as partners in Australian, Mainland Chinese, and Hong Kong universities

• Open access
• Published: 13 April 2024

Cite this article

You have full access to this open access article

• Yifei Liang 1 ,
• Kun Dai 2 &
• Kelly E. Matthews 3  

Engaging students as partners (SaP) is an approach promoting meaningful pedagogical relationships in higher education. Scholars have called for more culturally situated research on SaP that compares Anglophone countries with other contexts. In response, we conducted an exploratory qualitative study by interviewing 36 undergraduate students from Australia, Mainland China, and Hong Kong. Adopting the relational lens of SaP, the interviews focused on conceptualisations of pedagogical partnership, specifically learner–teacher identities and power dynamics. Through comparative and reflexive thematic analysis, we found that understandings of partnership in different contexts were influenced by broader cultural differences. The findings showed that the perception of SaP in Australia was consistent with the prevailing Western discourse, but the notion of SaP was adapted and re-shaped in Mainland China, and in Hong Kong, there were diverse interpretations of it. This study contributes to new understandings of the influence of specific sociocultural and policy variations in SaP practises through culturally situated and comparative research using theorisations of perpetual translation. We argue for future research to contribute collective insights and nuanced, diverse understandings that expand SaP as an approach to global scholarship.

Avoid common mistakes on your manuscript.

Introduction

Over the last few decades, there has been a growing focus on enhancing the quality of teaching and learning in the global higher education (HE) community. Researchers have focused on effective student engagement in curricula and pedagogy, demonstrating meaningful learner–teacher relationships as a key factor in fostering student learning, engagement, and a sense of belonging (Felten & Lambert, 2020 ). Engaging students as partners (SaP) in teaching and learning, which recognises students’ contribution to shaping educational practises, is gaining specific attention (Cook-Sather & Matthews, 2021 ). Many SaP studies draw on Cook-Sather et al.’s ( 2014 ) work to define the learner–teacher partnership as ‘a collaborative, reciprocal process through which all participants have the opportunity to contribute equally, although not necessarily in the same ways, to curricular or pedagogical conceptualisation, decision making, implementation, or analysis’ (pp. 6–7). Healey et al. ( 2014 ) further highlighted the importance of SaP as a means of promoting collaborative interactions between students and teachers for meaningful student engagement in HE. They proposed multiple forms of partnership—including co-teaching, co-researching, co-creating, and co-designing—to engage students in quality assurance and enhancement processes of HE.

In this article, we draw on the relational and critical theorisations of SaP that call into question assumed learner–teacher identities and power dynamics in HE (Bovill, 2020 ; Matthews et al., 2018 ). There are growing scholarly calls to understand SaP as a context-dependent practise (Healey & Healey, 2018 ) and a socially just pedagogy (Munevar-Pelton et al., 2022 ), including cross-cultural SaP practises (Zhang et al., 2022 ). We respond to the calls for understanding the cultural context of SaP beyond the dominant scholarly focus on Western or Anglophone practises (Cook-Sather et al., in press ). In doing so, we advance the development of SaP as a globally inclusive scholarship. In particular, the topic of the learner–teacher relationship as a precursor to SaP is now emerging in the Asia–Pacific region, with research in Mainland China and Hong Kong signalling important cultural variations in the understanding and practise of SaP (Dai et al., 2024 ; Liang & Matthews, 2021a , b ).

This study investigates understandings of SaP—identifying the perceptions among university students, which are influenced by the sociocultural and policy contexts in Australia, Mainland China, and Hong Kong. The findings suggest that perceptions are both convergent and divergent across contexts. There was a uniformity of understanding that SaP involves a change in learner–teacher relationships (convergence). However, the understandings then diverged in how those relationships changed through pedagogical partnerships reflecting the cultural context of students in the different countries. Our study advances collective understanding of SaP as a global praxis by naming and recognising what we refer to as ‘qualitative cultural variation’ or the quality (as opposed to quantity) of understandings influencing students’ perceptions of SaP shaped by their cultural context. In doing so, we offer new avenues for culturally understanding and practising the original Anglophone idea of SaP in the growing arena of relationship-rich education. We begin by situating our study within an overview of SaP theorisations, practises, and HE systems in the three contexts.

Engaging students as partners: a relational pedagogy in higher education

Over the last decade, engaging students as partners in teaching and learning has been receiving increasing attention in global HE systems (Healey et al., 2014 ). The scholarly consensus is that the ethos of SaP is fundamentally about building meaningful relationships between students and teachers by creating opportunities for them to work together in pedagogical practises (Bovill, 2020 ; Cook-Sather et al., 2014 ). SaP is thus positioned as a relational pedagogy that focuses on shifting the traditional learner–teacher identities and power dynamics in learner–teacher relationships (Dwyer, 2018 ; Matthews et al., 2018 ). SaP is a contested concept—different choices of terminology, approaches to theory development, and variations in practical design reflect that there are various interpretations and understandings of partnerships (Cook-Sather et al., 2018 ). In this study, we explore perceptions of SaP in three differing cultural contexts through focusing on the learner–teacher pedagogical relationships and interactions shaped by what previous studies, such as Dai et al. ( 2024 ) and Matthews and Dollinger ( 2023 ), describe as the transformation of the traditional identities of learners and teachers.

SaP is a value-based practise. Cook-Sather et al. ( 2014 ) asserted the significance of respect, reciprocity, and shared responsibility in partnership practises. In the discussion of SaP as an approach to aid quality assurance and enhancement of HE teaching and learning, Healey et al. ( 2014 ) emphasised values shared by all participants in teaching and learning that foster SaP practises—namely, ‘authenticity, inclusivity, reciprocity, empowerment, trust, challenge, community, and responsibility’ (pp. 14–15). Owing to the enactment of specific values and principles, SaP practises can occur in multiple ways. Over the last decade, SaP practises have been widely implemented as both pedagogical interactions and extra-curricular activities and programmes in the global HE sector, as evidenced by a systematic review of SaP research over 5 years (Mercer-Mapstone et al., 2017 ) and publications in the International Journal for Students as Partners and Teaching and Learning Together in Higher Education . Collaborative and reciprocal partnerships between learners and teachers have been shown to have a range of beneficial outcomes for both parties, including enhanced teaching and learning engagement and outcomes (Lubicz-Nawrocka and Bovill, 2023 ), improved self-awareness in terms of shifting identities and changing power dynamics in learner–teacher relationships, and the transformation of educational culture within university communities (Matthews et al., 2019 ).

The concept of SaP is context-dependent and culturally informed (Cook-Sather et al., in press ). Yet, the SaP literature is largely influenced by a Western-centric value system. Marquis et al. ( 2017 ) noted that this situation risks universalising SaP interpretations and practises, which may mask cultural variations in SaP. Scholars (e.g. Green, 2019 ) have called for extending SaP conceptions in the Global South, non-Anglophone, and cross-cultural contexts. Developing SaP as a globally inclusive scholarship involves the illumination of ‘cultural-historical understandings behind the constructs … [what] words refer to in different contexts’ (Cook-Sather et al., in press , p. 47).

Responding to these calls, researchers have explored SaP in Asian universities with a consensus view that such practises face specific cultural and contextual challenges in Asia that resonate with some, but otherwise differ significantly from, challenges reported in Anglo-American–British cultural contexts (e.g. Dai et al., 2024 ; Liang, 2023 ; Liang & Matthews, 2021a ; Sim, 2019 ; Tanaka, 2022 ; Toh & Chng, 2022 ). For our research responding to these calls, we conducted a comparative qualitative study utilising interviews with 36 undergraduate students from Australia, Mainland China, and Hong Kong.

Overview of Australian, Mainland Chinese, and Hong Kong higher education contexts

Australia is an immigrant nation with prevailing Anglo-Saxon-Celtic cultural influences (Kalantzis & Cope, 2020 ). Responding to global economic forces in the 1980s, Australian policy embraced neoliberalism to encourage market competition (Zajda, 2020 ), and the country has since sought to navigate the entanglement of the free market economy, democratic principles, equity values, and individual freedom, while espousing an ongoing commitment to multiculturalism (Hong, 2020 ).

Social equity and marketisation are thus crucial tensions shaping Australian HE (Rizvi & Lingard, 2011 ). On the one hand, with the continuous emphasis on social equity, Australian HE policy has transformed, expanding and diversifying student participation in HE by focusing on teaching and learning quality enhancement, assurance, and scholarship (Krause, 2020 ). This includes an emphasis on student engagement, implicitly or explicitly embedded in a democratic discourse in tension with market forces (Zajda, 2020 ). On the other hand, neoliberal market forces have increased the capitalistic function of universities, fostering the notion of students as customers. Thus, university teaching and learning has become a driver for economic development, highlighting individualism (Stahl, 2022 ).

Unlike the Australian context, the Mainland Chinese HE system has experienced a shift in focus from quantitative to qualitative reforms. Since the mid-1990s, the HE system in Mainland China has undergone significant changes and expansion. The number of universities has increased rapidly, and the size of the HE system has grown significantly in the last few decades (Guo et al., 2022 ; Yin, 2020 ). However, this rapid growth has come at a cost. The decline in quality of undergraduate education has become a major concern for Mainland Chinese universities (Yin et al., 2014 ). Against this backdrop, and in response to the globalisation and internationalisation of HE, the Chinese government has, since the early 2000s, gradually shifted the focus of HE development and reform from scaling up to quality assurance and enhancement (Yin, 2020 ). In this process, student engagement and meaningful learner–teacher interactions have come to be regarded as important indicators for assessing undergraduate students’ learning experiences and enhancing HE quality (Sargent & Xiao, 2018 ).

From a sociocultural perspective, Confucian heritage culture (CHC) is commonly regarded as one of the most influential cultures in China that is embedded in diverse Chinese traditions and customs (Liang & Matthews, 2023a ). The placement of family and society before the individual self (Tan, 2013 ) or the notion of ‘privilege the larger or public sphere over the smaller sphere’ (Marginson & Yang, 2020 , p. 36), which is promoted by Confucian norms and values, has fostered the collectivist orientation of Chinese society (Tang et al., 2021 ). This explains why Mainland Chinese HE is being constructed as a common good for society, characterised by top-down policy drivers and supervision (Marginson & Yang, 2020 ) and ‘decentralised centralisation’ (Wang, 2010 ).

Hong Kong, a former British colony, has a different sociocultural and educational context compared to Mainland China. Hong Kong HE has also undergone significant development over the last decades, driven by a rich cultural heritage and robust educational policies. In terms of policy, as with the Mainland Chinese HE system, the demand for quality assurance and enhancement of teaching and learning has been raised in Hong Kong in response to HE massification and internationalisation (Mok & Chan, 2016 ). Since the establishment of the Quality Assurance Committee in 2007, institutional policies in Hong Kong have been transformed and they now emphasise student engagement and learner–teacher interactions as focus areas in the auditing processes (Chan, 2017 ).

Since Hong Kong’s return to China in 1997, its HE system has reflected a fusion of Chinese and Western cultural influences. On the one hand, the historical ties between Hong Kong and the UK have had a lasting impact on academic traditions, curriculum design, and pedagogy, such as bilingual teaching and learning, in Hong Kong universities (Cheng et al., 2016 ). Further, driven by globalisation, neo-liberalisation, and marketisation, liberty and creativity are emphasised and fostered by the culture of academic excellence enshrined in individualism (Mok & Xiong, 2022 ). On the other hand, society and education in Hong Kong are profoundly impacted by Chinese sociocultural ideology, specifically the collectivist relational orientation emphasised by the CHC (Marginson, 2011 ). Therefore, as Dai et al., ( 2024 , p. 4) suggested, ‘Hong Kong is becoming an in-between space that has a hybridised sociocultural context’, and the values and norms brought about by multiple cultures significantly influence educational practises and learner–teacher relationships in Hong Kong universities.

The above overview shows the overlaps and differences of policies and cultures in Australia, Mainland China, and Hong Kong. Notably, Mainland China and Hong Kong policies emphasise HE quality by increasing student engagement and learner–teacher interactions. This explains the growing body of SaP research on the shaping of relational pedagogical partnerships in Mainland Chinese universities (e.g. Dai & Matthews, 2023 ; Dai et al., 2021 ; François et al., 2016 ; Liang et al., 2020 ; Sturman et al., 2018 ) and Hong Kong universities (e.g. Dai et al., 2024 ; Ho, 2017 ; Zou et al., 2023 ) in recent years. Although SaP is not a specific policy term, it is an approach increasingly adopted by academics and/or supported in local institutions as a means of achieving the broader HE quality policy agendas in Mainland China (Liang & Matthews, 2021a ) and Hong Kong (Dai et al., 2024 ). Nonetheless, it is unclear how the conceptualisations of SaP vary across the three sociocultural contexts according to lived experiences of such partnerships. Understanding the potential points of similarity and difference is essential as they will contribute to realising the ‘perpetual translation’ (Cook-Sather, 2018 ) of SaP in a specific HE context that culturally enriches the interpretation and naming of SaP.

This study investigates undergraduate students’ understanding of learner–teacher pedagogical partnerships within three universities in Australia, Mainland China, and Hong Kong. Guided by the research question— How does context in Australia, Mainland China, and Hong Kong influence students’ understanding of SaP?— we offer insights for culturally understanding and practising the original Anglophone idea of SaP in the growing arena of relationship-rich education.

Methodology

An exploratory qualitative study was conducted to understand students’ SaP experiences and perceptions, which are influenced and shaped by different sociocultural constructs. As qualitative researchers, we embrace the social constructivist worldview (Creswell, 2012 ) and focus on exploring individual university students’ subjective voices and engagement based on their lived experiences of teaching and learning (Merriam, 2009 ). This method allows the emergence of creative and novel perspectives through flexible and broad insights provided by individuals (Kember & Ginns, 2012 ).

Participants and contexts

Employing a purposeful sampling approach (Creswell, 2012 ), we recruited 36 local undergraduate students from three large research-intensive universities (12 from each institution) in Australia, Mainland China, and Hong Kong, to share their perceptions. We chose these three universities because it was evident that SaP practises were implemented in some of their teaching and learning processes. The student participants in this study were between 19 and 23 years old, and they were studying undergraduate programmes in multiple disciplines, such as Education, Business, Finance, Arts, Science, Social Science, and Engineering.

Data collection

Ethical approval was obtained from the first author’s university, and all volunteer participants signed informed consent forms. A one-hour semi-structured online interview was conducted with each participant. The participants were interviewed using questions that explored their perceptions both of explicitly named SaP practises and partnership-like learner–teacher interactions that were not named SaP. As Matthews et al. ( 2017 ) suggested, the latter reaches beyond a limited understanding of SaP, even in Australian universities. Guided by the interview questions, participants were invited to reflect on learner–teacher identities and power dynamics in learner–teacher interactions.

All interviews were audio recorded and transcribed manually. Interviews were conducted in English or Chinese, depending on the student’s preference. All Mainland Chinese participants and most Hong Kong participants selected Chinese language (Mandarin) interviews, while all Australian participants preferred English. The Chinese language interviews were transcribed in Chinese and then translated into English. As suggested by Regmi et al. ( 2010 ), two bilingual qualitative researchers in Education were invited to cross-check the translations. The English interviews were transcribed in English. All transcriptions were shared with participants to confirm their accuracy. Pseudonyms were assigned to each participant to protect privacy.

Data analysis

To ensure the consistency and reliability of the analysis, two authors analysed the interview data using NVivo 12 through a six-stage reflexive thematic analysis (Braun and Clarke, 2021 ). After the authors familiarised themselves with the data, all transcribed content was coded and analysed semantically and latently, and the initial codes were revised within an iterative process. In a reflexive approach, the emerging potential themes were modified and finalised to present the relationships with data in the way that was most meaningful.

The analysis found that students from the three contexts expressed both converging and diverging understandings of SaP. The analysis resulted in three main themes: (1) Australia: matching the Western concept of SaP; (2) Mainland China: highlighting the cultural adaptation of SaP; and (3) Hong Kong: reflecting the diverse possibilities of SaP. Each theme included a sub-theme related to how students perceive learner–teacher identities and power differences in partnerships or partnership-like learner–teacher interactions. Notably, although the perceptions of SaP in all three contexts indicated the ethos of SaP as questioning and transforming traditionally taken-for-granted learner–teacher relationships (convergence), students in different contexts discussed varying ways of understanding the breaking of traditional learner–teacher relationships by engaging in learner–teacher partnerships (divergence). The following sections present the students’ perceptions in detail.

Australia: matching the Western concept of SaP

The analysis shows that the Australian university participants’ perceptions reflect the interpretations and conceptualisations of SaP in the broad literature (e.g. Cook-Sather et al., 2014 ; Healey et al., 2014 ; Matthews et al., 2018 ). Perceiving SaP as a way of questioning traditional learner–teacher relationships, many students (e.g. Ann, Daniel, Laura, and Jonathan) saw SaP as a way to bring about creative pedagogical relationships and mutual knowledge exchange. For example, Daniel, who was studying Education, stated the following:

I think SaP breaks the traditional learner–teacher relationship so that our [students’] voice can have the chance to play the role as much as possible in the teaching and learning process. For example, our suggestions for teachers’ teaching according to our demands are more likely to be accepted. In doing so, not only can students learn what they want, but teachers can also understand students better and practically learn how to improve their teaching methods and skills.

Daniel’s reflection indicates that SaP practises could effectively improve the quality of teaching and learning. Furthermore, some students (e.g. Alex, Bonnie, Laura, and Matt) perceive the ethos of SaP as an approach to transforming their institutional cultures, as Laura, who was studying Science, shared:

The implementation of SaP practice fosters cultural change within disciplines and the university towards more genuine and meaningful ways that focus on cultivating both students’ and teachers’ self-awareness and responsibility.

Moreover, several students (e.g. Louis and Sophie) perceived SaP as an antidote to the neoliberal notion of students as consumers. Sophie, who studied Business, indicated that partnerships have challenged the passive engagement and learning experiences that emerged from students seeing themselves as consumers.

Students and teachers as equally pedagogical partners

By perceiving SaP as a way of questioning and transforming traditional learner–teacher relationships and the consumer model brought by neoliberal approaches, many participants perceived themselves as co-creators, co-teachers, and co-learners with teachers to contribute to the course pedagogically. Ted, who was studying Finance and Economics, described this as follows:

The shaping of pedagogical partnerships provides students with opportunities to contribute to curriculum design and delivery. I feel that I am no longer just a student but another teacher in charge of the course. When the course coordinator adopted my suggestions, I felt excited and nervous about whether the teaching and learning process could be carried out more effectively, because I was worried about whether I would be able to make a satisfactory contribution.

Meanwhile, in partnerships, students’ perceptions of their teachers’ identities also make a dramatic difference. Instead of the rigid hierarchy in the traditional teaching and learning model, Leo, who studied Computer Science, shared the following:

The teacher showed the students the feeling of being a collaborator and help seeker. Her own thoughts and opinions became less important and dominant, and [she] focused more on our expertise.

These experiences indicate that the students enjoyed an increased sense of responsibility and agency in their teaching and learning processes. This resonates with the partnership values of respect, reciprocity, and shared responsibility (Cook-Sather et al., 2014 ; Healey et al., 2014 ; Matthews et al., 2018 ). Furthermore, we found evidence of a shift in the traditional learner–teacher power relations but not an erasure of power dynamics. A student of Business, Alex, shared her feelings:

Although we were empowered to engage in some activities that we had never experienced before, such as engaging in some decision-making processes, I feel that this has a limited scope. It is more like teachers giving us the maximum power to exercise in the allowed matters.

Mainland China: highlighting cultural adaptation of SaP

Mainland Chinese participants’ perceptions of SaP highlight both the importance and adaptation of pedagogical partnerships. As mentioned earlier, one of the perceptions of Mainland Chinese students is about questioning traditional learner–teacher relationships. As with findings regarding Australian university students’ perceptions, some students (e.g. Liu, Sun, and Zhou) felt that SaP is a way of changing the functions of students and teachers in their pedagogical relationships, as it enables them to understand each other better. However, other students (e.g. Guan, Han, Tian, and Wang) perceived SaP as a way of transforming traditional learner–teacher relationships into ‘familyships’—relationships between students and teachers based on mutual care and support. These experiences indicate that the collective cultural environment may support SaP practises in the Chinese context, although Confucian cultural scripts are contested (Liang & Matthews, 2023a ). Students’ active engagement in teaching and learning activities was fostered as the teaching and learning environment became harmonious and warm. For example, Tian, studying in Education, described her feelings about engaging in SaP practise:

When we were studying a course that aims to achieve the goal of co-creation of lessons, in the second half of the term, I felt that both students and teachers were not simply implementing the practices according to the designed process, but as more like a kind of mutual care and support between friends. Specifically, because this teacher was old, I felt that she was more like a selfless and considerate mother who tried her best to accommodate our preferences. This also made us want to spare no effort to contribute to the course.

In contrast to those who saw SaP as questioning traditional learner–teacher relationships, some students (e.g. Deng, Gao, and Xu) perceived SaP as a tool merely for meeting the current institutional policy requirements. These students did not provide positive feedback; instead, they expressed a dislike of top-down policy-driven teaching and learning. Gao, who was studying Arts, reflected:

Because our university requires teachers to pay more attention to student engagement and learner–teacher interactions in daily teaching and learning, many teachers in our major have introduced SaP practices to comply with policy requirements. While these practices have been implemented, they only appear to scratch the surface. Teachers just want to complete them as soon as possible to meet the evaluation criteria and don’t care about the difference these practices can make.

Therefore, some students believed that, for institutional reasons, they did not gain genuine experiences of SaP learner–teacher interactions and practises. However, they proposed constructive suggestions. They thought that successfully implementing SaP, a Western concept, in the context of Chinese universities requires continuous adaptation and testing. For example, Gao indicated that:

As a pedagogical concept from a context that emphasises individualism, it [SaP practice] cannot be easily and directly implemented in the relational Chinese society, which emphasises collectivism. We can learn from its rationale, but the specific forms and content must be determined according to our shared values, beliefs, and policy orientation. In addition, this requires the strong support of relevant research in the Chinese context.

Students as helpers following the lead of teachers

Although many Mainland Chinese participants experienced SaP practises and learner–teacher interactions, they felt they did not truly represent the image of student partners as described in Western universities. Instead, they understood themselves as helpers and collaborators who followed and completed teachers’ requirements. For example, Liu, who was studying Science, reflected:

When teachers involve us in SaP practices, we can literally be perceived as pedagogical partners because we are indeed collaborating with teachers to complete some work together. However, we will only engage in the work assigned to us by teachers. The learner–teacher relationship has indeed been changed within a limited scope, but it remains limited within this scope. For us, it was like maintaining relationships with teachers in different ways depending on the situation. So, technically, we [the students] are both collaborators and followers.

Therefore, alongside the perceived identities of students as collaborators and followers, the teacher’s identity in the partnerships was still largely perceived as that of leader by most Mainland Chinese participants. For example, even in the evolved ‘familyships’ between students and teachers, Wang, studying in Arts, still emphasised the significance of teacher leadership:

At present, teachers still have the initiative to control the entire teaching and learning process. If you want these SaP practices to be effectively and meaningfully implemented, I think they need the leadership of teachers. Within this, I think a teacher’s attitude is a very crucial factor in leading to change. Students may not want to sincerely engage in activities if teachers appear to be pursuing their own interests.

Hong Kong: reflecting the diverse interpretations of SaP

The perceptions of SaP from Hong Kong university participants showed some similarities with both the perceptions of students from Australia and from Mainland China, reflecting the influence of hybrid cultural values and norms in the Hong Kong HE context (Dai et al., 2024 ) while also exhibiting some differences that demonstrate the diversity of interpretations of SaP. In seeing SaP as a way of questioning traditional learner–teacher relationships, Hong Kong participants had two ways of explaining this perception. On the one hand, some students (e.g. Chan, Fong, and Lo) described SaP as creating spaces for mutual learning among students and teachers. This aligns with students’ perceptions in both Australian and Mainland Chinese universities. However, other students (e.g. Ching, Hong, Leung, and Tsui) explained this perception only from the perspective of evolved one-way learner–teacher relationships that could benefit them personally. Tsui, who was studying Arts, described this based on his experience as a teaching assistant:

I was lucky to be invited by a teacher to take up a teaching assistant position this semester. In the process of helping teachers with teaching and preparing teaching materials, I felt that I gained deeper insights into the course content. It also improved my collaboration skills.

Unlike the Australian and Mainland Chinese students, more than half the Hong Kong participants saw SaP as an essential means of safeguarding the rights and interests of students. For example, Lai said:

When we engaged in SaP practices, I felt that students’ interests were being protected. These interests are not only about learning what should be taught but also about whether our preferences are treated with equal respect and attention.

Moreover, like the Mainland Chinese students, some Hong Kong students saw SaP as an important pathway for achieving institutional policy reform. However, unlike the Mainland Chinese students, the Hong Kong students also expressed the desire that the implementation of SaP practises would change the university’s culture, which is consistent with the views of the Australian university students.

Students as different customers partnering with teachers

The perceived identity changes in learner–teacher partnerships among Hong Kong participants reflected both Australian and Mainland Chinese understandings. The most frequently mentioned learner–teacher identity mode was one in which teachers still played a leading role in pedagogical activities, with students following teachers’ instructions to a certain extent, which highlights teacher domination in the teaching and learning environment of Hong Kong. This is similar to the experience of Mainland Chinese students. Nonetheless, many Hong Kong participants also demonstrated a strong sense of being customers in SaP practises, albeit without the motive of transforming the customer model that we found in students at the Australian university. Specifically, the Hong Kong participants had two different understandings of being customers. Many students noted that, as payers of tuition fees, they should be enabled to acquire as much knowledge and as many skills as possible. This type of student regarded SaP as a benefit to students, as mentioned above. For example, Ching, who was studying Social Science, said:

Students, as customers of higher education, deserve high-quality and responsible education. Teachers involve students in some teaching and curricular activities, which is one way of achieving that, as those activities can enhance our learning experience at the university. At the same time, this also allows us to acquire broader knowledge and skills not covered in the textbooks.

Another, smaller, group of students considered the customer identity differently. They believed that, because students are customers of the university, they have the right to engage in the decision-making processes associated with teaching and learning, and they believed that both students and teachers could benefit from such partnerships. For example, Chan, who was studying Engineering, said the following:

Since we are paying to the teaching and learning process, we should reasonably have the right to make selections and decisions, such as the design and delivery of curriculum, the choice of knowledge to learn, and the forms of assessment. Overall, our [tuition] fees must ensure that we gain the desired experience.

This study explored the views of undergraduate students on SaP in three different HE contexts: Australia, Mainland China, and Hong Kong. The aim was to advance the collective understanding of SaP as a global practise by identifying and recognising converging and diverging perceptions, which we refer to as qualitative cultural variations. The study found that students expressed convergent views on the intention of SaP to change learner–teacher relationships, but diverged in how and why those relationships changed, which illuminated context-dependent understandings of students as followers, customers, and partners. The three groups of participants acknowledged that SaP involved questioning taken-for-granted learner–teacher roles and relationships, which aligns with existing SaP theories (Matthews et al., 2018 ). However, diverging underlying logic shaped their views of why students and teachers might engage in SaP practises. Mainland Chinese participants emphasised the shaping of ‘familyship’ beyond pedagogical learner–teacher relationships, while Hong Kong participants focused more on individual benefits and interests. Australian students largely held well-documented conceptions of SaP, which is unsurprising, given that most SaP literature research has been conducted with students from Anglo-American–British contexts. Overall, the study showed that SaP is not a one-size-fits-all approach, and qualitative cultural variation plays a significant role in how it is perceived and practised.

The emergence of scholarship on SaP practises in Mainland China and Hong Kong allows for expanding global discourse as more practise-based research is published from Asia (see Liang, 2023 ; Sim, 2019 ; Sturman et al., 2018 ; Tanaka, 2022 ; Toh & Chng, 2022 ). One risk of country and cultural comparisons (particularly ones of either side of an ‘east/west’ dividing line) is essentialising or suggesting an evaluative judgement about a ‘right way’ to engage in SaP. To mitigate this risk, we draw on Cook-Sather’s ( 2018 ) notion of perpetual translation to examine the changes in understandings and relationships that SaP work can bring about. According to Cook-Sather ( 2018 ), perpetual translation entails an examination of ‘assumptions about the meanings of words, the cultural historical understanding behind the constructs, the practises and relationships they signal, and the possibilities for transformation that perpetual translation affords’ (p. 5) that is ‘necessary for this work of communicating across differences [of] identity, culture, position, and power’ (p. 5). The underlying principles of SaP used in defining this work as a relational pedagogy between students and teachers in HE have different resonances and dissonances with cultural scripts in each context we studied. These cultural scripts can be used to ‘anchor’ the innovation of pedagogical partnership (Cook-Sather, 2022 )—to connect what is perceived as new (a different way for teachers and students to understand and interact with one another) to what is considered familiar (the cultural script particular to the context). Both perpetual translation and this practise of anchoring can support necessary cultural variations as well as transformations in both theories and practises of SaP work. Thus, we draw on perpetual translation as a process for critical reflection done collectively through scholarship (see Cook-Sather et al., in press ) and in dialogic SaP practises.

We propose that the strong collectivist notion of ‘familyship’—which is derived from a Chinese CHC cultural tradition of hierarchical relationships between parents and children—can anchor SaP and serve as a foundation for SaP approaches in Mainland China. This foundation can be translated through SaP into mutual benefits for both teachers and students, thereby allowing the dynamic evolution of sociocultural practises. We draw on perpetual translation, as Cook-Sather et al. (in press) argue, as a dialogic process where partnership participants translate and are translated by partnership principles in their particular contexts. While Anglophone values and norms tend towards individualism, many SaP scholars are challenging this in Anglo-American–British contexts, as a more collective premise is offered by the ethos of SaP (Liang & Matthews, 2023b ). This premise echoes the collectivist social relationships in China, and thus there is the potential for ‘familyship’ and SaP to inform and be informed by each other. Research exploring learner–teacher relationships in Chinese universities found ‘a family dynamic with the hierarchy and tradition that come with familial relationships’ where the Chinese norm of Guanxi (meaning close connections between people to gain mutual benefits) fosters ‘family ties’ between students and teachers (Dai et al., 2021 , p. 11). The relational dynamics of ‘familyship’ assert a hierarchical logic that affects the identities of and power dynamics between engaging members. This cultural logic explains why participants from Mainland China perceived themselves as helpers and/or followers in SaP practises while also recognising that SaP questions and shifts traditional learner–teacher interactions.

Through the comparison across contexts, our findings show how Mainland Chinese students make sense of their identities and power dynamics in Chinese learner–teacher partnerships influenced by the notions of the ‘larger or public sphere’ and the ‘smaller sphere’ (Marginson & Yang, 2020 , p. 36) in collectivist Chinese society. However, as Liang ( 2023 ) reflected, growing individualism among Mainland Chinese university students may lead to increased utilitarianism in learner–teacher relationships, resulting in a shift away from collectivism and partnership principles of reciprocity and mutuality in HE. When culturally situated and practised without cross-cultural judgement, the critically reflective process of engaging in SaP can yield a new understanding of the relational dynamics between students and teachers in HE. Such dynamics are shaped by pedagogical orientations and socio-political forces influencing national policies, often in a conflicting manner, and therefore necessitate perpetual translation. In Mainland China’s HE system, the concept of mutual benefits for students and teachers through the ethos of SaP is manifested in the form of ‘familyship’. This relational dynamic is shaped by the intersection of the pedagogical orientation of increasing student engagement and learner–teacher interactions, the policy characteristics of ‘decentralised centralisation’, and the collectivist society.

In comparison, participants in the Hong Kong context expressed a mixture of Western, Mainland Chinese, and neoliberal influences, which was evident in the desire for SaP to maximise personal benefits while also following teacher instructions. According to Dai et al. ( 2024 ), Confucian values and norms have significantly shaped learner–teacher relationships in Hong Kong universities, where Dao , or ways of showing respect, manifest in intergenerational deference. This is evident in the Hong Kong participants’ preference that teachers take on the leadership in SaP practises. Despite this, they held notions of self-responsibility in SaP practises, which emerged as a strong sense of individualism resembling the positionality of a customer. Unlike the perception we found among Australian participants of SaP as a strategy combating the ‘students as customers’ discourse (Matthews et al., 2018 ), Hong Kong participants embraced SaP as a rich experience and a right that students as customers can leverage for their personal benefit and gain.

These examples demonstrate how student participation can be understood and practised in a way that respects the leadership of teachers while also acknowledging the rights of students. This process of understanding and practising reflects a perpetual translation (Cook-Sather, 2018 ) in Hong Kong in relation to both Confucian values and current notions of individualism. Using perpetual translation as an analytic lens to understand cultural variation across ‘three non-Western contexts’ (Hong Kong, Malaysia, and Pakistan) from the perspective of academic developers, Cook-Sather et al. ( in press , p. 60) argued:

Established associations, historical and current contexts, and possibilities will always influence terms and selves. But, instead of seeing these as (only) barriers to partnership, we can understand them as opportunities to revisit, dig deeper into, and learn from established roles and practises.

Resisting static categorisation, we argue for dynamic and evolving conceptions of SaP that allow for cultural variations to honour unique cultures and contexts. Critical reflective theorisations of perpetual translation pave the way for a dynamic orientation of SaP with practise and policy implications.

This study explored local undergraduate students’ perceptions of SaP in Australia, Mainland China, and Hong Kong to further advance the collective understanding of SaP as a global praxis by identifying and recognising qualitative cultural variation. Through comparative and reflexive thematic analysis using the relational lens of SaP, we demonstrate the ways in which differing sociocultural and policy contexts shape the converging, then diverging, understandings of students as followers, customers, and partners. We echo scholarly calls for culturally situated and comparative research on SaP. Theorisations using the notion of perpetual translation provide a critical reflexivity that mediates risks of making essentialising or comparative judgements in cross-cultural analyses of pedagogical partnership practises.

This study contributes to the existing SaP literature in two important ways. First, we provide insights into the conceptualisation of pedagogical partnership in the three contexts, especially Mainland China and Hong Kong, to enrich interpretations of SaP and go beyond the prevailing Western and Anglophone discourse. Second, we provide an example of recognising qualitative cultural variation in SaP conceptions and practises to guide future culturally situated research beyond Anglophone contexts. Rather than essentialising culture, we acknowledge the role of cultural variation in understanding and practising partnerships. We advocate expanding comparative research on pedagogically oriented partnership practises that contribute culturally nuanced insights to advance global scholarship.

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Perceptions of medical students on narrow learning objectives and structured debriefing in medical escape rooms: a qualitative study

• Tami Jørgensen 1 , 2 ,
• Oscar Rosenkrantz 1 , 3 ,
• Kristine Elisabeth Eberhard 1 , 4 ,
• Theo Walther Jensen 1 , 5 &
• Peter Dieckmann 1 , 7 , 6  

BMC Medical Education volume  24 , Article number:  403 ( 2024 ) Cite this article

Metrics details

Escape rooms are increasingly used in medical education as a complementary learning technique or even alternative to traditional educational approaches. Few studies focus on debriefing following medical escape rooms and how escape rooms can be used to achieve pre-defined learning objectives. Evaluating the use of narrow learning objectives may increase the depth of reflections and transform an engaging team event into an effective learning opportunity. This study aimed to explore participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing.

In this explorative, qualitative study, participants saw a video lecture, participated in an escape room experience, and in a following debriefing. Throughout this learning session, the learning objectives concerned “exchange of information” and are therefore relatively narrow. Participants then participated in a semi-structured focus group interview and completed a demographic questionnaire. Participants were volunteer final-year medical students. Focus group interview recordings were transcribed and analysed using systematic text condensation.

Thirty-two students in eight groups completed the study. Five themes were described in the analysis of the focus group interviews: Experience with the narrow learning objectives, topics discussed in the debriefing, learning mechanisms, learning outcomes concerning exchange of information and influences of the learning approach.

Conclusions

Narrow learning objectives and structured debriefing seem to increase perceived learning depth of medical escape room sessions. Using semi-structured debriefing still allows for discussions of other elements relevant to the students.

Clinical trials

Clinical.trials ID NCT04783259.

Peer Review reports

There is increasing evidence that medical students prefer interactive education styles with elements of gamification [ 1 , 2 , 3 ]. Gamification is applying game mechanics to a non-gaming environment [ 4 ], which improves achievement of learning goals compared to traditional teaching methods [ 5 , 6 , 7 ].

One interactive gamification technique is escape rooms, a themed exercise that involves solving puzzles and riddles to get out of a room within a specific time limit [ 8 ]. An example of an educational escape room is the Medical Escape Room Game Experience (MERGE) [ 9 ]. It is designed to raise awareness about non-technical skills (NTS) [ 10 , 11 ] among healthcare students by presenting medically themed logic- and skill-based puzzles to be solved as a team. NTS are defined as the social, cognitive and personal management skills necessary for safe and effective performance. These skills are important across various high risk industries including nuclear power, aviation and healthcare [ 12 ].

Like simulations, escape rooms are experiential learning settings. Compared to a simulation, however, participants engage less in role-play and more in a game. Where a simulation at least sometimes asks participants to assume a professional role other than their own, participants in an escape room typically enter as “themselves.”

In such a learning situation, participants share the experience but perceive it from different angles. Debriefing can enlighten differences and strengthen the learning outcome from experiential learning situations by allowing reflection on the educational experience [ 13 , 14 , 15 ]. Therefore, debriefing will supplement an escape room’s inherent entertainment value to increase learning [ 16 ]. Further, the debriefer can be a peer to the learners as peer-to-peer feedback is suggested to affect the learning outcome positively [ 17 ].

The considerable number of debriefing structures published indicate that there is value in organising the debriefing in one way or another. The research group also experienced that structure in the debriefing is appreciated by participants and facilitators. On a theoretical basis, structured debriefings might positively affect the collaboration between facilitators and participants, as both know what to expect, once the structure is established [ 18 , 19 ].

In a debriefing, learning objectives can be predetermined [ 14 , 20 ] with narrow or broad wording. The research group differentiates between narrow and broad learning objectives. Narrow learning objectives concern focused and well-defined questions as opposed to broad learning objectives that are more open and likely to spur many different discussions depending on the learner. The “breadth” metaphor is always relative: “Knowing how errors occur” or “Discussing communication” are examples of broader learning goals with many possible subtopics whereas “Understanding the role of eye contact in non-verbal communication” in contrast is relatively narrow. When using narrow rather than broad learning objectives, the discussion can reach deeper reflection levels, as fewer topics are covered [ 21 , 22 ]. The discussion might not cover topics of interest to participants if they are outside the narrow learning objectives, resulting in discussions being terminated during a debriefing.

Only four studies evaluated escape room debriefing [ 23 , 24 , 25 , 26 ] and concluded that participants would have preferred more structured debriefing relating to specific outcomes for the escape room sessions.

Published studies applied broad learning objectives or had no pre-set learning objective. Thus, no knowledge exists about how narrow learning objectives in a medical escape room are perceived by participants and how they affect the learning experience. The research group believes this knowledge might optimise the overall learning outcome of medical escape rooms by helping educators choose suitable learning objectives. Focusing on learning objectives during debriefing can optimise learning and emphasise the educational character of these entertaining activities. When having learning objectives tailored to the needs of the participants, it is, in the research group’s experience, easier for the educator to provide a high-quality learning session. This can be done by emphasising certain aspects of the learning objectives (e.g., spending more time on discussing them) to satisfy the learning needs and wishes of the participants.

For other experiential learning settings, like simulation, debriefing was declared the “heart and soul” of learning [ 27 ]. Therefore, the research group assumes that debriefing is valuable for escape rooms as well. Given the richness and openness of the learning situation in an escape room it is unclear whether the debriefing should focus on “everything” or specific potentials in the situation. Both approaches likely have advantages and disadvantages.

This study aimed to explore participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing.

This was a qualitative study using semi-structured focus group interviews and text condensing. The research group was interested in exploring participants’ perceptions and needed a method that allowed participants to express those experiences. Given the character of the learning objectives, the cognitive aspects of participants’ learning were of interest. Therefore, verbal descriptions in an interview would be a valuable method to collect data and answer the research question [ 28 ]. The research group operated within the constructivist paradigm as it tried to understand a phenomenon from the perspective of those experiencing it.

This section describes the approach, but the supplementary material should be read to understand the experimental work clearly.

The escape room followed the MERGE manual [ 9 ] and was conducted at Copenhagen Academy of Medical Education and Simulation (CAMES) at Herlev Hospital, Denmark. The theme was a zombie apocalypse. It consisted of seven medically themed, logic- and skill-based puzzles that had to be solved sequentially, and the award at the end was the cure for the fictive zombie virus. The MERGE ‘Triage’ puzzle was exchanged with a puzzle box with laparoscopic forceps, focussing on teamwork (see Appendix 2 ). Behind a see-through mirror, a facilitator monitored the escape room events. Participants had 45 min to solve the puzzles. If they struggled in progress, the facilitator provided planned scenario lifesavers to help keep the time frame [ 29 ]. All the faculty had experience facilitating experiential learning settings, including simulation and escape room experiences.

Data collection

Following the escape room, participants were interviewed semi-structured in focus groups and the individuals involved answered a questionnaire about their experience, perceived learning outcome, and demographic information (see Appendix 1 ).

The puzzles in the escape room were in English, while participants communicated in Danish. The video lecture, debriefing, focus group interview, and questionnaire were in Danish. Illustrative citations from the condensation process were translated from Danish into English.

Participants

Participants were medical students who had completed four out of six years of their studies at the University of Copenhagen (UCPH), Denmark. Participants had completed at least four months of internship, experienced clinical practice close to that experienced by young physicians, and had some experience with simulation. Participants were recruited via social media, signed up in groups of four to five, and chosen based on the order of application. Participants did not receive any compensation.

Intervention

The intervention was a structured learning session comprising four parts: a video lecture, focused instructions before the escape room, the escape room scenario, and a post-session debriefing. It was conducted in March 2021.

The learning session focused on two narrow learning objectives: “ Recognising the different ways of exchanging information ” and “ Discussing the impact of exchanging information on problem solving ”. These were chosen based on previous focus points and learning wishes by former participants [ 9 ]. The first learning objective concerned knowledge and comprehension of Bloom’s taxonomy, and the second concerned application and analysis [ 30 ].

The video lecture concerned theory of exchange of information in general terms, thus preparing participants to work with the concrete learning objectives and was developed within the research team (see Appendix 3 ). The focused instructions included practical information on the escape room’s course and emphasised the need to focus on exchange of information, as it was the learning objective. Debriefing was a semi-structured conversation steered by TJ, who has practical experience in the peer-to-peer debriefing of medical students and facilitated the discussion following a manual (Appendix 4 ) based on an established debriefing model [ 13 ].

Semi-structured focus group interviews

Immediately after debriefing, participants were focus group interviewed with a semi-structured interview guide by KE or PD (see interview guide, Appendix 5 ). Focus group interviews concerned participants’ experiences and perceived learning outcomes of narrow learning objectives in a medical escape room with debriefing. Some of the main questions explored how they felt about the format, if and why participants would have preferred a less structured format and whether or not they felt limited by the narrow focus of the debriefing. Furthermore, participants were asked when they experienced learning outcomes and what these were.

Focus group interviews were estimated to last 30 to 45 min and were video and audio recorded. Interviewers emphasised that all points of view were relevant and essential, including perceived challenges.

Focus group interviews were transcribed ad verbatim by TJ and OR and analysed using systematic text condensation [ 31 ]. Condensation focussed on participants’ statements. Unclear and explicitly irrelevant citations (e.g. chit-chat) were excluded. The coding was done in Microsoft Excel. The citations were loaded into one column, where each row represented a different speaker. After initially reading the focus group interview transcripts several times, the coding proceeded with paraphrasing each cell in the next column on a similar level of abstraction by TJ. Themes were assigned to each paraphrase, condensing content of the focus group interviews. Themes were used by TJ and OR to identify all citations relevant to the study aim. These steps were repeated until researchers concluded that saturation had been reached by watching the remaining focus group interviews, and no more codes or themes were identified. TJ condensed the statements, selecting and translating representative citations from Danish to English before grouping them into main themes. Three research group members not involved in the coding and condensation (KE, TWJ, PD) cross-checked the coding and condensation process.

Because of the qualitative character of this study, the purpose was to describe participants’ perceptions as detailed as possible but not to describe how widespread each perception was. Further quantifications were avoided, as the semi-structured nature of the focus group interviews possibly would strongly influence how often a point was made (e.g. when a follow-up question was posed). Points made by a single participant were therefore reported and treated equally important as those made by “some” or “all”.

The questionnaire provided some quantifiable information used in the discussion and conclusion to describe the general tendencies.

Several themes of interest not directly associated with the narrow learning objectives were included in a separate analysis, as they provided valuable insights into escape rooms and debriefings in general; the protocol did not cover this. The study protocol was uploaded to clinicaltrials.gov on 05/03/2021 (ClinicalTrials ID: NCT04783259).

Focus group interviews and participants

Eight groups, with a total of 32 participants completed the study. Participants were in their late twenties and evenly distributed amongst gender (see Table  1 ). In the post-interview questionnaire, they reported prior experience, educational preferences and familiarity (see Table  2 ). Focus group interview duration had a median of 36 min and ranged from 23 to 43 min. After coding and analysing six focus group interviews, saturation was reached, as no new themes could be identified from the last two focus group interviews. This was confirmed by TJ and OR watching the remaining focus group interviews on video. The remaining two focus group interviews were neither transcribed nor analysed.

Themes related to narrow learning objectives

Five main themes were identified from the focus group interviews (Table  2 ).

Within the first theme, experience with narrow learning objectives , participants expressed that they did not feel restricted by the narrow learning objectives but experienced the possibility of discussing other topics important to them.

Topics discussed in the debriefing were mainly about exchange of information . Participants understood the term communication as broader than exchange of information . Participants also discussed leadership and situational awareness .

Learning mechanisms : The single and narrow focus was seen to increase the depth and perceived outcome of the debriefing. Participants explained that the debriefer helped maintain focus on the learning objectives and increased the perceived learning outcome by guiding participants in their reflection.

Perceived learning outcomes in relation to exchange of information that were identified included: Knowledge of different ways of communicating and the importance of optimising communication when working together; skills in ignoring redundant information; and change of attitude by becoming aware that others perceive a situation differently. A few participants reported no learning outcome due to being familiar with the learning objectives prior to the intervention.

Influence of the learning approach covered the parts of the whole learning experience besides the debriefing, focussing on how each of the different phases affected perceived learning of participants. Participants expressed that the video lecture contained little educational value but supported the rest of the approach by setting the scene. Regarding the scenario briefing, some participants wished for more emphasis on the learning objectives just before entering the room. Some participants explained that they got caught up in the game and did not focus on the learning objectives during the escape room. Finally, participants indicated that they liked the coherence of the experience in that each part supported the next and enabled deeper reflection.

Other findings

The focus group interviews provided points beyond discussing the narrow learning objectives (Appendix 6 ). Two main themes were identified. Meta-learning regarding the debriefing itself, where participants realised the usefulness of debriefings in an educational context. And the general experience of the escape room , where participants stated that the experience was relevant to clinical practice. Some participants also described how learning within an escape room differed from conventional communication training because the lack of formal pressure promoted more genuine communication that reflected real-life behaviour. Furthermore, the format was engaging and fun, and the low requirements on medical expertise were appreciated as they did not steal focus.

Post-interview questionnaire

The questionnaire results concerning the learning objectives and their perceived learning outcome are presented in Table  3 . It shows that all participants experienced learning about exchange of information and many about other topics as well. The vast majority liked the narrow focus of the learning objectives and would not have preferred a broader learning objective.

This qualitative study identified narrow learning objectives and structured debriefing to increase perceived learning depth and general outcome of medical escape room sessions. Using semi-structured debriefing allowed for discussions of other elements relevant to the students.

Narrow learning objectives were not restricting

Unstructured game-like learning exercises allows for many different learning objectives catering to participants’ interests but can result in superficial and erratic discussions with frequent changes in topics. To increase the learning outcome, there is a need for some structure. According to the questionnaire, most participants preferred a narrow learning objective though they did not have a comparable experience with a broad learning objective. During the focus group interviews, participants did not feel restricted by the narrow learning objectives and felt free to discuss other topics of their interest. This is a benefit of the semi-structured rather than fully-structured debriefing format and illustrates an educational duality: participants feel a need for autonomy but also for being paced by the educator to focus on the learning objectives and return to the topic when getting off-topic. The results suggest that many educators’ fear– that guiding the debriefing is seen as negative by participants [ 32 ]– might not have an empirical basis. However, the current setting took several steps to focus on the narrow learning objectives (video lecture, scenario briefing, and debriefing). Therefore, this focus was more stringent than is typical in simulation practice.

Structuring debriefings affect perceived learning outcomes

By making participants verbalise perceptions and experiences during the escape room and their perception of aspects of the experience related to the narrow learning objective, the educator increased the perceived learning outcome by increasing the depth of the debriefing. Though the research group defines this as facilitation techniques, the participants refer to it as structure . This complies with others’ findings that participants prefer structured debriefing sessions [ 23 , 24 , 25 ]. This study emphasises that such structure indeed can improve– at least the perceived– learning outcome.

Medical expertise in the escape room

Participants expressed it as an advantage that the level of ambition for medical expertise in the escape room puzzles was low. If there had been difficult medical challenges, these could have reduced learning related to exchange of information . This could be related to matching the amount of new information to avoid an overload, as described in cognitive load theory [ 33 ]. It can also be challenging, especially for novice facilitators, not to overwhelm learners, as they might do so to avoid risking the participants perceiving the learning session as boring [ 34 ]. This study can make it easier for educators to accept that less can be more: participants see the value of discussing fewer topics in more depth.

Exchange of information as a learning objective

The learning objectives were “Recognising the different ways of exchanging information” and “Discussing the impact of exchanging information on problem solving”. Participants were thoroughly introduced to the definition of exchanging information and reminded of the learning objectives throughout the learning experience, yet participants widely used the term communication during the focus group interview. When asked, participants explained that they perceived exchange of information as a more narrow and instrumental term than communication . Participants considered the reflections in the debriefing to concern both the instrumental factors, such as structuring a message and taking notes, and elements, such as non-verbal communication and the distribution of roles within the group.

This exemplifies a challenge in concept learning [ 35 ]: Educators need to balance conceptual sharpness and keep learners motivated about a new concept. The literature on learning (second) languages shows that it may lead to steeper learning and acceptance curves if skills are presented practically with a focus on implementation instead of insisting on conceptual sharpness in using terms [ 36 , 37 , 38 ]. However, this may increase the risk of misunderstanding concepts and terms. Focusing on definitions can be frustrating for many and may slow down learning.

Limitations

In participant recruitment, the research group may have created a selection bias by having voluntary admissions for the study, thus risking a sample of the general population with a specific interest in innovative and interactive education. This potential bias is of little concern since the aim concerned the learning objectives, not the innovative and interactive education style.

The study design increases the risk of a social-desirability bias. The researchers attempted to pre-empt this by explicitly informing the participants of the importance of enlightening both positive and negative aspects.

As a medical student at UPCH, TJ had met some of the participants before, but none of the interviewers had met the participants. Although it cannot be ruled out that familiarity between participants and TJ affected the debriefing, the data collected during the focus group interview session is without this bias.

Narrow learning objectives and structured debriefing can increase perceived learning depth of medical escape room sessions. Using semi-structured debriefing still allows for discussions of other elements relevant to the students.

The findings of this study encourage the use of narrow learning objectives and semi-structured debriefings in future conductions of medical escape room sessions. This will hopefully aid educators in choosing suitable learning objectives to optimise the overall learning outcome of medical escape rooms.

Data availability

Not applicable.

Abbreviations

Copenhagen Academy of Medical Education and Simulation

Medical Escape Room Gaming Experience

Non-technical skills

University of Copenhagen

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Acknowledgements

We thank CAMES for funding the expenses required to set up and run the escape room and the participants for their time and insights.

No external funding was received for the conduct of the study.

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Tami Jørgensen, Oscar Rosenkrantz, Kristine Elisabeth Eberhard, Theo Walther Jensen & Peter Dieckmann

Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark

Tami Jørgensen

Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

Oscar Rosenkrantz

Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

Kristine Elisabeth Eberhard

Prehospital Center, Region Zealand, Denmark

Theo Walther Jensen

Department of Public Health, University of Copenhagen, Copenhagen , Denmark

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T.J. wrote the main manuscript and prepared Tables 1, 2, 3 and 4. All authors participated in conducting the intervention, analysing the data and reviewing the manuscript.

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Dieckmann holds a professorship with the University of Stavanger, Norway, which was established by an unconditional grant to the university by the Laerdal Foundation and is today financed by the university itself. Dieckmann is part of the leadership of the EuSim group, a network of simulation educators and centres providing faculty development courses. We believe that these activities do not substantially impact the study presented here. The other authors report no conflicts of interest.

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Jørgensen, T., Rosenkrantz, O., Eberhard, K.E. et al. Perceptions of medical students on narrow learning objectives and structured debriefing in medical escape rooms: a qualitative study. BMC Med Educ 24 , 403 (2024). https://doi.org/10.1186/s12909-024-05295-4

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Original research article, a comparative analysis of movement and physical activity in early childhood teacher education policy in five nordic countries.

• 1 Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
• 2 Department of Sport Sciences, Malmö University, Malmö, Sweden
• 3 Department of Education, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
• 4 Department of Sports, Physical Education and Outdoor Studies, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Notodden, Norway
• 5 Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
• 6 Faculty of Teacher Education, Kristianstad University, Kristianstad, Sweden
• 7 Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland
• 8 Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark

Introduction: The aim of this study is to investigate the integration of movement and physical activity (MoPA) within Early Childhood Teacher Education (ECTE) policies across Denmark, Finland, Iceland, Norway, and Sweden. This knowledge can inform the development of ECTE policies and practices that promote MoPA in Early Childhood Education and Care (ECEC) in Nordic countries and other countries worldwide.

Methods: In this study, a Nordic cross-national network of researchers collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. This study was inspired by the Non-affirmative Theory of Education, which provides a framework for understanding the various influences on curricular development in higher education. Based on this, a four-step comparative analytical process of national and university documents across the Nordic countries was conducted. It included keyword search for MoPA related courses and a qualitative description of MoPA in ECTE. Thus, a combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for international comparison.

Results: The comparative analysis of MoPA in ECTE reveals diverse approaches influenced by national and university policies. A central theme is the variability in MoPA integration across these nations. Finland and Norway prioritize MoPA with independent mandatory courses. In Iceland, compulsory MoPA courses exist at one of two universities, and in Sweden at three out of 19. All university colleges in Denmark offer an elective course. Furthermore, learning objectives related to MoPA are, to varying degrees, part of the internships in the countries, with Sweden being an exception. In the participating countries, the teachers decide the content of the MoPA courses with little guidance, support, and agreement on essential MoPA content within and across the ECTE's. Norway has established guidelines, and in Finland, there is a network of ECTE Physical Education (PE) educators, which, to some degree, increases the consistency and quality of MoPA in education.

Discussion: The Nordic countries present diverse MoPA integration approaches rooted in national policies and educational traditions. The findings emphasize the necessity of independent and mandatory MoPA courses, integration of MoPA into internships and promoting networks across the educational and academic sectors to equip future early childhood educators with competencies for fostering physical activity, motor development and children's well-being.

1 Introduction

Movement and physical activity (MoPA) are important components of children's holistic development in early childhood ( 1 ). It promotes children's physical and mental health, enhances their cognitive development, and supports their social and emotional well-being ( 2 – 6 ). According to a recent review and meta-analysis, 60% of preschool-aged children (3–5 years) meet the World Health Organization's guideline of engaging in a minimum of 180 minutes of physical activity per day, which includes at least 60 minutes of moderate to vigorous physical activity ( 7 ). With the generally high number of young children attending daycare, nursery, kindergarten, preschool, or similar, one way to effectively promote MoPA during the early childhood years is to ensure that teachers and caregivers are adequately trained and supported in this area ( 8 , 9 ). A recent review conducted by Jones et al. ( 8 ) highlighted that consistent and important characteristics of future interventions included providing extra time for children's physical activity each week and involving educators in professional development. Moreover, subgroup analyses in the systematic review by Wick et al. ( 10 ) suggest that interventions led by experts yield stronger effects compared to those led by regular childcare teachers, underscoring the essential role of integrating expert knowledge and pedagogic skills in promoting motor skills and physical activity in young children. This is where early childhood teacher education (ECTE) policies come into play.

In the five Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden, almost all children attend early childhood education and care (ECEC) as part of a universal service with well-educated staff ( 11 ). As in other countries, ECEC Teachers in the Nordic countries receive less salary compared to Compulsory School Teachers, but are no longer a low-paid group within the public sector ( 12 ). There are increased demands imposed by national government policies and parental expectations, which necessitate qualified staff, adequate time and favorable working conditions, which the countries encounter difficulties in fulfilling ( 12 ).

In the last decades, there has been a development towards more “education” and a more robust political prioritization of formal learning and evaluation in ECEC ( 8 , 13 , 14 ). Previous research analyzing the values of MoPA using government policy documents (e.g., laws and curricula) on ECEC shows that MoPA in the ECEC policy documents is to varying degrees of a low-priority value in the Nordic ECEC law documents and guidelines ( 15 ). Recently, a Swedish study found limited teaching competencies for MoPA in ECEC teachers and highlighted the need for improved education and competence development ( 16 ), which has also been found in other countries ( 17 ). To study this further, it is important to investigate to what extent MoPA is included and emphasized in ECTE policy documents at the national and university level, setting the direction for future teachers' knowledge, skills, and competencies for teaching and practicing MoPA among young children in the Nordic countries.

This paper aims to provide a comprehensive overview and description of the ECTE policies and regulations related to MoPA in the five Nordic countries. Examining the policies and regulations at the national and university level in these countries increases the understanding of different approaches and identifies areas where improvements can be made. This knowledge can be used to develop ECTE policies and practices that promote MoPA in ECEC within the Nordic countries and globally, considering contextual differences.

2 Materials and methods

A shared interest in promoting MoPA in ECEC and at ECTE has led to the establishment of a Nordic research network. The network comprises researchers at eight universities and research institutions from five Nordic countries: Denmark, Finland, Iceland, Norway, and Sweden. The network has previously analyzed policies related to MoPA in ECEC settings ( 15 ), and aims to enhance the quality of MoPA in ECTE and ECEC across the Nordic region. In this study, network members have collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. The study was inspired by the Non-affirmative Theory of Education, which offers a comprehensive approach to understanding multi-level leadership in higher education and how various levels and actors interact. In this view, curricular development in higher education is created in interaction between science, economy, politics, and culture and ranges from the supranational level down to the individual teacher and student level ( 18 ). The comparative analytical process can be described in four steps: (1) Delimitation and definitions, (2) Retrieval of documents, initial comparison, and analytical plan, (3) Keyword search, and (4) Qualitative description. During the process, there was an interaction between individual and collective reflection, which unfolded through analytical tasks and discussions within the research network. The process is elaborated in the following.

2.1 Delimitation and definitions

The analyses were limited to ECTE specializing in work within ECEC, the education before compulsory education, e.g., a daycare, nursery, kindergarten, or preschool, or other ECEC settings were professionals care for young children. The focus was set on the profession with the highest level of education and thus having the educational and pedagogical responsibility, even though the staff working in ECEC often comprises different disciplines. Two countries provide a master-level education in ECTE (Finland and Iceland). For this comparison, the focus was on the minimum education requirement for working as a teacher with educational and pedagogical responsibility in ECEC. For Finland, this is the bachelor level. For Iceland, this also includes the Master level. The percentages of ECEC staff with the minimum level of education ranges from 40% to 60% for the Nordic countries ( 12 ).

We use the term ECTS credits or just “credits”, which indicate the required workload to complete a study program. Each year of full-time study is worth 60 ECTS credits.

MoPA encompasses body movement, physical activity and sensory activities aimed at various purposes, such as fostering the joy of movement, developing skills and confidence in movement, and contributing to cognitive, social, and emotional development ( 1 , 3 , 19 , 20 ). In this regard, MoPA aligns with the goals of physical education (PE), which emphasize both learning through movement and using movement as a means of learning ( 21 ). MoPA activities in ECEC settings can be structured, guided by ECEC teachers, or unstructured, allowing children to freely explore their environment ( 22 ).

2.2 Retrieval of documents, initial comparison, and analytical plan

This study retrieved policy documents at the national and university levels that formally regulate the ECTE full-time campus-based programs starting in autumn 2022 ( Table 1 ). Documents used are thus valid for the whole program period, for example, in Sweden, for students from autumn 2022 to the end of autumn 2025. The members of the network were responsible for the retrieval of relevant national and university-level documents. Relevant documents at the national level are ratified documents governing the ECTE, such as laws, ordinances, and official guidelines ( Table 1 ). Documents at the university level are ratified by the university administrations. These documents (curriculums and educational plans) describe the overall ECTE at each university, including a purpose, structure, and requirements. They also entail a directory of courses, a description of internships and the learning objectives of the ECTE program. Internships are structured real-world work experience and exposure to professional environments within ECEC. Internships provide the students with hands-on learning opportunities to gain practical skills and knowledge related to their area of study. Internships can vary in duration ranging from a few weeks to several months, number of credits received, and may be either paid or unpaid ( 12 ).

Table 1 . The structure of early childhood teacher education (ECTE) in Denmark, Finland, Iceland, Norway and Sweden.

Based on an initial comparison of retrieved documents at the national and university level, the network found considerable differences across the Nordic countries regarding the extent of description of the ECTE, which will be elaborated in the results section. In the search for MoPA in policy documents, it became clear that different approaches were used to guide the content and learning objectives of the ECTE. This discrepancy limited the possibilities for direct cross-country comparison. Furthermore, the initial comparison revealed that most documents at the national level did not contain any information related to MoPA. Thus, the analytical plan combined keyword searches and analyses in course names and qualitative content descriptions of the ECTE.

2.3 Keyword search and analysis

We conducted a keyword search in the title of all courses at the local university level previously identified as important MoPA words Bod* (body), Coordin* (coordination), Idrott*/liikunta*/Idræt*, Motor*, Move* (movement), Physic* activ* (physical activity) and Physic* educ* (physical education) ( 15 ). As the course-level documents were in five different languages, the keywords were identified in each language and then translated into English to facilitate clear, continuous discussions within the research network. The course title keywords underwent independent searches by two researchers for each country. Afterwards, their findings were compared, and any disagreement was confirmed through a second count. Within each country, the number of courses containing MoPA words across the local universities was determined and expressed as the median, maximum, and minimum number of elective and compulsory courses.

2.4 Qualitative description

Based on a thorough examination of the national and university policy documents, the syllabuses of the identified ECTE MoPA courses and national expert knowledge of ECTE, a description of the ECTE with a focus on MoPA was provided for each country and compared. This comprised a description of the identified courses and information regarding the integration of MoPA in other parts of the ECTE (other courses and internships). Due to the national differences in structure and policy documents, the information is collected in different ways and dependent on the expert knowledge of the authors. How the study leaders and teachers interpret the policy documents and plan the individual MoPA courses was outside the focus of this study.

3.1 Regulation of early childhood teacher education (ECTE) at the national level

The ECTEs are guided and regulated by different policy documents at national levels in the five countries ( Supplementary Table 1 ). The documents are significantly different across the Nordic countries regarding the extent of description of the ECTE program. In Finland and Iceland, the ECTE's practical implementation is closely connected to the regulation of the Early Childhood Education and Care (ECEC). In Finland, for example, ECTE educators have professional freedoms and opportunities to impact their work (Ministry of Education and Culture, 2016); therefore, they can independently plan, for example, their PE course aims, learning outcomes, and content according to the regulation of the ECEC's [see, e.g. ( 23 ),]. In Iceland, a national curriculum document describes five core educational areas in the ECECs but does not describe the specific structure and content of the ECTE. In Denmark and Norway, the Executive Order, and the National Guidelines, respectively, and the learning outcomes of the ECTE are similar. However, universities are free to tone their program for specific profiles within the current law and the ECTE educators are free to choose contents of their courses related to the learning outcomes. In Sweden, the Higher Education Act is the law that regulates universities. ECTE is not explicitly mentioned in the law. The Higher Education Ordinance regulates all higher education in Sweden, such as the ECTE program, and it supplements or clarifies the Higher Education Act. Both the act and the ordinance contain qualitative targets for education. The universities in Sweden have freedom to plan their ECTE program within the current national regulations and thus the structure and courses differs between all universities.

3.2 Structure of early childhood teacher education at the university level

Across the Nordic countries, there are different requirements to become an ECEC teacher. The programs in Finland and Norway are at the bachelor level and take 3 years; Sweden and Denmark have 3.5 years of bachelor programs, while a bachelor and a master level education for 5 years is required in Iceland. All countries have internships of different durations as a part of the education.

The different requirements to become an ECEC teacher across the universities in the Nordic countries are elaborated in the following and in Table 1 .

- In Denmark, six university colleges offer education programs for pedagogues, with several of them having multiple campuses. After completing the compulsory basic education (70 credits), students choose to specialize in one of three areas—daycare and preschool, leisure and school, or social care and disability. All specializations qualify for working in ECEC. One campus has a specific MoPA profile and integrates movement into all courses without changing the learning objectives of ECTE education.

- In Finland, the education to become an ECEC teacher is possible at seven universities. A bachelor's education qualifies to work as an ECEC and pre-primary education teacher, and a master's education is a requirement for ECEC managers. The bachelor's education includes compulsory courses, electives, and guided teaching practice. Universities can create their own content for study programs ( 24 ), leading to minor variations in the structure of courses across the universities.

- In Iceland, two universities are responsible for ECTE. A master's degree is required for employment as an early childhood teacher. Icelandic students first complete a 3-year bachelor's degree followed by a 2-year master's degree including an elective field. The master's degree may include a final thesis (MEd degree) or be without a thesis (MT degree).

- In Norway, 13 universities or university colleges offer ECTE spread across the country on more than 20 campuses. ECTE is based on a national framework plan. In the framework plan, the compulsory areas of knowledge are described with learning outcomes. The individual educational institution must create its own learning outcomes that are based on the national ones, but they cannot be copies of the national ones. Each course is accompanied by an internship, where students carry out practical assignments related to the content of the courses.

- In Sweden, 19 universities are offering the ECTE program. The program is at the bachelor level for 3.5 years. In Sweden, each university needs to have a program syllabus based on the Higher Education Act and the Higher Education Ordinance. The program syllabus regulates the program at the university and must contain the courses within the program, the entry requirements, and other regulations needed. All universities have created their own program syllabus, leading to variations in the structure and content between the universities.

3.3 Movement and physical activity in university course titles

The number of compulsory and elective courses at the university level varies substantially across the countries and between the universities within Finland and Sweden ( Table 2 ). The keyword searches in the course titles showed that Finland and Norway have compulsory MoPA courses at 5 or 20 credits at all public universities. In Iceland and Sweden, required MoPA courses exist to a lesser degree (one of two universities in Iceland and three out of 19 universities in Sweden have at least one such course).

Table 2 . Courses and MoPA courses (MoPA keywords in the title) at the ECTE across the universities in Denmark, Finland, Iceland, Norway, and Sweden.

In Denmark, no university college offers compulsory MoPA courses according to the search on MoPA keywords in course titles if the MoPA profile campus is disregarded. All university colleges in Denmark have one MoPA elective courses, while some Norwegian and few universities in Finland offer elective courses containing any keywords. One university in Sweden has elective courses, however not in MoPA, and Iceland has variable number of elective courses but none in MoPA.

3.4 Elaborate description of MoPA in ECTE at university level

- In Denmark, students at all university colleges can enroll in the elective course “ Health Promotion and Movement ” corresponding to 10–20 credits. However, this course is across the three specializations in childcare-, school- and afterschool- or the social or special aid area. The course is not offered at all campuses, and the individual students are not guaranteed participation. Around 25%–50% of students are estimated to enroll in the course. The learning objectives in this elective course emphasize strengthening the students’ own movement skills and considering the children's prerequisite for participation in the planned pedagogical activities. During internships, the students should develop competencies to plan, implement and evaluate different educational activities and initiatives for care, health, and prevention. Furthermore, they should be able to motivate and support children's play and aesthetic, artistic, and physical expression. MoPA is, according to the learning outcomes (skills and competencies), also integrated to a small degree in other general courses.

- In Finland, the MoPA course, commonly called “Liikuntakasvatus” (Physical Education), is mandatory in all seven universities offering ECTE programs. Of those seven universities, three also integrate MoPA into other compulsory academic programs, such as music, mathematics, science, and arts. Learning objectives in the MoPA courses in Finland relate, for example, to teaching skills, supporting a child's physical development and health, and enabling learning environments [see also ( 23 )]. The Finnish students are given several options for completing the elective studies (25 ECTS) included in the ECTE degree; however, offered courses vary between the universities. For instance, the 25 elective credits can be completed in individual university-level courses, such as language and communication studies, studies completed abroad or working life studies. Furthermore, minor studies can be completed as one basic study unit, possibly in MoPA-related fields.

- In Iceland, at one of the two universities, there is one mandatory 10-credit course at the bachelor level titled “ Movement and artistic expression, indoors and outdoors ”. No other course titles mention MoPA keywords. The students can specialize in different areas and complete the area chosen with a final thesis, which could be related to MoPA. Furthermore, Iceland has a separate educational track for PE teachers, and the PE education is related to different school levels, although most PE teachers work at post ECEC levels.

- In Norway, all universities and university colleges offer a mandatory 20 credits course of “ Nature, Health and Movement ”. The learning objectives are among others related to children's use of their body and senses in play and learning, motor skills, health-promotion and life skills. There are up till 50 elective credits in the Norwegian model. During the first 2 years of the education the first 20 credits are offered as either one or two different courses. A few institutions offer the opportunity to use all 20 credits aimed at MoPA, while others offer 10 credits in subjects related to MoPA. Some institutions have also chosen to convert 10 or all 20 credits into compulsory subjects. Third year students, at all 12 institutions, have an elective specialization of 30 credits. Most of the institutions offer various forms of physical activity among their specialization subjects. It is important to note that besides the MoPA related keywords all universities offer electives within the area of outdoor pedagogy and outdoor recreation, which have an explicit focus in the Norwegian ECTE.

- In Sweden, there are 338 courses at the 19 universities offering ECTE. Some university courses comprise 30 credits containing sub-courses, which have not been analysed. Two universities have a 7.5 credit course, and one has a 15 credit course with MoPA in the title. These three courses are only partly directed towards MoPA as indicated in the titles such as “ Movement, Nutrition and Health in Preschool ” (7.5 credit ), “ Early Years Education II, Physical Education and Health ” (7.5 credit) and “ Play, Aesthetics, Creativity and Movement ” (15 credit). There are no elective courses directed at MoPA at the universities in Sweden.

4 Discussion

This study explores the integration of MoPA in the policy documents of ECTE in the Nordic countries. A network of researchers from the participating countries conducted a comparative analysis and revealed the varied approaches shaped by national and university policies across the Nordic countries. This difference has an impact on the ECEC teachers' competencies, their prioritizing and motivation for MoPA, and in the end, differences between the MoPA each child meets across ECEC's in the Nordic countries ( 16 , 23 ). This discussion explores the diverse policies employed in Denmark, Finland, Iceland, Norway, and Sweden while considering overarching themes and their implications. Additionally, it compares the findings with findings from other countries and suggests future directions for development and research within the field of MoPA in ECTE.

4.1 Nordic diversity in policies and approaches

Finland and Norway prioritize MoPA at the university level through compulsory courses within their ECTE programs. Although Finland has no binding national policy document obligating it, the universities commonly offer approximately five-credit PE courses. In contrast, Norway has a national framework plan guiding ECTE programs, and each university can make its teaching guidelines based on the framework plan. Finland's “ Physical Education ” and Norway's “ Nature, Health and Movement ” courses exemplify the commitment to standardizing MoPA education. Furthermore, Norway's elective MoPA courses and focus on outdoor pedagogy, enhance competency diversity within the ECEC workforce in Norway. A study of ECTE in Finland revealed that the relevant PE courses predicted pre-service teachers' higher perceived competence in teaching PE ( 25 ). However, the university did not influence pre-service teachers' perceived competence in PE, and only minor differences were observed in how PE was delivered between the universities ( 23 ). This slight difference in perceived competence could be explained by the compulsory course for PE, similar educational background in MoPA studies for ECTE educators, and collaboration between the educators in Finland. Almost all PE teachers in ECTE programs in Finland have a doctoral-level education in Sports or Health Sciences. Because they form a joint network, it might lead to similar course implementation and high priority of MoPA in ECTE ( 23 ).

In Denmark, the elective course option, the lack of specific MoPA compulsory courses, and the limited provision of national guidance and common approaches to MoPA leave a considerable variability in the pre-service teachers' MoPA competencies. In Sweden, there are binding national policy document regulating ECTE, but MoPA is not mentioned in these documents, and at university level, there are even more limited educational opportunities for ECTE students to study MoPA. General education does not offer any or very little MoPA education, which means generally low competence development within the MoPA area ( 16 ). In addition, there are no elective courses or specializations in MoPA, meaning no MoPA specialists are trained. Iceland also exhibits limited MoPA offerings, raising questions about the depth of MoPA education.

4.2 The role of internships

Internship plays a crucial role in ECTE programs but varies across countries. In Finland, the internship is limited to 15 credit, and findings point to the risk that limited training and supervision may pose challenges for students without prior experience organizing movement and physical activities or creating inspiring learning environments ( 23 ). Denmark has the most internship credits, with 75 credits. Iceland and Sweden have 38 and 30 credits, respectively. In Denmark, some learning objectives are directly related to organizing activities and motivating play and physical expression, but it might be ineffective due to the lack of MoPA in other parts of the education. In Norway, internships are closely related to the individual courses. Students plan and deliver smaller practical assignments related to the course's learning objectives, for example, in the course “ Nature, Health and Movement. ” The number and length of internships do not ensure practical competencies within MoPA—especially if MoPA practices are not required during the internship. Supporting students’ perceived competence during their studies becomes essential in these cases to bridge the gap between theory and practice. Culture, role models, responsibility, support, feedback, and transparent integration of MoPA competencies are all essential for the quality of internships.

4.3 Essential or optional competencies

The comparative analysis raises the question of whether competencies related to MoPA are crucial or optional for ECEC teachers. In Denmark, Iceland, and Sweden, MoPA is a direct requirement in the law or national curriculum governing the ECEC ( 15 ), but it needs to be prioritized to the same degree in the ECTE policies. In Denmark, students can choose elective courses and practice the necessary skills during internships, but there are minimal basic requirements. This opportunity seems even smaller in Sweden and in one of the two universities in Iceland. Thus, the students in ECTE do not obtain the necessary competencies to lead and facilitate MoPA in ECEC, which is indisputably essential for the children's development, health, and well-being and as prescribed in the curriculum for ECEC across the Nordic countries ( 15 ). The lack of education in MoPA at ECTE may most likely affect the teachers' self-efficacy and motivation to provide high-quality MoPA ( 16 , 23 , 26 ). This can lead to a missed opportunity for children to learn fundamental movement skills and obtain crucial positive experiences in early childhood, resulting in limited engagement in physical activity during later childhood and adulthood with consequences for quality of life and health ( 2 ). In these contexts, it is essential to consider ways to ensure that all ECTE students, regardless of program variations, receive adequate knowledge and skills related to MoPA.

4.4 The integration of MoPA in ECTE outside the Nordic countries

This paper investigates the integration of MoPA in ECTE in the Nordic countries, and while it appears that the international body of literature has recently increased regarding PE in ECEC it is still scarce on curriculum studies ( 27 ). A recent study compared perceptions of PE in ECTE courses in US, Brazil, and Finland. They found that MoPA was a compulsory part of the curriculum in Finland and Brazil, while specific guidelines are lacking in the US ( 28 ). This also seems to be the case in Slovenia, where there exists considerable variation in the understanding of PE in ECEC ( 29 ), and in Canada, where approximately one third of the newly graduated ECEC teachers have completed MoPA courses ( 30 ). Finally, a very recent study from Ankara, Turkey, found that the students improved their initial negative attitudes towards PE during a 16-week required course in PE and games. However, it was not sufficient for the students to feel ready to teach PE in ECEC ( 31 ). The knowledge of MoPA courses in ECTE internationally is limited, and specifically there is a severe lack of studies evaluating how pre-service teacher education in MoPA leads to higher quality practices in ECEC ( 27 ).

4.5 Development of MoPA for ECTE

In the Nordic countries, there is a tradition for a high degree of teaching autonomy in higher education, and recent developments towards defined learning objectives and systematic evaluations in ECEC have led to an increased focus on scholastic competencies and less emphasis on care, play, and child-centered holistic child development ( 8 , 13 , 14 ). Considering the scientific evidence underscoring the importance of MoPA for both health and holistic development ( 1 ), it is evident that gaps persist within ECTE programs in the Nordic countries. These gaps not only impact the Nordic countries but also hold global significance. On a global scale, UNESCO, stresses the vital role of well-trained early childhood educators in fostering comprehensive child development, including physical well-being ( 9 ).

In light of these considerations, future cross-country collaborations are envisioned to establish shared guidelines and frameworks that fortify MoPA in national policy documents and approaches within the Nordic countries. According to the Non-affirmative Theory of Education, understanding higher education leadership requires seeing it as a part of a more extensive dynamic process of creating direction collaboratively, spanning several leadership levels—from international to local levels, and includes a multitude of actors ( 18 ). ECTE policymaking is closely connected to ECEC policy and its role and function in society. In this regard, the autonomy of ECTE is limited compared to other higher education, where universities can have greater influence on the curriculum. That said, the ECTE managers and educators in the Nordic countries still experience a large degree of autonomy when it comes to course planning and teaching, which places parts of the leadership at the lower levels. MoPA in ECTE should therefore be considered in a larger context, including dynamic influence from society, culture, academia and actors at different levels of the higher education system, including the ECTE educators ( 18 ).

Based on the current study and in line with the theoretical offset, we suggest that ECTE in the Nordic countries should be inspired by best practices to further promote MoPA competencies in ECTE. This includes three areas:

• Compulsory MoPA : Establishing a mandatory independent course for PE would ensure that all students get basic skills within the area of MoPA, as seen in Finland ( 23 ). Furthermore, it will strengthen the ECTE educators' competencies and lead to professional development, resulting in higher-quality education. Guidelines like in Norway could be established to improve consistency and collaboration across the universities. The guideline gives the ECTE educators a shared understanding when prioritizing content and learning objectives.

• Integrate MoPA in internships : Second, internships can play a crucial role in developing MoPA competencies if they are prioritized and connected with other learning objectives of the education. In Denmark and Norway, parts of the internships are linked to MoPA learning outcomes, and the students should obtain experience with planning, implementing, and evaluating different activities.

• Professional network : Third, network and collaboration across universities and university colleges within and across the countries should be promoted. In Finland, for example, PE teachers in higher education have formed a network to share knowledge, good practices, and unify teaching content, aiming to enhance the competence of ECEC teachers. These networks could furthermore encompass external stakeholders and the research community to elevate MoPA in ECTE and ECEC.

4.6 Strengths and limitations

The comparative analysis across five Nordic countries included close collaboration by national experts and researchers. A combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for comparing MoPA in ECTE in those countries. However, there was a notable variation in the analyzed documents across countries, which posed a challenge for direct comparability and hindered systematic comparisons. Consequently, only course titles were employed for the keyword search. The rationale behind this choice was the consideration that if MoPA keywords were not explicitly mentioned in the title of the courses, they might be perceived as having lower educational value in terms of MoPA. It is acknowledged that certain universities may incorporate MoPA elements in specific courses, even if not evident in the course title analyses conducted in this study. In the keyword search, a select set of terms defining the field related to MoPA was utilized. Notably, terms such as “playing,” “nature,” or “outdoor” were deliberately excluded to maintain a focused delineation of the subject matter, recognizing that MoPA might not necessarily be explicitly defined as a target in these courses.

This study focused on the governance of ECTE and was related to the national and institutional levels of the education. We have only to a small degree included perspectives from other levels of the Higher Education Leadership hierarchy ( 18 ), and future studies should incorporate perspectives from the ECTE educators and include society and academia in the understanding of the context. This should also include a closer investigation of differences and similarities of the specific MoPA curriculum content and teaching methods.

4.7 Conclusion

In investigating the integration of MoPA within ECTE program policies in the five Nordic countries, we found considerable variations. Finland and Norway prioritize MoPA with independent mandatory courses accompanied by elective opportunities. In Iceland, a compulsory MoPA course exists at one of two universities, and in Sweden in three out of 19 universities. The university colleges in Denmark only offer elective courses. Furthermore, practical learning objectives related to MoPA are part of the internships in the countries to varying degrees, with Sweden being an exception. Generally, there needs to be a higher priority, more guidance, and better agreement on essential MoPA content within and across the countries.

This comparative analysis of MoPA in ECTE in the Nordic countries reveals diverse approaches influenced by national and university policies. Given that MoPA is not prioritized in some of the Nordic countries at the national levels of policy and governance, this absence extends to the governing documents and course titles at the university level. This lack of emphasis may lead to an inadequate integration of MoPA in ECTE. To promote quality MoPA education in ECTE, national parliaments must protect children's interests by ensuring that MoPA is incorporated into ECTE policies.

In conclusion, the Nordic countries offer diverse approaches to MoPA integration in ECTE programs, reflecting national policies and educational traditions. The variations underscore the importance of high-level national priority and cross-cultural collaboration to promote quality MoPA education in ECTE and equip future early childhood educators with the competencies to foster physical activity and healthy development among young children.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Author contributions

LC: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. JE-E: Conceptualization, Investigation, Writing – review & editing. AS: Conceptualization, Investigation, Writing – review & editing. RL: Conceptualization, Investigation, Writing – review & editing. GK: Conceptualization, Investigation, Writing – review & editing. KF: Conceptualization, Investigation, Writing – review & editing. AC-S: Conceptualization, Investigation, Writing – review & editing. AS: Conceptualization, Investigation, Writing – review & editing. IF: Conceptualization, Investigation, Writing – review & editing. RV: Conceptualization, Investigation, Writing – review & editing. LO: Conceptualization, Investigation, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgements

We sincerely thank colleagues for valuable advice and Nordplus Higher Education for financial support to the network activities.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fspor.2024.1352520/full#supplementary-material

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Keywords: education policies, preschool, early childhood education, international comparison, physical development and movement

Citation: Christiansen LB, Ekberg J-E, Soini A, Larsen R, Kristjánsdóttir G, Froberg K, Sollerhed A-C, Sääkslahti A, Fjørtoft I, Vilhjálmsson R and Olesen LG (2024) A comparative analysis of movement and physical activity in early childhood teacher education policy in five Nordic countries. Front. Sports Act. Living 6:1352520. doi: 10.3389/fspor.2024.1352520

Received: 8 December 2023; Accepted: 20 March 2024; Published: 5 April 2024.

Reviewed by:

© 2024 Christiansen, Ekberg, Soini, Larsen, Kristjánsdóttir, Froberg, Sollerhed, Sääkslahti, Fjørtoft, Vilhjálmsson and Olesen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lars Breum Christiansen [email protected]

Abbreviations MoPA, movement and physical activity; ECTE, early childhood teacher education; ECEC, early childhood education and care.

• Open access
• Published: 10 April 2024

Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis

• Wanting Xia 1 , 2 ,
• Meijun Ou 3 ,
• Yongyi Chen 1 ,
• Furong Chen 1 ,
• Mengyao Yan 1 , 2 ,
• Zhirui Xiao 1 &
• Xianghua Xu 4  

BMC Palliative Care volume  23 , Article number:  94 ( 2024 ) Cite this article

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To gain insight into the perceptions, and beliefs of patients with advanced cancer coping with chronic pain and to identify their attitudes and demands on pain management.

From July to September 2022, 17 patients with advanced cancer living with chronic pain were recruited from a tertiary cancer hospital in Hunan Province, China. Qualitative and semi-structured interviews were conducted individually, with 30-45 minutes for each. The Colaizzi 7-step analysis method in phenomenological research was used for data analysis.

The experience of pain acceptance by advanced cancer patients with chronic pain was summarized into four themes: pain catastrophizing (unable to ignore the pain, try various methods to relieve the pain, exaggerating pain perception, and lack of knowledge about proper pain management), rumination (compulsive rumination and worrying rumination), avoidance coping (situational avoidance and repressive avoidance) and constructive action (setting clear value goal and taking reciprocal action).

Most patients with advanced cancer had low pain acceptance and negative attitudes. Feeling helpless in the face of pain and suffering alone were their norm. Long-term negative emotions could lead to gradual depression and loss of hope for treatment, resulting in pain catastrophizing and persistent rumination. Nevertheless, a few patients accepted pain with positive attitudes. Medical professionals should pay more attention to the psychological status of advanced cancer patients with chronic pain, and employ alternative therapies, for example, cognitive behavioral therapy. More efforts are needed to reduce patients’ pain catastrophizing, and promote their pain acceptance by a better understanding of pain through health education.

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Introduction

Pain, as one of the most common symptoms in patients with advanced cancer, is an unpleasant feeling and emotional experience related to actual or potential tissue damage [ 1 , 2 ]. The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurs for more than three months, including cancer pain, neuropathic pain, and musculoskeletal pain [ 1 ]. Cancer pain is a persistent physical pain caused by tumor involvement in the bone, joint, muscle, or connective tissue. According to pathophysiological criteria, cancer pain can be divided into nociceptive pain and neuropathic pain [ 3 , 4 ]. Nociceptive pain, which includes somatic and visceral pain, is caused by actual or threatened damage to non-neural tissues caused by nociception stimulation [ 5 ], while neuropathic pain arises from lesions or damage to the somatosensory nervous system [ 6 ]. The mechanism contributing to cancer pain development is complicated, and not every type of pain in a patient with cancer is attributed to the tumor [ 5 ]. Studies have shown that around two-thirds to three-quarters of pains are triggered by tumor, around 10% to 20% by cancer treatment (particularly, chemotherapy and surgery), and about 10% by comorbidities [ 7 , 8 ].

Chronic pain may not always be a disruptive condition, yet the patient’s response to chronic pain can be quiet disabling [ 9 ]. A systematic review showed that the duration and chronicity of pain in maladjustment were also associated with the patient’s cognitive and emotional status, such as pain catastrophizing, kinesiophobia, and perception of motion [ 10 ]. Advanced cancer patients who suffer from chronic pain for a long time may experience symptoms such as anger, desperation, hopelessness, fatalism, pessimism, difficulty in adaptation, social withdrawal, fatigue, persistent anxiety, lack of planning, loss of ideas, and reduced activities [ 11 , 12 ], which hence requires different coping strategies.

In contrast to focusing on pain reduction, pain acceptance is a process of changing behavioral patterns, in which individuals adapt to pain experience without directing efforts towards reducing or resisting it [ 13 ]. Interestingly, attempting to control or reduce pain is the most common approach in clinical practice, while accepting pain seems counterintuitive. Baranoff et al. [ 14 ] found that pain acceptance was associated with lower pain intensity and higher pain tolerance, which may reduce further efforts to remove pain, thereby ending the negative effects of repeated failures [ 15 ]. A study by Gauthier et al. [ 16 ] on 81 patients attending pain and palliative care clinics in Canada also revealed a link between pain acceptance and psychological impact of ongoing disease-related pain. Advanced cancer patients who experience pain that cannot be completely cured maintain or restore their health in the following ways: acknowledging the ineffectiveness of some pain control strategies, accepting the pain, reducing focus on pain, taking their limited energy elsewhere ,and pursuing personal goals bravely [ 17 , 18 ]

Pain acceptance consists of two aspects: pain willingness (PW) and activity engagement (AE) [ 19 ]. PW refers to the recognition that avoidance and control are often ineffective ways to adapt to chronic pain, and the willingness to face pain and life changes it brings, reflecting the attitude of pain acceptance that can reduce negative feelings [ 15 ]. On the other hand, AE is characterized by the extent to which patients can perform daily activities regardless of pain, reflecting the behavior of pain acceptance [ 20 ]. The underlying mechanism of pain acceptance is that attempts to control and avoid pain instead aggravate pain symptoms or psychological distress [ 21 ]. Adjustment to pain can be promoted by pursuing goals and engaging in valued activities.

Cancer patients commonly believe that anxiety, depression, and sleep disorders are brought by chronic pain, but these factors are also inclined to induce chronic pain [ 22 ]. Previous evidence demonstrated that emotional support was a resilient factor in chronic pain that reduced its chronicity [ 23 ]. Studies have found that pain acceptance can effectively alleviate the pain of chronic pain patients and relieve anxiety, depression, and other negative emotions [ 24 ]. In a cross-sectional survey on 156 cancer patients in Hunan Province, China conducted by Xu X et al [ 25 ] found that cancer patients’ acceptance of pain was related to age, gender, marital status, pain duration, number of pain sites and duration of taking analgesics. Hassankhani et al [ 26 ] interviewed 17 Iranian patients with cancer pain about their pain experience, and found that nurses did not only need to ease patients’ physical pain, but also pay attention to their sociocultural and spiritual wellbeing, which was consistent with Orujlu et al’s findings [ 27 ]. Although there have been studies on the degree of acceptance among patients with chronic pain, most of them were quantitative studies with non-cancer pain as the main subjects [ 28 , 29 , 30 ], and little is known about the perceptions, needs, and pain acceptance of advanced cancer patients with chronic pain. Therefore, the aim of this study was to understand the illness experience, coping styles and dilemmas of patients with advanced cancer through semi-structured interviews. In understanding the real needs of advanced cancer patients for chronic pain, these interview results were embeded within a larger study, which aimed to construct an intervention program targeting the characteristics of chronic pain in advanced cancer patients to improve the quality of life of advanced cancer patients and better manage chronic pain.

Study design

This study adopted the phenomenological research method of qualitative research and utilized semi-structured interviews to explore the perceptions and feelings of pain acceptance in advanced cancer patients with chronic pain. This study adhered strictly to the Consolidated Criteria for Reporting Qualitative Studies (COREQ), and all research procedures were approved by the institutional ethics committee.

Setting and participants

The study was conducted at a cancer hospital in south-central China, which served as the province’s center for cancer treatment and offered medical care to an average of 25,200 cancer patients annually. To ensure maximum variation sampling, the researcher selected patients of different ages, occupations, and cancer types from July to September 2022. Inclusion criteria were: (1) aged ≥18 years; (2) pathologically diagnosed with malignant tumor in clinical stage III or stage IV; (3) showed symptoms of distant metastasis; (4) hospitalized with recurrent disease; (5) had pain lasting for over three months; (6) self-reported pain intensity >3 based on an 11-point Numerical Rating Scale (NRS); and (7) were aware of their own conditions. Patients with visual, auditory, cognitive or mental impairments; barriers in verbal expression and communication; or physical inability to receive interviews were not eligible.

Data collection and interview procedures

The researchers jointly developed a preliminary interview outline on the physical and mental changes, concerns, and coping strategies of advanced cancer patients experiencing chronic pain by reading relevant literature. A pilot interview was conducted on two of the candidates who met the inclusion criteria. With the feedback from the pilot interviewees, the researchers added patients’ views on pain relief treatment to the outline, and delete the question “How do you view pain differently before and after pain?”. The final revised interview questions were as follows: (1) Please describe your experience of illness. (2) Please describe your pain. (3) What do you do when the pain occurs? (4) How do you perceive pain and its alleviating methods? (5) How does pain affect your life? and (6) What changes have you made in the face of pain?

Prior to the interview, the researcher would explain the research purpose, method, and significance, patient’s rights as study participants, as well as detailed privacy protection measures. The appropriate time for the interview during non-therapy period (usually in the afternoon) was set after obtaining patient’s informed consent. Since the interviewer was the tool of qualitative research, a postgraduate student of the research group acted as the sole interviewer. The face-to-face semi-structured interviews were conducted in a private, comfortable and quite room free from distractions. Each interview usually lasted about 30-45 minutes and audiotaped for transcription within 24 hours. During the interview, the interviewer would stay neutral and avoid leading questions, while observing and taking notes on the interviewee’s demeanor, tone, emotional changes, and body movements. The questions were asked in a flexible order depending on the actual situation, with feedback given to the patients through retelling and rhetorical questioning, and unclear answers confirmed.

Dataanalysis

The descriptive phenomenological method for qualitative data analysis proposed by Colaizzi was adopted through the following process [ 31 ]: 1. read repeatedly the same interview data by two researchers to determine the feelings of the interviewees; 2. extract meaningful statements that occurred repeatedly and were relevant to pain acceptance; 3. summarize and extract meaning from important statements; 4. explore the common characteristics and internal correlation of different meanings, and classify them into different themes, and sub-theme groups; 5. link each theme with the research phenomenon and try to describe it comprehensively; 6. describe the intrinsic structure of pain acceptance experience in advanced cancer patients with chronic pain; 7. present the respondents the results to verify their authenticity and modify them based on feedback. Inconsistent results were analyzed and discussed by other research members. After several rounds of analysis, the final themes and topic words are determined.

Participant characteristics

The 17 participants included 7 females (41.2%) and 10 males (58.8%), ranged in age between 40 and 86 years ( mean age = 56.76±12.00). Fifteen participants (88.2%) were married; 13 participants (76.4%) had secondary school education. The NRS scored ranged from 5 to 10 (mean score = 8.12±1.45 points). Other demographic and disease information of the participants are as follows. (Table 1 ).

Themes and sub-themes

Four themes and nine sub-themes have been identified: 1) pain catastrophizing; 2) rumination; 3) avoidance coping; and 4) constructive action, as shown in Table 2 .

Theme 1: pain catastrophizing

Unable to ignore the pain.

Patients with advanced cancer often experience irregular and recurring pain that is difficult to control. Those who catastrophized their pain were preoccupied with pain perception and resistance. They can't ignore the misery of chronic pain, leading to a reduced awareness of their surroundings, and important people and matters in their lives. All participants in the study reported incapability to ignore the pain, most of whom identified sleep disturbance, limited activity, and decreased appetite as the biggest challenges associated with pain.

“I find it easy to fall asleep, but also easy to wake up. I am particularly prone to nightmares. Whether walking or biking along the edge of a cliff, it always makes for good horror. As for my current state, I can't stop thinking about it, the pain is making me restless and affecting my ability to eat and function properly.” (P7) “It hurts whether I stand or sit... (sighed)I can't ignore it, how can I even think about anything else?” (P8, P10)

Try various methods to relieve the pain

Patients with advanced cancer tried their best to manage and eliminate pain, as well as uncomfortable thoughts or feelings in the face of long-term chronic pain stimuli. However, these attempts often trapped them in a struggle with pain, diminishing their enthusiasm for valuable activities. All interviewees reported having tried various pain-relieving methods, such as traditional Chinese medicine, moxibustion, and painkillers, yet ended up finding none of them effective, which was a shattering blow to their confidence.

“I can not overcome this bad experience (lowered his head).” (P4) “I have tried all methods to relieve the pain, but nothing has worked.” (P6) “There is nothing I can do to alleviate the pain. As long as I heard that there was any way to relieve the pain, I was willing to try, and finally came to the hospital for hospitalization” (P17)

Exaggerating pain perception

Some advanced cancer patients expressed pain differently. They might exhibit exaggerated pain behaviors, mainly manifested as an excessive display of pain distress and threat. When a patient showed pain through frowning or crying aloud, he was intending to draw attention from others around them, seek sympathy and assistance, or dramatize their experience of existing or anticipated pain.

“When I am in pain, I become mentally upset and irritable.” (P6) “I am in so much pain that it feels like death, and I will cry to my daughter (with tears in her eyes).” (P9)

The participants were inclined to exaggerate the impact or threat of pain on their health, who were more likely to experience unpleasant emotions such as depression, anxiety, grief and anger. As pain catastrophizing might trigger negative feelings, making patients overwrought and sensitive to pain, the painkillers became less effective, leading to a vicious cycle.

“What if I have long-term pain in the future (looked away)?” (P4) “Anyway, if it hurts, what can I do? (sighed) There is no way. (shook head)” (P3) “Pain certainly has caused a lot of inconvenience to my life. It’s proof that I'm not getting better.” (P7) “Every time I went to the hospital, I would tell my family that this might be the end.” (P8) “As soon as the pain started, I felt I might as well die.” (P9)

Lack of knowledge about proper pain management

Participants felt helpless due to fear of recurrence and progressive loss of function. They were highly diffident in managing disease by medical care, who seemed as powerless towards pain relief and subsequent treatment. Most of them lacked knowledge about pain and even held misconceptions about pain and painkillers. However, these patients remain willing to try a variety of treatments, such as biotherapy, immunotherapy, new targeted drugs, and clinical trials to seek a glimmer of hope.

“My biggest wish is to cure the pain, please help me (hands clenched).” (P1) “Basically what pain relief methods haven’t you tried?...... (sighed) The pain seems to be getting worse.” (P6) “I don't know why, but sometimes taking 6 hydrocodone pills does not completely stop the pain.” (P9) “Painkillers are okay, but I do not want to use morphine because I am afraid of getting addicted even though it relieves the pain..... (Voice raised) Why should I take morphine?” (P12) “I am not sure if I can take painkillers for my condition, so I dare not take them.” (P13)

Theme 2: rumination

Compulsive rumination.

Generally, compulsive rumination is mainly characterized by thought cognition and self-cognition. It is self-reinforcing recalling of painful feelings that repeatedly occur, which can intensify pain and negative emotions. Advanced cancer patients with prolonged bed rest can experience muscle atrophy and general fatigue, hence impairing their self-care ability. These patients often have uncontrollable thoughts about their illness and worry they are a burden to their family.

“Why am I living so tired? (crouched shoulders)” “How could I be so bad...... (sighed).” (P4) “My son's economic condition is not good, so I am a burden to him. The more he tries to take care of me, the more it weighs on him.” (P5) “My husband is the sole breadwinner and he has to take care of both our elderly parents and children. Unfortunately, I cannot contribute financially.” (P10) “I do not smoke or drink, nor I have any bad habits. (turned emotional) How could I get this disease?” (P11) “Pain lingers in my mind and I can't get rid of it.” (P15) “Why do I have this disease? I feel like crying just thinking about it (eyes turned red).” (P9)

Worrying rumination

Worrying rumination is shown by worries about health and economic status. Patients with worrying rumination were concerned about changes in their disease and predicted their disease progression by pain severity. The participants, especially those middle-aged patients who might face job loss, income reduction or increasing expenses, would weigh the cost-effectiveness of treatment as they were afraid of bringing significant economic pressure to their families.

“Pain means that my disease is not getting better. If there is no pain, then my disease is under control.” (P3, P7) “When I come for chemotherapy, I suffer and my money is gone...... I don’t know if I can be cured.” “To pay for my treatment, I had to borrow money from all my relatives. I really do not know what to do next time.” (P10) “I am afraid it will end up costing so much that I will not be able to afford it anymore......” (P11) “I have not been able to work since I got sick. (with a forced smile) Where else can I get a job?” (P13) “Continuing with this treatment is not worthwhile in the end...... (looked away with tears in his eyes)” (P14)

Theme 3: avoidance coping

Situational avoidance.

Situational avoidance is the avoidance of pain and a painful environment. At first, patients with advanced cancer develop a fear of pain after a prolonged chronic pain, and their excessive fear increases dependence on painkillers which leads to lower placebo effect and pain relief. If they pay too much attention to painful experiences or activities, they will then take relevant avoidance measures. Some patients suffered from the side effects of the disease or painkillers, including edema, constipation, breathing difficulties and other symptoms that resulted in activity intolerance and inability to live a normal life. These patients felt that time passed so slowly that they did not see the meaning of life and hope of survival.

“Sometimes when I am in pain, I feel like going to extremes, such as euthanasia or jumping from a building to end my life as soon as possible” (P1) “ I got some sleeping pills, so it will not hurt when I die (depressed).” (P4) “ I want to die painlessly and quietly (in a firm tone).” (P5) “I have taken a lot of painkillers. Whenever I have a little pain, I am afraid that the pain will get worse, so I need to take painkillers to prevent the coming pain.” (P7) “Without painkillers, I would have already died.” (P9)

Repressive avoidance

Patients with advanced cancer often present repressive avoidance through behavior and mentality. They tend to suffer alone rather than share their feelings with family or others, and remain motionless in coping with the pain, such as through sleeping or keeping seated. Once they perceive pain as unbearable, they are unwilling to acknowledge the pain from within. They are afraid of not being understood or accepted, and social prejudice against them, hence impacting their psychological, and social/relational wellbeing.

“I usually don't move much, so I usually choose to watch TV alone at home.” (P6) “At first, I talked to my daughter about the pain. But after a long time, I stopped sharing (looked away)...... It didn’t help. It only made them worried.” (P8, P15) “I have experienced being abandoned by my friends because of my illness...... (in tears)” (P13) “Now I feel useless and incapable of doing anything. People in my village talked behind my back.” (P14)

Theme 4: constructive action

Setting clear value goal.

Defining value goals mainly involves re-establishing social bonds and regaining confidence in life. Despite being in the terminal stage of cancer, the participants maintained a positive attitude towards treatment, actively built close emotional connections with family members, looked forward to returning to work, strived to improve interpersonal relationships, and established a new social network.

“I am more willing to share my thoughts and feelings with my closest family members than I was before.” (P9) “Chronic pain has made me realize that the person I care about most is my son. He is the pillar of my treatment. I want to cherish the present life more.” (P11) “I can’t live like this forever. It should be me that take care of them (parents), but now they worry about me.” (P12) “I want to go back to work. I’m still so young (looking away), I should have a better life.” (P13, P14)

Taking reciprocal action

Almost all respondents expressed their aspiration to live a fulfilling life. Most patients chose to reconcile, and coexist with the pain by accepting the reality of living with pain, learning its etiology through various channels, changing unhealthy lifestyles, setting goals and action plans, taking corresponding pain-reduction measures as advised by their doctors, making positive changes, and improving their ability of pain management.

“If the doctor continues to prescribe me this painkiller, I will keep coming as long as the pain subsides.” (P3) “I still want to travel, make videos and do something I like.” (P9) “If the pain reduces, I would like to have a blast and breathe more fresh air.” (P10) “I will take my medication regularly, attend therapy sessions and embrace a more vibrant lifestyle instead of confining myself in the hospital.” (P13, P15)

The present study summarized the experiences of patients with advanced cancer coping with chronic pain into four themes: pain catastrophizing, rumination, avoidance coping, and constructive action. All participants reported an urgent need for pain reduction, a constant struggle with pain, and failed efforts to relieve the pain, with most of whom showing low acceptance of pain. It was believed that alleviating cancer-related psychological distress and physical pain were equally important. But patients should not be expected to ignore their pain. Some participants in this study developed pain avoidance behaviors as well as negative mood, such as pain catastrophizing and rumination, whereas a small number of participants with high levels of pain acceptance chose to reconcile with the pain, and devoted their time and energy to worthwhile pursuits. They re-established social connections, and regained confidence in life.

Unlike other non-malignant chronic pain, cancer pain is a complex physical, pathological and emotional experience caused by various factors such as the tumor itself, diagnostic/therapeutic procedures, or treatment-related adverse events [ 32 ]. The etiology of chronic pain in advanced cancer patients remains unknown and the mechanism is relatively complex [ 33 ]. Studies have shown that pain catastrophizing persists even after pain intensity was under controlled [ 34 ]. From a psychological perspective, it is the perception of chronic pain that triggers the anxious response [ 35 ]. Since advanced cancer patients are eager to remove pain and emotional stress, they tend to exaggerate the threat of pain, fear, and helplessness in the face of unpredictable pain, which may be a reason for their low level of pain acceptance. Such finding conforms to de Boer’s conclusion that acceptance level is a strong predictor of pain catastrophizing [ 36 ].

Rumination occurs when an individual repeatedly thinks about the same things, which often hinders a person’s ability to suppress thoughts, generate alternative ways of thinking, or move on [ 35 ]. In this study, most chronic pain patients were unable to distract themselves from their depressed mood and involuntarily engaged in compulsive rumination and worrying rumination. Studies have shown that rumination is a major predictor of disability and closely related to pain intensity [ 37 ]. Many patients in extreme pain believed that rumination was helpful in solving problems, even though the sense of lacking control over it could have a negative impact on mental health [ 38 ].

During the interview, the vast majority of participants expressed concerns about follow-up treatment and their financial capacities, whereas some even viewed themselves as a burden to families and gave up treatment. This finding is consistent with the results of Clarke’s qualitative study on elderly individuals with chronic pain in the community [ 38 ]. In addition, most patients with advanced cancer were reluctant to disclose their condition, influencing their normal social life and pursuit for goals. Consequently, they suffered from social stress, difficulty in coping with pain, and mental health disorders, as supported by the findings of a systematic review [ 39 ].

When dealing with chronic pain, patients often fall into unhelpful patterns of behavior that increase the risk of overtreatment, complications, and even death [ 40 , 41 ]. From the perspective of biopsychosocial integration, advanced cancer patients experiencing chronic pain are in urgent need of psychological interventions [ 42 ], which can promote self-management by changing behaviors [ 43 ], such as cognitive behavioral therapy [ 44 ], behavioral therapy, acceptance and commitment therapy, along with physical treatments such as routine massage and gymnastics, and educational interventions of the disease and its treatment. Acceptance represents the psychological flexibility of acceptance and commitment therapy, which reflects one’s flexibility in action, willingness to experience pain without struggle, and recognition that thoughts are not facts [ 45 ]. Only a few participants in this study expressed a willingness to identify value goals, and take appropriate actions accordingly. They hoped to improve their function and reduce pain interference through value-driven effects. Various forms of psychotherapy can assist chronic pain patients in enhancing their acceptance of pain.

There may be some possible limitations in this study. First, the small sample size may raise concerns regarding the representativeness of data for advanced cancer patients experiencing chronic pain. However, such concern can be dispelled by the abundance of data, since the study subjects were enrolled until data saturation occurred, i.e., until no additional information appeared and no further themes were derived from the data during the sampling. Second, despite the researchers’ training and expertise in conducting qualitative interviews, the quality of data collection and results depended largely on the researchers’ abilities as well as their analysis process.

This study found that most participants had a low level of pain acceptance and were unable to ignore their chronic pain experience. They exhibited pain avoidance behaviors, pain catastrophizing, rumination, and other negative emotions. Yet, a small number of participants with high pain acceptance chose to make peace with pain and devoted their time and energy to other worthwhile pursuits. It is critical to attach importance to the psychological health of patients with advanced cancer, and formulate reasonable psychological intervention strategies. We hope that these findings will encourage further efforts to develop and evaluate strategies that can effectively address patients’ inquiries of chronic pain, enhance communication between patients and healthcare professionals, and alleviate psychological stress in patients with chronic pain.

Availability of data and materials

No datasets were generated or analysed during the current study.

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Acknowledgment

The authors express their gratitude to all the patients for their generous efforts and time for the interviews.

This study was supported by grants from the Natural Science Foundation of Hunan Province, China (Grant No. 2021JJ40327) and the National Natural Science Foundation of China (Grant No. 82103026).

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Xiangya Nursing School, Central South University, Changsha, China

Wanting Xia & Mengyao Yan

Head & Neck Plastic Surgery, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

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Xia WT wrote the main manuscript. Ou MJ conceived and designed the study. Chen YY and Xu XH supervised and managed the manuscript. Chen FR, Yan MY and Xiao ZR were responsible for the phonetic text transcription. All authors reviewed and approved the final manuscript.

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The study was approved by the Institutional Review Board of Hunan Cancer Hospital (Scientific Review 2021 [04]) prior to data collection. Before the formal interview, informed consent was obtained from patients and their families, who were explained the study purpose, the length of interview, the voluntary nature of participation in the study, their right to refuse participation, and confidentiality. Participants were entitled to terminate the interview if they felt uncomfortable during the interview. The interview audio was transcribed, encoded, and assigned a unique individual number for management purposes. The results were described using participant numbers to ensure participants’ privacy. The text data was used for this study only.

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Xia, W., Ou, M., Chen, Y. et al. Experiences of patients with advanced cancer coping with chronic pain: a qualitative analysis. BMC Palliat Care 23 , 94 (2024). https://doi.org/10.1186/s12904-024-01418-2

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DOI : https://doi.org/10.1186/s12904-024-01418-2

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