how to write an abstract qualitative research

Writing an Abstract for Your Research Paper

Definition and Purpose of Abstracts

An abstract is a short summary of your (published or unpublished) research paper, usually about a paragraph (c. 6-7 sentences, 150-250 words) long. A well-written abstract serves multiple purposes:

• an abstract lets readers get the gist or essence of your paper or article quickly, in order to decide whether to read the full paper;
• an abstract prepares readers to follow the detailed information, analyses, and arguments in your full paper;
• and, later, an abstract helps readers remember key points from your paper.

It’s also worth remembering that search engines and bibliographic databases use abstracts, as well as the title, to identify key terms for indexing your published paper. So what you include in your abstract and in your title are crucial for helping other researchers find your paper or article.

If you are writing an abstract for a course paper, your professor may give you specific guidelines for what to include and how to organize your abstract. Similarly, academic journals often have specific requirements for abstracts. So in addition to following the advice on this page, you should be sure to look for and follow any guidelines from the course or journal you’re writing for.

The Contents of an Abstract

Abstracts contain most of the following kinds of information in brief form. The body of your paper will, of course, develop and explain these ideas much more fully. As you will see in the samples below, the proportion of your abstract that you devote to each kind of information—and the sequence of that information—will vary, depending on the nature and genre of the paper that you are summarizing in your abstract. And in some cases, some of this information is implied, rather than stated explicitly. The Publication Manual of the American Psychological Association , which is widely used in the social sciences, gives specific guidelines for what to include in the abstract for different kinds of papers—for empirical studies, literature reviews or meta-analyses, theoretical papers, methodological papers, and case studies.

Here are the typical kinds of information found in most abstracts:

• the context or background information for your research; the general topic under study; the specific topic of your research
• the central questions or statement of the problem your research addresses
• what’s already known about this question, what previous research has done or shown
• the main reason(s) , the exigency, the rationale , the goals for your research—Why is it important to address these questions? Are you, for example, examining a new topic? Why is that topic worth examining? Are you filling a gap in previous research? Applying new methods to take a fresh look at existing ideas or data? Resolving a dispute within the literature in your field? . . .
• your research and/or analytical methods
• your main findings , results , or arguments
• the significance or implications of your findings or arguments.

Your abstract should be intelligible on its own, without a reader’s having to read your entire paper. And in an abstract, you usually do not cite references—most of your abstract will describe what you have studied in your research and what you have found and what you argue in your paper. In the body of your paper, you will cite the specific literature that informs your research.

When to Write Your Abstract

Although you might be tempted to write your abstract first because it will appear as the very first part of your paper, it’s a good idea to wait to write your abstract until after you’ve drafted your full paper, so that you know what you’re summarizing.

What follows are some sample abstracts in published papers or articles, all written by faculty at UW-Madison who come from a variety of disciplines. We have annotated these samples to help you see the work that these authors are doing within their abstracts.

Choosing Verb Tenses within Your Abstract

The social science sample (Sample 1) below uses the present tense to describe general facts and interpretations that have been and are currently true, including the prevailing explanation for the social phenomenon under study. That abstract also uses the present tense to describe the methods, the findings, the arguments, and the implications of the findings from their new research study. The authors use the past tense to describe previous research.

The humanities sample (Sample 2) below uses the past tense to describe completed events in the past (the texts created in the pulp fiction industry in the 1970s and 80s) and uses the present tense to describe what is happening in those texts, to explain the significance or meaning of those texts, and to describe the arguments presented in the article.

The science samples (Samples 3 and 4) below use the past tense to describe what previous research studies have done and the research the authors have conducted, the methods they have followed, and what they have found. In their rationale or justification for their research (what remains to be done), they use the present tense. They also use the present tense to introduce their study (in Sample 3, “Here we report . . .”) and to explain the significance of their study (In Sample 3, This reprogramming . . . “provides a scalable cell source for. . .”).

Sample Abstract 1

From the social sciences.

Reporting new findings about the reasons for increasing economic homogamy among spouses

Gonalons-Pons, Pilar, and Christine R. Schwartz. “Trends in Economic Homogamy: Changes in Assortative Mating or the Division of Labor in Marriage?” Demography , vol. 54, no. 3, 2017, pp. 985-1005.

Sample Abstract 2

From the humanities.

Analyzing underground pulp fiction publications in Tanzania, this article makes an argument about the cultural significance of those publications

Emily Callaci. “Street Textuality: Socialism, Masculinity, and Urban Belonging in Tanzania’s Pulp Fiction Publishing Industry, 1975-1985.” Comparative Studies in Society and History , vol. 59, no. 1, 2017, pp. 183-210.

Sample Abstract/Summary 3

From the sciences.

Reporting a new method for reprogramming adult mouse fibroblasts into induced cardiac progenitor cells

Lalit, Pratik A., Max R. Salick, Daryl O. Nelson, Jayne M. Squirrell, Christina M. Shafer, Neel G. Patel, Imaan Saeed, Eric G. Schmuck, Yogananda S. Markandeya, Rachel Wong, Martin R. Lea, Kevin W. Eliceiri, Timothy A. Hacker, Wendy C. Crone, Michael Kyba, Daniel J. Garry, Ron Stewart, James A. Thomson, Karen M. Downs, Gary E. Lyons, and Timothy J. Kamp. “Lineage Reprogramming of Fibroblasts into Proliferative Induced Cardiac Progenitor Cells by Defined Factors.” Cell Stem Cell , vol. 18, 2016, pp. 354-367.

Sample Abstract 4, a Structured Abstract

Reporting results about the effectiveness of antibiotic therapy in managing acute bacterial sinusitis, from a rigorously controlled study

Note: This journal requires authors to organize their abstract into four specific sections, with strict word limits. Because the headings for this structured abstract are self-explanatory, we have chosen not to add annotations to this sample abstract.

Wald, Ellen R., David Nash, and Jens Eickhoff. “Effectiveness of Amoxicillin/Clavulanate Potassium in the Treatment of Acute Bacterial Sinusitis in Children.” Pediatrics , vol. 124, no. 1, 2009, pp. 9-15.

“OBJECTIVE: The role of antibiotic therapy in managing acute bacterial sinusitis (ABS) in children is controversial. The purpose of this study was to determine the effectiveness of high-dose amoxicillin/potassium clavulanate in the treatment of children diagnosed with ABS.

METHODS : This was a randomized, double-blind, placebo-controlled study. Children 1 to 10 years of age with a clinical presentation compatible with ABS were eligible for participation. Patients were stratified according to age (<6 or ≥6 years) and clinical severity and randomly assigned to receive either amoxicillin (90 mg/kg) with potassium clavulanate (6.4 mg/kg) or placebo. A symptom survey was performed on days 0, 1, 2, 3, 5, 7, 10, 20, and 30. Patients were examined on day 14. Children’s conditions were rated as cured, improved, or failed according to scoring rules.

RESULTS: Two thousand one hundred thirty-five children with respiratory complaints were screened for enrollment; 139 (6.5%) had ABS. Fifty-eight patients were enrolled, and 56 were randomly assigned. The mean age was 6630 months. Fifty (89%) patients presented with persistent symptoms, and 6 (11%) presented with nonpersistent symptoms. In 24 (43%) children, the illness was classified as mild, whereas in the remaining 32 (57%) children it was severe. Of the 28 children who received the antibiotic, 14 (50%) were cured, 4 (14%) were improved, 4(14%) experienced treatment failure, and 6 (21%) withdrew. Of the 28children who received placebo, 4 (14%) were cured, 5 (18%) improved, and 19 (68%) experienced treatment failure. Children receiving the antibiotic were more likely to be cured (50% vs 14%) and less likely to have treatment failure (14% vs 68%) than children receiving the placebo.

CONCLUSIONS : ABS is a common complication of viral upper respiratory infections. Amoxicillin/potassium clavulanate results in significantly more cures and fewer failures than placebo, according to parental report of time to resolution.” (9)

Some Excellent Advice about Writing Abstracts for Basic Science Research Papers, by Professor Adriano Aguzzi from the Institute of Neuropathology at the University of Zurich:

Academic and Professional Writing

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• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

• 3. The Abstract
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

An abstract summarizes, usually in one paragraph of 300 words or less, the major aspects of the entire paper in a prescribed sequence that includes: 1) the overall purpose of the study and the research problem(s) you investigated; 2) the basic design of the study; 3) major findings or trends found as a result of your analysis; and, 4) a brief summary of your interpretations and conclusions.

Writing an Abstract. The Writing Center. Clarion University, 2009; Writing an Abstract for Your Research Paper. The Writing Center, University of Wisconsin, Madison; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-first Century . Oxford, UK: Chandos Publishing, 2010;

Importance of a Good Abstract

Sometimes your professor will ask you to include an abstract, or general summary of your work, with your research paper. The abstract allows you to elaborate upon each major aspect of the paper and helps readers decide whether they want to read the rest of the paper. Therefore, enough key information [e.g., summary results, observations, trends, etc.] must be included to make the abstract useful to someone who may want to examine your work.

How do you know when you have enough information in your abstract? A simple rule-of-thumb is to imagine that you are another researcher doing a similar study. Then ask yourself: if your abstract was the only part of the paper you could access, would you be happy with the amount of information presented there? Does it tell the whole story about your study? If the answer is "no" then the abstract likely needs to be revised.

Farkas, David K. “A Scheme for Understanding and Writing Summaries.” Technical Communication 67 (August 2020): 45-60;  How to Write a Research Abstract. Office of Undergraduate Research. University of Kentucky; Staiger, David L. “What Today’s Students Need to Know about Writing Abstracts.” International Journal of Business Communication January 3 (1966): 29-33; Swales, John M. and Christine B. Feak. Abstracts and the Writing of Abstracts . Ann Arbor, MI: University of Michigan Press, 2009.

Structure and Writing Style

I.  Types of Abstracts

To begin, you need to determine which type of abstract you should include with your paper. There are four general types.

Critical Abstract A critical abstract provides, in addition to describing main findings and information, a judgment or comment about the study’s validity, reliability, or completeness. The researcher evaluates the paper and often compares it with other works on the same subject. Critical abstracts are generally 400-500 words in length due to the additional interpretive commentary. These types of abstracts are used infrequently.

Descriptive Abstract A descriptive abstract indicates the type of information found in the work. It makes no judgments about the work, nor does it provide results or conclusions of the research. It does incorporate key words found in the text and may include the purpose, methods, and scope of the research. Essentially, the descriptive abstract only describes the work being summarized. Some researchers consider it an outline of the work, rather than a summary. Descriptive abstracts are usually very short, 100 words or less. Informative Abstract The majority of abstracts are informative. While they still do not critique or evaluate a work, they do more than describe it. A good informative abstract acts as a surrogate for the work itself. That is, the researcher presents and explains all the main arguments and the important results and evidence in the paper. An informative abstract includes the information that can be found in a descriptive abstract [purpose, methods, scope] but it also includes the results and conclusions of the research and the recommendations of the author. The length varies according to discipline, but an informative abstract is usually no more than 300 words in length.

Highlight Abstract A highlight abstract is specifically written to attract the reader’s attention to the study. No pretense is made of there being either a balanced or complete picture of the paper and, in fact, incomplete and leading remarks may be used to spark the reader’s interest. In that a highlight abstract cannot stand independent of its associated article, it is not a true abstract and, therefore, rarely used in academic writing.

II.  Writing Style

Use the active voice when possible , but note that much of your abstract may require passive sentence constructions. Regardless, write your abstract using concise, but complete, sentences. Get to the point quickly and always use the past tense because you are reporting on a study that has been completed.

Abstracts should be formatted as a single paragraph in a block format and with no paragraph indentations. In most cases, the abstract page immediately follows the title page. Do not number the page. Rules set forth in writing manual vary but, in general, you should center the word "Abstract" at the top of the page with double spacing between the heading and the abstract. The final sentences of an abstract concisely summarize your study’s conclusions, implications, or applications to practice and, if appropriate, can be followed by a statement about the need for additional research revealed from the findings.

Composing Your Abstract

Although it is the first section of your paper, the abstract should be written last since it will summarize the contents of your entire paper. A good strategy to begin composing your abstract is to take whole sentences or key phrases from each section of the paper and put them in a sequence that summarizes the contents. Then revise or add connecting phrases or words to make the narrative flow clearly and smoothly. Note that statistical findings should be reported parenthetically [i.e., written in parentheses].

Before handing in your final paper, check to make sure that the information in the abstract completely agrees with what you have written in the paper. Think of the abstract as a sequential set of complete sentences describing the most crucial information using the fewest necessary words. The abstract SHOULD NOT contain:

• A catchy introductory phrase, provocative quote, or other device to grab the reader's attention,
• Lengthy background or contextual information,
• Redundant phrases, unnecessary adverbs and adjectives, and repetitive information;
• Acronyms or abbreviations,
• References to other literature [say something like, "current research shows that..." or "studies have indicated..."],
• Using ellipticals [i.e., ending with "..."] or incomplete sentences,
• Jargon or terms that may be confusing to the reader,
• Citations to other works, and
• Any sort of image, illustration, figure, or table, or references to them.

Abstract. Writing Center. University of Kansas; Abstract. The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Abstracts. The Writing Center. University of North Carolina; Borko, Harold and Seymour Chatman. "Criteria for Acceptable Abstracts: A Survey of Abstracters' Instructions." American Documentation 14 (April 1963): 149-160; Abstracts. The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Hartley, James and Lucy Betts. "Common Weaknesses in Traditional Abstracts in the Social Sciences." Journal of the American Society for Information Science and Technology 60 (October 2009): 2010-2018; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-first Century. Oxford, UK: Chandos Publishing, 2010; Procter, Margaret. The Abstract. University College Writing Centre. University of Toronto; Riordan, Laura. “Mastering the Art of Abstracts.” The Journal of the American Osteopathic Association 115 (January 2015 ): 41-47; Writing Report Abstracts. The Writing Lab and The OWL. Purdue University; Writing Abstracts. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-First Century . Oxford, UK: 2010; Writing an Abstract for Your Research Paper. The Writing Center, University of Wisconsin, Madison.

Writing Tip

Never Cite Just the Abstract!

Citing to just a journal article's abstract does not confirm for the reader that you have conducted a thorough or reliable review of the literature. If the full-text is not available, go to the USC Libraries main page and enter the title of the article [NOT the title of the journal]. If the Libraries have a subscription to the journal, the article should appear with a link to the full-text or to the journal publisher page where you can get the article. If the article does not appear, try searching Google Scholar using the link on the USC Libraries main page. If you still can't find the article after doing this, contact a librarian or you can request it from our free i nterlibrary loan and document delivery service .

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• How to Write an Abstract

Expedite peer review, increase search-ability, and set the tone for your study

The abstract is your chance to let your readers know what they can expect from your article. Learn how to write a clear, and concise abstract that will keep your audience reading.

How your abstract impacts editorial evaluation and future readership

After the title , the abstract is the second-most-read part of your article. A good abstract can help to expedite peer review and, if your article is accepted for publication, it’s an important tool for readers to find and evaluate your work. Editors use your abstract when they first assess your article. Prospective reviewers see it when they decide whether to accept an invitation to review. Once published, the abstract gets indexed in PubMed and Google Scholar , as well as library systems and other popular databases. Like the title, your abstract influences keyword search results. Readers will use it to decide whether to read the rest of your article. Other researchers will use it to evaluate your work for inclusion in systematic reviews and meta-analysis. It should be a concise standalone piece that accurately represents your research. 

What to include in an abstract

The main challenge you’ll face when writing your abstract is keeping it concise AND fitting in all the information you need. Depending on your subject area the journal may require a structured abstract following specific headings. A structured abstract helps your readers understand your study more easily. If your journal doesn’t require a structured abstract it’s still a good idea to follow a similar format, just present the abstract as one paragraph without headings. 

Background or Introduction – What is currently known? Start with a brief, 2 or 3 sentence, introduction to the research area. 

Objectives or Aims – What is the study and why did you do it? Clearly state the research question you’re trying to answer.

Methods – What did you do? Explain what you did and how you did it. Include important information about your methods, but avoid the low-level specifics. Some disciplines have specific requirements for abstract methods. 

• CONSORT for randomized trials.
• STROBE for observational studies
• PRISMA for systematic reviews and meta-analyses

Results – What did you find? Briefly give the key findings of your study. Include key numeric data (including confidence intervals or p values), where possible.

Conclusions – What did you conclude? Tell the reader why your findings matter, and what this could mean for the ‘bigger picture’ of this area of research. 

Writing tips

The main challenge you may find when writing your abstract is keeping it concise AND convering all the information you need to.

• Keep it concise and to the point. Most journals have a maximum word count, so check guidelines before you write the abstract to save time editing it later.
• Write for your audience. Are they specialists in your specific field? Are they cross-disciplinary? Are they non-specialists? If you’re writing for a general audience, or your research could be of interest to the public keep your language as straightforward as possible. If you’re writing in English, do remember that not all of your readers will necessarily be native English speakers.
• Focus on key results, conclusions and take home messages.
• Write your paper first, then create the abstract as a summary.
• Check the journal requirements before you write your abstract, eg. required subheadings.
• Include keywords or phrases to help readers search for your work in indexing databases like PubMed or Google Scholar.
• Double and triple check your abstract for spelling and grammar errors. These kind of errors can give potential reviewers the impression that your research isn’t sound, and can make it easier to find reviewers who accept the invitation to review your manuscript. Your abstract should be a taste of what is to come in the rest of your article.

Don’t

• Sensationalize your research.
• Speculate about where this research might lead in the future.
• Use abbreviations or acronyms (unless absolutely necessary or unless they’re widely known, eg. DNA).
• Repeat yourself unnecessarily, eg. “Methods: We used X technique. Results: Using X technique, we found…”
• Contradict anything in the rest of your manuscript.
• Include content that isn’t also covered in the main manuscript.
• Include citations or references.

Tip: How to edit your work

Editing is challenging, especially if you are acting as both a writer and an editor. Read our guidelines for advice on how to refine your work, including useful tips for setting your intentions, re-review, and consultation with colleagues.

• How to Write a Great Title
• How to Write Your Methods
• How to Report Statistics
• How to Write Discussions and Conclusions
• How to Edit Your Work

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

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31 Writing Up Qualitative Research

Jane F. Gilgun, School of Social Work, University of Minnesota, Twin Cities

• Published: 04 August 2014
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This chapter provides guidelines for writing journal articles based on qualitative approaches. The guidelines are part of the tradition of the Chicago School of Sociology and the author’s experience as a writer and reviewer. The guidelines include understanding experiences in context, immersion, interpretations grounded in accounts of informants’ lived experiences, and research as action-oriented. The chapter also covers writing articles that report findings based on ethnographies, autoethnographies, performances, poetry, and photography and other graphic media.

How researchers write up results for journal publications depends on the purposes of the research and the methodologies they use. Some topics are standard, such as statements about methods and methodologies, but how to represent other topics, like related research and theory, reflexivity, and informants’ accounts, may vary. For example, articles based on ethnographic research may be structured differently from writing up research whose purpose is theory development. Journal editors and reviewers often are familiar with variations in style of write-ups, but, when they are not, they may ask for modifications that violate the methodological principles of the research. A common reviewer request is for percentages, which has little meaning in almost all forms of qualitative research because the purpose of the research is to identify patterns of meanings and not distributions of variables. For example, Irvine’s (2013) ethnography of the meanings of pets to homeless people shows a variety of meaning without giving the number of participants from which she drew.

Authors sometimes move easily through the review process, but most often they do not, not only because reviewers might not “get it,” but also because authors have left out, underemphasized, or been less than clear about aspects of their research that reviewers and editors believe are important. Working with editors and reviewers frequently results in improved articles.

The purpose of this chapter is to provide guidelines for writing journal articles based on qualitative approaches. My intended audience is composed of researchers, reviewers for journals, and journal editors. Reviewers for funding agencies may also find this chapter useful. I use the terms “journal article” and “research report” as synonyms, even though some journal articles are not reports of research. I have derived the guidelines from ideas associated with the Chicago School of Sociology and my experience as an author and reviewer. Although the Chicago School was, as Becker (1999) wrote, “open to various ways of doing sociology” (p. 10), the ideas in this chapter are part of the tradition, but they are not representative of the entire tradition. Furthermore, the ideas are not fixed but are open-ended because they evolve over time. I have followed the principles of the Chicago School of Sociology throughout my career, augmented by updates to these ideas, experiments with other traditions, and the sense I make of my own experiences as researcher, author, and reviewer.

The ideas on which I draw include understanding experiences in context, immersion, interpretations grounded in accounts of informants’ lived experiences, and research as action-oriented ( Bulmer, 1984 ; Faris, 1967 ; Gilgun, 1999 d ; 2005 a ; 2012 a ; 2013 b ). To follow these principles, researchers do in-depth studies that take into account the multiple contextual factors that influence meanings and interpretations, seek multiple points of view, and often use multiple methods such as interviews, observations, and document analysis. Researchers do this style of research not only because what they learn is interesting, but because they want to do useful research; that is, research that leads to social actions and even transformations in policies, programs, and interventions. Authors and reviewers pay attention to these principles. Authors convey them in their write-ups, and reviewers look for them as they develop their appraisals.

Excellent writing up of qualitative research matches these principles. In other words, write-ups convey lived experience within multiple contexts, multiple points of view, and analyses that deepen understandings. In addition, if the research is applied, then authors write about how findings may contribute to quality of life. Qualitative researchers from other traditions may follow similar or different guidelines in their write-ups, and I sometimes note other styles of write-ups. Often these variations are related to terminology and not procedures. The reach of the Chicago School of Sociology is wide and deep.

Following these guidelines does not guarantee an easy review process, but this article will be helpful to researchers as they plan and craft their articles and as they respond to reviewers’ and editors’ comments. After almost thirty years of publishing research based on qualitative approaches, almost as many years as a reviewer, and the editing of three collections of qualitative research reports ( Gilgun, Daly, & Handel, 1992 ; Gilgun & Sussman, 1996 : Gilgun & Sands, 2012 ), I am positioned to offer helpful guidelines, not only to authors but also to reviewers and journal editors.

I begin this chapter with a discussion of general principles and then cover the content of typical sections of research reports. Some of the general material fits into various sections of reports, such as methods and findings. In those cases, I do not repeat material already covered and assume that my writing is clear enough so that readers know how the general material fits into particular sections of articles.

Although most of this chapter addresses the writing of conventional research reports, I also cover writing articles that report findings through ethnographies, autoethnographies, performances, poetry, and photography and other graphic media. Ethnographies are based on researchers’ immersion in the field, where they do extensive observations, interviews, and often document analysis (see Block, 2012 ). Geertz’s (1973) notion of “thick description” is associated with ethnographies. Thick description is characterized by research reports that show the matrix of meanings that researchers identify and attempt to represent in their reports. Autoethnographies are in-depth reflective accounts of individual lives that the narrators themselves write ( Ellis, 2009 ). Ethnographies and autoethnographies involve reflections on meanings, contexts, and other wider influences on individual lives. They are studies of intersections of individual lives and wider cultural themes and practices. Reports of these types of research can look different from conventional research reports in that they appear less formal; the usual sections of methods, literature review, findings, and analysis may have different names; and the sections may be in places that fit the logical flow of the research and not the typical structure of introductory material, methods, results, and discussion. Despite these superficial differences, researchers who write these kinds of articles seek to deepen understandings and hope to move audiences to action through conveying lived experience in context and through multiple points of view. They also typically seek transformations of persons and societies. Links between these forms of research and Chicago School traditions are self-evident.

Some General Principles

Research reports that have these characteristics depend on the quality of the data on which the reports are based, the quality of the analysis, and the skills of researchers in conveying the analysis concisely and with “grab” ( Glaser, 1978 ), which means writing that is vivid and memorable ( Gilgun, 2005 b ). Grab brings findings to life. With grab, human experiences jump off the page. Priority is given to the voices of research participants, whom I call informants, with citations and the wisdom of other researchers providing important contextual information. The voices and analyses of researchers do not dominate ( Gilgun, 2005 c ), except in some articles whose purpose is theory development or the presentation of a theory. Researcher analyses often are important, especially in putting forth social action recommendations that stem from the experiences of informants.

A well-done report shows consistency between research traditions and the writing-up of research. For example, reflexivity statements, writing with grab, and copious excerpts from fieldnotes, interviews, and documents of various sorts are consistent with phenomenological approaches whose emphasis is on lived experience and interpretations that informants make of their experiences. Researchers new to qualitative research, however, often mix their traditions without realizing it, which works when the traditions are compatible. When the traditions are not compatible, the write-ups can be confusing and even contradictory ( Gilgun, 2005 d ). Some authors may write in distanced, third-person styles while attempting to convey informants’ lived experiences. These scholars may, therefore, have difficulty getting their articles accepted. Hopefully, this chapter will facilitate the writing of research reports that show consistency across their many parts and save scholars from rejections of work over which they have taken much care.

Details on These General Principles

In this section, I provide more detail on writing up qualitative research. I begin with a discussion of the need for high-quality data, high-quality analysis, and grab. I then move on to the details of the report, such as the place of prior research and theory, contents of methods sections, organization of findings, and the balance between descriptive material and authors’ interpretations. Dilemmas abound. Writing up qualitative research is not for the faint of heart.

High-Quality Data

Since qualitative researchers seek to understand the subjective experiences of research informants in various contexts, high-quality data result in large part from the degree that researchers practice immersion and to the degree that both researchers and informants develop rapport and engage with each other. Through active engagement, informants share their experiences with the kind of detail that brings their experiences to life. How to develop rapport is beyond the scope of this article, but openness and acceptance of whatever informants say are fundamental to engagement. Interviewers do not have to agree with the values that informants’ accounts convey, as when I interview murderers and rapists ( Gilgun, 2008 ), but we do maintain a neutrality that allows the dialogue to continue ( Gilgun & Anderson, 2013 ). The content of interviews is not about us and our preferences, but about understanding informants.

Prolonged engagement can result in quality data. In interview research, prolonged engagement allows for informants’ multiple perspectives to emerge, including inconsistencies, contradictions, ambiguities, and ambivalences. In addition, prolonged engagement facilitates the kind of trust needed for informants to share personal, sensitive information in detail, which are the kinds of data that qualitative researchers seek. Prolonged engagement also gives researchers time to reflect on what they are learning and experiencing through the interviews. This provides opportunities to develop new understandings and test new understandings through subsequent research. Their understandings thus deepen and broaden. Informants, too, can reflect, reconsider, and deepen the accounts they share.

Prolonged engagement means in-depth interviews, typically multiple interviews of more than an hour each. As mentioned earlier, time between interviews allows researchers and informants to reflect on the previous interview and prepare for the next. Researchers can do background reading, discuss emerging ideas with others, and formulate pertinent new questions. Informants may retrieve long-forgotten memories and interpretations through interviews. If they have only one interview, they have no opportunity to share with researchers the material that arises after the single interview is concluded.

There are exceptions to multiple interviews as necessary for immersion and high-quality data. When researchers have expertise in interviewing and when the topic is focused, one interview of between ninety minutes to two hours could provide some depth. Even under these conditions, however, more than one interview is ideal. I did a study that involved one ninety-minute interview with perpetrators of child sexual abuse in order to understand the circumstances under which their abusive behaviors became known to law enforcement. Thus, the interview was focused. The interviewees were volunteers who had talked about the topic many times in the course of their involvement in sex abuse treatment programs. They shared their stories with depth and breadth. I, too, was well-prepared. By then, I had had about twenty-five years of experience interviewing people about personal, sensitive topics. The informants provided accounts not only because the topic was focused, but because they were willing to share and I was willing to listen and to ask questions about their sexually abusive behaviors. With one interview, however, I knew relatively little about their social histories and general worldviews. Thus, I did not have the specifics necessary to place their accounts into context. The material they provided remained valuable and resulted in one publication ( Sharma & Gilgun, 2008 ) and others in planning stages. I prefer two or more interviews because of the importance of contextual data.

In observational studies, prolonged engagement means that researchers do multiple observations over time to obtain the nuances and details that compose human actions. Observational studies often have interview components and also may have document analysis as well. In document analysis, prolonged engagement means researchers base their analyses on an ample storehouse of documents and not just flit in and out of the documents. The quality of document analysis depends on whether the analysis shows multiple perspectives, patterns, and variations within patterns. Ethnographies have these characteristics. Block’s (2012) ethnographic research on AIDS orphans in Lesotho, Africa, is an example of a well-done ethnography.

Sample Size

In principle, the size of the sample and the depth of the interview affect whether researchers can claim immersion. The more depth and breadth each case in a study has, the smaller the sample size can be. For example, researchers can engage in immersion through a single in-depth case study when they do multiple interviews and if multiple facets of the case are examined. Case studies are investigations of single units. The case can be composed of an individual, a couple, a family, a group, a nation, or a region. Single case studies are useful in the illustration, development, and testing of theories, as well as in in-depth descriptions.

The more focused the questions, the larger the sample will be. A study on long-term marriage would require a minimum of two or three interviews because the topic is complicated. The sample would include at least ten participants and up to twenty or thirty, depending on the number of interviews, to account for some of the many patterns that are likely to emerge in a study of a topic this complex. In the one-interview study I did of how sexual abuse came to the notice of law enforcement, one interview was adequate because of the tight focus of the question. Yet, I used a sample size of thirty-two to maximize the possibility of identifying a variety of patterns, which the study accomplished. As mentioned, the one interview, however, did not allow me to contextualize the stories the informants told. Fortunately, I have another large sample that involved multiple, in-depth interviews in which informants discussed multiple contexts over time. This other study was helpful to me in understanding the accounts from the single-interview study.

Recruitment can be difficult. When it is, researchers may not be able to obtain an adequate sample. For example, a sample of seven participants engaging in a single sixty- to ninety-minute interview may not provide enough data on which to base a credible analysis. In a similar vein, articles based on a single or even a few focus groups may not provide enough depth to be informative. Some depth is possible if, in a single-interview study of less than fifteen or twenty interviewees, researchers meet with informants a second time to go over what researchers understand about informants’ accounts. This sometimes is called member-checking , and it provides additional data on which to base the analysis. In summary, the more depth and breadth to a study, the smaller the sample size can be—even as small as one or two—depending on the questions and the complexity of the cases.

Quality of the Analysis

A quality analysis begins with initial planning of the research and continues until the article is accepted for publication. An excellent research report has transparency , meaning the write-up is clear in what researchers did, how they did it, and why. I often tell students they can do almost anything reasonable and ethical, as long as they make a clear account in the write-up.

During planning, some researchers identify those concepts that they can use as sensitizing concepts once in the field. Transparency about the sources of sensitizing concepts characterizes well-done reports. The sources are literature reviews and reflexivity statements. Most researchers, however, have only a limited awareness of the importance of being clear about the sources of sensitizing concepts and other notions that become part of research coding schemes. Sensitizing concepts are notions that researchers identify before beginning their research and that help researchers notice and name social processes that they might not have noticed otherwise ( Blumer, 1986 ). Other researchers wait until data analysis to begin to identify concepts that they may use as codes and that may also become core concepts that organize findings. Either approach is acceptable and depends on purpose and methodologies.

During data collection, researchers reflect on what they are learning, typically talk to other researchers about their emerging understandings, and read relevant research and theory to enlarge and deepen their understandings. Researchers also keep fieldnotes that are a form of reflection. Based on their various reflections, researchers can reformulate interview and research questions and formulate new ones, do within—and across—case comparisons while in the field, and develop new insights into the meanings of the material.

Also, while in the field, researchers identify promising patterns of meanings and identify tentative core concepts, sometimes called categories , which are ideas that organize the copious material that they amass. Once researchers identify tentative core concepts, they seek to test whether they hold up, and, when they do, they further develop the patterns and concepts. Sometimes researchers think they have “struck gold” when they identify a possible core concept or pattern, only to find that the data—or metaphorical vein of gold—peter out (Phyllis Stern, personal communication, November 2002). They then go on to identify and follow-up on other concepts and patterns that show promise of becoming viable.

Core concepts become viable when researchers are able to dimensionalize them ( Schatzman, 1991 ) through selective coding ( Corbin & Strauss, 2008 ). This means that researchers have found data that show the multiple facets of concepts, such as patterns and exceptions to any general patterns. Authors may use other terms to describe what they did, such as thematic analysis. What is important is to describe the processes and produces; and what researchers call them is of less importance.

Core concepts may begin as sensitizing concepts. Researchers sometimes identify, name, and code core concepts through notions that are part of their general stores of knowledge but were not part of the literature review or reflexivity statement. Glaser (1978) called the practice “theoretical sensitivity.” The names researchers choose may be words or phrases informants have used. However derived, core concepts are central to the organization of findings ( Gilgun, 2012 a ).

At some point, data collection stops, but analysis does not. Researchers carry analysis that occurred in the field into the next phases of the research. Immersion at this point means that researchers read and code transcripts of interviews, observations, and any documentary material they find useful. They carry forward the core concepts they identified in the field. An example of a core concept is “resilience,” which in my own research organized a great deal of interview material. The concept of resilience has been an organizing idea in several of the articles I have written and plan to write ( Gilgun, 1996 a ; 1996 b ; 2002 a ; 2002 b ; 2004 a ; 2004 b ; 2005 a ; 2006 , 2008 ; 2010 ; Gilgun & Abrams, 2005 ; Gilgun, Keskinen, Marti, & Rice, 1999 ; Gilgun, Klein, & Pranis, 2000 ).

Corbin and Strauss (2008) stated that selective coding helps researchers to decide if a concept can become a core concept, meaning it organizes a great deal of data that have multiple dimensions. An example of dimensionalization is a study of social workers in Australia whose clients were Aboriginal people. The researchers identified several core concepts, among them critical self-awareness ( Bennet, Zubrzycki, & Bacon, 2011 ). The dimensions of critical self-awareness included understanding motivations to work with Aboriginal people, fears of working with Aboriginal people, and personalization and internalization of the anger that some Aboriginal people express.

Like many other researchers, Bennet et al. (2011) were not working within an explicit Chicago School tradition. They therefore do not use terms such as core concepts, dimensionalization, and selective coding. Instead, they described their procedures as thematic analysis, conceptual mapping, and a search for meaning. However, they did use the term “saturation,” which is part of the Chicago School tradition.

A single core concept or multiple related core concepts compose research reports. The Bennet et al. (2011) article, for example, linked multiple core concepts. The authors showed how critical self-awareness leads to meaningful relationships that in turn connect to “acquiring Aboriginal knowledge” (p. 30).

With viable core concepts and rich data, researchers are positioned to present their findings in ways that are memorable and interesting; that is, with “grab” ( Glaser, 1978 ). “Grab” requires compelling descriptive material: excerpts from interviews, field notes, and various types of documents, as well as researchers’ paraphrases of these materials. An example of a research report with grab is Irvine’s (2013) account of her study of the meanings of pets to homeless people. She provided vivid descriptions of her interactions with the participants and compelling quotes that show what pets mean. Here, an example from Denise’s account of her relationship with her cat Ivy:

I have a history with depression up to suicide ideation, and Ivy, I refer to her as my suicide barrier. And I don’t say that in any light way. I would say, most days, she’s the reason why I keep going.... She is the only source of daily, steady affection and companionship that I have. (p. 19)

These and other quotes, as well as Irvine’s well-written, detailed descriptive material, show what grab means.

Grab equates with excellence in writing. Irvine’s (2013) article is an example. In terms of the grab of her article, her work is in the Chicago School tradition. She wrote in the first person. She told complete stories in which she quoted extensively from the interviews, described the persons she interviewed and the settings in which she interviewed them, and provided biographical sketches. Robert Park and Ernest Burgess, both of whom trained generations of graduate students in qualitative research at the University of Chicago in the first quarter of the twentieth century, held seminars on the use of literary techniques, such as those used in novels and autobiographies, in writing up research ( Bulmer, 1984 ; Gilgun, 1999 d ; 2012 a ). These educators wanted researchers to report on their “first-hand observation.” Park told a class of graduate students to

[g]o and sit in the lounges of the luxury hotels and on the doorsteps of the flophouses; sit on the Gold Coast settees and on the slum shakedowns; sit in the Orchestra Hall and in the Star and Garter Burlesk. In short, gentlemen [sic], go get the seat of your pants dirty. ( McKinney, 1966 , p. 71)

Park suggested to Pauline Young (1928 ; 1932) to “think and feel” like the residents of Russian Town, the subject of her dissertation, published in 1932 ( Faris, 1967 ). Irvine’s work shows these qualities. She immersed herself in the settings, she conducted in-depth interviews, and she conveyed her first-hand experiences in vivid terms.

The Chicago School also encouraged students to write in the first person. A good example is a report by Dollard (1937) , who was concerned about the racial practices of the Southern town where he was doing fieldwork. He said he was afraid that other white people watched as he talked to “Negroes” on his front porch, when he knew that custom regarding the “proper” place of “Negroes” was at the back door. He wrote

My Negro friend brought still another Negro up on the porch to meet me. Should we shake hands? Would he be insulted if I did not, or would he accept the situation? I kept my hands in pockets and did not do it, a device that was often useful in resolving such a situation. (p. 7)

This description is a portrait of a pivotal moment in Dollard’s fieldwork, and it is full of connotations about the racist practices of the time ( Gilgun, 1999 d ; 2012 a ).

Irvine (2013) also wrote in the first person. Here’s an example:

I met Trish on a cold December day in Boulder. She stood on the median at the exit of a busy shopping center with her Jack Russell Terrier bundled up in a dog bed beside her. She was “flying a sign,” or panhandling, with a piece of cardboard neatly lettered in black marker to read, “Sober. Doing the best I can. Please help.” (p. 14)

These two excerpts illustrate a methodological point Small (1916) made in his chapter on the first fifty years of sociological research in the United States: namely, the importance of going beyond “technical treatises” and providing first-person “frank judgments” that can help future generations interpret sociology. Without such contexts, “the historical significance of treatises will be misunderstood” (p. 722). Throughout his chapter, Small wrote in the first-person and provided his views—or frank judgments—on the events he narrated. From then until now, research reports in the Chicago tradition are vivid and contextual, conveying to the extent possible what it was like to be persons in situations.

There are many other examples of well-done research reports. Eck’s (2013) article on never-married men includes the basic elements that are present in almost all reports based on qualitative methods. It is transparent in its procedures, situated within scholarly traditions, well-organized, vivid, and instructive both for those new to qualitative research and for long-term researchers like me. The other articles I cite in this chapter also show many desirable qualities in research reports.

Research Report Sections

The main sections of standard reports based on qualitative methods are the same as for articles based on other types of methods: Introduction, Methods, Findings, and Discussion. The American Psychological Association (APA) manual (2009) provides information on what goes into each of these sections. Research reports in sociology journals follow a similar format, although the citation style is slightly different. The American Sociological Association uses first and last names in the reference section, a practice I support. In articles based on qualitative approaches, researchers sometimes change the names of sections, add or omit some, or reorder them. When changes are made, the general guideline is whether the changes make sense and are consistent with the purpose of the research. As Saldaña (2003) pointed out, researchers choose how to present their findings on the basis of credibility, vividness, and persuasive qualities and not for the sake of novelty. Because some articles report findings as fictionalized accounts, poetry, plays, songs, and performances (including plays), it makes sense that the sections on these findings vary from the standard format that I discuss here.

Although there are no rigid rules about how to write journal articles based on qualitative research, much depends on the methodological perspectives, purposes of the research, and the editorial guidelines of particular journals. For example, if researchers want to develop a theory, it is important to be clear from the beginning of the article to state this as the purpose of the research. The entire article should then focus on how the authors developed the theory. Research and theory cited in the literature review should have direct relevance to the substantive area on which the authors theorized. The methods section should explain what the researchers did to develop the theory. The findings section should begin with a statement of the theory that the researchers developed. The rest of the findings section should usually be composed of three parts. The first is composed of excerpts from those data that support the concepts of the theory. This is the grounding of the theory in something clear and concrete. The second is the authors’ thinking or interpretation of the meanings of each of the concepts. The third is an analysis of how the theory contributes to what is already known, such as how the findings elaborate on and call into question what is known. Thus, a research report on the development of a theory should contain a lot of scholarship that others have developed.

A report based on narrative principles or one based on an ethnography should contain copious excerpts from interviews, citing less scholarship than an article whose purpose is to develop theory. However, it is good practice to bring in related research and theory in the results section when this literature helps in interpretation, when findings have connections to other bodies of thought, and when findings are facets of a larger issue. In my now older publication on incest perpetrators ( Gilgun, 1995 ), the editors suggested that I show that when therapists engage in sexual relationships with clients, they are engaging in abuses of power similar to those of incest perpetrators. I was at first indignant that the editors wanted me to do even more work on the article, but I soon was glad they did. It is important to show that incest or any human phenomenon is not isolated from other phenomenon but is part of a larger picture. Doing so fit my purposes, which was to show how to do theory-testing/theory-guided qualitative research. Showing how findings fit into related research and theory is part of this type of research.

Whenever researchers are ready to submit an article for publication, it is wise to read recent issues of journals in which they would like to publish. If they can identify an article whose structure, methodologies, and general purpose are similar to theirs, they could study how those authors presented their material. If, for example, in a report on narrative research, the introductory material is relatively brief, and the findings and discussion sections compose most of the pages, researchers would do well to format their articles in similar ways. I study journals in which I have interest and model much of my own articles after those published in these journals. I make sure, however, that I cover topics that in my judgment are important to cover.

Prior Research and Theory

In my experience, something as simple as the place of prior research and theory can get complicated in the writing of reports based on qualitative research, even when the purpose of the article is primarily descriptive and is not to construct an explicit theory. In general, related research and theory literature can be presented at the beginning of a report as part of a review of pertinent research and theory, in the findings section when prior work helps in the interpretation and analysis of findings, or in the discussion section, where authors may reflect on how their findings add to, undermine, or correct what is known and even add something new.

Readers expect and journal editors typically want articles to begin with literature review, with some exceptions. A perusal of journals that publish qualitative studies shows this. Yet there are exceptions. Valásquez (2011) began her report on her encounter with scientology with an extended and rather meandering first-person narrative. Her literature review began toward the end of the article. She tailored the review to the report that preceded it. In this article and others, the literature review helped in the interpretation of findings and helped to situate the report in its scholarly contexts. In other articles, the literature review appears in the introductory section. This sets the scholarly context of the research, highlights the significance of topics, and identifies gaps in knowledge. Neither authors nor reviewers should have rigid expectations about where the scholarship of others belongs. It belongs where it makes the most sense and has the most impact.

For many, the placement of literature reviews seems self-evident. Yet, some well-known approaches, such as grounded theory, can set authors up for confusion about where the literature review belongs. This can result in delays in writing up their results. The procedures of grounded theory are open-ended and designed to find new aspects of phenomena—often underresearched—and then develop theories from the findings. At the outset of their work, researchers cannot anticipate what they will find. Therefore, teachers such as Strauss and Glaser advised students not to do literature reviews until they had identified basic social processes that become the focus of the research ( Covan, 2007 ; Glaser & Strauss, 1967 ).

How, then, do researchers write up research reports when they are doing an open-ended study that, by definition, will culminate in unanticipated findings? Do they write their reports as records on how they proceeded chronologically, or do they follow APA style and the dominant tradition that says the literature review comes first? For the most part, I follow the tradition, as, apparently, do most researchers. However, to structure reports in this way sometimes feels strained and artificial. I would prefer to write a more chronological account, in which I can share with readers the lines of inquiry and procedures I followed. The literature review at the beginning of the report, therefore, would be brief. The methods section is quite detailed in how I went about developing the theory. The findings section would have the three-part format I discussed earlier: statement of the theory, presentations of excerpts that support assertions that certain concepts compose the theory, my interpretation of the meanings of the concepts and the excerpts that support them, and then the use of related research and theory to further develop the theory and to situate it in its scholarly traditions.

In all but one of the research reports that I have published, I did the literature after I had identified findings. The one exception was research I did based on the method of analytic induction, in which researchers can use literature reviews to focus their research from the outset ( Gilgun, 1995 , 2007 ). In this research, I used concepts from theories on justice and care to analyze transcripts of interviews I had previously conducted on how perpetrators view child sexual abuse. Even though I was familiar with the transcripts, I found that the concepts of justice and care and their definitions sensitized me to see things in the material that I had not noticed as I did data collection and during previous analyses of the data.

Furthermore, in writing up the results, I brought in research that was not part of the literature review to help me to interpret findings and to show how findings fit with and added to what was already known. I did not place this material in the introductory literature review. Placing related research and theory as parts of the results and discussion sections is common and may be necessary in articles that are reporting on a theory that the authors developed. For descriptive studies whose purpose is not theory-building, such as ethnographies, some findings sections include the addition of research and theory not present in the introductory section. Often, however, authors do not follow this pattern. An example is found in Ahmed (2013) , who described how migrants experience settling into a new country. She presents excerpts from interviews and her interpretation of them, including organizing them into a typology, but she does not bring additional research and theory into her interpretations.

Tensions can arise between how much space to give to literature reviews and how much to allot to presentation of informants’ accounts/findings ( Gilgun, 2005 c ). This happened in the most recent article I co-wrote, which is on mothers’ perspectives on the signs of child sexual abuse ( Gilgun & Anderson, 2013 ). We believed the literature review was important because it not only set up our research but summarized a great deal of information that was important to our intended audience of social service professionals. We also wanted to anticipate the expectations of reviewers and the journal editor. Yet, we put much effort into making the literature review as concise as possible in order to have reasonable space for findings. We wrote the literature review before we did data analysis. When we wrote up the results, the first draft was probably three times longer than any journal article could be.

We had written case studies first to be sure that we understood each case in detail. We had wanted to share what the women said in the kind of detail that had helped us deepen our own understandings, so we cut back on the case material. The article was still too long. We decided to exclude the few instances we had in which women knew of the abuse but tried to handle it themselves or did not believe the children when told. We did more summarizing of the literature review. We eliminated many references.

After much effort, we finally had a manuscript that was the required length of twenty-two pages. It included a literature review that set up the research in good form, an adequate accounting of the method, and findings that conveyed with grab the complexities of the signs and lack of signs of child sexual abuse. We wove points made in the literature review into our interpretations, yet we had to leave out important patterns for the sake of space. The editor’s decision was a revise and resubmit, which we did. The main recommendation was to elaborate on applications. This was a great suggestion, and we dug deep to think about this. We are pleased with the results. We had to do further reading on topics we had not anticipated at the onset of our project, and we squeezed in a few new citations in the discussion section that related to implications of the research. This additional material greatly enhanced the meanings and usefulness of the research.

There is much more to say about qualitative research and literature reviews. Sometimes researchers get stuck, as I have more than once. I have research that I have not yet published because I have been unable to figure out how to do the multiple literature reviews I think I must show how my theory builds on, adds to, and challenges what is already known. I have written up this research as conference papers, where expectations about literature reviews are more relaxed ( Gilgun, 1996c , 1998 , 1999c , 2000 ). One of these. papers was on a comprehensive theory of interpersonal violence ( Gilgun, 2000 ). I wanted to write my theory first and then show how the findings contribute to what is already known. Doing so doesn’t seem so outlandish today, and I now can imagine writing it up exactly as I would want to. At the same time, I wonder if I would? I really don’t know if any journal that would publish a theory of violence would also accept an article that places a literature review after findings. Furthermore, my writing up of the theory would take so many pages that I would not have enough space to do a comprehensive literature review. As of today, the theory I am developing has links to sixteen or more bodies of literature. No way can I publish a journal-length article that will accommodate that much research and theory!

So, here I am, many years into the development of a comprehensive theory, still reflecting on how to create journal articles out of my analysis. I have published many articles in social media outlets exploring ideas that are the basis for the theory. I have put these articles into collections that are available on the internet ( Gilgun, 2012 b ; 2012 c ; 2013 a ). The theory is so complex that writing bits and pieces over the years and having a place to put them have been very helpful.

Finally, some articles may cite few if any related research and theory. This may fit articles whose purpose is to convey lived experience that stands on its own. These articles feature performances, plays, autoethnographies, fictionalized accounts, poetry, and song, among others. Egbe (2013) wrote two poems that she explained were accounts of her experiences of doing research in Nigeria with young smokers. She said she was “dazed by the vast opportunity this method gives a researcher to dig deep into a research problem and be submerged into the world of participants” (p. 353). Her two-page article is composed of two poems and her explanation. The article showed grab, evidence of immersion, experiences in contexts, and multiple perspectives. Her work, therefore, followed well-established guidelines for writing up qualitative research. Egbe not only omitted a literature review, but she did not write about how to use the results of her research, assuming that its uses are self-evident. Obviously, she thought a literature review unnecessary; the reviewers and journal editors agreed with her.

Reflexivity Statements

A growing number of journals encourage researchers to include reflexivity statements in research reports. Researchers may place these in the introductory material of an article, after the literature review and before the methods section; this probably is the most important place to put them because reflexivity statements often influence the focus and design of the research, including the choice of sensitizing concepts and codes. Reflexivity statements may also appear in the methods and findings and methods sections when important. Reflexivity statements are accounts of researchers’ experiences with the topic of research; accounts of their expectations regarding informant issues and their relationships to informants, especially in regard to power differentials and other ethical concerns; and accounts of their reflections on various issues related to possible experiences that informants may have had. They also may include the experience they had while participating in the research ( D’Cruz, Gillingham, & Melendez, 2007 ; Presser, 2005 ). My article on doing research on violence is an extended reflexivity statement ( Gilgun, 2008 ). There appears to be no standard content for reflexivity statements and no standard places for them to appear. Personal and professional experiences and reflections on power differentials may be the emergent standard. Whatever decisions researchers make about reflexivity statements, they alert audiences to researchers’ perspectives, which can be helpful to readers as they attempt to make sense of research reports.

An example of a reflexivity statement is found in Winter (2010) work. Winter is a practitioner turned researcher who had a previous relationship as a guardian ad litem with the children with whom she later conducted the research that she was reporting. Winter was reflexive about the implications of her prior relationship with these children. I imagine, based on my own experience, that she put only a fraction of her thinking into her article. Not only did she write in her reflexivity statement that she had a prior relationship with the children, but she also wrote about the ethical issues involved.

Ethical issues have a place in reflexivity statements. I have run into ethical questions over the course of my research career. One situation that stands out is the encounter I had with a mother and her eleven-year-old daughter who had participated in my dissertation research on child sexual abuse ( Gilgun, 1983 ). The mother cried and told her daughter how sorry she was that she had been unable to protect her from sexual abuse. The girl was touched but did not seem to know what to do. I suggested that she go stand by her mother. When she got close, the mother and daughter hugged each other and cried. This is a significant event with ethical implications that I included in the findings section of my dissertation and in a subsequent research report ( Gilgun, 1984 ). The ethical issue is, first, whether I should have stepped out of my role as detached researcher and guided the girl to go to her mother, and, second, whether I should have made my blurring of boundaries public by publishing them.

As far as the placement of reflexivity statements, the initial statement has a logical location after the literature review because the reflexivity statement contributes to the development of the research questions, the identification of sensitizing concepts, the interview schedule, and the overall design of research procedures. Accounts of ongoing reflexivity could be part the findings section and of the discussion section. Reflexivity statements are not a standard part of research reports, but they can contribute to readers’ understandings of the research.

Along with the literature review, reflexivity statements contribute to practical and applied significance statements and may also help to identify gaps in knowledge. Literature reviews and reflexivity statements contain key concepts. The concepts that researchers define at the end of introductory sections typically become codes during analysis, although researchers may not label the concepts as codes either in the introductory section or in the methods section. I am unsure why such labeling has not become routine. When concepts carry the label code , this clarifies where codes come from. Without naming codes and stating where they come from, much of analysis is mystified. Many reports read as if the codes appear out of nowhere during analysis. Even Glaser’s (1978) notion of theoretical sensitivity mystifies the origins of codes. How, for example, do researchers become theoretically sensitive? What if researchers are beginning their scholarly careers? How theoretically sensitive are they ( Covan, 2007 )? What are the implications for the quality of the analysis?

Research Questions, Hypotheses, and Definitions

The final part of the introductory section of a research report is devoted to research questions, hypotheses to be tested (if any), and definitions of core concepts. In general, in qualitative research, hypotheses are statements of relationships between concepts. Theories usually are composed of two or more hypotheses, although, at times, some researchers may use the term theory to designate a single hypothesis ( Gilgun, 2005 b ). Concepts are extractions from concrete data. Sometimes concepts are called second-order concepts and data first-order concepts .

Research questions may be absent. In their place are purpose statements that make the focus of the report clear. Hypotheses are rarely present in qualitative research. When they are, the purpose of the research is to test them and typically to develop them more fully. This type of research has in the past been called analytic induction ( Gilgun, 1995 e), whereas a more up-to-date version of qualitative hypothesis testing and theory-guided research is called deductive qualitative analysis ( Gilgun, 2005 d ; 2013 ). Analytic induction and deductive qualitative analysis are part of the Chicago School tradition.

Methods Section

Most methods sections for reports based on qualitative approaches have the same elements as any other research report. Descriptions of the sample, recruitment, interview schedule, and plans for data analysis are standard. The APA manual provides guidelines ( American Psychological Association, 2009 ) that fit many types of qualitative research reports. However, reports based on autoethnographies, poetry, and performances may have brief or no methods sections. As is clear by now, the report’s contents depend on the purposes and methodologies of the research and on the editorial requirements of journals.

Accounts of Methodologies

In writing up qualitative research, methods sections usually contain a brief overview of the research methodology, which is the set of principles that guided the research. The following is an account of the methodology used in a research report on cancer treatment in India:

For this project we drew upon interpretive traditions within qualitative research. This involved us taking an in-depth exploratory approach to data collection, aimed at documenting the subjective and complex experiences of the respondents. Our aim was to achieve a detailed understanding of the varying positions adhered to, and to locate those within a broader spectrum underlying beliefs and/or agendas. ( Broom & Doron, 2013 , p. 57)

Sometimes, statements of methodology are much more elaborate, but in research reports, such a statement is sufficient, again depending on the editorial policies of particular journals. A few citations, which this article had, round out an adequate statement of methodology.

However, many reports are written in a clear and straightforward way with scant or no account of methodologies. Examples are the work of Eck (2013) and Spermon, Darlington, and Gibney (2013) . These kinds of well-done write-ups might eventually be considered generic. Spermon et al. said their study was phenomenological, which sets up assumptions that the report will be primarily descriptive. In actuality, the intent was to develop theory. Such mixing of methodologies may be the wave of the future; in many ways, distinctions between phenomenological studies whose purposes are descriptive and those whose purposes are to build theory are blurred. Such blurring may have been the case for decades because it is possible and often desirable to build theories based on phenomenological perspectives; that is, in-depth descriptions of lived experience. However, authors are wise to state in one place what their methodologies are and how they put them to use, such as for descriptive purposes or for theory-building.

Description of Sample

Placing descriptions of sample size and the demographics of the sample in the methods sections is typical. As mentioned earlier, evaluation of sample size depends on the depth and breadth of the study. The more depth a study has, the smaller the number of cases can be. The more breadth and the sharper the focus, the larger sample sizes typically are. Samples on which a study is based must provide enough material on which to base a credible article. A sample size of one may be adequate if researchers show their work demonstrates the basic principles of almost all forms of qualitative research: perspectives of persons who participate in the research, researcher immersion into the settings or the life stories of persons interviewed, multiple perspectives, contextual information of various types, and applications. Autoethnographies often have an n of one, but joint autoethnographies are possible. Ethnographies may not give a sample size, as was the case in the performance ethnography of Valásquez (2011) who wrote in the first person about her experience with scientology. In her first-person ethnography, Irvine (2013) also did not mention sample size. She said that the narratives she used for the article were from a larger study on the meanings of animals to people who have no homes. She did not describe the usual demographics of age, gender, social class, and ethnicity.

Most articles describe the demographics of the sample. In a recently accepted article ( Gilgun & Anderson, 2013 ), I saw no relevance in mentioning the size of the larger sample from which we drew in order to tell the stories of how mothers responded to their learning that their husbands or life partners had sexually abused their children. We included an exact count of the larger sample because we assumed that it would be the journal’s expectations. We also gave particulars of the demographics. Except for social class and ethnicity, we saw little relevance for the other descriptors. These status variables were relevant to us because most of the sample was white and middle or upper class. This is important because much research on child sexual abuse is done with poor people, and there are stereotypes that poor families and families of color are more likely to experience incest than are white middle and upper class families. Overall, as with some other issues related to writing, the adequacy of the sample description depends on the methodological principles of the research and the journal’s editorial policies.

Recruitment

Accounts of recruitment procedures are important because researchers want to show that their work is ethical. Respect for the autonomy or freedom of choice of participants needs to be demonstrated. In addition, often the persons in whose lives we are interested have vulnerabilities. To show that the research procedures have not exploited these vulnerabilities is part of ethical considerations. Most articles have these accounts. Furthermore, when there are accounts of recruitment procedures, it becomes obvious why the sample is not randomly selected. Irvine’s (2013) account of recruitment is exemplary. She recruited through veterinary clinics that took care of the pets of homeless persons. She did not approach potential participants herself. Doing so risked making refusals difficult. The staff informed persons of the research and its purposes. If individuals said they were interested, they gave permission for the staff to give their names to researchers. The research interviews took place in the clinics.

The ethics of recruitment revolve around values, such as respect for autonomy, dignity, and worth. Other ethical issues that are important to mention in reports include the use of incentives for participation. Although many human subjects committees now require monetary incentives for participation, this has ethical implications. Irvine (2013) solved this by giving gift cards after the interviews were completed. Reports on ethical issues have a place in methods sections.

Data Collection and Analysis

Accounts of data collection and analysis are part of the methods section. Data collection procedures should be detailed for many reasons. Primary among them is the need for transparency in terms of the ethical standards the researchers followed, as well as the need to allow for replication of the study. Such details also provide guidelines for others who might be interested in using the methods. In addition, there are many different schools of thought and procedures for each of the methods used with the three general types of data collection: interviews, observations, and documents. It is helpful to state which particular data collection procedures the researchers used. Researchers often provide examples of the kinds of questions asked and procedures used for recording observations and excerpts from documents. Some researchers may omit such an accounting, as with some autoethnographies and articles that turn research material into performances.

How researchers analyzed data is part of the methods sections. As with data collection, there are so many types of analysis that researchers need to describe the particular forms that they used. For figuring out how to report on data analysis, researchers would do well to study articles in journals in which they want to publish. Irvine (2013) used a method of analysis I have never heard of called “personal narrative analysis” (p. 8). She gave enough detail to provide the general idea of what she did and a sufficient number of citations for additional information.

The level of detail can vary. In some sociology journals, for example, researchers may say little about analysis and sometimes little about data collection. This is because the journal editors, reviewers, and those who publish in and read the articles have assumptions that they for the most part take for granted. Even in these journals, however, researchers may want to account for their analytic procedures, especially if they are writing on topics outside of what is usual in such journals.

Other journals require a great deal of detail. In those instances, researchers first decide what they think is essential and then shape their accounts to fit what appears to be usual practice in the journal. The following paragraphs describe data analysis in a recently accepted article on signs of child sexual abuse in families ( Gilgun & Anderson, 2013 ).

Data Analysis

In the analysis of data, the first author read the transcripts multiple times and coded them for instances related to disclosures of child sexual abuse and associated signs of the abuse, such as how and when the women first learned of the abuse or suspected it was occurring in their families, their responses, and their reflections on the signs of abuse they might have missed, as well as child and perpetrator behaviors that they did not realize were related to child sexual abuse. Their initial and longer term responses and reflections were also coded. The second author independently read and coded about one-third of the transcripts using this coding scheme to arrive at a 100 percent agreement.

Sources of the codes were our professional experiences in the area of child sexual abuse, the review of research, and the first author’s familiarity with the content of the interviews because she had been the interviewer. These codes served as sensitizing concepts, which, as Blumer (1986) explained, are ideas that guide researchers to see aspects of phenomena that they might otherwise not notice. Although altering researchers’ ideas to what might be significant serves an obvious useful purpose, sensitizing concepts might also may blind researchers to other aspects of phenomena that might be important. Therefore, we also used negative case analysis, which is a procedure that guides researchers to look for aspects of phenomena that contradict or do not fit with emerging understandings. In this way, researchers are positioned to see patterns, variations within patterns, exceptions, and contradictions in findings ( Becker et al., 1961 ; Bogdan & Biklen, 2007 ; Cressey, 1953 ; Lindesmith, 1947 ).

As we wrote this section, we were aware of the limited space that we had to fill. Yet we were committed to accounting for where our codes came from for reviewers and editors who may be unfamiliar with pre-established codes. As discussed earlier, many reports are written as if codes appear by magic. We decided that, in this report, we would be as clear as possible about where our codes came from. We also reasoned that we would have to call on the authority of well-respected methodologists if reviewers and editors had questions about what we had done. Furthermore, we were aware of the dated nature of the references; we could do nothing about that because there has not been much written recently about pre-established codes. I have written about this quite a bit, but as one of the authors, I not only had to be anonymous during the review process, but I could not be the sole authority.

Generalizability

Many reviewers and editors have questions about the generalizability of the results of qualitative research. Authors themselves sometimes question the generalizability of their own findings. That’s why it remains important to provide clear guidelines in research reports about how the authors view the usefulness of their findings. The following ideas may be helpful to authors as they write their reports and to reviewers who are positioned as gatekeepers. The results of qualitative research are not meant to be generalized in a probabilistic sense. But because dropouts and refusals limit the randomness of samples, most forms of research can’t be generalized in a probabilistic sense.

Conversely, as Cronbach (1975) wrote almost forty years ago, the results of any form of research are working hypotheses that must be tested in local settings. Thus, the applicability of qualitative or any other kind of research can be demonstrated only through attempts at application. Do the findings illuminate other situations? Do the results provide researchers, policy makers, and direct practitioners with ideas on how to proceed? Those who apply the research expect to have to adjust findings to fit particular new situations. Many researchers and some journal editors and reviewers know through common sense and everyday experience how to use the results of qualitative research. Our personal lives are extended case studies. What we learn in one situation, we carry over into another. We know we have to test what we have learned in past situations for fit with new situations. If we do not, we impose our ideas on situations that may demand new perspectives. This common practice of applying results to all situations is disrespectful of local conditions and autonomy of persons. We want to avoid such disrespect in how we suggest readers use the results of our research.

Trustworthiness and Authenticity

Pointing out the trustworthiness of procedures and the findings that result from them sometimes are parts of methods sections. Related to trustworthiness are issues of authenticity ( Guba & Lincoln, 2005 ). Both trustworthiness and authenticity arise from immersion, seeking to understand the perspectives of others in context, reflexivity, and seeking multiple points of view. Researchers who have applied these principles will produce reports that are trustworthy and authentic. In addition, the reports will have grab. Extended discussions related to these issues are beyond the scope of this chapter and the scope of research reports as well.

I get more requests for revisions of methods sections, especially for accounts of data collection and analysis, than for any other parts of a manuscript. This is not surprising, given the multiple possible variations. I never know who the reviewers will be and what their expectations are. I rely first on my beliefs about what I want in the procedures section and then I study articles the journal has already publishes. I include what journal editors appear to expect, but I also add information that I think is important, even when it is not part of what I see in methods sections.

Findings Sections

Findings sections in research reports include both descriptive and conceptual material. Descriptive material is composed of researchers’ paraphrasing and summarizing of what they found and excerpts from interviews, fieldnotes, and documents. The descriptive material, at its best, is detailed and lively; it not only is informative, it has grab. This material contributes to understandings of human experiences in context. In addition, descriptive material is the basis of researchers’ theorizing and it also provides documentation and illustrations of assertions that researchers make.

Conceptual material comprises the analysis and is made up of inferences such as the general statements, concepts, and hypotheses that researchers develop from the material (data). One way to think about the relationship between descriptive and conceptual material is to think of descriptive material as composed of first-order concepts and conceptual material as composed of second-order concepts. Each type depends on the other. Credible conceptual material is based on descriptive material, some of which is contained in the article. Qualitative research yields mountains of data, a fraction of which can be placed into a published article.

As with other sections of research reports, findings sections have many possible variations that depend on the purpose of the research and the methodologies on which the research is based. Thus, the findings can range from heavily descriptive to heavily conceptual. Heavily conceptual research reports arise from research whose purpose is theoretical, in which researchers set out to test, refine, reformulate, or develop theory. Theoretical reports require some descriptive material to show the basis of theoretical statements, but they are often relatively short on descriptive material.

Reports that are primarily descriptive are composed of excerpts from data. Theoretical material appears in often subtle ways, such as in the form of concepts that organize findings. Irvine’s (2013) study of homeless people and their pets is largely descriptive, composed of excerpts from the interviews and Irvine’s paraphrases and narration of what she did, how, and when. The findings were narrative case studies based on interviews and observations. The details of the narratives were vivid and had the kind of grab that Glaser (1978) recommended. They showed multiples perspectives and variations on what it meant to homeless informants to have pets in their lives. The first three pages were a review of relevant literature and a presentation of method. The last five pages were a discussion of the findings.

As lengthy as the descriptive material is, conceptual material frames the entire report. In the literature review, Irvine introduced notions of positive identity, generativity, and redemption. She used them to analyze her data and organize findings, which were the narrative case studies. She used the concept of redemption as the core or organizing concept, going into some detail about how the research material supports the significance of this idea of pets as redemptive for homeless people.

This analysis is based squarely on the descriptive material. For instance, Irvine wrote that in the stories she presented in her article, “animals provide the vehicle for redemption.” She illustrated this point with a quote from one of the narratives and then reminded readers that the narratives “contain variations on the theme” of “ life is better because this animal is in it ” (p. 20; emphasis in original). Readers do not take this on faith because the basis of this general statement in presented multiple times in the case studies. Irvine has much more material on which she based these ideas, but there is not enough room in a journal-length article to show all of her evidence.

An example of an article that is theoretical in purpose and short on descriptive material is found in the work of Cordeau (2012) . She developed a grounded theory of the “transition from student to professional nurse” when student nurses work with “mannequins as simulated patients” (p. 90). Based on interviews, observations, and reports that the students wrote on their clinical experiences, the study was composed of about 10 percent descriptive material. This material included excerpts interviews and student reports. In the results section, she used this descriptive material to illustrate and possibly document the grounded theory she constructed. The theory’s “core category” was “linking,” which had four components, called properties. She documented the properties, primarily with her own thinking about her research material and also with excerpts from interviews, observations, and student reports.

Like Irvine’s (2013) study, the purpose of Cordeau’s (2012) work was applied where she wanted to build theory that would contribute to the development of clinical expertise in nursing students. She also devoted about one page of her study to applications.

Core Concepts

I’ve previously provided an extended discussion of core concepts. This section highlights some key points and illustrates them. Core concepts, often called core categories , organize findings. I prefer the term concept because concept is the term used in discussing theory, such as “concepts are the building blocks of theory,” and theory is one of several possible products of qualitative research. Researchers decide on which concepts are core in the course of analysis. Researchers are ready to write up their reports when they have settled on, named, and dimensionalized one or more core concepts. The terms “core concepts” and “core categories” are associated with grounded theory ( Charmaz, 2006 ; Corbin & Strauss, 2008 ), but they are useful in other types of qualitative research, such as interpretive phenomenology and narrative analysis. Core concepts both organize findings and, typically, bring together a great deal of information. The term “dimension” means that researchers account for as many aspects of the core concepts as they can in order to show the multiple perspectives and patterns that typically compose concepts.

In reporting on core concepts, I recommend that researchers name them, introduce them, describe them using excerpts from the research material, comment on them, and then situate each of the concepts and their commentaries within their scholarly contexts. As discussed earlier, this shows how the findings fit with what is already known, or add to, force modification of, or refute what is known. Although many researchers, do not situate findings in their scholarly contexts, they usually cover the other topics.

No matter how authors report findings, they should do so with grab. An example of a report exemplary for its grab is the work of Scott (2003) on what it means to be a professional with a physical disability. Scott began her article not with a literature review but with three reviewer comments on other articles she had written. She then stated that the present article was a response to these comments. She followed up with a description of three male students who waited to speak to her after class about her disability and the notion of embodiment that she discussed in class. She brought in related literature throughout the article. Through her own reflections, reports on how others have responded to her, reports on the accounts that three other women with disabilities gave to her as a person with cerebral palsy, and her literature review, Scott not only showed the meanings of disabilities to persons who have them, but also what others say about their own disabilities, what some people who are able-bodied say about women with disabilities, and how all of this connects to what is known about disabilities and to wide-spread beliefs about disabilities. Her article is full of grab, such as the header that read, “The Day I Became Human.” With the authors’ own experience as the centerpiece, this article exemplifies write-ups that demonstrate the meanings of lived experience in various contexts, immersion, grab, and implications for social action. The analysis she presented as part of her findings is exemplary.

In the production of quality research, no matter the type of write-up, there are no short cuts. Research reports based on poetry, for example, are held to the same standards as any other article: grab, immersion, lived experience in context, and implications for action. In addition, such research reports typically locate themselves within social and human sciences traditions. Furman’s (2007) reflections and analysis of poetry that he wrote over the course of many years provide an example of how poetry can be used in qualitative analysis. This kind of research is a type of document analysis. In performance studies, researchers create a theater production of informant’s accounts of their experiences whose purpose is to transform audiences and move them to action ( Saldaña, 2003 ). The performances are the equivalent of research reports and when they are effective, they have the four characteristics of qualitative research under discussion.

Discussion Sections

In traditional research reports, the discussion section follows the results section. In discussion sections, authors reflect on findings, including what the findings are, how findings contribute to understandings of phenomena of interest, the lines of inquiry the results open up, and implications for policy and practice. Other generic topics to consider are those related to the focus of the journal. For example, if the journal’s focus is related to health, then authors show how findings are related to health.

Discussion sections present the author with opportunities to advocate for how his or her research can be used. The applied purposes of Irvine’s (2013) research come through when she devoted an entire page to make observations about implications. She pointed out how her research contributes to a transformation of images of homeless persons as isolated to images of them as engaged in relationships not only with their pets but with other persons, too. She noted that rehousing homeless persons requires a change in policy that would allow them to have pets. Furthermore, she said that caring for a pet “can turn things around” (p. 24).

In the discussion section I wrote with Anderson ( Gilgun & Anderson, 2013 ), we addressed methodological issues, such as the probable existence of other patterns in addition to those we identified and the nonrandom nature of our sample. We also acknowledged the difficulties in working with families in which child sexual abuse has occurred. Since qualitative researchers want to understand lived experiences, we had to prepare ourselves to deal effectively in research areas that are difficult emotionally for us as researchers. Although we may acknowledge the emotional challenges of some topics in reflexivity statements, discussion sections are opportunities for authors to acknowledge the difficulties of using the results we produce. In the article I wrote with Anderson, we made such an acknowledgment, one that we hoped would facilitate more effective practice. We wrote

Practitioners themselves may experience shock, rage, and disgust. The practice of neutrality, in its therapeutic sense, is important in these cases ( Gil & Johnson, 1993 ; Rober, 2011 ). Neutrality means that practitioners maintain their analytic stances while at the same time they remain attuned not only to service users but also to themselves. When practicing neutrality, service providers regulate their own emotional responses in order to remain emotionally available to service users. Neutrality also means that service providers remain open-minded so that they can hear stories that they may not expect to hear; in other words, to make room for the unexpected ( Rober, 2011 ). Attunement to inner processes is a form of reflection that can facilitate the development of trust between service users and providers. When providers are reflective, they are less likely to tune out, close down, and otherwise stop listening to what services users express. When they listen and hear what service users say, they are more likely to facilitate the best possible outcomes in difficult situations ( Weingarten, 2012 ).

Doing research on lived experience can be difficult for informants and for researchers. Acknowledgment of the implications of these difficulties for users of the research has a place in discussion sections.

In summary, most articles are fairly straightforward in their write-ups: focused literature reviews, reflexivity statements in many cases, clear statements of purpose, clarity about sources of research questions and/or hypotheses, identification and definition of key concepts, identification of codes the researcher develops from literature reviews and reflexivity statements, succinct accounting of methods, and findings organized logically by core concepts around which the researcher organizes the multiple dimensions of those concepts. Excellent writing makes articles interesting and accessible. Some kinds of write-ups deviate from these components, but they are held to the same standards of immersion, experiences in context, multiple perspectives, and implications for action and other applications. When authors have the good fortune to have a recommendation to revise and resubmit, suggestions for revisions often improve the quality of the article.

The seemingly endless variations that are possible in the write-up of qualitative research makes writing and reviewing manuscripts challenging, especially when compared to traditions in which rigid rules prevail. However, it is important that approaches to qualitative research continue to evolve to meet with our ever-changing understandings of human phenomena. The clarity and transparency of reports are the fundamental guidelines for making judgments about quality. I often tell my students that the guidelines for doing qualitative research are flexible, and what is important is to be clear about what you did, why you did it, and what you came up with.

The notion of grab is central to write-up. Since qualitative research seeks to understand lived experiences, it is logical that findings report on the lived experiences in vivid terms, replete with quotes from data. This is not to undermine the importance of analysis, but grab is possible even in write-ups that require a great deal of analysis. Grab becomes possible because researchers must provide the evidence for the theories and concepts they develop.

When there are questions about priorities related to informants’ voices, researchers’ interpretations, and prior research, I hope that authors, reviewers, and editors remember that as important as analysis and previous work may be, the voices of informants bring these other important parts of manuscripts to life. Researchers make decisions about whose voices take priority.

There is no one way to respond to these dilemmas. Authors must make their own decisions about what is important to them and then search for journals that will welcome what they want to convey. It’s important to consider pushing the boundaries and writing an article in a way that the researcher thinks will best convey his or her findings.

The importance of quality data, quality analysis, and “grab” are foundational. I began this chapter with a discussion of the balance between description and analysis. I then considered core concepts as organizers of findings, the place of literature reviews, styles of presenting methods and methodologies, and the balance between the voices of informants and researchers. I concluded with the many variations in types of reports that result from the various purposes that qualitative research projects can have. There are many different types of qualitative research and many styles of write-ups. This chapter may sensitize readers to enduring issues in the writing of research reports. Like qualitative research itself, there are multiple points of view on how to write up qualitative research.

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Home » Research Paper Abstract – Writing Guide and Examples

Research Paper Abstract – Writing Guide and Examples

Table of Contents

Research Paper Abstract

Research Paper Abstract is a brief summary of a research pape r that describes the study’s purpose, methods, findings, and conclusions . It is often the first section of the paper that readers encounter, and its purpose is to provide a concise and accurate overview of the paper’s content. The typical length of an abstract is usually around 150-250 words, and it should be written in a concise and clear manner.

Research Paper Abstract Structure

The structure of a research paper abstract usually includes the following elements:

• Background or Introduction: Briefly describe the problem or research question that the study addresses.
• Methods : Explain the methodology used to conduct the study, including the participants, materials, and procedures.
• Results : Summarize the main findings of the study, including statistical analyses and key outcomes.
• Conclusions : Discuss the implications of the study’s findings and their significance for the field, as well as any limitations or future directions for research.
• Keywords : List a few keywords that describe the main topics or themes of the research.

How to Write Research Paper Abstract

Here are the steps to follow when writing a research paper abstract:

• Start by reading your paper: Before you write an abstract, you should have a complete understanding of your paper. Read through the paper carefully, making sure you understand the purpose, methods, results, and conclusions.
• Identify the key components : Identify the key components of your paper, such as the research question, methods used, results obtained, and conclusion reached.
• Write a draft: Write a draft of your abstract, using concise and clear language. Make sure to include all the important information, but keep it short and to the point. A good rule of thumb is to keep your abstract between 150-250 words.
• Use clear and concise language : Use clear and concise language to explain the purpose of your study, the methods used, the results obtained, and the conclusions drawn.
• Emphasize your findings: Emphasize your findings in the abstract, highlighting the key results and the significance of your study.
• Revise and edit: Once you have a draft, revise and edit it to ensure that it is clear, concise, and free from errors.
• Check the formatting: Finally, check the formatting of your abstract to make sure it meets the requirements of the journal or conference where you plan to submit it.

Research Paper Abstract Examples

Research Paper Abstract Examples could be following:

Title : “The Effectiveness of Cognitive-Behavioral Therapy for Treating Anxiety Disorders: A Meta-Analysis”

Abstract : This meta-analysis examines the effectiveness of cognitive-behavioral therapy (CBT) in treating anxiety disorders. Through the analysis of 20 randomized controlled trials, we found that CBT is a highly effective treatment for anxiety disorders, with large effect sizes across a range of anxiety disorders, including generalized anxiety disorder, panic disorder, and social anxiety disorder. Our findings support the use of CBT as a first-line treatment for anxiety disorders and highlight the importance of further research to identify the mechanisms underlying its effectiveness.

Title : “Exploring the Role of Parental Involvement in Children’s Education: A Qualitative Study”

Abstract : This qualitative study explores the role of parental involvement in children’s education. Through in-depth interviews with 20 parents of children in elementary school, we found that parental involvement takes many forms, including volunteering in the classroom, helping with homework, and communicating with teachers. We also found that parental involvement is influenced by a range of factors, including parent and child characteristics, school culture, and socio-economic status. Our findings suggest that schools and educators should prioritize building strong partnerships with parents to support children’s academic success.

Title : “The Impact of Exercise on Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis”

Abstract : This paper presents a systematic review and meta-analysis of the existing literature on the impact of exercise on cognitive function in older adults. Through the analysis of 25 randomized controlled trials, we found that exercise is associated with significant improvements in cognitive function, particularly in the domains of executive function and attention. Our findings highlight the potential of exercise as a non-pharmacological intervention to support cognitive health in older adults.

When to Write Research Paper Abstract

The abstract of a research paper should typically be written after you have completed the main body of the paper. This is because the abstract is intended to provide a brief summary of the key points and findings of the research, and you can’t do that until you have completed the research and written about it in detail.

Once you have completed your research paper, you can begin writing your abstract. It is important to remember that the abstract should be a concise summary of your research paper, and should be written in a way that is easy to understand for readers who may not have expertise in your specific area of research.

Purpose of Research Paper Abstract

The purpose of a research paper abstract is to provide a concise summary of the key points and findings of a research paper. It is typically a brief paragraph or two that appears at the beginning of the paper, before the introduction, and is intended to give readers a quick overview of the paper’s content.

The abstract should include a brief statement of the research problem, the methods used to investigate the problem, the key results and findings, and the main conclusions and implications of the research. It should be written in a clear and concise manner, avoiding jargon and technical language, and should be understandable to a broad audience.

The abstract serves as a way to quickly and easily communicate the main points of a research paper to potential readers, such as academics, researchers, and students, who may be looking for information on a particular topic. It can also help researchers determine whether a paper is relevant to their own research interests and whether they should read the full paper.

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The Dissertation Abstract: 101

How to write a clear & concise abstract (with examples).

By:   Madeline Fink (MSc) Reviewed By: Derek Jansen (MBA)   | June 2020

So, you’ve (finally) finished your thesis or dissertation or thesis. Now it’s time to write up your abstract (sometimes also called the executive summary). If you’re here, chances are you’re not quite sure what you need to cover in this section, or how to go about writing it. Fear not – we’ll explain it all in plain language , step by step , with clear examples .

Overview: The Dissertation/Thesis Abstract

• What exactly is a dissertation (or thesis) abstract
• What’s the purpose and function of the abstract
• Why is the abstract so important
• How to write a high-quality dissertation abstract
• Example/sample of a quality abstract
• Quick tips to write a high-quality dissertation abstract

What is an abstract?

Simply put, the abstract in a dissertation or thesis is a short (but well structured) summary that outlines the most important points of your research (i.e. the key takeaways). The abstract is usually 1 paragraph or about 300-500 words long (about one page), but but this can vary between universities.

A quick note regarding terminology – strictly speaking, an abstract and an executive summary are two different things when it comes to academic publications. Typically, an abstract only states what the research will be about, but doesn’t explore the findings – whereas an executive summary covers both . However, in the context of a dissertation or thesis, the abstract usually covers both, providing a summary of the full project.

In terms of content, a good dissertation abstract usually covers the following points:

• The purpose of the research (what’s it about and why’s that important)
• The methodology (how you carried out the research)
• The key research findings (what answers you found)
• The implications of these findings (what these answers mean)

We’ll explain each of these in more detail a little later in this post. Buckle up.

What’s the purpose of the abstract?

A dissertation abstract has two main functions:

The first purpose is to  inform potential readers  of the main idea of your research without them having to read your entire piece of work. Specifically, it needs to communicate what your research is about (what were you trying to find out) and what your findings were . When readers are deciding whether to read your dissertation or thesis, the abstract is the first part they’ll consider. 

The second purpose of the abstract is to  inform search engines and dissertation databases  as they index your dissertation or thesis. The keywords and phrases in your abstract (as well as your keyword list) will often be used by these search engines to categorize your work and make it accessible to users. 

Simply put, your abstract is your shopfront display window – it’s what passers-by (both human and digital) will look at before deciding to step inside. 

Why’s it so important?

The short answer – because most people don’t have time to read your full dissertation or thesis! Time is money, after all…

If you think back to when you undertook your literature review , you’ll quickly realise just how important abstracts are! Researchers reviewing the literature on any given topic face a mountain of reading, so they need to optimise their approach. A good dissertation abstract gives the reader a “TLDR” version of your work – it helps them decide whether to continue to read it in its entirety. So, your abstract, as your shopfront display window, needs to “sell” your research to time-poor readers.

You might be thinking, “but I don’t plan to publish my dissertation”. Even so, you still need to provide an impactful abstract for your markers. Your ability to concisely summarise your work is one of the things they’re assessing, so it’s vital to invest time and effort into crafting an enticing shop window.  

A good abstract also has an added purpose for grad students . As a freshly minted graduate, your dissertation or thesis is often your most significant professional accomplishment and highlights where your unique expertise lies. Potential employers who want to know about this expertise are likely to only read the abstract (as opposed to reading your entire document) – so it needs to be good!

Think about it this way – if your thesis or dissertation were a book, then the abstract would be the blurb on the back cover. For better or worse, readers will absolutely judge your book by its cover .

How to write your abstract

As we touched on earlier, your abstract should cover four important aspects of your research: the purpose , methodology , findings , and implications . Therefore, the structure of your dissertation or thesis abstract needs to reflect these four essentials, in the same order.  Let’s take a closer look at each of them, step by step:

Step 1: Describe the purpose and value of your research

Here you need to concisely explain the purpose and value of your research. In other words, you need to explain what your research set out to discover and why that’s important. When stating the purpose of research, you need to clearly discuss the following:

• What were your research aims and research questions ?
• Why were these aims and questions important?

It’s essential to make this section extremely clear, concise and convincing . As the opening section, this is where you’ll “hook” your reader (marker) in and get them interested in your project. If you don’t put in the effort here, you’ll likely lose their interest.

Step 2: Briefly outline your study’s methodology

In this part of your abstract, you need to very briefly explain how you went about answering your research questions . In other words, what research design and methodology you adopted in your research. Some important questions to address here include:

• Did you take a qualitative or quantitative approach ?
• Who/what did your sample consist of?
• How did you collect your data?
• How did you analyse your data?

Simply put, this section needs to address the “ how ” of your research. It doesn’t need to be lengthy (this is just a summary, after all), but it should clearly address the four questions above.

Need a helping hand?

Step 3: Present your key findings

Next, you need to briefly highlight the key findings . Your research likely produced a wealth of data and findings, so there may be a temptation to ramble here. However, this section is just about the key findings – in other words, the answers to the original questions that you set out to address.

Again, brevity and clarity are important here. You need to concisely present the most important findings for your reader.

Step 4: Describe the implications of your research

Have you ever found yourself reading through a large report, struggling to figure out what all the findings mean in terms of the bigger picture? Well, that’s the purpose of the implications section – to highlight the “so what?” of your research. 

In this part of your abstract, you should address the following questions:

• What is the impact of your research findings on the industry /field investigated? In other words, what’s the impact on the “real world”. 
• What is the impact of your findings on the existing body of knowledge ? For example, do they support the existing research?
• What might your findings mean for future research conducted on your topic?

If you include these four essential ingredients in your dissertation abstract, you’ll be on headed in a good direction.

Example: Dissertation/thesis abstract

Here is an example of an abstract from a master’s thesis, with the purpose , methods , findings , and implications colour coded.

The U.S. citizenship application process is a legal and symbolic journey shaped by many cultural processes. This research project aims to bring to light the experiences of immigrants and citizenship applicants living in Dallas, Texas, to promote a better understanding of Dallas’ increasingly diverse population. Additionally, the purpose of this project is to provide insights to a specific client, the office of Dallas Welcoming Communities and Immigrant Affairs, about Dallas’ lawful permanent residents who are eligible for citizenship and their reasons for pursuing citizenship status . The data for this project was collected through observation at various citizenship workshops and community events, as well as through semi-structured interviews with 14 U.S. citizenship applicants . Reasons for applying for U.S. citizenship discussed in this project include a desire for membership in U.S. society, access to better educational and economic opportunities, improved ease of travel and the desire to vote. Barriers to the citizenship process discussed in this project include the amount of time one must dedicate to the application, lack of clear knowledge about the process and the financial cost of the application. Other themes include the effects of capital on applicant’s experience with the citizenship process, symbolic meanings of citizenship, transnationalism and ideas of deserving and undeserving surrounding the issues of residency and U.S. citizenship. These findings indicate the need for educational resources and mentorship for Dallas-area residents applying for U.S. citizenship, as well as a need for local government programs that foster a sense of community among citizenship applicants and their neighbours.

Practical tips for writing your abstract

When crafting the abstract for your dissertation or thesis, the most powerful technique you can use is to try and put yourself in the shoes of a potential reader. Assume the reader is not an expert in the field, but is interested in the research area. In other words, write for the intelligent layman, not for the seasoned topic expert. 

Start by trying to answer the question “why should I read this dissertation?”

Remember the WWHS.

Make sure you include the  what , why ,  how , and  so what  of your research in your abstract:

• What you studied (who and where are included in this part)
• Why the topic was important
• How you designed your study (i.e. your research methodology)
• So what were the big findings and implications of your research

Keep it simple.

Use terminology appropriate to your field of study, but don’t overload your abstract with big words and jargon that cloud the meaning and make your writing difficult to digest. A good abstract should appeal to all levels of potential readers and should be a (relatively) easy read. Remember, you need to write for the intelligent layman.

Be specific.

When writing your abstract, clearly outline your most important findings and insights and don’t worry about “giving away” too much about your research – there’s no need to withhold information. This is the one way your abstract is not like a blurb on the back of a book – the reader should be able to clearly understand the key takeaways of your thesis or dissertation after reading the abstract. Of course, if they then want more detail, they need to step into the restaurant and try out the menu.

Psst... there’s more!

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

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19 Comments

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Writing an abstract - a six point checklist (with samples)

Posted in: abstract , dissertations

The abstract is a vital part of any research paper. It is the shop front for your work, and the first stop for your reader. It should provide a clear and succinct summary of your study, and encourage your readers to read more. An effective abstract, therefore should answer the following questions:

• Why did you do this study or project?
• What did you do and how?
• What did you find?
• What do your findings mean?

So here's our run down of the key elements of a well-written abstract.

• Size - A succinct and well written abstract should be between approximately 100- 250 words.
• Background - An effective abstract usually includes some scene-setting information which might include what is already known about the subject, related to the paper in question (a few short sentences).
• Purpose  - The abstract should also set out the purpose of your research, in other words, what is not known about the subject and hence what the study intended to examine (or what the paper seeks to present).
• Methods - The methods section should contain enough information to enable the reader to understand what was done, and how. It should include brief details of the research design, sample size, duration of study, and so on.
• Results - The results section is the most important part of the abstract. This is because readers who skim an abstract do so to learn about the findings of the study. The results section should therefore contain as much detail about the findings as the journal word count permits.
• Conclusion - This section should contain the most important take-home message of the study, expressed in a few precisely worded sentences. Usually, the finding highlighted here relates to the primary outcomes of the study. However, other important or unexpected findings should also be mentioned. It is also customary, but not essential, to express an opinion about the theoretical or practical implications of the findings, or the importance of their findings for the field. Thus, the conclusions may contain three elements:
• The primary take-home message.
• Any additional findings of importance.
• Implications for future studies.

Example Abstract 2: Engineering Development and validation of a three-dimensional finite element model of the pelvic bone.

Abstract from: Dalstra, M., Huiskes, R. and Van Erning, L., 1995. Development and validation of a three-dimensional finite element model of the pelvic bone. Journal of biomechanical engineering, 117(3), pp.272-278.

And finally...  A word on abstract types and styles

Abstract types can differ according to subject discipline. You need to determine therefore which type of abstract you should include with your paper. Here are two of the most common types with examples.

Informative Abstract

The majority of abstracts are informative. While they still do not critique or evaluate a work, they do more than describe it. A good informative abstract acts as a surrogate for the work itself. That is, the researcher presents and explains all the main arguments and the important results and evidence in the paper. An informative abstract includes the information that can be found in a descriptive abstract [purpose, methods, scope] but it also includes the results and conclusions of the research and the recommendations of the author. The length varies according to discipline, but an informative abstract is usually no more than 300 words in length.

Descriptive Abstract A descriptive abstract indicates the type of information found in the work. It makes no judgements about the work, nor does it provide results or conclusions of the research. It does incorporate key words found in the text and may include the purpose, methods, and scope of the research. Essentially, the descriptive abstract only describes the work being summarised. Some researchers consider it an outline of the work, rather than a summary. Descriptive abstracts are usually very short, 100 words or less.

Adapted from Andrade C. How to write a good abstract for a scientific paper or conference presentation. Indian J Psychiatry. 2011 Apr;53(2):172-5. doi: 10.4103/0019-5545.82558. PMID: 21772657; PMCID: PMC3136027 .

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A Practical Guide to Writing Quantitative and Qualitative Research Questions and Hypotheses in Scholarly Articles

Edward barroga.

1 Department of General Education, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan.

Glafera Janet Matanguihan

2 Department of Biological Sciences, Messiah University, Mechanicsburg, PA, USA.

The development of research questions and the subsequent hypotheses are prerequisites to defining the main research purpose and specific objectives of a study. Consequently, these objectives determine the study design and research outcome. The development of research questions is a process based on knowledge of current trends, cutting-edge studies, and technological advances in the research field. Excellent research questions are focused and require a comprehensive literature search and in-depth understanding of the problem being investigated. Initially, research questions may be written as descriptive questions which could be developed into inferential questions. These questions must be specific and concise to provide a clear foundation for developing hypotheses. Hypotheses are more formal predictions about the research outcomes. These specify the possible results that may or may not be expected regarding the relationship between groups. Thus, research questions and hypotheses clarify the main purpose and specific objectives of the study, which in turn dictate the design of the study, its direction, and outcome. Studies developed from good research questions and hypotheses will have trustworthy outcomes with wide-ranging social and health implications.

INTRODUCTION

Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses. 1 , 2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results. 3 , 4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the inception of novel studies and the ethical testing of ideas. 5 , 6

It is crucial to have knowledge of both quantitative and qualitative research 2 as both types of research involve writing research questions and hypotheses. 7 However, these crucial elements of research are sometimes overlooked; if not overlooked, then framed without the forethought and meticulous attention it needs. Planning and careful consideration are needed when developing quantitative or qualitative research, particularly when conceptualizing research questions and hypotheses. 4

There is a continuing need to support researchers in the creation of innovative research questions and hypotheses, as well as for journal articles that carefully review these elements. 1 When research questions and hypotheses are not carefully thought of, unethical studies and poor outcomes usually ensue. Carefully formulated research questions and hypotheses define well-founded objectives, which in turn determine the appropriate design, course, and outcome of the study. This article then aims to discuss in detail the various aspects of crafting research questions and hypotheses, with the goal of guiding researchers as they develop their own. Examples from the authors and peer-reviewed scientific articles in the healthcare field are provided to illustrate key points.

DEFINITIONS AND RELATIONSHIP OF RESEARCH QUESTIONS AND HYPOTHESES

A research question is what a study aims to answer after data analysis and interpretation. The answer is written in length in the discussion section of the paper. Thus, the research question gives a preview of the different parts and variables of the study meant to address the problem posed in the research question. 1 An excellent research question clarifies the research writing while facilitating understanding of the research topic, objective, scope, and limitations of the study. 5

On the other hand, a research hypothesis is an educated statement of an expected outcome. This statement is based on background research and current knowledge. 8 , 9 The research hypothesis makes a specific prediction about a new phenomenon 10 or a formal statement on the expected relationship between an independent variable and a dependent variable. 3 , 11 It provides a tentative answer to the research question to be tested or explored. 4

Hypotheses employ reasoning to predict a theory-based outcome. 10 These can also be developed from theories by focusing on components of theories that have not yet been observed. 10 The validity of hypotheses is often based on the testability of the prediction made in a reproducible experiment. 8

Conversely, hypotheses can also be rephrased as research questions. Several hypotheses based on existing theories and knowledge may be needed to answer a research question. Developing ethical research questions and hypotheses creates a research design that has logical relationships among variables. These relationships serve as a solid foundation for the conduct of the study. 4 , 11 Haphazardly constructed research questions can result in poorly formulated hypotheses and improper study designs, leading to unreliable results. Thus, the formulations of relevant research questions and verifiable hypotheses are crucial when beginning research. 12

CHARACTERISTICS OF GOOD RESEARCH QUESTIONS AND HYPOTHESES

Excellent research questions are specific and focused. These integrate collective data and observations to confirm or refute the subsequent hypotheses. Well-constructed hypotheses are based on previous reports and verify the research context. These are realistic, in-depth, sufficiently complex, and reproducible. More importantly, these hypotheses can be addressed and tested. 13

There are several characteristics of well-developed hypotheses. Good hypotheses are 1) empirically testable 7 , 10 , 11 , 13 ; 2) backed by preliminary evidence 9 ; 3) testable by ethical research 7 , 9 ; 4) based on original ideas 9 ; 5) have evidenced-based logical reasoning 10 ; and 6) can be predicted. 11 Good hypotheses can infer ethical and positive implications, indicating the presence of a relationship or effect relevant to the research theme. 7 , 11 These are initially developed from a general theory and branch into specific hypotheses by deductive reasoning. In the absence of a theory to base the hypotheses, inductive reasoning based on specific observations or findings form more general hypotheses. 10

TYPES OF RESEARCH QUESTIONS AND HYPOTHESES

Research questions and hypotheses are developed according to the type of research, which can be broadly classified into quantitative and qualitative research. We provide a summary of the types of research questions and hypotheses under quantitative and qualitative research categories in Table 1 .

Research questions in quantitative research

In quantitative research, research questions inquire about the relationships among variables being investigated and are usually framed at the start of the study. These are precise and typically linked to the subject population, dependent and independent variables, and research design. 1 Research questions may also attempt to describe the behavior of a population in relation to one or more variables, or describe the characteristics of variables to be measured ( descriptive research questions ). 1 , 5 , 14 These questions may also aim to discover differences between groups within the context of an outcome variable ( comparative research questions ), 1 , 5 , 14 or elucidate trends and interactions among variables ( relationship research questions ). 1 , 5 We provide examples of descriptive, comparative, and relationship research questions in quantitative research in Table 2 .

Hypotheses in quantitative research

In quantitative research, hypotheses predict the expected relationships among variables. 15 Relationships among variables that can be predicted include 1) between a single dependent variable and a single independent variable ( simple hypothesis ) or 2) between two or more independent and dependent variables ( complex hypothesis ). 4 , 11 Hypotheses may also specify the expected direction to be followed and imply an intellectual commitment to a particular outcome ( directional hypothesis ) 4 . On the other hand, hypotheses may not predict the exact direction and are used in the absence of a theory, or when findings contradict previous studies ( non-directional hypothesis ). 4 In addition, hypotheses can 1) define interdependency between variables ( associative hypothesis ), 4 2) propose an effect on the dependent variable from manipulation of the independent variable ( causal hypothesis ), 4 3) state a negative relationship between two variables ( null hypothesis ), 4 , 11 , 15 4) replace the working hypothesis if rejected ( alternative hypothesis ), 15 explain the relationship of phenomena to possibly generate a theory ( working hypothesis ), 11 5) involve quantifiable variables that can be tested statistically ( statistical hypothesis ), 11 6) or express a relationship whose interlinks can be verified logically ( logical hypothesis ). 11 We provide examples of simple, complex, directional, non-directional, associative, causal, null, alternative, working, statistical, and logical hypotheses in quantitative research, as well as the definition of quantitative hypothesis-testing research in Table 3 .

Research questions in qualitative research

Unlike research questions in quantitative research, research questions in qualitative research are usually continuously reviewed and reformulated. The central question and associated subquestions are stated more than the hypotheses. 15 The central question broadly explores a complex set of factors surrounding the central phenomenon, aiming to present the varied perspectives of participants. 15

There are varied goals for which qualitative research questions are developed. These questions can function in several ways, such as to 1) identify and describe existing conditions ( contextual research question s); 2) describe a phenomenon ( descriptive research questions ); 3) assess the effectiveness of existing methods, protocols, theories, or procedures ( evaluation research questions ); 4) examine a phenomenon or analyze the reasons or relationships between subjects or phenomena ( explanatory research questions ); or 5) focus on unknown aspects of a particular topic ( exploratory research questions ). 5 In addition, some qualitative research questions provide new ideas for the development of theories and actions ( generative research questions ) or advance specific ideologies of a position ( ideological research questions ). 1 Other qualitative research questions may build on a body of existing literature and become working guidelines ( ethnographic research questions ). Research questions may also be broadly stated without specific reference to the existing literature or a typology of questions ( phenomenological research questions ), may be directed towards generating a theory of some process ( grounded theory questions ), or may address a description of the case and the emerging themes ( qualitative case study questions ). 15 We provide examples of contextual, descriptive, evaluation, explanatory, exploratory, generative, ideological, ethnographic, phenomenological, grounded theory, and qualitative case study research questions in qualitative research in Table 4 , and the definition of qualitative hypothesis-generating research in Table 5 .

Qualitative studies usually pose at least one central research question and several subquestions starting with How or What . These research questions use exploratory verbs such as explore or describe . These also focus on one central phenomenon of interest, and may mention the participants and research site. 15

Hypotheses in qualitative research

Hypotheses in qualitative research are stated in the form of a clear statement concerning the problem to be investigated. Unlike in quantitative research where hypotheses are usually developed to be tested, qualitative research can lead to both hypothesis-testing and hypothesis-generating outcomes. 2 When studies require both quantitative and qualitative research questions, this suggests an integrative process between both research methods wherein a single mixed-methods research question can be developed. 1

FRAMEWORKS FOR DEVELOPING RESEARCH QUESTIONS AND HYPOTHESES

Research questions followed by hypotheses should be developed before the start of the study. 1 , 12 , 14 It is crucial to develop feasible research questions on a topic that is interesting to both the researcher and the scientific community. This can be achieved by a meticulous review of previous and current studies to establish a novel topic. Specific areas are subsequently focused on to generate ethical research questions. The relevance of the research questions is evaluated in terms of clarity of the resulting data, specificity of the methodology, objectivity of the outcome, depth of the research, and impact of the study. 1 , 5 These aspects constitute the FINER criteria (i.e., Feasible, Interesting, Novel, Ethical, and Relevant). 1 Clarity and effectiveness are achieved if research questions meet the FINER criteria. In addition to the FINER criteria, Ratan et al. described focus, complexity, novelty, feasibility, and measurability for evaluating the effectiveness of research questions. 14

The PICOT and PEO frameworks are also used when developing research questions. 1 The following elements are addressed in these frameworks, PICOT: P-population/patients/problem, I-intervention or indicator being studied, C-comparison group, O-outcome of interest, and T-timeframe of the study; PEO: P-population being studied, E-exposure to preexisting conditions, and O-outcome of interest. 1 Research questions are also considered good if these meet the “FINERMAPS” framework: Feasible, Interesting, Novel, Ethical, Relevant, Manageable, Appropriate, Potential value/publishable, and Systematic. 14

As we indicated earlier, research questions and hypotheses that are not carefully formulated result in unethical studies or poor outcomes. To illustrate this, we provide some examples of ambiguous research question and hypotheses that result in unclear and weak research objectives in quantitative research ( Table 6 ) 16 and qualitative research ( Table 7 ) 17 , and how to transform these ambiguous research question(s) and hypothesis(es) into clear and good statements.

a These statements were composed for comparison and illustrative purposes only.

b These statements are direct quotes from Higashihara and Horiuchi. 16

a This statement is a direct quote from Shimoda et al. 17

The other statements were composed for comparison and illustrative purposes only.

CONSTRUCTING RESEARCH QUESTIONS AND HYPOTHESES

To construct effective research questions and hypotheses, it is very important to 1) clarify the background and 2) identify the research problem at the outset of the research, within a specific timeframe. 9 Then, 3) review or conduct preliminary research to collect all available knowledge about the possible research questions by studying theories and previous studies. 18 Afterwards, 4) construct research questions to investigate the research problem. Identify variables to be accessed from the research questions 4 and make operational definitions of constructs from the research problem and questions. Thereafter, 5) construct specific deductive or inductive predictions in the form of hypotheses. 4 Finally, 6) state the study aims . This general flow for constructing effective research questions and hypotheses prior to conducting research is shown in Fig. 1 .

Research questions are used more frequently in qualitative research than objectives or hypotheses. 3 These questions seek to discover, understand, explore or describe experiences by asking “What” or “How.” The questions are open-ended to elicit a description rather than to relate variables or compare groups. The questions are continually reviewed, reformulated, and changed during the qualitative study. 3 Research questions are also used more frequently in survey projects than hypotheses in experiments in quantitative research to compare variables and their relationships.

Hypotheses are constructed based on the variables identified and as an if-then statement, following the template, ‘If a specific action is taken, then a certain outcome is expected.’ At this stage, some ideas regarding expectations from the research to be conducted must be drawn. 18 Then, the variables to be manipulated (independent) and influenced (dependent) are defined. 4 Thereafter, the hypothesis is stated and refined, and reproducible data tailored to the hypothesis are identified, collected, and analyzed. 4 The hypotheses must be testable and specific, 18 and should describe the variables and their relationships, the specific group being studied, and the predicted research outcome. 18 Hypotheses construction involves a testable proposition to be deduced from theory, and independent and dependent variables to be separated and measured separately. 3 Therefore, good hypotheses must be based on good research questions constructed at the start of a study or trial. 12

In summary, research questions are constructed after establishing the background of the study. Hypotheses are then developed based on the research questions. Thus, it is crucial to have excellent research questions to generate superior hypotheses. In turn, these would determine the research objectives and the design of the study, and ultimately, the outcome of the research. 12 Algorithms for building research questions and hypotheses are shown in Fig. 2 for quantitative research and in Fig. 3 for qualitative research.

EXAMPLES OF RESEARCH QUESTIONS FROM PUBLISHED ARTICLES

• EXAMPLE 1. Descriptive research question (quantitative research)
• - Presents research variables to be assessed (distinct phenotypes and subphenotypes)
• “BACKGROUND: Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts.
• RESEARCH QUESTION: Does the clinical spectrum of patients with COVID-19 contain distinct phenotypes and subphenotypes? ” 19
• EXAMPLE 2. Relationship research question (quantitative research)
• - Shows interactions between dependent variable (static postural control) and independent variable (peripheral visual field loss)
• “Background: Integration of visual, vestibular, and proprioceptive sensations contributes to postural control. People with peripheral visual field loss have serious postural instability. However, the directional specificity of postural stability and sensory reweighting caused by gradual peripheral visual field loss remain unclear.
• Research question: What are the effects of peripheral visual field loss on static postural control ?” 20
• EXAMPLE 3. Comparative research question (quantitative research)
• - Clarifies the difference among groups with an outcome variable (patients enrolled in COMPERA with moderate PH or severe PH in COPD) and another group without the outcome variable (patients with idiopathic pulmonary arterial hypertension (IPAH))
• “BACKGROUND: Pulmonary hypertension (PH) in COPD is a poorly investigated clinical condition.
• RESEARCH QUESTION: Which factors determine the outcome of PH in COPD?
• STUDY DESIGN AND METHODS: We analyzed the characteristics and outcome of patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) with moderate or severe PH in COPD as defined during the 6th PH World Symposium who received medical therapy for PH and compared them with patients with idiopathic pulmonary arterial hypertension (IPAH) .” 21
• EXAMPLE 4. Exploratory research question (qualitative research)
• - Explores areas that have not been fully investigated (perspectives of families and children who receive care in clinic-based child obesity treatment) to have a deeper understanding of the research problem
• “Problem: Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment? This review aims to explore the scope of perspectives reported by families of children with obesity who have received individualized outpatient clinic-based obesity treatment.” 22
• EXAMPLE 5. Relationship research question (quantitative research)
• - Defines interactions between dependent variable (use of ankle strategies) and independent variable (changes in muscle tone)
• “Background: To maintain an upright standing posture against external disturbances, the human body mainly employs two types of postural control strategies: “ankle strategy” and “hip strategy.” While it has been reported that the magnitude of the disturbance alters the use of postural control strategies, it has not been elucidated how the level of muscle tone, one of the crucial parameters of bodily function, determines the use of each strategy. We have previously confirmed using forward dynamics simulations of human musculoskeletal models that an increased muscle tone promotes the use of ankle strategies. The objective of the present study was to experimentally evaluate a hypothesis: an increased muscle tone promotes the use of ankle strategies. Research question: Do changes in the muscle tone affect the use of ankle strategies ?” 23

EXAMPLES OF HYPOTHESES IN PUBLISHED ARTICLES

• EXAMPLE 1. Working hypothesis (quantitative research)
• - A hypothesis that is initially accepted for further research to produce a feasible theory
• “As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness .” 24
• “In conclusion, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response . The difference in perceived safety of these agents in COVID-19 illness could be related to the more potent efficacy to reduce fever with ibuprofen compared to acetaminophen. Compelling data on the benefit of fever warrant further research and review to determine when to treat or withhold ibuprofen for early stage fever for COVID-19 and other related viral illnesses .” 24
• EXAMPLE 2. Exploratory hypothesis (qualitative research)
• - Explores particular areas deeper to clarify subjective experience and develop a formal hypothesis potentially testable in a future quantitative approach
• “We hypothesized that when thinking about a past experience of help-seeking, a self distancing prompt would cause increased help-seeking intentions and more favorable help-seeking outcome expectations .” 25
• “Conclusion
• Although a priori hypotheses were not supported, further research is warranted as results indicate the potential for using self-distancing approaches to increasing help-seeking among some people with depressive symptomatology.” 25
• EXAMPLE 3. Hypothesis-generating research to establish a framework for hypothesis testing (qualitative research)
• “We hypothesize that compassionate care is beneficial for patients (better outcomes), healthcare systems and payers (lower costs), and healthcare providers (lower burnout). ” 26
• Compassionomics is the branch of knowledge and scientific study of the effects of compassionate healthcare. Our main hypotheses are that compassionate healthcare is beneficial for (1) patients, by improving clinical outcomes, (2) healthcare systems and payers, by supporting financial sustainability, and (3) HCPs, by lowering burnout and promoting resilience and well-being. The purpose of this paper is to establish a scientific framework for testing the hypotheses above . If these hypotheses are confirmed through rigorous research, compassionomics will belong in the science of evidence-based medicine, with major implications for all healthcare domains.” 26
• EXAMPLE 4. Statistical hypothesis (quantitative research)
• - An assumption is made about the relationship among several population characteristics ( gender differences in sociodemographic and clinical characteristics of adults with ADHD ). Validity is tested by statistical experiment or analysis ( chi-square test, Students t-test, and logistic regression analysis)
• “Our research investigated gender differences in sociodemographic and clinical characteristics of adults with ADHD in a Japanese clinical sample. Due to unique Japanese cultural ideals and expectations of women's behavior that are in opposition to ADHD symptoms, we hypothesized that women with ADHD experience more difficulties and present more dysfunctions than men . We tested the following hypotheses: first, women with ADHD have more comorbidities than men with ADHD; second, women with ADHD experience more social hardships than men, such as having less full-time employment and being more likely to be divorced.” 27
• “Statistical Analysis
• ( text omitted ) Between-gender comparisons were made using the chi-squared test for categorical variables and Students t-test for continuous variables…( text omitted ). A logistic regression analysis was performed for employment status, marital status, and comorbidity to evaluate the independent effects of gender on these dependent variables.” 27

EXAMPLES OF HYPOTHESIS AS WRITTEN IN PUBLISHED ARTICLES IN RELATION TO OTHER PARTS

• EXAMPLE 1. Background, hypotheses, and aims are provided
• “Pregnant women need skilled care during pregnancy and childbirth, but that skilled care is often delayed in some countries …( text omitted ). The focused antenatal care (FANC) model of WHO recommends that nurses provide information or counseling to all pregnant women …( text omitted ). Job aids are visual support materials that provide the right kind of information using graphics and words in a simple and yet effective manner. When nurses are not highly trained or have many work details to attend to, these job aids can serve as a content reminder for the nurses and can be used for educating their patients (Jennings, Yebadokpo, Affo, & Agbogbe, 2010) ( text omitted ). Importantly, additional evidence is needed to confirm how job aids can further improve the quality of ANC counseling by health workers in maternal care …( text omitted )” 28
• “ This has led us to hypothesize that the quality of ANC counseling would be better if supported by job aids. Consequently, a better quality of ANC counseling is expected to produce higher levels of awareness concerning the danger signs of pregnancy and a more favorable impression of the caring behavior of nurses .” 28
• “This study aimed to examine the differences in the responses of pregnant women to a job aid-supported intervention during ANC visit in terms of 1) their understanding of the danger signs of pregnancy and 2) their impression of the caring behaviors of nurses to pregnant women in rural Tanzania.” 28
• EXAMPLE 2. Background, hypotheses, and aims are provided
• “We conducted a two-arm randomized controlled trial (RCT) to evaluate and compare changes in salivary cortisol and oxytocin levels of first-time pregnant women between experimental and control groups. The women in the experimental group touched and held an infant for 30 min (experimental intervention protocol), whereas those in the control group watched a DVD movie of an infant (control intervention protocol). The primary outcome was salivary cortisol level and the secondary outcome was salivary oxytocin level.” 29
• “ We hypothesize that at 30 min after touching and holding an infant, the salivary cortisol level will significantly decrease and the salivary oxytocin level will increase in the experimental group compared with the control group .” 29
• EXAMPLE 3. Background, aim, and hypothesis are provided
• “In countries where the maternal mortality ratio remains high, antenatal education to increase Birth Preparedness and Complication Readiness (BPCR) is considered one of the top priorities [1]. BPCR includes birth plans during the antenatal period, such as the birthplace, birth attendant, transportation, health facility for complications, expenses, and birth materials, as well as family coordination to achieve such birth plans. In Tanzania, although increasing, only about half of all pregnant women attend an antenatal clinic more than four times [4]. Moreover, the information provided during antenatal care (ANC) is insufficient. In the resource-poor settings, antenatal group education is a potential approach because of the limited time for individual counseling at antenatal clinics.” 30
• “This study aimed to evaluate an antenatal group education program among pregnant women and their families with respect to birth-preparedness and maternal and infant outcomes in rural villages of Tanzania.” 30
• “ The study hypothesis was if Tanzanian pregnant women and their families received a family-oriented antenatal group education, they would (1) have a higher level of BPCR, (2) attend antenatal clinic four or more times, (3) give birth in a health facility, (4) have less complications of women at birth, and (5) have less complications and deaths of infants than those who did not receive the education .” 30

Research questions and hypotheses are crucial components to any type of research, whether quantitative or qualitative. These questions should be developed at the very beginning of the study. Excellent research questions lead to superior hypotheses, which, like a compass, set the direction of research, and can often determine the successful conduct of the study. Many research studies have floundered because the development of research questions and subsequent hypotheses was not given the thought and meticulous attention needed. The development of research questions and hypotheses is an iterative process based on extensive knowledge of the literature and insightful grasp of the knowledge gap. Focused, concise, and specific research questions provide a strong foundation for constructing hypotheses which serve as formal predictions about the research outcomes. Research questions and hypotheses are crucial elements of research that should not be overlooked. They should be carefully thought of and constructed when planning research. This avoids unethical studies and poor outcomes by defining well-founded objectives that determine the design, course, and outcome of the study.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

• Conceptualization: Barroga E, Matanguihan GJ.
• Methodology: Barroga E, Matanguihan GJ.
• Writing - original draft: Barroga E, Matanguihan GJ.
• Writing - review & editing: Barroga E, Matanguihan GJ.

Product development: Leveraging qualitative research to meet customer expectations

Explore four stages in product development where implementing qualitative research can provide deep insights, guiding companies to better meet consumer needs and stay ahead of the competition.

Tips for collecting customer feedback  

Editor’s note: Kimberly Pate is managing director, corporate research, at Arlington, Va.-based market research firm Hanover Research. This is an edited version of a post that originally appeared here . 

Customer expectations for their products are higher than ever, and companies are struggling to keep up.

A recent survey found that one in three consumers is struggling to find products that meet their needs. Companies that do not gather customer insights and incorporate them into product development will lose customers to their competitors. In fact, that same survey showed that 72% of customers are willing to try new products to find one that meets their needs.

Companies have several options for collecting customer feedback on products, the most common of which are customer surveys. However, there are a few stages of the product development process where companies can benefit from going beyond a survey by gathering qualitative data. This data allows companies to discover rich and valuable insights that can direct areas for future research or development.

What is qualitative product feedback?

Qualitative product feedback involves asking customers questions directly. The two most common formats are customer interviews and focus groups. This approach allows companies to gather in-depth feedback and ask follow-up questions to delve deeper into the reasoning behind responses. The open-ended questions center on a product’s value, features and product experience allowing companies to build products and features customers want.

Though asking interview questions may seem straightforward and relatively easy, it is critical to enlist an experienced facilitator. A skilled moderator ensures that questions are asked in a way that gets the desired insights without influencing customers’ responses. They also need to correctly code and accurately interpret the responses without bias or assumptions.

By gathering and incorporating qualitative product feedback companies can:

• Understand customer perceptions and preferences on various aspects of the company and its products.
• Gather unanticipated feedback that would not be collected from a formatted survey.
• Clarify customers’ opinions by asking for follow-up questions that provide more context.

Understanding when to collect product feedback

There are four key stages of product development where qualitative feedback is critical: initial product development, product refinement, pre-launch and post-launch. 

1. Initial product development.  Qualitative research can help narrow and refine potential product concepts during the initial idea-generation phase of product development. Its approaches can produce a detailed picture of customers’ experiences with a product and reveal unmet needs and untapped opportunities.

For example, a company looking to update a product can interview current customers about the existing product and gather opinions on potential features. Gathering direct feedback at this stage allows companies to identify the products and features customers are most interested in and why.

2. Product refinement.   Customer feedback is also critical in the product refinement stage. Even if you confirmed a product is in demand in earlier development stages, your produced product may not align with what customers are willing to buy.

Gathering feedback on proposed elements (features, pricing, etc.,) and allowing customers to beta test and evaluate products helps companies determine if the proposed product is viable and identify what additional refinement is necessary.

In this phase, engaging an audience that spans different age groups, ethnicities, income levels and genders is critical to take cultural differences and considerations into account that may not be top of mind for design or marketing teams.

3. Pre-launch.   Companies need to fine-tune how they will market the new product before releasing it. Qualitative feedback at this stage can help companies identify what themes and elements of the product resonate most with customers.

A common example is focus groups that are shown new messaging or ads before launch. This allows researchers to collect a group’s reaction to new concepts and spark conversation on what resonates and what’s falling off the mark. Not only does collecting direct customer feedback help companies optimize their messaging, but it can also produce customer quotes that can showcase the product’s value, enhancing marketing and sales strategies.

4. Post-launch.   Most rigorous post-launch reviews include some type of customer experience survey to evaluate the product’s performance. By conducting follow-up qualitative research, companies can collect additional data and context to clarify the results of the post-launch surveys.

For example, if a typically loyal and engaged customer segment expresses dissatisfaction with functionality or a lack of desire to buy a new product, qualitative research can uncover the reasons why and allow a company to direct future product improvements.

Qualitative feedback can uncover potential product pitfalls

While it is hard to foresee every potential product pitfall, a well-designed research plan that includes qualitative feedback can identify potential concerns with product features at different stages in product development and bring to light new perceptions and interpretations that companies can leverage to further enhance their products.

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• Open access
• Published: 09 May 2024

Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study

• Katharina Tjernström 1 ,
• Inger Lindberg 1 ,
• Maria Wiklund 2 &
• Margareta Persson 1  

BMC Health Services Research volume  24 , Article number:  610 ( 2024 ) Cite this article

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During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 – February 2022. The data was analysed using inductive qualitative content analysis.

Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women’s difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a ‘key person’ in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.

Conclusions

Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Peer Review reports

Intrapartum and postpartum healthcare should ideally be high-quality, evidence-based, and a positive experience stemming from woman-centred care with a holistic approach based on human rights [ 1 ]. This approach acknowledges each woman’s articulated needs and expectations in her social, emotional, physical, spiritual, and cultural context [ 2 ]. Nevertheless, during the first year postpartum, about one in four Swedish women with severe perineal trauma (SPT) [ 3 ], i.e., a third- or fourth-degree perineal laceration involving the anal sphincter muscle and anorectal mucosa at vaginal childbirth [ 4 ], are dissatisfied with their care and one in three women report ongoing health problems related to their SPT. Women with SPT may suffer from various physiological and psychological consequences such as pain [ 5 , 6 ] , incontinence [ 7 ], defecation problems [ 8 ], vaginal prolapse [ 5 ], sexual dysfunction [ 9 ] or depression and anxiety [ 10 , 11 , 12 ].

Reducing physical symptoms is essential to support emotional and social recovery after any perineal trauma [ 13 , 14 ]. Women with SPT emphasise that professional, competent, and respectful attitudes from healthcare professionals (HCPs), including individual and adapted information, facilitate, and promote their postpartum recovery. Thus, the HCPs’ competence and knowledge of treatment options is a prerequisite for women to access needed care [ 15 ]. An additional problem in the Swedish context is the lack of national recommendations or guidelines, which enables each of the 21 regions to develop own regional and local guidelines. An audit of the existing regional and local guidelines for prevention and care of SPT shows an unexpected diversity or lack of evidence-based recommendations [ 16 ]. However, dissatisfaction with access to healthcare has been expressed by women with persistent, i.e., beyond one year postpartum, SPT-related health problems [ 6 , 17 ]. Furthermore, women criticise inadequate or absent support [ 6 , 18 ], poor information and education [ 6 , 10 , 18 ], and lack of follow-up care regarding SPT and its potential psychological and social consequences [ 6 , 10 ]. Postpartum care focuses more on the baby than the mother’s well-being [ 18 , 19 ]. Also, the available treatment options are perceived as limited and outdated by those with access to needed care [ 17 , 18 ]. Moreover, women with SPT describe that some HCPs tend to normalise their SPT-related problems [ 10 , 17 , 18 , 19 , 20 , 21 , 22 ], and women are met in unprofessional and disrespectful ways [ 17 , 23 ], where HCPs are perceived as ignorant, nonchalant, and questioning women’s symptoms [ 10 , 17 ]. Previous research [ 24 ] indicates an institutional objectification of women with SPT by Swedish healthcare providers hindering access to healthcare, sick leave, and occupational rehabilitation after SPT. In contrast, women also report being acknowledged and liberated when HCPs have a professional and empathic approach and provide continuity of care that enables access to care for persistent SPT-related health problems [ 17 , 18 , 19 , 25 ]. Thus, several women who sustained an SPT during childbirth do not experience access to needed and necessary care, a fact that needs further exploration.

Globally, sexual and reproductive health and rights (SRHR) are crucial for individual health and gender equality [ 26 ]. Current issues within SRHR and midwifery are controlled by the institutional power in health institutions, i.e., medical power [ 27 ], connected to the still-existing economic and educational disadvantages of women globally, which are also feminist issues [ 26 , 28 ]. As midwife stands for ‘with woman’ [ 28 ], gender or feminist approaches are used in advancing midwifery theory [ 27 , 29 ] and various aspects of SRHR topics such as breastfeeding promotion [ 30 ], birth plans [ 31 ] and attitudes towards contraceptives [ 32 ]. In midwifery and feminist approaches, the biological material body and the socially constructed gendered body are viewed as intertwined [ 33 ]. Moreover, midwifery care is recommended to be woman-centred [ 1 , 2 ], focusing on the individual woman’s needs and transferring control from the institution to the woman herself. However, despite the different organisations of sexual and reproductive healthcare between countries, international research shows similar results regarding women’s diverging experiences with postpartum SPT-related healthcare [ 6 , 15 , 17 , 18 ].

In sum, there is growing evidence showing that many women with persisting health problems caused by SPT are often, but not always, met with mistrust and ignorance when seeking care for their problems. Even though there may be national, regional, or local protocols or guidelines for care after SPT, women with persistent SPT-related problems still raise their voices about the difficulty of getting access to competent quality care. This indicates a potential gender bias [ 34 ] and a need for gender theoretical perspectives in midwifery [ 28 ], as utilized in this study. Additionally, few studies explore the care-seeking experience among this group of women in a longer time perspective after childbirth when the SPT occurred.

The aim of this study is to explore how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

Study design and context

The present study is part of a larger research project investigating the long-term consequences of SPT on quality of life, working life, and healthcare contacts. This study had an inductive qualitative interview study design applying qualitative content analysis to analyse data [ 35 , 36 , 37 ]. This method searches for patterns, e.g., by identifying similarities and differences in the data. The researchers obtain an in-depth understanding of the studied phenomenon through abstraction and interpretation [ 36 ]; thus, an appropriate method to apply to capture women’s experiences of their healthcare encounters when seeking medical help and support. Throughout the research process, the recommendations for qualitative research according to ‘Consolidated criteria for reporting qualitative research’ (COREQ) were followed [ 38 ].

Sweden has 21 partly independent regions primarily responsible for providing healthcare services to the population. Healthcare services are tax-funded, and the regions have extensive autonomy to decide upon the healthcare services within each region based on the frameworks of the Health and Medical Service Act [ 39 ]. Additionally, within the Swedish social security system, 480 days of paid parental leave are allocated to each child in Sweden and can be utilised by their legal guardian(s) until the child is twelve years old. Of these 480 days, 60 days are specifically assigned to each parent, and the remaining days are split between parents as desired. The financial compensation is based on the parent’s income and is financed by taxes [ 40 ].

In Sweden, midwives are the primary care providers to women with normal pregnancies, births, and postpartum care. In case of complications to pregnancy and childbirth, midwives collaborate with other medical professionals, especially obstetricians. For example, midwives suture first- and second-degree perineal lacerations, while obstetricians are responsible for all SPT repairs [ 41 ]. Generally, in Sweden, women who sustain an SPT during childbirth are offered a check-up with the obstetrician responsible for the repair before discharge and should also have a follow-up with an obstetrician or sometimes a physiotherapist within the postnatal period. Thereafter, women with no mayor initial healing problems are advised to contact relevant healthcare services if any health issues related to the SPT should arise in the future. Women presenting with complicated healing are treated accordingly. Additionally, women with second- to fourth-degree perineal lacerations are assessed with questionnaires three times during the first year postpartum by the National Perineal Laceration Register. However, there are no recommendations in Sweden for prolonged check-ups for women with SPT after the postnatal period and no guidelines on organised check-ups for women with prolonged symptoms due to SPT exist [ 42 , 43 ].

Women with persistent SPT-related health problems and characteristics were purposively recruited to achieve a heterogeneous sample reflecting multiple experiences. An overview of inclusion and exclusion criteria can be found in Table 1 .

The closed Swedish Facebook community ‘Förlossningsskadad? Du är inte ensam!’ [‘Injured at childbirth? You are not alone!’] functioned as a recruitment platform for a national sample of women reporting persistent SPT-related health problems. The Facebook community is secluded to women with SPT and started in 2014. During the data collection period (Nov 2020 – Feb 2022), the group had over 7,600 members; today, the community has grown to include over 9,500 members [ 44 ].

In late November 2020, the administrators of the Facebook community pinned a digital poster with study information and a link to the study homepage in the group feed. The study homepage contained written information on the research project and contact details for the research group if any women wanted additional information about the study. Interested potential participants contacted the research group via a contact form on the homepage, and the first author (KT) confirmed that the potential participants met the inclusion criteria via telephone. Thirteen participants from different parts of Sweden showed interest in participating and left their contact information. One woman never responded to our efforts to reach her. The remaining twelve women fulfilled the inclusion criteria and were invited to an interview. Before the interview, the women answered a digital survey on background data (such as demographic data, education, employment, sick leave, and childbirth history) distributed via REDCap ® , a web-based application to create secure online questionnaires and research databases [ 45 ]. The interviews were finalised in February 2022.

Data collection

We collected data via individual open-ended interviews [ 46 ], supported by a semi-structured interview guide [see Additional file 1 ]. The interview guide, developed by KT and MP with input from MW and IL, was based on literature reviews, our awareness of gender as a social construct [ 33 ], and the clinical pre-understanding within the research group. After a pilot interview conducted by KT (not included in the data), minor adjustments were made to the interview guide. The final interview guide covered the topics of everyday life experiences, work, and general functioning. However, despite the mentioned interview topics, the emergent study design and the ability to speak freely about what was perceived as important for their daily functioning, the contacts with healthcare services was brought up in vivid and extensive narratives by all participants as part of their descriptions of their challenges in everyday life and their ability to function at work. Hence, the experiences the women made of the healthcare services played an important role for the women in their daily management of SPT-related health problems.

As data collection occurred during the COVID-19 pandemic, all participants were interviewed digitally via Zoom ® [ 47 , 48 ]. With the participant’s consent, the interviews were audio-recorded via Zoom ® and a separate digital recorder (as backup). Any Zoom video files automatically generated were deleted directly after the termination of the interview to protect participants’ identities. The first author interviewed all women; in two interviews, co-authors (IL or MW) also attended. The authors had no professional or personal affiliation with the enrolled participants . Detailed interviews ranging from 29 – 112 minutes (median: 61.5 minutes) gave extensive data. All interviews were performed in Swedish and transcribed verbatim. After that, the first author validated the transcripts for accuracy by reviewing the text while listening to the recordings.

Authors’ pre-understanding and theoretical positionality

The research group comprises three midwives (KT, IL, MP) and one physiotherapist (MW). We all have extensive professional experiences from clinical practice in primary and in-patient care, where three authors (KT, IL, MP) have specific professional experiences of caring for women with SPT. Additionally, we are women, feminists, and mothers with various birth experiences. Further, the group holds expertise in gender studies and qualitative research within midwifery science, such as perineal trauma and medical sociology. Hence, we stem from a social constructivist research standpoint and utilise ourselves as co-constructors in the analysis process. As feminist researchers, we apply a gender theoretical lens to the data.

Data analysis

The interviews were analysed using qualitative content analysis with an inductive and stepwise approach focusing on the manifest and latent content [ 35 , 36 , 37 ]. The interviews, transcripts, and analysis steps were performed in Swedish.

The analytical procedure started with reading the transcripts multiple times while highlighting text, meaning units, with content relevant to the aim of this study. Then, identified meaning units were condensed, focusing on preserving their core meaning and labelled with manifest codes [ 35 , 36 , 37 ]. Initially, KT coded one interview and triangulated those codes with the principal investigator (MP). KT then coded the rest of the interviews. In the next step, similar codes were clustered, forming subcategories based on the manifest content. Moving towards an interpretation of the content, categories were created by the abstraction of subcategories. This was done by KT and MP separately and then triangulated to identify significant concepts. Next, the preliminary categories and subcategories were triangulated with the whole research group until a consensus was obtained. To answer the question of ‘what?’ and ‘how?’ within the data, the latent content and thread of meaning were identified by clustering and abstracting the emerging findings to form subthemes and a theme [ 36 , 37 ]. The emerging findings were also peer-reviewed and discussed at a research seminar. The finalisation of the analysis resulted in an overarching theme and four subthemes. The translation of categories, subthemes, theme and inserted citations from Swedish into English was performed as a last step. The translation and choice of words were discussed between authors (all knowledgeable in English) to reach a consensus and minimise translation bias.

During the coding process, the researchers used MAXQDA ® [ 49 ], a software for organising, transcribing, analysing, and visualising qualitative research data, and Microsoft Excel ® [ 50 ] as aids to organise the codes.

Demographics of included participants

The background characteristics of the twelve participants in the final sample are presented in Table 2 .

The participants identified themselves as cis women, i.e., their gender identity matched their sex assigned at birth [ 51 ], and are thus referred to as ‘women’ in this paper. All women were in a partner relationship. The women reported a broad spectrum of physical and phycological health problems following the SPT at childbirth, e.g., urine or anal incontinence, pain in the lower abdomen, sexual dysfunction, and depression. Thirty per cent of the women had full-time employment, and the proportion of parental leave varied from 12% to 100% (three women had an ongoing parental leave with subsequent children at the interview). Further, 60% of the women had a sedentary occupation. Five women had been on sick leave after reconstructive surgery, and five reported sick leave for other reasons than their SPT.

The analysis resulted in one theme, ‘Overlooked by the obstetric gaze – living the paradox of a normalised but traumatised postpartum body’, with related subthemes ‘Questioning whether it’s all in my head’, ‘Fighting persistently for access and legitimacy in no (wo)man's-land’, ‘Facing multidimensional losses when no help in sight’, and ‘Depending on other’s advocacy to navigate an arbitrary system’. An overview of the findings is presented in Table 3 . The findings are presented as an overarching theme and thereafter, the related subthemes and categories. Citations from the participants illustrate the findings. All women have been allocated pseudonyms in the result presentation.

Overlooked by the obstetric gaze – living the paradox of a normalised but traumatised postpartum body

The latent theme ‘Overlooked by the obstetric gaze – living the paradox of a normalised but traumatised postpartum body’ represented the women’s experiences of healthcare encounters covering HCPs’ diminishing attitudes towards women’s persistent SPT-related health problems and the women’s difficulties accessing healthcare and sick leave. We interpreted that the women were assessed by the HCPs’ ‘obstetric gaze’, i.e., a medical gaze in postpartum healthcare normalising their persistent health problems and judging the women’s lower abdomen as ‘fine’ by their looks. The obstetric gaze put the women in a paradoxical situation where HCPs normalised tangible symptoms to be a natural part of childbirth. With no medical legitimacy of the health problems, the women also felt labelled as ‘hysterical’ (exaggerating health problems) by the HCPs. As a result, on the one hand, they had to continue facing persistent and tangible health problems such as incontinence, pain or prolapses. On the other hand, no acknowledgement by HCPs of their health problems led them to question whether their problems were merely a product of their imagination and, thus, only existed ‘in their head’. The theme also comprised women’s struggle for legitimacy in a gendered healthcare system - a no-(wo)man's land. They experienced that healthcare services and social insurance systems were challenging to access and demanded a tenacious and extensive fight to obtain legitimacy for their health problems. Consequently, the women had to put up with neglected healthcare needs, negatively impacting their physical and emotional well-being, and financial and social status when no medical help or rehabilitation was available. However, some women had encountered an HCP who was empathic and understanding, hence not guided by the obstetric gaze. Such encounters legitimised persistent problems and were crucial for accessing needed care, sick leave, and rehabilitation.

Questioning whether it’s all in my head

The subtheme ‘Questioning whether it’s all in my head’ focused on the women’s experiences of facing ignoration and no confirmation of perceived health problems and thus being labelled as a hysterical woman. The related categories referred to a normalisation process that the women experienced in their encounters with HCPs, which made them question their bodily perceptions. Furthermore, the women felt accused of exaggerating symptoms because their persistent SPT-related health problems did not match HPCs’ views of acceptable postpartum symptoms. Thus, it could be understood that the women found themselves in a paradox of suffering from tangible physical consequences after SPT, which were normalised by HCPs and their ‘obstetric gaze’.

Facing HCP's ignoration of perceived problems

The women experienced the HCPs defining their persistent health problems after the SPT as ‘normal’. The HCPs assured the women that their problems would disappear with time or that transient motherhood-related aspects, such as breastfeeding or fragile vaginal mucosa, were the cause of the problem. One woman expressed:

“Then I felt, ‘It should not feel like this; this is something wrong’, and I sought medical attention and was seen by multiple physicians […] They thought my vaginal mucous membrane was not ready for intercourse. I was still breastfeeding, so they thought I should stop breastfeeding. Then maybe the mucous membrane would be restored, which was causing me the pain. I was not listened to at all. I was treated very poorly by one physician in particular, and despite second opinions and so on, nobody… nobody took me seriously.” (Linda)

Consequently, the women perceived that their concerns were ignored. They also learned that the HCPs saw their prolonged physical problems after SPT as an inevitable part of childbirth, which the women should accept. One woman resigned:

“But then [the physician] says something like this: ’Well, that's completely normal’, but I felt like, ‘Yes, but it doesn't feel normal'.” (Emma)

After the genital and pelvic floor examinations, the HCPs often guaranteed the women that ‘everything looked fine’, i.e., reinforcing the normality of the genital area. Although the women described to the HCPs that they struggled with SPT-related problems, their concerns were met with a comment on the physical appearance rather than a comprehensive examination of the pelvic floor's functionality.

One woman responded:

“They think ‘everything looks fine’ and ‘everything looks good and repaired’. I still have problems. I was also referred to a surgeon, who did a rectoscopy, and ‘it looked so nice’. Then, I was referred to a urotherapist to learn how to pinch my muscles because ‘everything would be so good’. She helped me get a second opinion in XX [town], where they discovered that there was still damage." (Jin)

Another woman expressed:

”I couldn’t care less what it [genital area] looks like. Nobody will be down there watching. I only need it [genital area] to function as intended.” (Anna)

Consequently, the women felt ignored and unheard in their contact with healthcare services. They perceived that HCPs did not listen to them, leaving them feeling invisible, sometimes even having severe health problems.

“I was hospitalised with sepsis before someone listened to me.” (Josefin)

Being labelled as a hysterical woman

The women also experienced being labelled as the ‘hysterical woman’ who exaggerated their persistent symptoms and had mental health problems. The women described how the HCPs accused them of imagining their SPT-related health problems. One woman indignantly revealed that the HCP she encountered said, 'These problems only exist in your head’ (Joanna), i.e., suggesting that the perceived symptoms did not exist and rejecting the health concerns. Hence, this attitude made some women believe their problems were a product of their imagination and sometimes made them even question their sanity.

Moreover, the HCPs’ condescending attitudes towards the women made them feel dismissed and devalued. For example, the women shared that HCPs laughed at them or were rough or cold during the examination. Moreover, HCPs expressed that they had ‘seen worse’ (Amanda). Some women also conveyed that they were advised ‘to drink some wine to feel better’ (Elin) when discussing painful intercourses due to their SPT-related health problems.

“You are constantly dismissed, ‘No, but everything looks fine, you have no problems’. Then you start to think you’re imagining things. And then you may not dare to talk about the injuries.” (Jin)

Fighting persistently for access and legitimacy in no (wo)man's-land

The subtheme ‘Fighting persistently for access and legitimacy in no (wo)man's-land’ referred to the women’s experience of gender constructs related to inaccessible healthcare services and their often year-long struggles to access this gendered healthcare and linked social insurance systems. The difficulties in accessing care created negative attitudes towards the healthcare services, making the women wish for general improvements in women’s healthcare.

Struggling to access the gendered healthcare and social insurance systems

The women pointed out that after giving birth, they needed more extensive information on their injury, precautions, available help (follow-up care or re-operation), and sick leave. To overcome the lack of required information, they had to request or actively search for it on their own, which also led to uncertainty about where and when to seek further help if needed.

“I was sent home with a brochure and a pat on the shoulder.” (Amanda)

The women also experienced a lack of adequate healthcare services targeted at their SPT-related health problems. For example, many women did not have access to a pelvic floor clinic or had to travel long distances to see specialists. Hence, their place of residence decided the quality of care the women received. Moreover, some women problematised the organisation of postpartum care as they missed out on follow-up care and even, in some cases, were denied follow-up care or referrals to specialised care were lost. As a result, some women had no opportunity to talk to the operating physician or experienced no follow-up care, although they requested it.

“They said it can take up to a year to get better. So, when that year had passed, and before starting to work again, I called different places in the hospital and asked: What should I do now? […] It took several months before I got an appointment with the surgeon for an assessment. And then I had to get a second opinion. So, it took like seven months before I got an appointment at [a specialist clinic].” (Hawa)

For the women, access to healthcare services, sick leave certificates, and HCPs’ dismissive attitudes were perceived as gender-related, i.e., difficulties in obtaining help from women’s healthcare services would not exist if the services were more women-oriented. One woman illustrated this by expressing: ‘If men gave birth to babies, the situation would not be like this’ (Joanna). Moreover, they perceived that women’s healthcare services were not prioritised. They explicitly stated that the absence of sick leave certificates and benefits was related to their gender. The women were expected to cope without sick leave benefits because vaginal and perineal lacerations of any scope were viewed as a natural part of childbirth, a normal process of a woman’s body. Thus, sequelae thereof did not exist or were taboo in society.

“Everything that happens during and after childbirth and related injuries has been a taboo discussion topic, so it has been completely ‘normal’ to suffer from persistent pain.” (Anna)

“I have applied for compensation from the national patient insurance. I got rejection after rejection; nothing has gone wrong. I was told: 'You simply must expect these things in childbirth. And a caesarean section is not less risky'.” (Hawa)

Thus, the women argued that society and the government did not invest needed resources in women’s healthcare. In addition, those few women receiving a short period of sick cash benefits had it immediately after giving birth or after re-operation, but not for prolonged problems. Further, the women noted that they were not offered sick leave certificates due to persistent physical SPT-related health problems but instead due to mental issues, such as depression or anxiety.

“I've heard about women who have been mentally unwell and have hurt their children. So maybe physicians get cautious and put women on sick leave if they say, ‘I'm not feeling mentally well’. Then they act quickly because they think it's so important. But they don't think about the physical injuries because that's part of [childbirth].” (Jenny)

However, the women shared how they fought long and hard for acknowledgement and care and made demands; for many, this process had covered years. They had to repeatedly insist that something was wrong and felt pressure to prove their health problems to the HCPs. In some women, this led to their persistent problems being diagnosed and acknowledged after several years of delay. The struggle for care involved countless visits and referrals to different HCPs, demanding much strength and persistence, which exhausted them. Sometimes, the sequelae had to develop into an acute health situation, or some women decided to pay for private care to access the proper treatment and rehabilitation. Further, with time, they also became explicit about their demands for sick leave certificates and benefits.

“Well, it [short sick leave period because of birth traumas] just feels like scorn. To me, it is not a sufficient length of sick leave.” (Elin)

Wishing for improvement in women's healthcare

The perceived lack of adequate care and rehabilitation, access to sick leave benefits, and HCPs’ attitude negatively influenced the women’s opinions on healthcare services, especially postpartum healthcare. In addition, the women perceived many HCPs as unprofessional, indifferent, and unstructured. As a result, the women mistrusted the HCPs and lost hope in healthcare services. Thus, they were reluctant to seek further care and were anxious about receiving proper treatment or that HCPs would miss important things.

“I am not being listened to in women's healthcare. This is partly why I feel so disappointed.” (Linda) “You just don't trust the healthcare system. […] Some people have been struggling with their injuries for like 18 years. But the [specialist clinic] – I finally received fantastic treatment, and what if it could be available everywhere [in Sweden]?” (Hawa)

Moreover, the women described a struggle for their rights when deciding whether to report the HCPs to the authorities and pointed out the need to improve women’s healthcare. Reporting HCPs was perceived as complicated as the women did not want to blame specific individuals. The women saw that the major problem lay within the healthcare system and with individual HCPs.

“In the end, I met a fantastic person [healthcare professional]. She wanted me to report the mistreatment when I eventually had the strength. Because no one listened when I said I was ill. So, she has offered to help me if I want to, but I don't know if I have the strength to file a complaint.” (Josefin)

A wish to improve women’s healthcare services was articulated, especially regarding personal follow-up care beyond one year postpartum and the possibility of full-time or part-time sick leave certificates and benefits for persistent problems on equal terms. This wish also strengthened their decision not to give up searching for help and to raise their voices to help themselves and other women.

“I received physiotherapy and the follow-up surveys [the Perineal Laceration Register] during the first year, but thereafter I would have liked to have an annual follow-up for the next years to ensure the status and potential re-operations. […] I can google, but I want to have that information in dialog with a living person, but you do not get that.” (Jenny)

Partaking in developing educational material for HCPs or starting a career within women’s healthcare were some women’s ways to contribute and increase competency in persistent SPT-related health problems.

“One of my strategies since I got the injury is also to try to influence. Being able to be involved and influence what postpartum care should consist of.” (Jin)

Facing multidimensional losses when no help in sight

The subtheme ‘Facing multidimensional losses when no help in sight’ covered physical and mental health consequences and the financial and social losses the participating women faced when no support or access to needed care and rehabilitation was provided.

Being physically victimised by HCP's malpractice

The women’s experiences covered either being misdiagnosed during the suturing after birth or in the following years when seeking help for persistent SPT-related health problems. Further, they shared how physicians had incorrectly sutured vaginal and perineal muscles after childbirth, leading the women to live with incontinence, pain, prolapses, or sexual dysfunction if their vaginas were sutured too tight. They also described how they endured infections, wound ruptures, sepsis, necrosis, and re-operations. Additionally, the women perceived a general lack of competency regarding communication and persistent SPT-related health problems, including problems related to sex life and sexual functioning, besides a more specific lack regarding suturing techniques and ultrasound examinations.

“I was referred to a specialist clinic. And they found out that all the muscles were separated, the internal and external sphincters were torn, and my pinching ability was kind of weak. So, it was quite the opposite, really, quite the opposite. None of what the other physician had said was true [laughs]. Absolutely incredible. And she is supposed to be a specialist.” (Hawa)

Aching inside

Living with troubled postpartum bodies and the absence of HCPs’ legitimation of the women´s problems made them struggle mentally, feeling speechless and silenced. This neglect reinforced irritation, anger, distress, bitterness, and disappointment towards the HCPs and the healthcare services. One woman illustrated the emotional struggle in this way:

“It's just that the health services don’t believe you, which makes you feel terrible. It's a big deal that no one listens.” (Josefin)

Moreover, the women felt uncertain about their health status due to a default medical diagnosis with concerns for their future and which staff to trust. Consequently, some had to bite the bullet, put up with their situation, and try to think positively. Other women were denying or diminishing their SPT-related health problems, accepting that their symptoms would improve, even disappear or that their condition was ‘normal’ as they had been told. Further, the women described despair because their neglected health problems caused by their SPT made them feel exposed, unsure, and hopeless. In some, this desperation resulted in a mental breakdown, a fear of losing custody of their child due to mental illness or suicidal thoughts.

“Something broke inside of me that day. I felt entirely omitted; I was close to leaving my son and committing suicide. Nobody understood how bad everything was.” (Elin)

Additionally, the women suffered emotionally when motherhood was crushed. Their partner had to take the primary responsibility for the family, and the children had to come in second place as the mothers suffered from various physical and mental health problems. As a result, the women felt they missed their children’s development and could not use their parental social security benefits as desired.

“I feel devasted because people tell me, ‘You are on maternity leave’. I’m not on maternity leave; I’m sick. I should be on sick leave.” (Jaanika)

Suffering financial and societal losses

Moreover, the women suffered financially and societally due to persistent health problems. Some women were denied financial compensation from Patient Insurance (a national insurance system where patients can seek compensation for care injuries). The Social Security Agency and the HCPs were perceived as obstacles to receiving sick cash benefits. They noted that ‘extensive’ health problems were required to receive sick cash benefits and that their health problems paradoxically were not seen as extensive or even a problem per se by the HCPs; hence, no sick leave certificates were issued.

“He [the physician] tried to argue and clarify my pain situation in the sick leave certificate to meet the requirements for a sick leave benefit at the Social Security Agency. I was in so much pain and had to lie down to breastfeed. But, no, ‘If you can manage to hold the baby when breastfeeding, then you are on maternity leave, not sick leave benefit’ [mimicking the official at the Social Security Agency who rejected the certificate and consequently also the sick cash benefit]”. (Jaanika)

Furthermore, the women were set back financially and societally because they could not work full-time due to their persistent health problems. Therefore, some women chose to compensate for their work absence with part-time parental benefits to diminish their working hours and cover their inability to work due to persistent SPT-related health problems. Without a sick leave certificate, i.e., the physicians or the officials at the Social Security Agency’s acknowledgement of a ‘true’ health problem, partners or other relatives were obliged to adjust their work schedules to support or unburden the woman’s suffering and inability to work full-time. This reduction in working hours for the SPT-affected women and, in some cases, their partners was expressed to potentially negatively affect their upcoming careers and pensions. As a result, the women experienced being caught between stools in the social insurance systems:

“[…] You end up in a position where you are neither on sick leave nor unemployment benefits and at the same time cannot perform any offered work [due to persistent problems]. But multiple societal bodies demand and expect you to be a part of the working force, and nobody really listens.” (Elin)

Depending on other’s advocacy to navigate an arbitrary system

The last subtheme, ‘Depending on other’s advocacy to navigate an arbitrary system’, highlights the women’s experiences of, often by chance, finding a single devoted professional, i.e., a ‘key person’, to access needed care and rehabilitation. Such a ‘key person’ was vital to recognising persistent problems, legitimating symptoms, and enabling access to needed care, sick leave, and rehabilitation. The women who finally had legitimation for their health problems described that the medical diagnosis also came with a feeling of sanity and empowerment, relieving them of their paradoxical situation.

Encountering a ‘key person’ to receive needed care

A support system was a prerequisite for enduring their health problems and finding the strength to fight for access to care. This system could be a partner, other family members, or friends who gave the women power and courage, but most importantly – encountering a professional who saw their problems and provided referrals or other options to obtain the needed help and support. In most cases, women would search for years for competent HCPs, such as midwives, physicians, or physiotherapists, who would listen and acknowledge persistent problems. This ‘key person’ showed empathy and trustworthiness, creating relief and security. Further, the ‘key person’ was portrayed as competent, attentive, professional, and respectful. The ‘key persons’ also shared women’s outrage at the mistreatment and default healthcare they endured. Additionally, these ‘key persons’ were surprised that the women were not on sick cash benefits due to their symptoms and that they had to compensate for their financial situation with parental benefits or reduced working hours and lower salaries. Consequently, finding this ‘key person’, often by chance or word of mouth, was crucial for accessing care and marked a significant turning point in the women’s recovery.

“I sought help from another midwife, as I felt something was wrong. This midwife referred me to the physiotherapist, who referred me to a specialist, who then referred me to surgery and rehabilitation.” (Malin)

Some women received follow-up care for their persistent SPT-related health problems during the first year postpartum. If persistent problems occurred and were acknowledged, the women were offered different surgical approaches with various outcomes, consultations by colon specialists, physiotherapy, and psychiatric care. They were grateful for the help they received but felt more comprehensive care was needed.

Feeling sane and empowered

Confirmation of persistent SPT-related health problems was expressed as liberating, strengthening and, as one woman put it, a ‘win’ (Elin). Receiving a medical diagnosis and appurtenant treatment was relieving because the medical confirmation of the symptoms released a considerable burden. These women described being acknowledged, and the diagnosis proved that health problems existed, and the struggles were not in vain. Furthermore, it explicitly stated to everyone, including themselves, that they were not ‘crazy’, ‘imagining things’ or ‘hysterical’.

“So, my laceration has been classified as an injury caused by the healthcare services. This was somehow a confirmation. It's not just that it's in my head, but it has been established that it is a medical injury, and it could have been avoided.” (Jin)

Alongside feelings of sanity and being legitimised, the women experienced empowerment. The women felt supported and confident. Thus, finding an agency to address the taboo of their SPT by talking openly about it and helping others in the same situation was also seen as therapeutic. Further, the legitimation of the sequelae and access to appropriate care gave them time to heal and process their trauma. Receiving sick leave certificates and benefits was seen as a part of the empowerment and legitimacy of their persistent SPT-related health problems, reducing stress, and easing the financial burden. Furthermore, access to occupational rehabilitation and understanding at work became available. Thus, the women who had received the help they needed after a struggle to obtain it were hopeful about the future and possible recovery.

“I have regained my authority to speak up. It [SPT-related health problems] should be out in the open, not withheld.” (Jaanika)

Our main finding was that women with persistent health problems due to SPT at childbirth were caught in a paradox of living in a normalised but traumatised body, and their health problems were rejected as postpartum normalities. Furthermore, our results elucidated the difficulties in accessing postpartum healthcare, rehabilitation, and sick leave benefits. Therefore, the women struggled with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our study highlighted experiences up to 5 years after sustaining SPT, which showed that some women’s SPT-related health problems do not diminish with time. They faced challenges functioning in daily life, at work, and in society. In contrast, finding a ‘key person’, i.e., a professional who acknowledged the women’s persistent problems as legitimate, was a prerequisite for accessing all the needed care and sick leave and enhancing empowerment for the women. Thus, this ‘key person’ was not blinded by the obstetric gaze and instead used their agency and advocacy as support.

In the following, we will discuss our findings related to other empirical studies and problematise them with theoretical reflections.

The paradox of normalising the postpartum body

In our findings, the paradox arose when the HCPs dismissed physical health problems after SPT despite women’s perceived symptoms. Central in this context was a normalisation process where health problems were regarded as ‘normal’ by HCPs, a phenomenon also found in prior research on SPT [ 17 , 18 , 19 , 20 , 21 , 22 ]. The HCPs’ normalisation of women’s health problems can also be found regarding other medical conditions affecting women, such as pelvic organ prolapse [ 52 ], menstrual pain [ 53 ], endometriosis [ 54 ] or nausea and vomiting during pregnancy [ 55 ]. In light of the medicalisation of women’s healthcare, where the medical field has sought to pathologise natural bodily processes such as pregnancy and childbirth [ 33 ], actual medical conditions such as persistent SPT-related health problems are paradoxically normalised. Our findings, therefore, highlight the need to challenge HCPs’ views of what constitutes a ‘normal postpartum body’ or ‘normal postpartum symptoms’ after sustaining SPT.

The key to healthcare

In the context of denied legitimacy of health problems and neglected needs, it appeared that the women became dependent on the goodwill of a ‘key person’, personified as the respectful, competent, and empathetic HCP. Prior research on SPT has also found women struggling with accessing healthcare [ 6 , 17 ] and specific HCPs as enablers of care [ 12 ]. The dependency on a ‘key person’ to access adequate care might highlight a structural problem within the provision of postpartum SPT-related healthcare. Globally, there are a few national guidelines on SPT management and prevention [ 56 ]. Additionally, no national guidelines regarding postpartum care of SPT exist in Sweden, and pelvic floor teams are only available in some Swedish regions [ 16 ]. In our study, the women lacked information, and competent HCPs were hard to find or located far away. Other studies have shown poor patient information and education as a postpartum problem [ 6 , 10 , 18 ], indicating a need to develop targeted oral and written information on wound healing and recovery. Further, women in Australia describe similar challenges to accessing SPT-related healthcare when having persistent SPT-related health problems [ 18 ]. The absence of national Australian guidelines may have led to inconsistent care, failing to meet women’s healthcare needs. Further, women from rural areas have had additional difficulties accessing needed care. In 2021, a clinical standard for SPT was implemented in Australia, comprising care standards for follow-up [ 57 ]. Thus, to improve the national situation in Sweden, more research and resources must be allocated to develop evidence-based recommendations, preferably internationally accepted guidelines [ 56 ]. Moreover, the accessibility of SPT-related healthcare, such as pelvic floor clinics, needs to be expanded so that women can easily meet their ‘key person’ if required.

Woman-(de)centred care?

We found that HCPs were obstructed by their obstetric gaze when assessing women with persistent SPT-related health problems. Obstetric gaze derives from the medical gaze notions [ 58 ], suggesting a gaze that splits the individual from the body, constructing the care-seeker as a medical object or condition instead of an individual with a social context. This gaze blinded HCPs who normalised obvious health problems. Recent advances in women’s healthcare in industrial countries and midwifery research show development towards continuity of care models with a woman-centred approach in different caseload-midwifery projects and informed choice regarding place of childbirth [ 28 , 59 , 60 , 61 ]. Wom e n-centred care [ 2 ] is a widespread care philosophy within midwifery that advocates for providing individualised care to women. Further, wom a n-centred care emphasises the individual woman’s healthcare needs and situation, incorporating the concepts of choice, control, continuity of caregiver, and self-determination. It can be argued that the obstetric gaze obstructed HCPs in providing wom a n-centred care because they did not acknowledge the women’s healthcare needs. Consequently, the women did not have control over their health situation. Making women feel empowered [ 2 , 62 ] is crucial in woman-centred care. Hence, the ‘key persons’ in our study managed to provide wom a n-centred care where acknowledgement of problems as real medical problems and access to care made the women experience empowerment. Therefore, we argue that guidelines regarding follow-up care after SPT should ideally be developed with wom a n-centred care as its core.

Everything looks fine

The biomedical model has traditionally focused on normality and abnormality rather than health [ 63 ]. Theoretically, the ‘obstetric gaze’ is closely tied to the ‘medical gaze’ and the ‘male gaze’, referring to the biomedical paradigm and its power [ 27 , 58 ]. In our study, the obstetric gaze judged the women’s persistent health problems due to SPT as ‘normal’ and the appearance of their genital area as ‘fine’, which created a paradoxical situation regarding the legitimacy of their ongoing health problems after SPT. Generally, the healthcare sector is critiqued for reducing the body to only incorporating organs and tissue, i.e., focusing on physical symptoms [ 27 ].

The women in our study, of which most showed more than one significant symptom after SPT, noted that HCPs would comment on the physical appearance of the perineal area rather than its functionality by telling them that ‘everything looked fine’. The focus on looks rather than functionality regarding SPT-related health problems aligns with the findings presented by others [ 17 ]. Having women describe how their persistent physical pelvic floor problems after SPT during childbirth are trivialised, normalised, questioned, and labelled as mental health issues is of utmost concern. This implies the need for rapid improvements in HCPs’ knowledge and organisation of care but also raises the question of what is considered a normal status and recovery after any perineal laceration in the short- and long-term perspective. A similar discursive focus on women’s appearance instead of their health problems has also been found among HCPs when women seek care for chronic pain [ 64 ]. The sentence ‘Everything looks fine’ can be interpreted as an objectifying, gendered discourse in an obstetric context. This discourse may reinforce the obstetric gaze and, in the broader sense, the medical gaze [ 58 ]. The Swedish Health and Medical Care Act [ 39 ] advocates for the respectful treatment of patients. Hence, it is noteworthy that the women experienced being judged by the looks of their genital area in their medical encounters rather than HCPs addressing the functionality. Such treatment does not align with the legislation and calls for a discourse analysis of the attitudes of HCPs towards women with persistent SPT-related health problems and their experiences of providing care for affected women.

Being subjected to obstetric gaslighting

In light of the women’s perception of their dismissal as dramatic, illegitimate, and irrational patients, we argue that they faced so-called ‘gaslighting’ in an obstetric context [ 65 , 66 ]. Thus, the women experienced being offered sick leave for mental problems instead of their perceived physical health problems, depicting them as hysterical women who exaggerated their condition. Gaslighting is a concept used in medicine in general [ 66 ] and in obstetrics regarding traumatic childbirth experiences [ 65 ]. The concept of hysteria, i.e., a prior medical diagnosis and historical concept theoretically linked to femininity [ 67 , 68 ] and ‘obstetric gaslighting’ [ 65 ], has also been found in research on women’s chronic pain [ 64 ] and endometriosis [ 69 ]. Men with chronic pain are perceived as brave, and women in pain are hysterical, emotional, whining, malingering, or imagining pain [ 64 ]. Further, women with endometriosis are viewed as ‘reproductive bodies’ with a proneness for hysteria [ 69 ]. Obstetric gaslighting, enforced by the normalisation of SPT-related health problems and the gendered stereotype of women as hysterical patients, puts women with SPT in an inferior position towards HCPs and can, therefore, be interpreted as a demonstration of institutional power [ 65 ]. Hence, being overlooked by the obstetric gaze might constitute a form of obstetric gaslighting, a concept that has not been applied to SPT before.

Implications and significance

Our study indicated that women continue to have problems accessing healthcare for persistent SPT-related health problems several years postpartum. Additionally, women with persistent SPT-related health problems often depended on a ‘key person’ with the competence to open the doors to comprehensive care, as shown in our findings. The Swedish Government launched a multi-million project from 2015 to 2022 to improve and promote women’s health [ 70 ]. Despite this investment, the depicted experiences of the included women reflect upon remaining structural and clinical problems within Swedish healthcare, which need further attention, investigation, and actions. Additionally, there are considerable differences in reported satisfaction and prevalence of complications at the one-year follow-up between the regions [ 3 ], indicating that there are suboptimal healthcare services. With a significant variation in satisfaction and recovery at one year, there are reasons to believe that women with prolonged problems may experience problems getting access to needed care.

Our study also showed that SPT-related healthcare services are not available on equal terms to women with persistent SPT-related health problems. In general, many women within this group had problems accessing care and sick leave for years. However, depending on where the women reside, not all women have access to specialised care. This inequity may be explained by Sweden having 21 self-governing health regions, and in the absence of national guidelines regarding SPT care and follow-up, the healthcare provision for affected women varies. To secure access to postpartum care for women with SPT in general and those with different prerequisites within this group, implementation studies are needed to develop and evaluate the effect of national guidelines for follow-up care regarding SPT.

Strengths and limitations

This study has strengths and limitations that need to be addressed. A significant strength, enhancing credibility and transferability, was providing a clear context and thick descriptions of our results, where we thoroughly portrayed the women’s voices using quotations [ 35 ]. Further, our detailed account of the study context, data collection, and data analysis process facilitated the transferability of our study. Including three women born outside of Sweden added to the variety of the sample and thus improved credibility because qualitative research often overlooks immigrants' experiences. However, the migrant women spoke Swedish well enough to participate in an interview, indicating that they have been living in Sweden for some time and might be familiar with the healthcare system. Finally, the credibility and dependability of this study were also strengthened by the frequent use of interdisciplinary triangulation between the authors throughout data analysis and the writing process, as well as peer review at a research seminar.

A potential limitation was that this study may not have fully explored the situation of women with fourth-degree lacerations or those with lower education, as most participants had third-degree perineal lacerations and higher education. Further, we could not include non-binary persons and same-sex or single parents, which may be a weakness; consequently, future studies should focus on the under-represented participant groups and migrant women needing an interpreter. Additionally, all women responded voluntarily to the study invitation. Thus, our participants might be particularly outspoken about their problems or interested in raising their voices or experiences. However, they represented a variety of persistent SPT-related health problems of various severity, and some had been able to get access to medical help, whereas others had not. Additionally, our findings cohered to similar studies [ 12 , 17 ] covering shorter periods after the SPT, which may indicate that the experiences of the challenging search for needed help remain over time. Therefore, our findings may reflect other women’s experiences seeking care for SPT-related health problems and may be transferable to other women’s experiences with persistent health problems of a rare condition.

The data for this study was comprehensive and rich. Information power in qualitative research is an ongoing discussion, and the number of participants and their representativity can be seen as a limitation of credibility and transferability [ 71 , 72 ]. Graneheim, Lindgren and Lundman [ 36 ] argue that sample size should be determined by the study’s aim and the data’s quality so that variations in experiences can be captured. They do, therefore, not recommend a specific number of participants, but others do [ 71 ]. With this in mind, the authors believe that the women’s detailed descriptions of the included concepts and the extensive length of the conducted interviews enabled us to achieve sufficient information power based on the richness of the data [ 72 ].

By qualitatively exploring how women with persistent SPT-related health problems experienced their healthcare encounters, we interpreted that they faced a paradox of being reassured of normality by HCPs despite reporting sequelae symptoms. Thus, women’s needs for medical care, rehabilitation, and sick leave were largely neglected. Further, our study might indicate a structural problem within women’s postpartum healthcare, indicating that access to care depended on encountering a ‘key person’, a professional who acknowledged persistent problems as real symptoms. Access to quality care provided with a professional attitude was essential for the future well-being of women with persistent SPT-related health problems. Thus, it should not depend on meeting a single ‘key person’. Therefore, national guidelines for long-term postpartum care of persistent SPT-related health problems must be developed in Sweden. Additionally, to ensure that healthcare services meet the individual needs of women with persistent SPT-related health problems, it is crucial to consider arranging the organisation and availability of quality care for these women from a woman-centred perspective.

Availability of data and materials

The original recordings and transcripts from the current study are not publicly available due to securing the individual privacy and confidentiality of the participants. Data are available from the corresponding author upon reasonable request.

Abbreviations

Healthcare professionals

Interquartile range

Strategic Research Area Health Care Science

• Severe perineal trauma

Sexual and reproductive health and rights

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Acknowledgements

We want to thank the participating women for generously sharing their experiences.

Open access funding provided by Umea University. This work was supported by the Research Lift (SWE: Forskningslyftet) and Strategic Research Area Health Care Science (SFO-V), Umeå University. The funders had no specific role in the conceptualisation, design, data collection, analysis, publication decision, or manuscript preparation.

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Katharina Tjernström, Inger Lindberg & Margareta Persson

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KT: conceptualisation; data curation; formal analysis; investigation; methodology; validation; visualisation; writing - original draft; writing - review & editing. IL: conceptualisation; methodology; supervision; visualisation; writing - review & editing. MW: conceptualisation; methodology; supervision; visualisation; writing - review & editing. MP: conceptualisation; data curation; funding acquisition; methodology; project administration; supervision; visualisation; writing - review & editing. All authors read and approved the final manuscript.

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Correspondence to Katharina Tjernström .

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The Swedish Ethical Review Authority approved the study. An amendment to the original ethical approval of the research project to further explore the experiences of encounters with healthcare services was obtained (Dnr: 2020-035410908 and Dnr: 2022-02784-02). The study was undertaken in compliance with research ethics guidelines. All participation was voluntary, and participants received oral and written information about the study and provided written informed consent before the interviews. No interview questions were mandatory, and the women decided if and how detailed they wanted to share their experiences.

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12913_2024_11037_moesm1_esm.pdf.

Additional file 1. Semi-structured interview guide for individual interviews; contains interview questions aimed at highlighting the experience of everyday life and working life after suffering 3 rd or 4 th degree perineal laceration at childbirth (i.e., severe perineal trauma [SPT]).

Additional file 2. Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist.

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Tjernström, K., Lindberg, I., Wiklund, M. et al. Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study. BMC Health Serv Res 24 , 610 (2024). https://doi.org/10.1186/s12913-024-11037-5

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Received : 11 September 2023

Accepted : 23 April 2024

Published : 09 May 2024

DOI : https://doi.org/10.1186/s12913-024-11037-5

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