• CASP Subquestions
Note . The CASP questions are adapted from “10 questions to help you make sense of qualitative research,” by Critical Appraisal Skills Programme, 2013, retrieved from http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf . Its license can be found at http://creativecommons.org/licenses/by-nc-sa/3.0/
Once articles were assessed by the two authors independently, all three authors discussed and reconciled our assessment. No articles were excluded based on CASP results; rather, results were used to depict the general adequacy (or rigor) of all 55 articles meeting inclusion criteria for our systematic review. In addition, the CASP was included to enhance our examination of the relationship between the methods and the usefulness of the findings documented in each of the QD articles included in this review.
To further assess each of the 55 articles, data were extracted on: (a) research objectives, (b) design justification, (c) theoretical or philosophical framework, (d) sampling and sample size, (e) data collection and data sources, (f) data analysis, and (g) presentation of findings (see Table 2 ). We discussed extracted data and identified common and unique features in the articles included in our systematic review. Findings are described in detail below and in Table 3 .
Elements for Data Extraction
Elements | Data Extraction |
---|---|
Research objectives | • Verbs used in objectives or aims |
• Focuses of study | |
Design justification | • If the article cited references for qualitative description |
• If the article offered rationale to choose qualitative description | |
• References cited | |
• Rationale reported | |
Theoretical or philosophical frameworks | • If the article has theoretical or philosophical frameworks for study |
• Theoretical or philosophical frameworks reported | |
• How the frameworks were used in data collection and analysis | |
Sampling and sample sizes | • Sampling strategies (e.g., purposeful sampling, maximum variation) |
• Sample size | |
Data collection and sources | • Data collection techniques (e.g., individual or focus-group interviews, interview guide, surveys, field notes) |
Data analysis | • Data analysis techniques (e.g., qualitative content analysis, thematic analysis, constant comparison) |
• If data saturation was achieved | |
Presentation of findings | • Statement of findings |
• Consistency with research objectives |
Data Extraction and Analysis Results
Authors Country | Research Objectives | Design justification | Theoretical/ philosophical frameworks | Sampling/ sample size | Data collection and data sources | Data analysis | Findings |
---|---|---|---|---|---|---|---|
• USA | • Explore • Responses to communication strategies | • (-) Reference • (-) Rationale | Not reported (NR) | • Purposive sampling/ maximum variation • 32 family members | • Interviews • Observations • Review of daily flow sheet • Demographics | • Inductive and deductive qualitative content analysis • (-) Data saturation | Five themes about family members’ perceptions of nursing communication approaches |
• Sweden | • Describe • Experiences of using guidelines in daily practice | • (-) Reference • (+) Rationale • Part of a research program | NR | • Unspecified • 8 care providers | • Semistructured, individual interviews • Interview guide | • Qualitative content analysis • (-) Data saturation | One theme and seven subthemes about care providers’ experiences of using guidelines in daily practice |
• USA | • Examine • Culturally specific views of processes and causes of midlife weight gain | • (-) Reference • (-) Rationale | Health belief model and Kleiman’s explanatory model | • Unspecified • 19 adults | • Semistructured, individual interview | • Conventional content analysis • (-) Data saturation | Three main categories (from the model) and eight subthemes about causes of weight gain in midlife |
• Iran | • Explore • Factors initiating responsibility among medical trainees | • (-) Reference • (+) Rationale | NR | • Convenience, snowball, and maximum variation sampling • 15 trainees and other professionals | • Semistructured, individual interview • Interview guide | • Conventional content analysis • Constant comparison • (+) Data saturation | Two themes and individual and non- individual-based factors per theme |
• Iran | • Explore • Factors related to job satisfaction and dissatisfaction | • (-) Reference • (-) Rationale | NR | • Convenience sampling • 85 nurses | • Semistructured focus group interviews • Interview guide | • Thematic analysis • (+) Data saturation | Three main themes and associated factors regarding job satisfaction and dissatisfaction |
• Norway | • Describe • Perceptions on simulation-based team training | • (-) Reference • (-) Rationale | NR | • Strategic sampling • 18 registered nurses | • Semistructured individual interviews | • Inductive content analysis • (-) Data saturation | One main category, three categories, and six sub- categories regarding nurses’ perceptions on simulation-based team training |
• USA | • Determine • Barriers and supports for attending college and nursing school | • (-) Reference • (-) Rationale | NR | • Unspecified • 45 students | • Focus-group interviews • Using Photovoice and SHOWeD | • Constant comparison • (-) Data saturation | Five themes about facilitators and barriers |
• USA | • Explore • Reasons for choosing home birth and birth experiences | • (-) Reference • (-) Rationale | NR | • Purposeful sampling • 20 women | • Semistructured focus-group interviews • Interview guide • Field notes | • Qualitative content analysis • (+) Data saturation | Five common themes and concepts about reasons for choosing home birth based on their birth experiences |
• New Zealand | • Explore • Normal fetal activity related to hunger and satiation | • (+) Reference • (+) Rationale • • Denzin & Lincoln (2011) | NR | • Purposive sampling • 19 pregnant women | • Semistructured individual interviews • Open-ended questions | • Inductive qualitative content analysis • Descriptive statistical analysis • (+) Data saturation | Four patterns regarding fetal activities in relation to meal anticipation, maternal hunger, maternal meal consummation, and maternal satiety |
• Italy | • Explore, describe, and compare • perceptions of nursing caring | • (+) Reference • (-) Rationale • | NR | • Purposive sampling • 20 nurses and 20 patients | • Semistructured individual interviews • Interview guide • Field notes during interviews | • Unspecified various analytic strategies including constant comparison • (-) Data saturation | Nursing caring from both patients’ and nurses’ perspectives – a summary of data in visible caring and invisible caring |
• Hong Kong | • Address • How to reduce coronary heart disease risks | • (+) Reference • (+) Rationale • Secondary analysis • • | NR | • Convenience and snowball sampling • 105 patients | • Focus-group interviews • Interview guide | • Content analysis • (+) Data saturation | Four categories about patients’ abilities to reduce coronary heart disease |
• Taiwan | • Explore • Reasons for young–old people not killing themselves | • (-) Reference • (-) Rationale | NR | • Convenience sampling • 31 older adults | • Semistructured individual interviews • Interview guide • Observation with memos/reflective journal | • Content analysis • (+) Data saturation | Six themes regarding reasons for not committing to suicide |
• USA | • Explore • Neonatal intensive care unit experiences | • (+) Reference • (+) Rationale • | NR | • Purposive sampling and convenience sample • 15 mothers | • Semistructured individual interviews • Interview guide | • Qualitative content analysis • (+) Data saturation | Four themes about participants’ experiences of neonatal intensive care unit |
• Colombia | • Investigate • Barriers/facilitators to implementing evidence-based nursing | • (+) Reference • (-) Rationale • | Ottawa model for research use: knowledge translation framework | • Convenience sampling • 13 nursing professionals | • Semistructured individual interviews • Interview guide | • Inductive qualitative content analysis • Constant comparison • (-) Data saturation | Four main barriers and potential facilitators to evidence-based nursing |
• Australia | • Explore • Perceptions and utilization of diaries | • (+) Reference • (-) Rationale • | NR | • Unspecified • 19 patients and families | • Responses to open-ended questions on survey | • Unspecified analysis strategy • (-) Data saturation | Five themes regarding perceptions on use of diaries and descriptive statistics using frequencies of utilization |
• USA | • Explore • Knowledge, attitudes, and beliefs about sexual consent | • (-) Reference • (-) Rationale • Part of a larger mixed-method study | Theory of planned behavior | • Purposive sampling • snowball sampling • 26 women | • Semistructured focus-group interviews • Interview guide | • Content analysis • (+) Data saturation | Three main categories and subthemes regarding sexual consent |
• Sweden | • Describe • Experiences of knowledge development in wound management | • (+) Reference • (+) Rationale: weak • | NR | • Purposive sampling • 16 district nurses | • Individual interviews • Interview guide | • Qualitative content analysis • (-) Data saturation | Three categories and eleven sub-categories about knowledge development experiences in wound management |
• USA | • Describe • Parental-pain journey, beliefs about pain, and attitudes/behaviors related to children’s responses | • (+) Reference • (+) Rationale • • • Part of a larger mixed methods study | NR | • Purposive sampling • 9 parents | • Individual interviews • One open- ended question | • Qualitative content analysis • (+) Data saturation | Two main themes, categories, and subcategories about parents’ experiences of observing children’s pain |
• USA | • Describe • Challenges and barriers in providing culturally competent care | • (+) Reference • (+) Rationale • • Secondary analysis | NR | • Stratified sampling • 253 nurses | • Written responses to 2 open-ended questions on survey | • Thematic analysis • (-) Data saturation | Three themes regarding challenges/barriers |
• Denmark | • Describe • Experiences of childbirth | • (-) Reference • (-) Rationale • A substudy | NR | • Purposive sampling with maximum variation • Partners of 10 women | • Semistructured, individual interviews • Interview guide | • Thematic analysis • (+) Data saturation | Three themes and four subthemes about partners’ experiences of women’s childbirth |
• Australia | • Explore • Perceptions about medical nutrition and hydration at the end of life | • (+) Reference • (+) Rationale • | NR | • Purposeful sampling • 10 nurses | • Focus-group interviews | • “analyzed thematically” • (-) Data saturation | One main theme and four subthemes regarding nurses’ perceptions on EOL- related medical nutrition and hydration |
• USA | • Describe • Reasons for leaving a home visiting program early | • (-) Reference • (-) Rationale | NR | • Convenience sample • 32 mothers, nurses, and nurse supervisors | • Semistructured, individual interviews • Focus-group interviews • Interview guide | • Inductive content analysis • Constant comparison approach • (+) Data saturation | Three sets of reasons for leaving a home visiting program |
• Sweden | • Explore and describe • Beliefs and attitudes around the decision for a caesarean section | • (+) Reference • (+) Rationale • • | NR | • Unspecified • 21 males | • Individual telephone interviews | • Thematic analysis • Constant comparison approach • (-) Data saturation | Two themes and subthemes in relation to the research objective |
• Taiwan | • Explore • Illness experiences of early onset of knee osteoarthritis | • (+) Reference • (+) Rationale • • • Part of a large research series | NR | • Purposive sampling • 17 adults | • Semistructured, Individual interviews • Interview guide • Memo/field notes (observations) | • Inductive content analysis • (+) Data saturation | Three major themes and nine subthemes regarding experiences of early onset-knee osteoarthritis |
• Australia | • Explore • Perceptions about bedside handover (new model) by nurses | • (+) Reference • (+) Rationale • • | NR | • Purposive sampling • 30 patients | • Semistructured, individual interviews • Interview guide | • Thematic content analysis • (-) Data analysis | Two dominant themes and related subthemes regarding patients’ thoughts about nurses’ bedside handover |
• Sweden | • Identify • Patterns in learning when living with diabetes | • (-) Reference • (-) Rationale | NR | • Purposive sampling with variations in age and sex • 13 participants | • Semistructured, individual interviews (3 times over 3 years) | • analysis process • Inductive qualitative content analysis • (-) Data saturation | Five main patterns of learning when living with diabetes for three years following diagnosis |
• Canada | • Evaluate • Book chat intervention based on a novel | • (-) Reference • (-) Rationale • Part of a larger research project | NR | • Unspecified • 11 long-term- care staff | • Questionnaire with two open- ended questions | • Thematic content analysis • (-) Data saturation | Five themes (positive comments) about the book chat with brief description |
• Taiwan | • Explore • Facilitators and barriers to implementing smoking- cessation counseling services | • (-) Reference • (-) Rationale | NR | • Unspecified • 16 nurse- counselors | • Semistructured individual interviews • Interview guide | • Inductive content analysis • Constant comparison • (-) Data saturation | Two themes and eight subthemes about facilitators and barriers described using 2-4 quotations per subtheme |
• USA | • Identify • Educational strategies to manage disruptive behavior | • (-) Reference • (-) Rationale • Part of a larger study | NR | • Unspecified • 9 nurses | • Semistructured, individual interviews • Interview guide | • Content analysis procedures • (-) Data saturation | Two main themes regarding education strategies for nurse educators |
• USA | • Explore • Experiences of difficulty resolving patient- related concerns | • (-) Reference • (-) Rationale • Secondary analysis | NR | • Unspecified • 1932 physician, nursing, and midwifery professionals | • E-mail survey with multiple- choice and free- text responses | • Inductive thematic analysis • Descriptive statistics • (-) Data saturation | One overarching theme and four subthemes about professionals’ experiences of difficulty resolving patient-related concerns |
• Singapore | • Explicate • Experience of quality of life for older adults | • (+) Reference • (+) Rationale • | Parse’s human becoming paradigm | • Unspecified • 10 elderly residents | • Individual interviews • Interview questions presented (Parse) | • Unspecified analysis techniques • (-) Data saturation | Three themes presented using both participants’ language and the researcher’s language |
• China | • Explore • Perspectives on learning about caring | • (-) Reference • (-) Rationale | NR | • Purposeful sampling • 20 nursing students | • Focus-group interviews • Interview guide | • Conventional content analysis • (-) Data saturation | Four categories and associated subcategories about facilitators and challenges to learning about caring |
• Poland | • Describe and assess • Components of the patient–nurse relationship and pediatric-ward amenities | • (+) Reference • (-) Rationale • | NR | • Purposeful, maximum variation sampling • 26 parents or caregivers and 22 children | • Individual interviews | • Qualitative content analysis • (-) Data saturation | Five main topics described from the perspectives of children and parents |
• Canada | • Evaluate • Acceptability and feasibility of hand-massage therapy | • (-) Reference • (-) Rationale • Secondary to a RCT | Focused on feasibility and acceptability | • Unspecified • 40 patients | • Semistructured, individual interviews • Field notes • Video recording | • Thematic analysis for acceptability • Quantitative ratings of video items for feasibility • (-) Data analysis | Summary of data focusing on predetermined indicators of acceptability and descriptive statistics to present feasibility |
• USA | • Understand • Challenges occurring during transitions of care | • (+) Reference • (+) Rationale • • Part of a larger study | NR | • Convenience sample • 22 nurses | • Focus groups • Interview guide | • Qualitative content analysis methods • (+) Data analysis | Three themes about challenges regarding transitions of care: |
• Canada | • Understand • Factors that influence nurses’ retention in their current job | • (-) Reference • (-) Rationale | NR | • Purposeful sampling • 41 nurses | • Focus-group interviews • Interview guide | • Directed content analysis • (+) Data saturation | Nurses’ reasons to stay and leave their current job |
• Australia | • Extend • Understanding of caregivers’ views on advance care planning | • (+) Reference • (+) Rationale • • Grounded theory overtone | NR | • Theoretical sampling • 18 caregivers | • Semistructured focus group and individual interviews • Interview guide • Vignette technique | • Inductive, cyclic, and constant comparative analysis • (-) Data analysis | Three themes regarding caregivers’ perceptions on advance care planning |
• USA | • Describe • Outcomes older adults with epilepsy hope to achieve in management | • (-) Reference • (-) Rationale | NR | • Unspecified • 20 patients | • Individual interview | • Conventional content analysis • (-) Data saturation | Six main themes and associated subthemes regarding what older adults hoped to achieve in management of their epilepsy |
• The Netherlands | • Gain • Experience of personal dignity and factors influencing it | • (+) Reference • (-) Rationale • | Model of dignity in illness | • Maximum variation sampling • 30 nursing home residents | • Individual interviews • Interview guide | • Thematic analysis • Constant comparison • (+) Data saturation | The threatening effect of illness and three domains being threatened by illness in relation to participants’ experiences of personal dignity |
• USA | • Identify and describe • Needs in mental health services and “ideal” program | • (+) Reference • (+) Rationale • • There is a primary study | NR | • Unspecified • 52 family members | • Semistructured, individual and focus-group interviews | • “Standard content analytic procedures” with case-ordered meta-matrix • (-) Data saturation | Two main topics – (a) intervention modalities that would fit family members’ needs in mental health services and (b) topics that programs should address |
• USA | • “What are the perceptions of staff nurses regarding palliative care…?” | • (-) Reference • (-) Rationale | NR | • Purposive, convenience sampling • 18 nurses | • Semistructured and focus-group interviews • Interview guide | • Ritchie and Spencer’s framework for data analysis • (-) Data saturation | Five thematic categories and associated subcategories about nurses’ perceptions of palliative care |
• Canada | • Describe • Experience of caring for a relative with dementia | • (+) Reference • (+) Rationale • Sandelowski ( ; ) • Secondary analysis • Phenomenological overtone | NR | • Purposive sampling • 11 bereaved family members | • Individual interviews • 27 transcripts from the primary study | • Unspecified • (-) Data saturation | Five major themes regarding the journey with dementia from the time prior to diagnosis and into bereavement |
• Canada | • Describe Experience of fetal fibronectin testing | • (+) Reference • (+) Rationale • • | NR | • Unspecified • 17 women | • Semistructured individual interviews • Interview guide | • Conventional content analysis • (+) Data saturation | One overarching theme, three themes, and six subthemes about women’s experiences of fetal fibronectin testing |
• New Zealand | • Explore • Role of nurses in providing palliative and end-of-life care | • (+) Reference • (+) Rationale • • Part of a larger study | NR | • Purposeful sampling • 21 nurses | • Semistructured individual interviews | • Thematic analysis • (-) Data saturation | Three themes about practice nurses’ experiences in providing palliative and end-of-life care |
• Brazil | • Understand • Experience with postnatal depression | • (+) Reference • (-) Rationale • | NR | • Purposeful, criterion sampling • 15 women with postnatal depression | • Minimally structured, individual interviews | • Thematic analysis • (+) Data saturation | Two themes – women’s “bad thoughts” and their four types of responses to fear of harm (with frequencies) |
• Australia | • Understand • Experience of peripherally inserted central catheter insertion | • (+) Reference • (+) Rationale • | NR | • Purposeful sampling • 10 patients | • Semistructured, individual interviews • Interview guide | • Thematic analysis • (+) Data saturation | Four themes regarding patients’ experiences of peripherally inserted central catheter insertion |
• USA | • Discover • Context, values, and background meaning of cultural competency | • (+) Reference • (+) Rationale • | Focused on cultural competence | • Purposive, maximum variation, and network • 20 experts | • Semistructured, individual interviews | • Within-case and across-case analysis • (-) Data saturation | Three themes regarding cultural competency |
• USA | • Explore and describe • Cancer experience | • (+) Reference • (+) Rationale • | NR | • Unspecified • 15 patients | • Longitudinal individual interviews (4 time points) • 40 interviews | • Inductive content analysis • (-) Data saturation | Processes and themes about adolescent identify work and cancer identify work across the illness trajectory |
• Sweden | • Explore • Experiences of giving support to patients during the transition | • (-) Reference • (-) Rationale | Focused on support and transition | • Unspecified (but likely purposeful sampling) • 8 nurses | • Semistructured Individual interviews • Interview guide | • Content analysis • (-) Data saturation | One theme, three main categories, and eight associated categories |
• Taiwan | • Describe • Process of women’s recovery from stillbirth | • (+) Reference • (+) Rationale • | NR | • Purposeful sampling • 21 women | • Individual interview techniques | • Inductive analytic approaches ( ) • (+) Data saturation | Three stages (themes) regarding the recovery process of Taiwanese women with stillbirth |
• Iran | • Describe • Perspectives of causes of medication errors | • (+) Reference • (+) Rationale • | NR | • Purposeful sampling • 24 nursing students | • Focus-group interviews • Observations with notes | • Content analysis • (-) Data saturation | Two main themes about nursing students’ perceptions on causes of medication errors |
• Iran | • Explore • Image of nursing | • (-) Reference • (-) Rationale | NR | • Purposeful sampling • 18 male nurses | • Semistructured individual, interviews • Field notes | • Content analysis • (-) Data saturation | Two main views (themes) on nursing presented with subthemes per view |
• Spain | • Ascertain • Barriers to sexual expression | • (-) Reference • (-) Rationale | NR | • Maximum variation • 100 staff and residents | • Semistructured, individual interview | • Content analysis • (-) Data saturation | 40% of participants without identification of barriers and 60% with seven most cited barriers to sexual expression in the long-term care setting |
• Canada | • Explore • Perceptions of empowerment in academic nursing environments | • (+) Reference • (+) Rationale • Sandelowski ( , ) | Theories of structural power in organizations and psychological empowerment | • Unspecified • 8 clinical instructors | • Semistructured, individual • interview guide | • Unspecified (but used pre-determined concepts) • (+) Data saturation | Structural empowerment and psychological empowerment described using predetermined concepts |
• China | • Investigate • Meaning of life and health experience with chronic illness | • (+) Reference • (+) Rationale • Sandelowski ( , ) | Positive health philosophy | • Purposive, convenience sampling • 11 patients | • Individual interviews • Observations of daily behavior with field notes | • Thematic analysis • (-) Data saturation | Four themes regarding the meaning of life and health when living with chronic illnesses |
Note . NR = not reported
Justification for use of a QD design was evident in close to half (47.3%) of the 55 publications. While most researchers clearly described recruitment strategies (80%) and data collection methods (100%), justification for how the study setting was selected was only identified in 38.2% of the articles and almost 75% of the articles did not include any reason for the choice of data collection methods (e.g., focus-group interviews). In the vast majority (90.9%) of the articles, researchers did not explain their involvement and positionality during the process of recruitment and data collection or during data analysis (63.6%). Ethical standards were reported in greater than 89% of all articles and most articles included an in-depth description of data analysis (83.6%) and development of categories or themes (92.7%). Finally, all researchers clearly stated their findings in relation to research questions/objectives. Researchers of 83.3% of the articles discussed the credibility of their findings (see Table 1 ).
In statements of study objectives and/or questions, the most frequently used verbs were “explore” ( n = 22) and “describe” ( n = 17). Researchers also used “identify” ( n = 3), “understand” ( n = 4), or “investigate” ( n = 2). Most articles focused on participants’ experiences related to certain phenomena ( n = 18), facilitators/challenges/factors/reasons ( n = 14), perceptions about specific care/nursing practice/interventions ( n = 11), and knowledge/attitudes/beliefs ( n = 3).
A total of 30 articles included references for QD. The most frequently cited references ( n = 23) were “Whatever happened to qualitative description?” ( Sandelowski, 2000 ) and “What’s in a name? Qualitative description revisited” ( Sandelowski, 2010 ). Other references cited included “Qualitative description – the poor cousin of health research?” ( Neergaard et al., 2009 ), “Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research” ( Pope & Mays, 1995 ), and general research textbooks ( Polit & Beck, 2004 , 2012 ).
In 26 articles (and not necessarily the same as those citing specific references to QD), researchers provided a rationale for selecting QD. Most researchers chose QD because this approach aims to produce a straight description and comprehensive summary of the phenomenon of interest using participants’ language and staying close to the data (or using low inference).
Authors of two articles distinctly stated a QD design, yet also acknowledged grounded-theory or phenomenological overtones by adopting some techniques from these qualitative traditions ( Michael, O'Callaghan, Baird, Hiscock, & Clayton, 2014 ; Peacock, Hammond-Collins, & Forbes, 2014 ). For example, Michael et al. (2014 , p. 1066) reported:
The research used a qualitative descriptive design with grounded theory overtones ( Sandelowski, 2000 ). We sought to provide a comprehensive summary of participants’ views through theoretical sampling; multiple data sources (focus groups [FGs] and interviews); inductive, cyclic, and constant comparative analysis; and condensation of data into thematic representations ( Corbin & Strauss, 1990 , 2008 ).
Authors of four additional articles included language suggestive of a grounded-theory or phenomenological tradition, e.g., by employing a constant comparison technique or translating themes stated in participants’ language into the primary language of the researchers during data analysis ( Asemani et al., 2014 ; Li, Lee, Chen, Jeng, & Chen, 2014 ; Ma, 2014 ; Soule, 2014 ). Additionally, Li et al. (2014) specifically reported use of a grounded-theory approach.
In most (n = 48) articles, researchers did not specify any theoretical or philosophical framework. Of those articles in which a framework or philosophical stance was included, the authors of five articles described the framework as guiding the development of an interview guide ( Al-Zadjali, Keller, Larkey, & Evans, 2014 ; DeBruyn, Ochoa-Marin, & Semenic, 2014 ; Fantasia, Sutherland, Fontenot, & Ierardi, 2014 ; Ma, 2014 ; Wiens, Babenko-Mould, & Iwasiw, 2014 ). In two articles, data analysis was described as including key concepts of a framework being used as pre-determined codes or categories ( Al-Zadjali et al., 2014 ; Wiens et al., 2014 ). Oosterveld-Vlug et al. (2014) and Zhang, Shan, and Jiang (2014) discussed a conceptual model and underlying philosophy in detail in the background or discussion section, although the model and philosophy were not described as being used in developing interview questions or analyzing data.
In 38 of the 55 articles, researchers reported ‘purposeful sampling’ or some derivation of purposeful sampling such as convenience ( n = 10), maximum variation ( n = 8), snowball ( n = 3), and theoretical sampling ( n = 1). In three instances ( Asemani et al., 2014 ; Chan & Lopez, 2014 ; Soule, 2014 ), multiple sampling strategies were described, for example, a combination of snowball, convenience, and maximum variation sampling. In articles where maximum variation sampling was employed, “variation” referred to seeking diversity in participants’ demographics ( n = 7; e.g., age, gender, and education level), while one article did not include details regarding how their maximum variation sampling strategy was operationalized ( Marcinowicz, Abramowicz, Zarzycka, Abramowicz, & Konstantynowicz, 2014 ). Authors of 17 articles did not specify their sampling techniques.
Sample sizes ranged from 8 to 1,932 with nine studies in the 8–10 participant range and 24 studies in the 11–20 participant range. The participant range of 21–30 and 31–50 was reported in eight articles each. Six studies included more than 50 participants. Two of these articles depicted quite large sample sizes (N=253, Hart & Mareno, 2014 ; N=1,932, Lyndon et al., 2014 ) and the authors of these articles described the use of survey instruments and analysis of responses to open-ended questions. This was in contrast to studies with smaller sample sizes where individual interviews and focus groups were more commonly employed.
In a majority of studies, researchers collected data through individual ( n = 39) and/or focus-group ( n = 14) interviews that were semistructured. Most researchers reported that interviews were audiotaped ( n = 51) and interview guides were described as the primary data collection tool in 29 of the 51 studies. In some cases, researchers also described additional data sources, for example, taking memos or field notes during participant observation sessions or as a way to reflect their thoughts about interviews ( n = 10). Written responses to open-ended questions in survey questionnaires were another type of data source in a small number of studies ( n = 4).
The analysis strategy most commonly used in the QD studies included in this review was qualitative content analysis ( n = 30). Among the studies where this technique was used, most researchers described an inductive approach; researchers of two studies analyzed data both inductively and deductively. Thematic analysis was adopted in 14 studies and the constant comparison technique in 10 studies. In nine studies, researchers employed multiple techniques to analyze data including qualitative content analysis with constant comparison ( Asemani et al., 2014 ; DeBruyn et al., 2014 ; Holland, Christensen, Shone, Kearney, & Kitzman, 2014 ; Li et al., 2014 ) and thematic analysis with constant comparison ( Johansson, Hildingsson, & Fenwick, 2014 ; Oosterveld-Vlug et al., 2014 ). In addition, five teams conducted descriptive statistical analysis using both quantitative and qualitative data and counting the frequencies of codes/themes ( Ewens, Chapman, Tulloch, & Hendricks, 2014 ; Miller, 2014 ; Santos, Sandelowski, & Gualda, 2014 ; Villar, Celdran, Faba, & Serrat, 2014 ) or targeted events through video monitoring ( Martorella, Boitor, Michaud, & Gelinas, 2014 ). Tseng, Chen, and Wang (2014) cited Thorne, Reimer Kirkham, and O’Flynn-Magee (2004)’s interpretive description as the inductive analytic approach. In five out of 55 articles, researchers did not specifically name their analysis strategies, despite including descriptions about procedural aspects of data analysis. Researchers of 20 studies reported that data saturation for their themes was achieved.
Researchers described participants’ experiences of health care, interventions, or illnesses in 18 articles and presented straightforward, focused, detailed descriptions of facilitators, challenges, factors, reasons, and causes in 15 articles. Participants’ perceptions of specific care, interventions, or programs were described in detail in 11 articles. All researchers presented their findings with extensive descriptions including themes or categories. In 25 of 55 articles, figures or tables were also presented to illustrate or summarize the findings. In addition, the authors of three articles summarized, organized, and described their data using key concepts of conceptual models ( Al-Zadjali et al., 2014 ; Oosterveld-Vlug et al., 2014 ; Wiens et al., 2014 ). Martorella et al. (2014) assessed acceptability and feasibility of hand massage therapy and arranged their findings in relation to pre-determined indicators of acceptability and feasibility. In one longitudinal QD study ( Kneck, Fagerberg, Eriksson, & Lundman, 2014 ), the researchers presented the findings as several key patterns of learning for persons living with diabetes; in another longitudinal QD study ( Stegenga & Macpherson, 2014 ), findings were presented as processes and themes regarding patients’ identity work across the cancer trajectory. In another two studies, the researchers described and compared themes or categories from two different perspectives, such as patients and nurses ( Canzan, Heilemann, Saiani, Mortari, & Ambrosi, 2014 ) or parents and children ( Marcinowicz et al., 2014 ). Additionally, Ma (2014) reported themes using both participants’ language and the researcher’s language.
In this systematic review, we examined and reported specific characteristics of methods and findings reported in journal articles self-identified as QD and published during one calendar year. To accomplish this we identified 55 articles that met inclusion criteria, performed a quality appraisal following CASP guidelines, and extracted and analyzed data focusing on QD features. In general, three primary findings emerged. First, despite inconsistencies, most QD publications had the characteristics that were originally observed by Sandelowski (2000) and summarized by other limited available QD literature. Next, there are no clear boundaries in methods used in the QD studies included in this review; in a number of studies, researchers adopted and combined techniques originating from other qualitative traditions to obtain rich data and increase their understanding of the phenomenon under investigation. Finally, justification for how QD was chosen and why it would be an appropriate fit for a particular study is an area in need of increased attention.
In general, the overall characteristics were consistent with design features of QD studies described in the literature ( Neergaard et al., 2009 ; Sandelowski, 2000 , 2010 ; Vaismoradi et al., 2013 ). For example, many authors reported that study objectives were to describe or explore participants’ experiences and factors related to certain phenomena, events, or interventions. In most cases, these authors cited Sandelowski (2000) as a reference for this particular characteristic. It was rare that theoretical or philosophical frameworks were identified, which also is consistent with descriptions of QD. In most studies, researchers used purposeful sampling and its derivative sampling techniques, collected data through interviews, and analyzed data using qualitative content analysis or thematic analysis. Moreover, all researchers presented focused or comprehensive, descriptive summaries of data including themes or categories answering their research questions. These characteristics do not indicate that there are correct ways to do QD studies; rather, they demonstrate how others designed and produced QD studies.
In several studies, researchers combined techniques that originated from other qualitative traditions for sampling, data collection, and analysis. This flexibility or variability, a key feature of recently published QD studies, may indicate that there are no clear boundaries in designing QD studies. Sandelowski (2010) articulated: “in the actual world of research practice, methods bleed into each other; they are so much messier than textbook depictions” (p. 81). Hammersley (2007) also observed:
“We are not so much faced with a set of clearly differentiated qualitative approaches as with a complex landscape of variable practice in which the inhabitants use a range of labels (‘ethnography’, ‘discourse analysis’, ‘life history work’, narrative study’, ……, and so on) in diverse and open-ended ways in order to characterize their orientation, and probably do this somewhat differently across audiences and occasions” (p. 293).
This concept of having no clear boundaries in methods when designing a QD study should enable researchers to obtain rich data and produce a comprehensive summary of data through various data collection and analysis approaches to answer their research questions. For example, using an ethnographical approach (e.g., participant observation) in data collection for a QD study may facilitate an in-depth description of participants’ nonverbal expressions and interactions with others and their environment as well as situations or events in which researchers are interested ( Kawulich, 2005 ). One example found in our review is that Adams et al. (2014) explored family members’ responses to nursing communication strategies for patients in intensive care units (ICUs). In this study, researchers conducted interviews with family members, observed interactions between healthcare providers, patients, and family members in ICUs, attended ICU rounds and family meetings, and took field notes about their observations and reflections. Accordingly, the variability in methods provided Adams and colleagues (2014) with many different aspects of data that were then used to complement participants’ interviews (i.e., data triangulation). Moreover, by using a constant comparison technique in addition to qualitative content analysis or thematic analysis in QD studies, researchers compare each case with others looking for similarities and differences as well as reasoning why differences exist, to generate more general understanding of phenomena of interest ( Thorne, 2000 ). In fact, this constant comparison analysis is compatible with qualitative content analysis and thematic analysis and we found several examples of using this approach in studies we reviewed ( Asemani et al., 2014 ; DeBruyn et al., 2014 ; Holland et al., 2014 ; Johansson et al., 2014 ; Li et al., 2014 ; Oosterveld-Vlug et al., 2014 ).
However, this flexibility or variability in methods of QD studies may cause readers’ as well as researchers’ confusion in designing and often labeling qualitative studies ( Neergaard et al., 2009 ). Especially, it could be difficult for scholars unfamiliar with qualitative studies to differentiate QD studies with “hues, tones, and textures” of qualitative traditions ( Sandelowski, 2000 , p. 337) from grounded theory, phenomenological, and ethnographical research. In fact, the major difference is in the presentation of the findings (or outcomes of qualitative research) ( Neergaard et al., 2009 ; Sandelowski, 2000 ). The final products of grounded theory, phenomenological, and ethnographical research are a generation of a theory, a description of the meaning or essence of people’s lived experience, and an in-depth, narrative description about certain culture, respectively, through researchers’ intensive/deep interpretations, reflections, and/or transformation of data ( Streubert & Carpenter, 2011 ). In contrast, QD studies result in “a rich, straight description” of experiences, perceptions, or events using language from the collected data ( Neergaard et al., 2009 ) through low-inference (or data-near) interpretations during data analysis ( Sandelowski, 2000 , 2010 ). This feature is consistent with our finding regarding presentation of findings: in all QD articles included in this systematic review, the researchers presented focused or comprehensive, descriptive summaries to their research questions.
Finally, an explanation or justification of why a QD approach was chosen or appropriate for the study aims was not found in more than half of studies in the sample. While other qualitative approaches, including grounded theory, phenomenology, ethnography, and narrative analysis, are used to better understand people’s thoughts, behaviors, and situations regarding certain phenomena ( Sullivan-Bolyai et al., 2005 ), as noted above, the results will likely read differently than those for a QD study ( Carter & Little, 2007 ). Therefore, it is important that researchers accurately label and justify their choices of approach, particularly for studies focused on participants’ experiences, which could be addressed with other qualitative traditions. Justifying one’s research epistemology, methodology, and methods allows readers to evaluate these choices for internal consistency, provides context to assist in understanding the findings, and contributes to the transparency of choices, all of which enhance the rigor of the study ( Carter & Little, 2007 ; Wu, Thompson, Aroian, McQuaid, & Deatrick, 2016 ).
Use of the CASP tool drew our attention to the credibility and usefulness of the findings of the QD studies included in this review. Although justification for study design and methods was lacking in many articles, most authors reported techniques of recruitment, data collection, and analysis that appeared. Internal consistencies among study objectives, methods, and findings were achieved in most studies, increasing readers’ confidence that the findings of these studies are credible and useful in understanding under-explored phenomenon of interest.
In summary, our findings support the notion that many scholars employ QD and include a variety of commonly observed characteristics in their study design and subsequent publications. Based on our review, we found that QD as a scholarly approach allows flexibility as research questions and study findings emerge. We encourage authors to provide as many details as possible regarding how QD was chosen for a particular study as well as details regarding methods to facilitate readers’ understanding and evaluation of the study design and rigor. We acknowledge the challenge of strict word limitation with submissions to print journals; potential solutions include collaboration with journal editors and staff to consider creative use of charts or tables, or using more citations and less text in background sections so that methods sections are robust.
Several limitations of this review deserve mention. First, only articles where researchers explicitly stated in the main body of the article that a QD design was employed were included. In contrast, articles labeled as QD in only the title or abstract, or without their research design named were not examined due to the lack of certainty that the researchers actually carried out a QD study. As a result, we may have excluded some studies where a QD design was followed. Second, only one database was searched and therefore we did not identify or describe potential studies following a QD approach that were published in non-PubMed databases. Third, our review is limited by reliance on what was included in the published version of a study. In some cases, this may have been a result of word limits or specific styles imposed by journals, or inconsistent reporting preferences of authors and may have limited our ability to appraise the general adequacy with the CASP tool and examine specific characteristics of these studies.
A systematic review was conducted by examining QD research articles focused on nursing-related phenomena and published in one calendar year. Current patterns include some characteristics of QD studies consistent with the previous observations described in the literature, a focus on the flexibility or variability of methods in QD studies, and a need for increased explanations of why QD was an appropriate label for a particular study. Based on these findings, recommendations include encouragement to authors to provide as many details as possible regarding the methods of their QD study. In this way, readers can thoroughly consider and examine if the methods used were effective and reasonable in producing credible and useful findings.
This work was supported in part by the John A. Hartford Foundation’s National Hartford Centers of Gerontological Nursing Excellence Award Program.
Hyejin Kim is a Ruth L. Kirschstein NRSA Predoctoral Fellow (F31NR015702) and 2013–2015 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar. Justine Sefcik is a Ruth L. Kirschstein Predoctoral Fellow (F31NR015693) through the National Institutes of Health, National Institute of Nursing Research.
Conflict of Interest Statement
The Authors declare that there is no conflict of interest.
Hyejin Kim, MSN, CRNP, Doctoral Candidate, University of Pennsylvania School of Nursing.
Justine S. Sefcik, MS, RN, Doctoral Candidate, University of Pennsylvania School of Nursing.
Christine Bradway, PhD, CRNP, FAAN, Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing.
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Part 2 – descriptive studies.
Aggarwal, Rakesh; Ranganathan, Priya 1
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
1 Department of Anaesthesiology, Tata Memorial Centre, Mumbai, Maharashtra, India
Address for correspondence: Dr. Rakesh Aggarwal, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
One of the first steps in planning a research study is the choice of study design. The available study designs are divided broadly into two types – observational and interventional. Of the various observational study designs, the descriptive design is the simplest. It allows the researcher to study and describe the distribution of one or more variables, without regard to any causal or other hypotheses. This article discusses the subtypes of descriptive study design, and their strengths and limitations.
In our previous article in this series,[ 1 ] we introduced the concept of “study designs”– as “the set of methods and procedures used to collect and analyze data on variables specified in a particular research question.” Study designs are primarily of two types – observational and interventional, with the former being loosely divided into “descriptive” and “analytical.” In this article, we discuss the descriptive study designs.
A descriptive study is one that is designed to describe the distribution of one or more variables, without regard to any causal or other hypothesis.
Descriptive studies can be of several types, namely, case reports, case series, cross-sectional studies, and ecological studies. In the first three of these, data are collected on individuals, whereas the last one uses aggregated data for groups.
A case report refers to the description of a patient with an unusual disease or with simultaneous occurrence of more than one condition. A case series is similar, except that it is an aggregation of multiple (often only a few) similar cases. Many case reports and case series are anecdotal and of limited value. However, some of these bring to the fore a hitherto unrecognized disease and play an important role in advancing medical science. For instance, HIV/AIDS was first recognized through a case report of disseminated Kaposi's sarcoma in a young homosexual man,[ 2 ] and a case series of such men with Pneumocystis carinii pneumonia.[ 3 ]
In other cases, description of a chance observation may open an entirely new line of investigation. Some examples include: fatal disseminated Bacillus Calmette–Guérin infection in a baby born to a mother taking infliximab for Crohn's disease suggesting that adminstration of infliximab may bring about reactivation of tuberculosis,[ 4 ] progressive multifocal leukoencephalopathy following natalizumab treatment – describing a new adverse effect of drugs that target cell adhesion molecule α4-integrin,[ 5 ] and demonstration of a tumor caused by invasive transformed cancer cells from a colonizing tapeworm in an HIV-infected person.[ 6 ]
Studies with a cross-sectional study design involve the collection of information on the presence or level of one or more variables of interest (health-related characteristic), whether exposure (e.g., a risk factor) or outcome (e.g., a disease) as they exist in a defined population at one particular time. If these data are analyzed only to determine the distribution of one or more variables, these are “descriptive.” However, often, in a cross-sectional study, the investigator also assesses the relationship between the presence of an exposure and that of an outcome. Such cross-sectional studies are referred to as “analytical” and will be discussed in the next article in this series.
Cross-sectional studies can be thought of as providing a “snapshot” of the frequency and characteristics of a disease in a population at a particular point in time. These are very good for measuring the prevalence of a disease or of a risk factor in a population. Thus, these are very helpful in assessing the disease burden and healthcare needs.
Let us look at a study that was aimed to assess the prevalence of myopia among Indian children.[ 7 ] In this study, trained health workers visited schools in Delhi and tested visual acuity in all children studying in classes 1–9. Of the 9884 children screened, 1297 (13.1%) had myopia (defined as spherical refractive error of −0.50 diopters (D) or worse in either or both eyes), and the mean myopic error was −1.86 ± 1.4 D. Furthermore, overall, 322 (3.3%), 247 (2.5%) and 3 children had mild, moderate, and severe visual impairment, respectively. These parts of the study looked at the prevalence and degree of myopia or of visual impairment, and did not assess the relationship of one variable with another or test a causative hypothesis – these qualify as a descriptive cross-sectional study. These data would be helpful to a health planner to assess the need for a school eye health program, and to know the proportion of children in her jurisdiction who would need corrective glasses.
The authors did, subsequently in the paper, look at the relationship of myopia (an outcome) with children's age, gender, socioeconomic status, type of school, mother's education, etc. (each of which qualifies as an exposure). Those parts of the paper look at the relationship between different variables and thus qualify as having “analytical” cross-sectional design.
Sometimes, cross-sectional studies are repeated after a time interval in the same population (using the same subjects as were included in the initial study, or a fresh sample) to identify temporal trends in the occurrence of one or more variables, and to determine the incidence of a disease (i.e., number of new cases) or its natural history. Indeed, the investigators in the myopia study above visited the same children and reassessed them a year later. This separate follow-up study[ 8 ] showed that “new” myopia had developed in 3.4% of children (incidence rate), with a mean change of −1.09 ± 0.55 D. Among those with myopia at the time of the initial survey, 49.2% showed progression of myopia with a mean change of −0.27 ± 0.42 D.
Cross-sectional studies are usually simple to do and inexpensive. Furthermore, these usually do not pose much of a challenge from an ethics viewpoint.
However, this design does carry a risk of bias, i.e., the results of the study may not represent the true situation in the population. This could arise from either selection bias or measurement bias. The former relates to differences between the population and the sample studied. The myopia study included only those children who attended school, and the prevalence of myopia could have been different in those did not attend school (e.g., those with severe myopia may not be able to see the blackboard and hence may have been more likely to drop out of school). The measurement bias in this study would relate to the accuracy of measurement and the cutoff used. If the investigators had used a cutoff of −0.25 D (instead of −0.50 D) to define myopia, the prevalence would have been higher. Furthermore, if the measurements were not done accurately, some cases with myopia could have been missed, or vice versa, affecting the study results.
Ecological (also sometimes called as correlational) study design involves looking for association between an exposure and an outcome across populations rather than in individuals. For instance, a study in the United States found a relation between household firearm ownership in various states and the firearm death rates during the period 2007–2010.[ 9 ] Thus, in this study, the unit of assessment was a state and not an individual.
These studies are convenient to do since the data have often already been collected and are available from a reliable source. This design is particularly useful when the differences in exposure between individuals within a group are much smaller than the differences in exposure between groups. For instance, the intake of particular food items is likely to vary less between people in a particular group but can vary widely across groups, for example, people living in different countries.
However, the ecological study design has some important limitations. First, an association between exposure and outcome at the group level may not be true at the individual level (a phenomenon also referred to as “ecological fallacy”).[ 10 ] Second, the association may be related to a third factor which in turn is related to both the exposure and the outcome, the so-called “confounding”. For instance, an ecological association between higher income level and greater cardiovascular mortality across countries may be related to a higher prevalence of obesity. Third, migration of people between regions with different exposure levels may also introduce an error. A fourth consideration may be the use of differing definitions for exposure, outcome or both in different populations.
Descriptive studies, irrespective of the subtype, are often very easy to conduct. For case reports, case series, and ecological studies, the data are already available. For cross-sectional studies, these can be easily collected (usually in one encounter). Thus, these study designs are often inexpensive, quick and do not need too much effort. Furthermore, these studies often do not face serious ethics scrutiny, except if the information sought to be collected is of confidential nature (e.g., sexual practices, substance use, etc.).
Descriptive studies are useful for estimating the burden of disease (e.g., prevalence or incidence) in a population. This information is useful for resource planning. For instance, information on prevalence of cataract in a city may help the government decide on the appropriate number of ophthalmologic facilities. Data from descriptive studies done in different populations or done at different times in the same population may help identify geographic variation and temporal change in the frequency of disease. This may help generate hypotheses regarding the cause of the disease, which can then be verified using another, more complex design.
As with other study designs, descriptive studies have their own pitfalls. Case reports and case-series refer to a solitary patient or to only a few cases, who may represent a chance occurrence. Hence, conclusions based on these run the risk of being non-representative, and hence unreliable. In cross-sectional studies, the validity of results is highly dependent on whether the study sample is well representative of the population proposed to be studied, and whether all the individual measurements were made using an accurate and identical tool, or not. If the information on a variable cannot be obtained accurately, for instance in a study where the participants are asked about socially unacceptable (e.g., promiscuity) or illegal (e.g., substance use) behavior, the results are unlikely to be reliable.
Conflicts of interest.
There are no conflicts of interest.
Epidemiologic methods; observational studies; research design
Study designs: part 1 – an overview and classification, study designs: part 3 - analytical observational studies, research studies on screening tests, introduction to qualitative research methods – part i, designing and validating a research questionnaire - part 1.
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This article discusses the subtypes of descriptive study design, and their strengths and limitations. Keywords: Epidemiologic methods, observational studies, research design INTRODUCTION
In this blog, we will explore the definition, characteristics, and common flaws in descriptive research design, and provide tips on how to avoid these pitfalls to produce high-quality results. Whether you are a seasoned researcher or a student just starting, understanding the fundamentals of descriptive research design is essential to ...
Some of the main limitations of descriptive research design are: Cannot establish cause and effect: Descriptive research design cannot establish cause and effect relationships between variables. It only provides a description of the characteristics of the population or phenomenon of interest.
Descriptive research aims to accurately and systematically describe a population, situation or phenomenon. It can answer what, where, when and how questions, but not why questions. A descriptive research design can use a wide variety of research methods to investigate one or more variables.
Descriptive studies describe the characteristics of interest in the study population (also referred to as sample, to differentiate it from the entire population in the universe). These studies do not have a comparison group. The simplest type of descriptive study is the case report.
Limitations: Descriptive studies cannot be used to establish cause and effect relationships. Respondents may not be truthful when answering survey questions or may give socially desirable responses. The choice and wording of questions on a questionnaire may influence the descriptive findings.
Descriptive research design aims to systematically obtain information to describe a phenomenon, situation, or population. More specifically, it helps answer the what, when, where, and how questions regarding the research problem rather than the why.
Frequently asked questions. When should researchers conduct descriptive research? What is the difference between descriptive and exploratory research? What is the difference between descriptive and experimental research? Is descriptive research only for social sciences? How important is descriptive research? What is descriptive research?
The research used a qualitative descriptive design with grounded theory overtones (Sandelowski, 2000). We sought to provide a comprehensive summary of participants’ views through theoretical sampling; multiple data sources (focus groups [FGs] and interviews); inductive, cyclic, and constant comparative analysis; and condensation of data into ...
This article discusses the subtypes of descriptive study design, and their strengths and limitations. INTRODUCTION. In our previous article in this series, [1] we introduced the concept of “study designs”– as “the set of methods and procedures used to collect and analyze data on variables specified in a particular research question.”