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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

• Flexibility

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

• Natural settings

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

• Meaningful insights

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

• Generation of new ideas

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

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

• Unreliability

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

• Subjectivity

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

• Limited generalizability

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

• Labor-intensive

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

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

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

Research bias

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

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

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

There are five common approaches to qualitative research :

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

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

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

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

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

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Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images.  In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).   

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• Methodology
• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on 4 April 2022 by Pritha Bhandari . Revised on 30 January 2023.

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

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

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

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

Table of contents

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

• Flexibility

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

• Natural settings

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

• Meaningful insights

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

• Generation of new ideas

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

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

• Unreliability

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

• Subjectivity

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

• Limited generalisability

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

• Labour-intensive

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

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

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

There are five common approaches to qualitative research :

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

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

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

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

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

Bhandari, P. (2023, January 30). What Is Qualitative Research? | Methods & Examples. Scribbr. Retrieved 12 August 2024, from https://www.scribbr.co.uk/research-methods/introduction-to-qualitative-research/

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Pritha Bhandari

Quantitative and Qualitative Research

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What is qualitative research?

Qualitative research is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the "why" rather than the "what" of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives. Rather than by logical and statistical procedures, qualitative researchers use multiple systems of inquiry for the study of human phenomena including biography, case study, historical analysis, discourse analysis, ethnography, grounded theory, and phenomenology.

University of Utah College of Nursing, (n.d.). What is qualitative research? [Guide] Retrieved from  https://nursing.utah.edu/research/qualitative-research/what-is-qualitative-research.php#what 

The following video will explain the fundamentals of qualitative research.

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

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What is Qualitative Research? Methods, Types, Approaches and Examples

Qualitative research is a type of method that researchers use depending on their study requirements. Research can be conducted using several methods, but before starting the process, researchers should understand the different methods available to decide the best one for their study type. The type of research method needed depends on a few important criteria, such as the research question, study type, time, costs, data availability, and availability of respondents. The two main types of methods are qualitative research and quantitative research. Sometimes, researchers may find it difficult to decide which type of method is most suitable for their study. Keeping in mind a simple rule of thumb could help you make the correct decision. Quantitative research should be used to validate or test a theory or hypothesis and qualitative research should be used to understand a subject or event or identify reasons for observed patterns.  

Qualitative research methods are based on principles of social sciences from several disciplines like psychology, sociology, and anthropology. In this method, researchers try to understand the feelings and motivation of their respondents, which would have prompted them to select or give a particular response to a question. Here are two qualitative research examples :  

• Two brands (A & B) of the same medicine are available at a pharmacy. However, Brand A is more popular and has higher sales. In qualitative research , the interviewers would ideally visit a few stores in different areas and ask customers their reason for selecting either brand. Respondents may have different reasons that motivate them to select one brand over the other, such as brand loyalty, cost, feedback from friends, doctor’s suggestion, etc. Once the reasons are known, companies could then address challenges in that specific area to increase their product’s sales.  
• A company organizes a focus group meeting with a random sample of its product’s consumers to understand their opinion on a new product being launched.  

Table of Contents

What is qualitative research? 1

Qualitative research is the process of collecting, analyzing, and interpreting non-numerical data. The findings of qualitative research are expressed in words and help in understanding individuals’ subjective perceptions about an event, condition, or subject. This type of research is exploratory and is used to generate hypotheses or theories from data. Qualitative data are usually in the form of text, videos, photographs, and audio recordings. There are multiple qualitative research types , which will be discussed later.  

Qualitative research methods 2

Researchers can choose from several qualitative research methods depending on the study type, research question, the researcher’s role, data to be collected, etc.  

The following table lists the common qualitative research approaches with their purpose and examples, although there may be an overlap between some.  

Types of qualitative research 3,4

The data collection methods in qualitative research are designed to assess and understand the perceptions, motivations, and feelings of the respondents about the subject being studied. The different qualitative research types include the following:  

• In-depth or one-on-one interviews : This is one of the most common qualitative research methods and helps the interviewers understand a respondent’s subjective opinion and experience pertaining to a specific topic or event. These interviews are usually conversational and encourage the respondents to express their opinions freely. Semi-structured interviews, which have open-ended questions (where the respondents can answer more than just “yes” or “no”), are commonly used. Such interviews can be either face-to-face or telephonic, and the duration can vary depending on the subject or the interviewer. Asking the right questions is essential in this method so that the interview can be led in the suitable direction. Face-to-face interviews also help interviewers observe the respondents’ body language, which could help in confirming whether the responses match.  
• Document study/Literature review/Record keeping : Researchers’ review of already existing written materials such as archives, annual reports, research articles, guidelines, policy documents, etc.  
• Focus groups : Usually include a small sample of about 6-10 people and a moderator, to understand the participants’ opinion on a given topic. Focus groups ensure constructive discussions to understand the why, what, and, how about the topic. These group meetings need not always be in-person. In recent times, online meetings are also encouraged, and online surveys could also be administered with the option to “write” subjective answers as well. However, this method is expensive and is mostly used for new products and ideas.  
• Qualitative observation : In this method, researchers collect data using their five senses—sight, smell, touch, taste, and hearing. This method doesn’t include any measurements but only the subjective observation. For example, “The dessert served at the bakery was creamy with sweet buttercream frosting”; this observation is based on the taste perception.  

Qualitative research : Data collection and analysis

• Qualitative data collection is the process by which observations or measurements are gathered in research.  
• The data collected are usually non-numeric and subjective and could be recorded in various methods, for instance, in case of one-to-one interviews, the responses may be recorded using handwritten notes, and audio and video recordings, depending on the interviewer and the setting or duration.  
• Once the data are collected, they should be transcribed into meaningful or useful interpretations. An experienced researcher could take about 8-10 hours to transcribe an interview’s recordings. All such notes and recordings should be maintained properly for later reference.  
• Some interviewers make use of “field notes.” These are not exactly the respondents’ answers but rather some observations the interviewer may have made while asking questions and may include non-verbal cues or any information about the setting or the environment. These notes are usually informal and help verify respondents’ answers.  

2. Qualitative data analysis 

• This process involves analyzing all the data obtained from the qualitative research methods in the form of text (notes), audio-video recordings, and pictures.  
• Text analysis is a common form of qualitative data analysis in which researchers examine the social lives of the participants and analyze their words, actions, etc. in specific contexts. Social media platforms are now playing an important role in this method with researchers analyzing all information shared online.   

There are usually five steps in the qualitative data analysis process: 5

• Prepare and organize the data  
• Transcribe interviews  
• Collect and document field notes and other material  
• Review and explore the data  
• Examine the data for patterns or important observations  
• Develop a data coding system  
• Create codes to categorize and connect the data  
• Assign these codes to the data or responses  
• Review the codes  
• Identify recurring themes, opinions, patterns, etc.  
• Present the findings  
• Use the best possible method to present your observations  

The following table 6 lists some common qualitative data analysis methods used by companies to make important decisions, with examples and when to use each. The methods may be similar and can overlap.  

Characteristics of qualitative research methods 4

• Unstructured raw data : Qualitative research methods use unstructured, non-numerical data , which are analyzed to generate subjective conclusions about specific subjects, usually presented descriptively, instead of using statistical data.  
• Site-specific data collection : In qualitative research methods , data are collected at specific areas where the respondents or researchers are either facing a challenge or have a need to explore. The process is conducted in a real-world setting and participants do not need to leave their original geographical setting to be able to participate.  
• Researchers’ importance : Researchers play an instrumental role because, in qualitative research , communication with respondents is an essential part of data collection and analysis. In addition, researchers need to rely on their own observation and listening skills during an interaction and use and interpret that data appropriately.  
• Multiple methods : Researchers collect data through various methods, as listed earlier, instead of relying on a single source. Although there may be some overlap between the qualitative research methods , each method has its own significance.  
• Solving complex issues : These methods help in breaking down complex problems into more useful and interpretable inferences, which can be easily understood by everyone.  
• Unbiased responses : Qualitative research methods rely on open communication where the participants are allowed to freely express their views. In such cases, the participants trust the interviewer, resulting in unbiased and truthful responses.  
• Flexible : The qualitative research method can be changed at any stage of the research. The data analysis is not confined to being done at the end of the research but can be done in tandem with data collection. Consequently, based on preliminary analysis and new ideas, researchers have the liberty to change the method to suit their objective.  

When to use qualitative research   4

The following points will give you an idea about when to use qualitative research .  

• When the objective of a research study is to understand behaviors and patterns of respondents, then qualitative research is the most suitable method because it gives a clear insight into the reasons for the occurrence of an event.  
• A few use cases for qualitative research methods include:  
• New product development or idea generation  
• Strengthening a product’s marketing strategy  
• Conducting a SWOT analysis of product or services portfolios to help take important strategic decisions  
• Understanding purchasing behavior of consumers  
• Understanding reactions of target market to ad campaigns  
• Understanding market demographics and conducting competitor analysis  
• Understanding the effectiveness of a new treatment method in a particular section of society  

A qualitative research method case study to understand when to use qualitative research 7

Context : A high school in the US underwent a turnaround or conservatorship process and consequently experienced a below average teacher retention rate. Researchers conducted qualitative research to understand teachers’ experiences and perceptions of how the turnaround may have influenced the teachers’ morale and how this, in turn, would have affected teachers’ retention.  

Method : Purposive sampling was used to select eight teachers who were employed with the school before the conservatorship process and who were subsequently retained. One-on-one semi-structured interviews were conducted with these teachers. The questions addressed teachers’ perspectives of morale and their views on the conservatorship process.  

Results : The study generated six factors that may have been influencing teachers’ perspectives: powerlessness, excessive visitations, loss of confidence, ineffective instructional practices, stress and burnout, and ineffective professional development opportunities. Based on these factors, four recommendations were made to increase teacher retention by boosting their morale.  

Advantages of qualitative research 1

• Reflects real-world settings , and therefore allows for ambiguities in data, as well as the flexibility to change the method based on new developments.  
• Helps in understanding the feelings or beliefs of the respondents rather than relying only on quantitative data.  
• Uses a descriptive and narrative style of presentation, which may be easier to understand for people from all backgrounds.  
• Some topics involving sensitive or controversial content could be difficult to quantify and so qualitative research helps in analyzing such content.  
• The availability of multiple data sources and research methods helps give a holistic picture.  
• There’s more involvement of participants, which gives them an assurance that their opinion matters, possibly leading to unbiased responses.   

Disadvantages of qualitative research 1

• Large-scale data sets cannot be included because of time and cost constraints.  
• Ensuring validity and reliability may be a challenge because of the subjective nature of the data, so drawing definite conclusions could be difficult.  
• Replication by other researchers may be difficult for the same contexts or situations.  
• Generalization to a wider context or to other populations or settings is not possible.  
• Data collection and analysis may be time consuming.  
• Researcher’s interpretation may alter the results causing an unintended bias.  

Differences between qualitative research and quantitative research 1

Frequently asked questions on qualitative research  

Q: how do i know if qualitative research is appropriate for my study  .

A: Here’s a simple checklist you could use:  

• Not much is known about the subject being studied.  
• There is a need to understand or simplify a complex problem or situation.  
• Participants’ experiences/beliefs/feelings are required for analysis.  
• There’s no existing hypothesis to begin with, rather a theory would need to be created after analysis.  
• You need to gather in-depth understanding of an event or subject, which may not need to be supported by numeric data.  

Q: How do I ensure the reliability and validity of my qualitative research findings?  

A: To ensure the validity of your qualitative research findings you should explicitly state your objective and describe clearly why you have interpreted the data in a particular way. Another method could be to connect your data in different ways or from different perspectives to see if you reach a similar, unbiased conclusion.   

To ensure reliability, always create an audit trail of your qualitative research by describing your steps and reasons for every interpretation, so that if required, another researcher could trace your steps to corroborate your (or their own) findings. In addition, always look for patterns or consistencies in the data collected through different methods.  

Q: Are there any sampling strategies or techniques for qualitative research ?   

A: Yes, the following are few common sampling strategies used in qualitative research :  

1. Convenience sampling  

Selects participants who are most easily accessible to researchers due to geographical proximity, availability at a particular time, etc.  

2. Purposive sampling  

Participants are grouped according to predefined criteria based on a specific research question. Sample sizes are often determined based on theoretical saturation (when new data no longer provide additional insights).  

3. Snowball sampling  

Already selected participants use their social networks to refer the researcher to other potential participants.  

4. Quota sampling  

While designing the study, the researchers decide how many people with which characteristics to include as participants. The characteristics help in choosing people most likely to provide insights into the subject.  

Q: What ethical standards need to be followed with qualitative research ?  

A: The following ethical standards should be considered in qualitative research:  

• Anonymity : The participants should never be identified in the study and researchers should ensure that no identifying information is mentioned even indirectly.  
• Confidentiality : To protect participants’ confidentiality, ensure that all related documents, transcripts, notes are stored safely.  
• Informed consent : Researchers should clearly communicate the objective of the study and how the participants’ responses will be used prior to engaging with the participants.  

Q: How do I address bias in my qualitative research ?  

  A: You could use the following points to ensure an unbiased approach to your qualitative research :  

• Check your interpretations of the findings with others’ interpretations to identify consistencies.  
• If possible, you could ask your participants if your interpretations convey their beliefs to a significant extent.  
• Data triangulation is a way of using multiple data sources to see if all methods consistently support your interpretations.  
• Contemplate other possible explanations for your findings or interpretations and try ruling them out if possible.  
• Conduct a peer review of your findings to identify any gaps that may not have been visible to you.  
• Frame context-appropriate questions to ensure there is no researcher or participant bias.

We hope this article has given you answers to the question “ what is qualitative research ” and given you an in-depth understanding of the various aspects of qualitative research , including the definition, types, and approaches, when to use this method, and advantages and disadvantages, so that the next time you undertake a study you would know which type of research design to adopt.  

References:  

• McLeod, S. A. Qualitative vs. quantitative research. Simply Psychology [Accessed January 17, 2023]. www.simplypsychology.org/qualitative-quantitative.html    
• Omniconvert website [Accessed January 18, 2023]. https://www.omniconvert.com/blog/qualitative-research-definition-methodology-limitation-examples/  
• Busetto L., Wick W., Gumbinger C. How to use and assess qualitative research methods. Neurological Research and Practice [Accessed January 19, 2023] https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-020-00059  
• QuestionPro website. Qualitative research methods: Types & examples [Accessed January 16, 2023]. https://www.questionpro.com/blog/qualitative-research-methods/  
• Campuslabs website. How to analyze qualitative data [Accessed January 18, 2023]. https://baselinesupport.campuslabs.com/hc/en-us/articles/204305675-How-to-analyze-qualitative-data  
• Thematic website. Qualitative data analysis: Step-by-guide [Accessed January 20, 2023]. https://getthematic.com/insights/qualitative-data-analysis/  
• Lane L. J., Jones D., Penny G. R. Qualitative case study of teachers’ morale in a turnaround school. Research in Higher Education Journal . https://files.eric.ed.gov/fulltext/EJ1233111.pdf  
• Meetingsnet website. 7 FAQs about qualitative research and CME [Accessed January 21, 2023]. https://www.meetingsnet.com/cme-design/7-faqs-about-qualitative-research-and-cme     
• Qualitative research methods: A data collector’s field guide. Khoury College of Computer Sciences. Northeastern University. https://course.ccs.neu.edu/is4800sp12/resources/qualmethods.pdf  

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Research fills a vital and important role in society: it is the means by which discoveries are made, ideas are confirmed or refuted, events controlled or predicted and theory developed or refined. All of these functions contribute to the development of knowledge. However, no single research approach fulfills all of these functions, and the contribution of qualitative research is both vital and unique to the goals of research in general. Qualitative research enables us to make sense of reality, to describe and explain the social world and to develop explanatory models and theories. It is the primary means by which the theoretical foundations of social sciences may be constructed or re-examined.

Research is to see what everybody has seen and to think what nobody has thought. (Albert Szent-Gyorgy)

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Bohannan, L. (1956/1992) Shakespeare in the bush, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 20–30.

Google Scholar  

Brace, C.L., Gamble, G.R. and Bond, J.T. (eds) (1971) Race and Intelligence: Anthropological Studies Number 8 , American Anthropological Association, Washington, DC.

Burton, A. (1974) The nature of personality theory, in Operational Theories of Personality , (ed. A. Burton), Brunner/Mazel, New York, pp. 1–19.

Chapman, C.R. (1976) Measurement of pain: problems and issues. Advances in Pain Research and Therapy , 1 , 345.

Corbin, J. (1986) Coding, writing memos, and diagramming, in From Practice to Grounded Theory , (eds W.C. Chenitz and J.M. Swanson), Addison-Wesley, Menlo Park, CA, pp. 91–101.

Duffy, M.E. (1985) Designing nursing research: the qualitative — quantitative debate. Journal of Advanced Nursing , 10 , 225–32.

Article   PubMed   CAS   Google Scholar  

Elliott, M.R. (1983) Maternal infant bonding. Canadian Nurse , 79 (8), 28–31.

PubMed   CAS   Google Scholar  

Engelhardt, H.T. (1974/1992) The disease of masturbation: values and the concept of disease, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 5–19.

Feyerabend, P. (1978) Against Method , Varo, London.

Geertz, C. (1973) The Interpretation of Cultures , Basic Books, New York.

Glaser, B.G. (1978) Theoretical Sensitivity , The Sociology Press, Mill Valley, CA.

Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research , Aldine, Chicago.

Goodwin, L.D. and Goodwin, W.L. (1984) Qualitative vs. quantitative research or qualitative and quantitative research? Nursing Research , 33 (6), 378–80.

Hinds, P.S., Chaves, D.E. and Cypess, S.M. (1992) Context as a source of meaning and understanding, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 31–49.

Klaus, M.H. and Kennel, J.H. (1976) Parent Infant Bonding: The Impact of Early Separation or Loss on Family Development , Mosby, St Louis.

Morse, J.M. (1989/1992) ‘Euch, those are for your husband!’: examination of cultural values and assumptions associated with breastfeeding, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 50–60.

Morse, J.M. (1992) If you believe in theories.... Qualitative Health Research , 2 (3), 259–61.

Article   Google Scholar  

Morse, J.M., Harrison, M. and Prowse, M. (1986) Minimal breastfeeding. Journal of Obstetric Gynecologic and Neonatal Nursing , 15 (4), 333–8.

Article   CAS   Google Scholar  

Pelto, P.J. and Pelto, G.H. (1978) Anthropological Research: The Structure of Inquiry , Cambridge University Press, Cambridge.

Book   Google Scholar  

Scheper-Hughes, N. (1992) Death Without Weeping , University of California Press, Berkeley, CA.

Smith, J.K. (1983) Quantitative versus qualitative research: an attempt to clarify the issue. Educational Researcher , 12 (3), 6–13.

Smith, J.K. and Heshusius, L. (1986) Closing down the conversation: the end of the quantitative — qualitative debate among educational inquirers. Educational Researcher , 15 , 4–12.

Strauss, A. and Corbin, J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques , Sage, Newbury Park, CA.

Tesch, S. (1981) Disease causality and politics. Journal of Health Politics, Policy and Law , 6 (1), 369–89.

Vidich, A.J. and Lyman, S.M. (1994) Qualitative methods: their history in sociology and anthropology, in Handbook of Qualitative Research , (eds N.K. Denzin and Y.S. Lincoln), Sage, Newbury Park, CA, pp. 23–59.

Wolcott, H.F. (1992) Posturing in qualitative research, in The Handbook of Qualitative Research in Education , (eds M.D. LeCompte, W.L. Millroy and J. Preissle), Academic Press, San Diego, CA, pp. 3–52.

Further Reading

Atkinson, P. (1994) Some perils of paradigms. Qualitative Health Research , 5 (1).

Denzin, N.K. and Lincoln, Y.S. (eds) (1994) Part II: Major paradigms and perspectives, in Handbook of Qualitative Research , Sage, Thousand Oaks, CA, pp. 99–198.

Filstead, W.J. (ed.) (1970) Qualitative Methodology: Firsthand Involvement with the Social World , Rand McNally, Chicago.

Gilbert, N. (ed.) (1993) Researching Social Life , Sage, London.

Glassner, B. and Moreno, J.D. (eds) (1989) The Qualitative-Quantitative Distinction in the Social Sciences , Kluwer, Dordrecht, The Netherlands.

Hammersley, M. (ed) (1993) Social Research: Philosophy, Politics and Practice , Sage, London.

Morse, J.M. (ed.) (1992) Part I: The characteristics of qualitative research, in Qualitative Health Research , Sage, Newbury Park, CA, pp. 69–90.

Morse, J.M., Bottorff, J.L., Neander, W. et al. (1991/1992) Comparative analysis of conceptualizations and theories of caring, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 69–90.

Noblit, G.W. and Engel, J.D. (1991/1992) The holistic injunction: an ideal and a moral imperative for qualitative research, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 43–63.

Rabinow, P. and Sullivan, W.M. (eds) (1979) Interpretive Social Science: A Reader , University of California Press, Berkeley, CA.

Smith, R.B. and Manning, P.K. (eds) (1982) A Handbook of Social Science Methods , Ballinger, Cambridge, MA.

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What is qualitative research?

"Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1]  Instead of collecting numerical data points or intervene or introduce treatments just like in quantitative research, qualitative research helps generate hypotheses as well as further investigate and understand quantitative data."

"Qualitative research at its core, ask open-ended questions whose answers are not easily put into numbers such as ‘how’ and ‘why’. [2]  Due to the open-ended nature of the research questions at hand, qualitative research design is often not linear in the same way quantitative design is. [2]  One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3]  Phenomena such as experiences, attitudes, and behaviors can be difficult to accurately capture quantitatively, whereas a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a certain time or during an event of interest."

• Qualitative Study - Steven Tenny; Grace D. Brannan; Janelle M. Brannan; Nancy C. Sharts-Hopko. This article details what qualitative research is, and some of the methodologies used.

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• Quantitative vs Qualitative Chart Chart showing examples of quantitative vs. qualitative research.

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Qualitative Research Definition

Qualitative research methods and examples, advantages and disadvantages of qualitative approaches, qualitative vs. quantitative research, showing qualitative research skills on resumes, what is qualitative research methods and examples.

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Table of Contents

Qualitative research seeks to understand people’s experiences and perspectives by studying social organizations and human behavior. Data in qualitative studies focuses on people’s beliefs and emotional responses. Qualitative data is especially helpful when a company wants to know how customers feel about a product or service, such as in user experience (UX) design or marketing . 

Researchers use qualitative approaches to “determine answers to research questions on human behavior and the cultural values that drive our thinking and behavior,” says Margaret J. King, director at The Center for Cultural Studies & Analysis in Philadelphia.

Data in qualitative research typically can’t be assessed mathematically — the data is not sets of numbers or quantifiable information. Rather, it’s collections of images, words, notes on behaviors, descriptions of emotions, and historical context. Data is collected through observations, interviews, surveys, focus groups, and secondary research. 

However, a qualitative study needs a “clear research question at its base,” notes King, and the research needs to be “observed, categorized, compared, and evaluated (along a scale or by a typology chart) by reference to a baseline in order to determine an outcome with value as new and reliable information.”

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Who Uses Qualitative Research?

Researchers in social sciences and humanities often use qualitative research methods, especially in specific areas of study like anthropology, history, education, and sociology. 

Qualitative methods are also applicable in business, technology , and marketing spaces. For example, product managers use qualitative research to understand how target audiences respond to their products. They may use focus groups to gain insights from potential customers on product prototypes and improvements or surveys from existing customers to understand what changes users want to see. 

Other careers that may involve qualitative research include: 

• Marketing analyst
• UX and UI analyst
• Market researcher
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• Business analyst
• Data analyst
• Research assistant
• Claims investigator

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Good research begins with a question, and this question informs the approach used by qualitative researchers. 

Grounded Theory

Grounded theory is an inductive approach to theory development. In many forms of research, you begin with a hypothesis and then test it to see if you’re correct. In grounded theory, though, you go in without any assumptions and rely on the data you collect to form theories. You start with an open question about a phenomenon you are studying and collect and analyze data until you can form a fully-fledged theory from the information. 

Example: A company wants to improve its brand and marketing strategies. The company performs a grounded theory approach to solving this problem by conducting interviews and surveys with past, current, and prospective customers. The information gathered from these methods helps the company understand what type of branding and marketing their customer-base likes and dislikes, allowing the team to inductively craft a new brand and marketing strategy from the data. 

Action Research

Action research is one part study and one part problem-solving . Through action research, analysts investigate a problem or weakness and develop practical solutions. The process of action research is cyclical —- researchers assess solutions for efficiency and effectiveness, and create further solutions to correct any issues found. 

Example: A manager notices her employees struggle to cooperate on group projects. She carefully reviews how team members interact with each other and asks them all to respond to a survey about communication. Through the survey and study, she finds that guidelines for group projects are unclear. After changing the guidelines, she reviews her team again to see if there are any changes to their behavior.  

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Phenomenological Research

Phenomenological research investigates a phenomenon in depth, looking at people’s experiences and understanding of the situation. This sort of study is primarily descriptive and seeks to broaden understanding around a specific incident and the people involved. Researchers in phenomenological studies must be careful to set aside any biases or assumptions because the information used should be entirely from the subjects themselves. 

Example : A researcher wants to better understand the lived experience of college students with jobs. The purpose of this research is to gain insights into the pressures of college students who balance studying and working at the same time. The researcher conducts a series of interviews with several college students, learning about their past and current situations. Through the first few interviews, the researcher builds a relationship with the students. Later discussions are more targeted, with questions prompting the students to discuss their emotions surrounding both work and school and the difficulties and benefits arising from their situation. The researcher then analyzes these interviews, and identifies shared themes to contextualize the experiences of the students.

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Ethnography

Ethnography is an immersive study of a particular culture or community. Through ethnographic research, analysts aim to learn about a group’s conventions, social dynamics, and cultural norms. Some researchers use active observation methods, finding ways to integrate themselves into the culture as much as possible. Others use passive observation, watching closely from the outside but not fully immersing themselves. 

Example: A company hires an external researcher to learn what their company’s culture is actually like. The researcher studies the social dynamics of the employees and may even look at how these employees interact with clients and with each other outside of the office. The goal is to deliver a comprehensive report of the company’s culture and the social dynamics of its employees.

Case Studies

A case study is a type of in-depth analysis of a situation. Case studies can focus on an organization, belief system, event, person, or action. The goal of a case study is to understand the phenomenon and put it in a real-world context. Case studies are also commonly used in marketing and sales to highlight the benefits of a company’s products or services. 

Example: A business performs a case study of its competitors’ strategies. This case study aims to show why the company should adopt a specific business strategy. The study looks at each competitor’s business structure, marketing campaigns, product offerings, and historical growth trends. Then, using this data on other businesses, the researcher can theorize how that strategy would benefit their company.

>>MORE: Learn how companies use case study interviews to assess candidates’ research and problem-solving skills. 

Qualitative research methods are great for generating new ideas. The exploratory nature of qualitative research means uncovering unexpected information, which often leads to new theories and further research topics. Additionally, qualitative findings feel meaningful. These studies focus on people, emotions, and societies and may feel closer to their communities than quantitative research that relies on more mathematical and logical data. 

However, qualitative research can be unreliable at times. It’s difficult to replicate qualitative studies since people’s opinions and emotions can change quickly. For example, a focus group has a lot of variables that can affect the outcome, and that same group, asked the same questions a year later, may have entirely different responses. The data collection can also be difficult and time-consuming with qualitative research. Ultimately, interviewing people, reviewing surveys, and understanding and explaining human emotions can be incredibly complex.

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While qualitative research deals with data that isn’t easily manipulated by mathematics, quantitative research almost exclusively involves numbers and numerical data. Quantitative studies aim to find concrete details, like units of time, percentages, or statistics. 

Besides the types of data used, a core difference between quantitative and qualitative research is the idea of control and replication. 

“Qualitative is less subject to control (as in lab studies) and, therefore, less statistically measurable than quantitative approaches,” says King.

One person’s interview about a specific topic can have completely different responses than every other person’s interview since there are so many variables in qualitative research. On the other hand, quantitative studies can often be replicated. For instance, when testing the effects of a new medication, quantifiable data, like blood test results, can be repeated. Qualitative data, though, like how people feel about the medication, may differ from person to person and from moment to moment.

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You can show your experience with qualitative research on your resume in your skills or work experience sections and your cover letter . 

• In your skills section , you can list types of qualitative research you are skilled at, like conducting interviews, performing grounded theory research, or crafting case studies. 
• In your work or internship experience descriptions , you can highlight specific examples, like talking about a time you used action research to solve a complex issue at your last job. 
• In your cover letter , you can discuss in-depth qualitative research projects you’ve completed. For instance, say you spent a summer conducting ethnographic research or a whole semester running focus groups to get feedback on a product. You can talk about these experiences in your cover letter and note how these skills make you a great fit for the job. 

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• 1 University of Nebraska Medical Center
• 2 GDB Research and Statistical Consulting
• 3 GDB Research and Statistical Consulting/McLaren Macomb Hospital
• PMID: 29262162
• Bookshelf ID: NBK470395

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

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Conflict of interest statement

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

• Introduction
• Issues of Concern
• Clinical Significance
• Enhancing Healthcare Team Outcomes
• Review Questions

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Qualitative Research

The “what,” “why,” “who,” and “how”.

Cypress, Brigitte S. EdD, RN, CCRN

Brigitte S. Cypress, EdD, RN, CCRN, is assistant professor at Lehman College and The Graduate Center, City University of New York.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Brigitte S. Cypress, EdD, RN, CCRN, PO Box 2205, Pocono Summit, PA 18346 ( [email protected] ).

There has been a general view of qualitative research as a lower level form of inquiry and the diverse conceptualizations of what it is, its use or utility, its users, the process of how it is conducted, and its scientific merit. This fragmented understanding and varied ways in which qualitative research is conceived, synthesized, and presented have a myriad of implications in demonstrating and enhancing the utilization of its findings and the ways and skills required in transforming knowledge gained from it. The purpose of this article is to define qualitative research and discuss its significance in research, the questions it addresses, its characteristics, methods and criteria for rigor, and the type of results it can offer. A framework for understanding the “what,” “why,” “who,” and “how” of qualitative research; the different approaches; and the strategies to achieve trustworthiness are presented. Qualitative research provides insights into health-related phenomena and seeks to understand and interpret subjective experience and thus humanizes health care and can enrich further research inquiries and be made clearer and more rigorous as it is relevant to the perspective and goals of nursing.

Qualitative research methods began to appear in nursing in 1960s and 1970s amid cautious and reluctant acceptance. In the 1980s, qualitative health research emerged as a distinctive domain and mode of inquiry. 1 Qualitative research refers to any kind of research that produces findings not arrived at by means of statistical analysis or other means of quantification. 2,3 It uses a naturalistic approach that seeks to understand phenomena about persons’ lives, stories, and behavior including those related to health, organizational functioning, social movements, or interactional relationships. Qualitative research is underpinned by several theoretical perspectives, namely, constructivist-interpretive, critical, postpositivist, poststructural/postmodern, and feminism. 4 One conducts a qualitative study to uncover the nature of the person’s experiences with a phenomenon in context-specific conditions such as illness (acute and chronic), addiction, loss, disability, and end of life. Qualitative research is used to explore, uncover, describe, and understand what lies behind any phenomenon about which maybe little is known. This deeper understanding of the phenomenon in its specific context can be attained only through a qualitative inquiry than mere numbers and statistical models could provide using a quantitative approach. Qualitative inquiry represents a legitimate mode of social and human science exploration, without apology or comparisons to quantitative research. 5

This article describes what is qualitative research methodology, the “what,” “why,” “who,” and “how,” including its components. The aim is to simplify the terminology and process of qualitative inquiry to enable novice readers of research to better understand the concepts involved.

WHY DO QUALITATIVE RESEARCH?

The tradition of using qualitative methods to study human phenomena is grounded in the social sciences. 6 This methodological revolution has made way for a more interpretative approach because aspects of human values, culture, and relationships are not described fully using quantitative research methods. Unlike quantitative researchers who seek causal determination, prediction, and generalization of findings, qualitative researchers allow for the phenomenon of interest to unfold naturally, 7 strive to explore, describe and understand it, and delve into a colorful, deep, contextual world of interpretations. 8 Thus, the practice of qualitative research has expanded to clinical settings because empirical approaches have proven to be inadequate in answering questions related to human subjectivity where interpretation is involved. 9 Consequently, qualitative health research is a research approach to exploring health and illness as they are perceived by the people themselves rather than from the researcher’s perspective. 10 Morse 10 further stated that “Researchers use qualitative research methods to illicit emotions and perspectives, beliefs and values, actions, and behaviors and to understand the participant’s responses to health and illness and the meanings they construct about the experience.” 10 (p21) It provides a rich inductive description that necessitates interpretations. Researchers in the health care arena, practitioners, and policy makers are increasingly pressed to translate these findings for practice, put them to use, and evaluate how useful they actually are in effecting desired change with goal of improving public health and reducing disparities in health care delivery. 1 Even though qualitative research has been used for many decades, and it is in fact flourishing, it is not free of criticisms from experts with impoverished view of the methodology.

Despite the current urgency of the utilization of qualitative methodologies in research studies, questions are raised for its lack of objectivity, generalizability, utility, and its tendency to be anecdotal. 1 Critics continue to make these charges related to their limited understanding of qualitative designs, approaches, and methods. Sandelowski 1 asserted that the current urgency about the utility of qualitative research findings is the result of several converging trends in health care research that include the elevation of practical over basic knowledge as the highest form of knowledge, the proliferation of qualitative health research studies, and the rise of evidence-based practice as a paradigm and methodology for health care. 1 Consequently, these events have, in turn, contributed to the growing interest of incorporating qualitative health research findings into evidence-based practice.

Morse 10 asserted that there are other reasons for conducting a qualitative inquiry. Others believe that the role of qualitative inquiry is to provide hypothesis and research questions that can be posed from the findings of qualitative research studies. Qualitative research can also serve as a foundation from which surveys and questionnaires could be developed, thus increasing its validity that would produce models for quantitative testing. But, what is really the most important function of qualitative inquiry? According to Morse, 10 this key function is the moral imperative of qualitative inquiry to humanize health care. She stated, “The social justice agenda of qualitative health research is one that humanizes health care.” 10 (p52) So, what is humanizing health care? Morse 10 stated, “Humanizing encompasses a perspective on attitudes, beliefs, expectations, practices, and behaviors that influence the quality of care, administration of that care, conditions judged to warrant (or not warrant) empathetic care, responses to care and therapeutics, and anticipated and actual outcomes of patient or community care.” 10 (pp54,55)

Conducting research should be sort of a social justice project. 10 Denzin 11 recognizes making social justice a public agenda within qualitative inquiry. He emphasized that qualitative inquiry can contribute to social justice through ( a ) identifying different definitions of a problem and/or situation that is being evaluated with some agreement that change is required; ( b ) the assumptions that are held by policy makers, clients, welfare workers, online professionals, and other interested parties can be located and shown to be correct or incorrect; ( c ) strategic points of interventions can be identified and thus evaluated and improved; ( d ) suggest alternative moral points of view from which the problem, the policy, and the program can be interpreted and assessed; and ( e ) the limits of statistics and statistical evaluations can be exposed with the more qualitative materials furnished by this approach. 11

WHO DOES QUALITATIVE RESEARCH?

Qualitative research is done by researchers in the social sciences as well as by practitioners in fields that concern themselves with issues related to human behavior and functioning. 3 They are also health professionals who are able to identify a research question and able to recognize the particular context and situation that would achieve the best answers. 10 According to Morse, 10 the qualitative health researcher should be an expert methodologist who should have the understanding of illness, the patient’s condition, and the staff roles and relationships and able to balance the clinical situation from different perspectives. 10 (p23) A qualitative researcher also requires theoretical and social sensibility, interactional skills, and the ability to maintain analytical distance while drawing upon past experience and theoretical knowledge to interpret what is seen or observed. 3

WHAT ARE THE CHARACTERISTICS OF QUALITATIVE RESEARCH?

Creswell 12 discussed that qualitative research studies today involve closer attention to the interpretive nature of inquiry and situating the study within the political, social, and cultural context of the researchers, participants, and readers of the study. He presented several characteristics of qualitative research, which are ( a ) natural setting: data are collected face-to-face in the field at the site where participants experience the phenomenon under study; the inquiry should be conducted in a way that does not disturb the natural context of the phenomenon; ( b ) researcher as key instrument: the researchers collect the data themselves rather than relying on instruments developed by others; ( c ) multiple sources of data: researchers gather multiple forms of data including interviews, observations, and examining documents rather than rely on a single source; ( d ) inductive data analysis: data are organized into abstract units of information (“bottom-up” or moving from specific to general), working back and forth between the themes and the database until a comprehensive set of themes is established and ending up with general conclusions or theories; ( e ) participant’s meanings: the researchers keep a focus on learning the meaning that the participants hold about the phenomenon, not the meaning that the researchers bring to the study; ( f ) emergent design: the initial plan for the study cannot be tightly prescribed; rather, it is emergent, and all phases of the process may change or shift after the researchers enter the field and begin to collect the data; ( g ) theoretical lens: use of a “lens” to view the study such as the concept of culture, gender, race or class differences, and social, political, or historical context of the problem under study; ( h ) interpretive inquiry: a form of inquiry in which researchers make interpretation of what they see, hear, and understand that cannot be separated from their own background, history, context, and prior understanding; ( i ) holistic account: reporting multiple perspectives, identifying the many factors involved in a situation, and sketching the larger picture that emerges. 12

WHAT ARE THE METHODS FREQUENTLY USED IN QUALITATIVE RESEARCH?

The research question dictates the method to be used for a qualitative study. Qualitative and quantitative questions are distinct and serve different purposes. 10 Some of the different types of qualitative research that will be discussed in this article are phenomenology, grounded theory, ethnography, case study, and narrative research. Researchers from different disciplines use these approaches depending on what the purpose of the study is.

Narrative research begins with the experiences as expressed in lived and told stories of individuals. Narrative is a spoken word or written text giving an account of an event/action chronologically connected. Some examples of this approach are biographical studies, autobiographies, and life stories. Kvangarsnes et al 13 explored the patient perceptions of chronic obstructive pulmonary disease exacerbation and their experiences of their relations with health personnel during care and treatment using narrative research design. Ten in-depth qualitative interviews were conducted with patients who had been admitted to 2 intensive care units (ICUs) in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyze the interviews. The patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected. This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.

Whereas a narrative approach explores the life of a single person, a phenomenological study describes the meaning for several individuals of their lived experiences of a phenomenon. 12 Phenomenology is the most inductive of all qualitative methods. 10 The philosophical assumptions of phenomenology rest on some common grounds: the study of the lived experiences of persons, the view that these experiences are conscious ones and the development of descriptions of the essences of these experiences, not explanations or analysis. 12 There are different types of phenomenological approaches, namely, descriptive-transcendental (Husserl, Giorgi), interpretive/hermeneutic (Heidegger, Gadamer, Jen-Luc Nancy), descriptive-hermeneutic (van Manen), empirical-transcendental (Moustakas), and existential (Sarte, Heidegger, Merleau-Ponty). A phenomenological study conducted by Cypress 14 explored the lived experiences of nurses, patients, and family members during critical illness in the emergency department (ED). Data were collected over a 6-month period by means of in-depth interviews, and thematic analysis was done using van Manen’s 15 hermeneutic-phenomenological approach. The findings of this qualitative phenomenological study indicate that the patient’s and family member’s perception of the nurses in the ED relates to their critical thinking skills, communication, sensitivity, and caring abilities. Nurses of this study identified that response to the patient’s physiological deficit is paramount in the ED, and involving the patients and families in the human care processes will help attain this goal.

While phenomenology aims to illuminate themes and describe the meaning of lived experiences of a number of individuals, grounded theory has the intent to move beyond description and to generate or discover a theory, an abstract analytical schema of a process, or interaction shaped by the views of a large number of participants. 12 This qualitative method was developed by Glaser and Strauss 16 in 1967. Other grounded theorists followed, including Clarke, 17 who relies on postmodern perspectives, and Charmaz, 18 on constructivist approach. Gallagher et al 19 collected and analyzed qualitative data using grounded theory to understand nurses’ end-of-life (EOL) decision-making practices in 5 ICUs in different cultural contexts. Interviews were conducted with 51 experienced ICU nurses in university or hospital premises in 5 countries. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EOL decision-making practices in the ICU. The core category that emerged was “negotiated reorienting.” Gallagher et al 19 stated, “Whilst nurses do not make the ‘ultimate’ EOL decisions, they engage in 2 core practices: consensus seeking (involving coaxing, information cuing and voice enabling) and emotional holding (creating time-space and comfort giving).” 19 (p794)

Although a grounded theory approach examines a number of individuals to develop a theory, participants are not studied as 1 unit. Ethnography uses a larger number of individuals and focuses on an entire cultural group as 1 unit of analysis. This qualitative approach describes and interprets the shared and learned patters of values, behaviors, beliefs, and language of a cultural-sharing group. 12 There are many forms of ethnography, namely, confessional, life history, autoethnography, feminist, ethnographic novels, visual ethnography found in photography and video, and electronic media. Price 20 explored what aspects affect registered health care professionals’ ability to care for patients within the technological environment of a critical care unit. Ethnography was utilized to focus on the cultural elements within a situation. Data collection involved participant observation, document review, and semistructured interviews. Nineteen participants took part in the study. An overarching theme of the “crafting process” was developed with subthemes of “vigilance,” “focus of attention,” “being present,” and “expectations,” with the ultimate goal of achieving the best interests for the individual patient.

A culture-sharing group in ethnography can be considered a case, but its aim is to ascertain how the culture works rather than understanding 1 or more specific cases within a bounded system. Creswell 12 defines case study research as an approach in which the researcher explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed in-depth data collection involving multiple sources of information and reports a case description and case-based themes. 12 (p73) In terms of intent, there are 3 types of case study: single instrumental, collective or multiple, and the intrinsic case study. Hyde-Wyatt 21 studied spinally injured patients on sedation in the ICU. A reflection-on-action exercise was carried out when a spinally injured patient became physically active during a sedation hold. This was attributed to hyperactive delirium. Reflection on this incident led to a literature search for guidance on the likelihood of delirium causing secondary spinal injury in patients with unstable fractures. Through a case study approach, the research was reviewed in relation to a particular patient. This case study illustrated that there was a knowledge deficit when it came to managing the combination of the patient’s spinal injury and delirium. Sedation cessation episodes are an essential part of patient care on intensive care. For spinally injured patients, these may need to be modified to sedation reductions to prevent sudden wakening and uncontrolled movement should the patient be experiencing hyperactive delirium.

WHAT IS THE PROCESS OF CONCEPTUALIZING AND DESIGNING A QUALITATIVE RESEARCH?

Designing a qualitative is not a fully structured, rigid process. Even books and experts vary in their understanding and guides in the “how to” perspective of a qualitative inquiry. Conducting a qualitative study is also extremely difficult. 10 Sometimes there is concern about access and the qualitative procedures involved in data collection including disclosure of participant’s identity and confidentiality of data. Nevertheless, qualitative research involves a rigorous and scientific process that serves as guide for researchers who are planning to embark on a journey and complete a naturalistic inquiry.

Unlike quantitative research that involves a fairly linear process, qualitative studies have a flexible approach and flow of activities, and the researchers do not know in advance exactly how the study will unfold. 22 The process of designing a qualitative study does not begin with the methods—which in fact is the easiest part of naturalistic research. 12 Qualitative researchers usually begin with a broad topic focusing on 1 aspect or a phenomenon of which little is known. The phenomenon may be one in the “real world,” a gap in the literature, or past findings of investigations, for example, in the area of social and human sciences. 12 A fairly broad question is then posed to be able to allow the focus to be delineated and sharpened once the study is underway.

Once the research question is posed, the researchers should conduct a brief literature review to inform the question asked and to help establish the significance of the problem. There is a continuous debate about the value of doing a literature review prior to collecting of data and how much of it should be done. Some believe that knowledge about findings of previous studies might influence the conceptualization of the phenomenon of interest, which ideally should be illuminated from the participants rather than on prior findings. 22 A grounded theory investigator, for example, may make a point of not conducting a review of literature before beginning the study to avoid “contamination” of the data with preconceived concepts and notions about what might be relevant. 2 After the review of literature, the researchers must identify an appropriate site for the study to be conducted.

Selecting and gaining entry to the site require knowledge of settings in which participants in their lifeworld are experiencing the phenomenon under study. For example, research in the area of health is a very broad topic. A researcher should determine definitions, concepts, scope, and theories about health that will be used for the proposed qualitative inquiry. Health can be perceived as absence or presence of illness, physical, psychosocial, psychological, and spiritual health of individuals, families, or groups. 10 Morse 10 further stated that “Research into the intimate, experiential and interpersonal aspects of illness, into caring for the ill, and into seeking and maintaining wellness introduces extraordinary methodological challenges.” 10 (p89) Thus, knowledge about the characteristics of participants who will be recruited for the study and the specific context of the settings (ie, hospital/institution, community/outpatient) where they are at the time when research will be conducted is important. To be able to gain entry to the site, the ethical aspect of the study should also be addressed. Approval from the institution’s institutional review board and informed consent from the participants must be obtained. Qualitative studies have special ethical concerns involved because of the more intimate nature of the relationship that typically develop between researchers and participants. 22 The researchers must develop specific plans addressing these issues. After addressing the ethical concerns and gaining entry to the site, an overall approach should be planned and developed.

It has been previously addressed that even though the researchers plan for a specific approach to be used, the design can be emergent during the course of data collection. Modifications are made as the need arises. It is rare that a qualitative study has rigidly structured design that will prohibit changes while in the field, 22 but being aware that the purposes, questions, and methods of research are all interconnected and interrelated so that the study appears as a cohesive whole rather than fragmented isolated parts. 5 For example, patients in hospitals have limited abilities related to their medical condition and the contextual features of a hospital. A patient’s condition may demand a different method be used because of patient fatigue, the interruptions of data collection for treatments, or physician’s rounds and visitors. In this context, the study requires modifications of methods, and participation in a research study has the lowest priority at this specific moment and time. 10

In qualitative studies, sampling, data collection, and analysis including interpretation take place repetitively. The sampling method usually used is purposive. Qualitative researchers use rigorous data collection procedures by talking to participants face-to-face, interviewing, and observing them (individual, focus groups, or an entire culture) to be able to explore the phenomenon under study. The discussions and observations are loosely structured, allowing participants full range of beliefs, feelings, and behaviors. 22 Other types of information that can be collected are documents, photographs, audiovisual materials, sounds, e-mail massages, digital text messages, and computer software. The backbone of qualitative research is extensive collection of data from multiple sources of information. 12 After organizing and storing the data, the researcher will try to make sense of the data, working inductively from particulars to more general perspectives until categories, codes, and themes emerge and are illuminated, which are used to build a rich description of the phenomenon. 12,22 The researcher analyzes data using multiple levels of abstraction. Analysis and interpretation are ongoing concurrent activities that guide the researchers about the kinds of questions to ask or observations to make. The kinds of data gathered become increasingly meaningful as the theory emerges. When themes and categories become repetitive and redundant and no new information can be gleaned, the researcher has reached data saturation and thus stops collecting data and recruitment of participants. 22 Trustworthiness of the data and rigor have to be then established. Steps have to be taken to confirm that the findings accurately reflect the experiences and perceptions of participants rather than the researcher’s viewpoints. Some of the strategies that can be used are validation techniques that include confirming and triangulating data from several sources, going back to participants, sharing preliminary interpretations with them, asking them whether the researcher’s thematic analysis is consistent with their experiences, 22 (p55) and having other expert researchers review the procedures undertaken and interpretations made. 12

FINAL THOUGHTS

Qualitative research uses a naturalistic approach that seeks to understand phenomena in context-specific settings, attempting to make sense of it and interpreting in terms of meaning people bring to them. It contributes to the humanizing of health care as it addresses content about health and illness. Qualitative research does not have firm or rigid guidelines and takes time to conduct. Some of the methods for a qualitative inquiry are narrative research, phenomenology, grounded theory, case study, and ethnography. Although the study design emerges during the inquiry, it follows the pattern of scientific research. Researchers collect data rigorously in natural settings over a period and analyze them inductively to establish patterns or themes. Ethical decisions and considerations for rigor and trustworthiness are also continuously threaded throughout the study. The final report presents the active voices of participants and the description and interpretation of the meaning of the phenomenon including the reflexivity of the researcher.

Goals of nursing; Health care; Qualitative research

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Qualitative Research: Data Collection, Analysis, and Management

Introduction.

In an earlier paper, 1 we presented an introduction to using qualitative research methods in pharmacy practice. In this article, we review some principles of the collection, analysis, and management of qualitative data to help pharmacists interested in doing research in their practice to continue their learning in this area. Qualitative research can help researchers to access the thoughts and feelings of research participants, which can enable development of an understanding of the meaning that people ascribe to their experiences. Whereas quantitative research methods can be used to determine how many people undertake particular behaviours, qualitative methods can help researchers to understand how and why such behaviours take place. Within the context of pharmacy practice research, qualitative approaches have been used to examine a diverse array of topics, including the perceptions of key stakeholders regarding prescribing by pharmacists and the postgraduation employment experiences of young pharmacists (see “Further Reading” section at the end of this article).

In the previous paper, 1 we outlined 3 commonly used methodologies: ethnography 2 , grounded theory 3 , and phenomenology. 4 Briefly, ethnography involves researchers using direct observation to study participants in their “real life” environment, sometimes over extended periods. Grounded theory and its later modified versions (e.g., Strauss and Corbin 5 ) use face-to-face interviews and interactions such as focus groups to explore a particular research phenomenon and may help in clarifying a less-well-understood problem, situation, or context. Phenomenology shares some features with grounded theory (such as an exploration of participants’ behaviour) and uses similar techniques to collect data, but it focuses on understanding how human beings experience their world. It gives researchers the opportunity to put themselves in another person’s shoes and to understand the subjective experiences of participants. 6 Some researchers use qualitative methodologies but adopt a different standpoint, and an example of this appears in the work of Thurston and others, 7 discussed later in this paper.

Qualitative work requires reflection on the part of researchers, both before and during the research process, as a way of providing context and understanding for readers. When being reflexive, researchers should not try to simply ignore or avoid their own biases (as this would likely be impossible); instead, reflexivity requires researchers to reflect upon and clearly articulate their position and subjectivities (world view, perspectives, biases), so that readers can better understand the filters through which questions were asked, data were gathered and analyzed, and findings were reported. From this perspective, bias and subjectivity are not inherently negative but they are unavoidable; as a result, it is best that they be articulated up-front in a manner that is clear and coherent for readers.

THE PARTICIPANT’S VIEWPOINT

What qualitative study seeks to convey is why people have thoughts and feelings that might affect the way they behave. Such study may occur in any number of contexts, but here, we focus on pharmacy practice and the way people behave with regard to medicines use (e.g., to understand patients’ reasons for nonadherence with medication therapy or to explore physicians’ resistance to pharmacists’ clinical suggestions). As we suggested in our earlier article, 1 an important point about qualitative research is that there is no attempt to generalize the findings to a wider population. Qualitative research is used to gain insights into people’s feelings and thoughts, which may provide the basis for a future stand-alone qualitative study or may help researchers to map out survey instruments for use in a quantitative study. It is also possible to use different types of research in the same study, an approach known as “mixed methods” research, and further reading on this topic may be found at the end of this paper.

The role of the researcher in qualitative research is to attempt to access the thoughts and feelings of study participants. This is not an easy task, as it involves asking people to talk about things that may be very personal to them. Sometimes the experiences being explored are fresh in the participant’s mind, whereas on other occasions reliving past experiences may be difficult. However the data are being collected, a primary responsibility of the researcher is to safeguard participants and their data. Mechanisms for such safeguarding must be clearly articulated to participants and must be approved by a relevant research ethics review board before the research begins. Researchers and practitioners new to qualitative research should seek advice from an experienced qualitative researcher before embarking on their project.

DATA COLLECTION

Whatever philosophical standpoint the researcher is taking and whatever the data collection method (e.g., focus group, one-to-one interviews), the process will involve the generation of large amounts of data. In addition to the variety of study methodologies available, there are also different ways of making a record of what is said and done during an interview or focus group, such as taking handwritten notes or video-recording. If the researcher is audio- or video-recording data collection, then the recordings must be transcribed verbatim before data analysis can begin. As a rough guide, it can take an experienced researcher/transcriber 8 hours to transcribe one 45-minute audio-recorded interview, a process than will generate 20–30 pages of written dialogue.

Many researchers will also maintain a folder of “field notes” to complement audio-taped interviews. Field notes allow the researcher to maintain and comment upon impressions, environmental contexts, behaviours, and nonverbal cues that may not be adequately captured through the audio-recording; they are typically handwritten in a small notebook at the same time the interview takes place. Field notes can provide important context to the interpretation of audio-taped data and can help remind the researcher of situational factors that may be important during data analysis. Such notes need not be formal, but they should be maintained and secured in a similar manner to audio tapes and transcripts, as they contain sensitive information and are relevant to the research. For more information about collecting qualitative data, please see the “Further Reading” section at the end of this paper.

DATA ANALYSIS AND MANAGEMENT

If, as suggested earlier, doing qualitative research is about putting oneself in another person’s shoes and seeing the world from that person’s perspective, the most important part of data analysis and management is to be true to the participants. It is their voices that the researcher is trying to hear, so that they can be interpreted and reported on for others to read and learn from. To illustrate this point, consider the anonymized transcript excerpt presented in Appendix 1 , which is taken from a research interview conducted by one of the authors (J.S.). We refer to this excerpt throughout the remainder of this paper to illustrate how data can be managed, analyzed, and presented.

Interpretation of Data

Interpretation of the data will depend on the theoretical standpoint taken by researchers. For example, the title of the research report by Thurston and others, 7 “Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory,” indicates at least 2 theoretical standpoints. The first is the culture of the indigenous population of Canada and the place of this population in society, and the second is the social constructivist theory used in the constructivist grounded theory method. With regard to the first standpoint, it can be surmised that, to have decided to conduct the research, the researchers must have felt that there was anecdotal evidence of differences in access to arthritis care for patients from indigenous and non-indigenous backgrounds. With regard to the second standpoint, it can be surmised that the researchers used social constructivist theory because it assumes that behaviour is socially constructed; in other words, people do things because of the expectations of those in their personal world or in the wider society in which they live. (Please see the “Further Reading” section for resources providing more information about social constructivist theory and reflexivity.) Thus, these 2 standpoints (and there may have been others relevant to the research of Thurston and others 7 ) will have affected the way in which these researchers interpreted the experiences of the indigenous population participants and those providing their care. Another standpoint is feminist standpoint theory which, among other things, focuses on marginalized groups in society. Such theories are helpful to researchers, as they enable us to think about things from a different perspective. Being aware of the standpoints you are taking in your own research is one of the foundations of qualitative work. Without such awareness, it is easy to slip into interpreting other people’s narratives from your own viewpoint, rather than that of the participants.

To analyze the example in Appendix 1 , we will adopt a phenomenological approach because we want to understand how the participant experienced the illness and we want to try to see the experience from that person’s perspective. It is important for the researcher to reflect upon and articulate his or her starting point for such analysis; for example, in the example, the coder could reflect upon her own experience as a female of a majority ethnocultural group who has lived within middle class and upper middle class settings. This personal history therefore forms the filter through which the data will be examined. This filter does not diminish the quality or significance of the analysis, since every researcher has his or her own filters; however, by explicitly stating and acknowledging what these filters are, the researcher makes it easer for readers to contextualize the work.

Transcribing and Checking

For the purposes of this paper it is assumed that interviews or focus groups have been audio-recorded. As mentioned above, transcribing is an arduous process, even for the most experienced transcribers, but it must be done to convert the spoken word to the written word to facilitate analysis. For anyone new to conducting qualitative research, it is beneficial to transcribe at least one interview and one focus group. It is only by doing this that researchers realize how difficult the task is, and this realization affects their expectations when asking others to transcribe. If the research project has sufficient funding, then a professional transcriber can be hired to do the work. If this is the case, then it is a good idea to sit down with the transcriber, if possible, and talk through the research and what the participants were talking about. This background knowledge for the transcriber is especially important in research in which people are using jargon or medical terms (as in pharmacy practice). Involving your transcriber in this way makes the work both easier and more rewarding, as he or she will feel part of the team. Transcription editing software is also available, but it is expensive. For example, ELAN (more formally known as EUDICO Linguistic Annotator, developed at the Technical University of Berlin) 8 is a tool that can help keep data organized by linking media and data files (particularly valuable if, for example, video-taping of interviews is complemented by transcriptions). It can also be helpful in searching complex data sets. Products such as ELAN do not actually automatically transcribe interviews or complete analyses, and they do require some time and effort to learn; nonetheless, for some research applications, it may be a valuable to consider such software tools.

All audio recordings should be transcribed verbatim, regardless of how intelligible the transcript may be when it is read back. Lines of text should be numbered. Once the transcription is complete, the researcher should read it while listening to the recording and do the following: correct any spelling or other errors; anonymize the transcript so that the participant cannot be identified from anything that is said (e.g., names, places, significant events); insert notations for pauses, laughter, looks of discomfort; insert any punctuation, such as commas and full stops (periods) (see Appendix 1 for examples of inserted punctuation), and include any other contextual information that might have affected the participant (e.g., temperature or comfort of the room).

Dealing with the transcription of a focus group is slightly more difficult, as multiple voices are involved. One way of transcribing such data is to “tag” each voice (e.g., Voice A, Voice B). In addition, the focus group will usually have 2 facilitators, whose respective roles will help in making sense of the data. While one facilitator guides participants through the topic, the other can make notes about context and group dynamics. More information about group dynamics and focus groups can be found in resources listed in the “Further Reading” section.

Reading between the Lines

During the process outlined above, the researcher can begin to get a feel for the participant’s experience of the phenomenon in question and can start to think about things that could be pursued in subsequent interviews or focus groups (if appropriate). In this way, one participant’s narrative informs the next, and the researcher can continue to interview until nothing new is being heard or, as it says in the text books, “saturation is reached”. While continuing with the processes of coding and theming (described in the next 2 sections), it is important to consider not just what the person is saying but also what they are not saying. For example, is a lengthy pause an indication that the participant is finding the subject difficult, or is the person simply deciding what to say? The aim of the whole process from data collection to presentation is to tell the participants’ stories using exemplars from their own narratives, thus grounding the research findings in the participants’ lived experiences.

Smith 9 suggested a qualitative research method known as interpretative phenomenological analysis, which has 2 basic tenets: first, that it is rooted in phenomenology, attempting to understand the meaning that individuals ascribe to their lived experiences, and second, that the researcher must attempt to interpret this meaning in the context of the research. That the researcher has some knowledge and expertise in the subject of the research means that he or she can have considerable scope in interpreting the participant’s experiences. Larkin and others 10 discussed the importance of not just providing a description of what participants say. Rather, interpretative phenomenological analysis is about getting underneath what a person is saying to try to truly understand the world from his or her perspective.

Once all of the research interviews have been transcribed and checked, it is time to begin coding. Field notes compiled during an interview can be a useful complementary source of information to facilitate this process, as the gap in time between an interview, transcribing, and coding can result in memory bias regarding nonverbal or environmental context issues that may affect interpretation of data.

Coding refers to the identification of topics, issues, similarities, and differences that are revealed through the participants’ narratives and interpreted by the researcher. This process enables the researcher to begin to understand the world from each participant’s perspective. Coding can be done by hand on a hard copy of the transcript, by making notes in the margin or by highlighting and naming sections of text. More commonly, researchers use qualitative research software (e.g., NVivo, QSR International Pty Ltd; www.qsrinternational.com/products_nvivo.aspx ) to help manage their transcriptions. It is advised that researchers undertake a formal course in the use of such software or seek supervision from a researcher experienced in these tools.

Returning to Appendix 1 and reading from lines 8–11, a code for this section might be “diagnosis of mental health condition”, but this would just be a description of what the participant is talking about at that point. If we read a little more deeply, we can ask ourselves how the participant might have come to feel that the doctor assumed he or she was aware of the diagnosis or indeed that they had only just been told the diagnosis. There are a number of pauses in the narrative that might suggest the participant is finding it difficult to recall that experience. Later in the text, the participant says “nobody asked me any questions about my life” (line 19). This could be coded simply as “health care professionals’ consultation skills”, but that would not reflect how the participant must have felt never to be asked anything about his or her personal life, about the participant as a human being. At the end of this excerpt, the participant just trails off, recalling that no-one showed any interest, which makes for very moving reading. For practitioners in pharmacy, it might also be pertinent to explore the participant’s experience of akathisia and why this was left untreated for 20 years.

One of the questions that arises about qualitative research relates to the reliability of the interpretation and representation of the participants’ narratives. There are no statistical tests that can be used to check reliability and validity as there are in quantitative research. However, work by Lincoln and Guba 11 suggests that there are other ways to “establish confidence in the ‘truth’ of the findings” (p. 218). They call this confidence “trustworthiness” and suggest that there are 4 criteria of trustworthiness: credibility (confidence in the “truth” of the findings), transferability (showing that the findings have applicability in other contexts), dependability (showing that the findings are consistent and could be repeated), and confirmability (the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest).

One way of establishing the “credibility” of the coding is to ask another researcher to code the same transcript and then to discuss any similarities and differences in the 2 resulting sets of codes. This simple act can result in revisions to the codes and can help to clarify and confirm the research findings.

Theming refers to the drawing together of codes from one or more transcripts to present the findings of qualitative research in a coherent and meaningful way. For example, there may be examples across participants’ narratives of the way in which they were treated in hospital, such as “not being listened to” or “lack of interest in personal experiences” (see Appendix 1 ). These may be drawn together as a theme running through the narratives that could be named “the patient’s experience of hospital care”. The importance of going through this process is that at its conclusion, it will be possible to present the data from the interviews using quotations from the individual transcripts to illustrate the source of the researchers’ interpretations. Thus, when the findings are organized for presentation, each theme can become the heading of a section in the report or presentation. Underneath each theme will be the codes, examples from the transcripts, and the researcher’s own interpretation of what the themes mean. Implications for real life (e.g., the treatment of people with chronic mental health problems) should also be given.

DATA SYNTHESIS

In this final section of this paper, we describe some ways of drawing together or “synthesizing” research findings to represent, as faithfully as possible, the meaning that participants ascribe to their life experiences. This synthesis is the aim of the final stage of qualitative research. For most readers, the synthesis of data presented by the researcher is of crucial significance—this is usually where “the story” of the participants can be distilled, summarized, and told in a manner that is both respectful to those participants and meaningful to readers. There are a number of ways in which researchers can synthesize and present their findings, but any conclusions drawn by the researchers must be supported by direct quotations from the participants. In this way, it is made clear to the reader that the themes under discussion have emerged from the participants’ interviews and not the mind of the researcher. The work of Latif and others 12 gives an example of how qualitative research findings might be presented.

Planning and Writing the Report

As has been suggested above, if researchers code and theme their material appropriately, they will naturally find the headings for sections of their report. Qualitative researchers tend to report “findings” rather than “results”, as the latter term typically implies that the data have come from a quantitative source. The final presentation of the research will usually be in the form of a report or a paper and so should follow accepted academic guidelines. In particular, the article should begin with an introduction, including a literature review and rationale for the research. There should be a section on the chosen methodology and a brief discussion about why qualitative methodology was most appropriate for the study question and why one particular methodology (e.g., interpretative phenomenological analysis rather than grounded theory) was selected to guide the research. The method itself should then be described, including ethics approval, choice of participants, mode of recruitment, and method of data collection (e.g., semistructured interviews or focus groups), followed by the research findings, which will be the main body of the report or paper. The findings should be written as if a story is being told; as such, it is not necessary to have a lengthy discussion section at the end. This is because much of the discussion will take place around the participants’ quotes, such that all that is needed to close the report or paper is a summary, limitations of the research, and the implications that the research has for practice. As stated earlier, it is not the intention of qualitative research to allow the findings to be generalized, and therefore this is not, in itself, a limitation.

Planning out the way that findings are to be presented is helpful. It is useful to insert the headings of the sections (the themes) and then make a note of the codes that exemplify the thoughts and feelings of your participants. It is generally advisable to put in the quotations that you want to use for each theme, using each quotation only once. After all this is done, the telling of the story can begin as you give your voice to the experiences of the participants, writing around their quotations. Do not be afraid to draw assumptions from the participants’ narratives, as this is necessary to give an in-depth account of the phenomena in question. Discuss these assumptions, drawing on your participants’ words to support you as you move from one code to another and from one theme to the next. Finally, as appropriate, it is possible to include examples from literature or policy documents that add support for your findings. As an exercise, you may wish to code and theme the sample excerpt in Appendix 1 and tell the participant’s story in your own way. Further reading about “doing” qualitative research can be found at the end of this paper.

CONCLUSIONS

Qualitative research can help researchers to access the thoughts and feelings of research participants, which can enable development of an understanding of the meaning that people ascribe to their experiences. It can be used in pharmacy practice research to explore how patients feel about their health and their treatment. Qualitative research has been used by pharmacists to explore a variety of questions and problems (see the “Further Reading” section for examples). An understanding of these issues can help pharmacists and other health care professionals to tailor health care to match the individual needs of patients and to develop a concordant relationship. Doing qualitative research is not easy and may require a complete rethink of how research is conducted, particularly for researchers who are more familiar with quantitative approaches. There are many ways of conducting qualitative research, and this paper has covered some of the practical issues regarding data collection, analysis, and management. Further reading around the subject will be essential to truly understand this method of accessing peoples’ thoughts and feelings to enable researchers to tell participants’ stories.

Appendix 1. Excerpt from a sample transcript

The participant (age late 50s) had suffered from a chronic mental health illness for 30 years. The participant had become a “revolving door patient,” someone who is frequently in and out of hospital. As the participant talked about past experiences, the researcher asked:

• What was treatment like 30 years ago?
• Umm—well it was pretty much they could do what they wanted with you because I was put into the er, the er kind of system er, I was just on
• endless section threes.
• Really…
• But what I didn’t realize until later was that if you haven’t actually posed a threat to someone or yourself they can’t really do that but I didn’t know
• that. So wh-when I first went into hospital they put me on the forensic ward ’cause they said, “We don’t think you’ll stay here we think you’ll just
• run-run away.” So they put me then onto the acute admissions ward and – er – I can remember one of the first things I recall when I got onto that
• ward was sitting down with a er a Dr XXX. He had a book this thick [gestures] and on each page it was like three questions and he went through
• all these questions and I answered all these questions. So we’re there for I don’t maybe two hours doing all that and he asked me he said “well
• when did somebody tell you then that you have schizophrenia” I said “well nobody’s told me that” so he seemed very surprised but nobody had
• actually [pause] whe-when I first went up there under police escort erm the senior kind of consultants people I’d been to where I was staying and
• ermm so er [pause] I . . . the, I can remember the very first night that I was there and given this injection in this muscle here [gestures] and just
• having dreadful side effects the next day I woke up [pause]
• . . . and I suffered that akathesia I swear to you, every minute of every day for about 20 years.
• Oh how awful.
• And that side of it just makes life impossible so the care on the wards [pause] umm I don’t know it’s kind of, it’s kind of hard to put into words
• [pause]. Because I’m not saying they were sort of like not friendly or interested but then nobody ever seemed to want to talk about your life [pause]
• nobody asked me any questions about my life. The only questions that came into was they asked me if I’d be a volunteer for these student exams
• and things and I said “yeah” so all the questions were like “oh what jobs have you done,” er about your relationships and things and er but
• nobody actually sat down and had a talk and showed some interest in you as a person you were just there basically [pause] um labelled and you
• know there was there was [pause] but umm [pause] yeah . . .

This article is the 10th in the CJHP Research Primer Series, an initiative of the CJHP Editorial Board and the CSHP Research Committee. The planned 2-year series is intended to appeal to relatively inexperienced researchers, with the goal of building research capacity among practising pharmacists. The articles, presenting simple but rigorous guidance to encourage and support novice researchers, are being solicited from authors with appropriate expertise.

Previous articles in this series:

Bond CM. The research jigsaw: how to get started. Can J Hosp Pharm . 2014;67(1):28–30.

Tully MP. Research: articulating questions, generating hypotheses, and choosing study designs. Can J Hosp Pharm . 2014;67(1):31–4.

Loewen P. Ethical issues in pharmacy practice research: an introductory guide. Can J Hosp Pharm. 2014;67(2):133–7.

Tsuyuki RT. Designing pharmacy practice research trials. Can J Hosp Pharm . 2014;67(3):226–9.

Bresee LC. An introduction to developing surveys for pharmacy practice research. Can J Hosp Pharm . 2014;67(4):286–91.

Gamble JM. An introduction to the fundamentals of cohort and case–control studies. Can J Hosp Pharm . 2014;67(5):366–72.

Austin Z, Sutton J. Qualitative research: getting started. C an J Hosp Pharm . 2014;67(6):436–40.

Houle S. An introduction to the fundamentals of randomized controlled trials in pharmacy research. Can J Hosp Pharm . 2014; 68(1):28–32.

Charrois TL. Systematic reviews: What do you need to know to get started? Can J Hosp Pharm . 2014;68(2):144–8.

Competing interests: None declared.

Further Reading

Examples of qualitative research in pharmacy practice.

• Farrell B, Pottie K, Woodend K, Yao V, Dolovich L, Kennie N, et al. Shifts in expectations: evaluating physicians’ perceptions as pharmacists integrated into family practice. J Interprof Care. 2010; 24 (1):80–9. [ PubMed ] [ Google Scholar ]
• Gregory P, Austin Z. Postgraduation employment experiences of new pharmacists in Ontario in 2012–2013. Can Pharm J. 2014; 147 (5):290–9. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Marks PZ, Jennnings B, Farrell B, Kennie-Kaulbach N, Jorgenson D, Pearson-Sharpe J, et al. “I gained a skill and a change in attitude”: a case study describing how an online continuing professional education course for pharmacists supported achievement of its transfer to practice outcomes. Can J Univ Contin Educ. 2014; 40 (2):1–18. [ Google Scholar ]
• Nair KM, Dolovich L, Brazil K, Raina P. It’s all about relationships: a qualitative study of health researchers’ perspectives on interdisciplinary research. BMC Health Serv Res. 2008; 8 :110. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pojskic N, MacKeigan L, Boon H, Austin Z. Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists. Res Soc Adm Pharm. 2014; 10 (2):341–54. [ PubMed ] [ Google Scholar ]

Qualitative Research in General

• Breakwell GM, Hammond S, Fife-Schaw C. Research methods in psychology. Thousand Oaks (CA): Sage Publications; 1995. [ Google Scholar ]
• Given LM. 100 questions (and answers) about qualitative research. Thousand Oaks (CA): Sage Publications; 2015. [ Google Scholar ]
• Miles B, Huberman AM. Qualitative data analysis. Thousand Oaks (CA): Sage Publications; 2009. [ Google Scholar ]
• Patton M. Qualitative research and evaluation methods. Thousand Oaks (CA): Sage Publications; 2002. [ Google Scholar ]
• Willig C. Introducing qualitative research in psychology. Buckingham (UK): Open University Press; 2001. [ Google Scholar ]

Group Dynamics in Focus Groups

• Farnsworth J, Boon B. Analysing group dynamics within the focus group. Qual Res. 2010; 10 (5):605–24. [ Google Scholar ]

Social Constructivism

• Social constructivism. Berkeley (CA): University of California, Berkeley, Berkeley Graduate Division, Graduate Student Instruction Teaching & Resource Center; [cited 2015 June 4]. Available from: http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/social-constructivism/ [ Google Scholar ]

Mixed Methods

• Creswell J. Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks (CA): Sage Publications; 2009. [ Google Scholar ]

Collecting Qualitative Data

• Arksey H, Knight P. Interviewing for social scientists: an introductory resource with examples. Thousand Oaks (CA): Sage Publications; 1999. [ Google Scholar ]
• Guest G, Namey EE, Mitchel ML. Collecting qualitative data: a field manual for applied research. Thousand Oaks (CA): Sage Publications; 2013. [ Google Scholar ]

Constructivist Grounded Theory

• Charmaz K. Grounded theory: objectivist and constructivist methods. In: Denzin N, Lincoln Y, editors. Handbook of qualitative research. 2nd ed. Thousand Oaks (CA): Sage Publications; 2000. pp. 509–35. [ Google Scholar ]

• Open access
• Published: 12 August 2024

Patient responsiveness as a safewards fidelity indicator: a qualitative interview study on an acute psychiatric in-patient ward

• Veikko Pelto-Piri 1 ,
• Lars Kjellin 1 ,
• Gabriella Backman 2 ,
• Karoline Carlsson 3 &
• Anna Björkdahl 4  

BMC Health Services Research volume  24 , Article number:  922 ( 2024 ) Cite this article

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The Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness.

The study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis.

The findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards.

Conclusions

This study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients’ descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients’ experiences of care.

Peer Review reports

The use of coercion in European psychiatric and mental health services has been extensively criticized for violating the UN General Assembly agreement on the Convention on the Rights of Persons with Disabilities and the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [ 1 , 2 , 3 ]. An implication of these conventions is that states should actively work towards finding ways to minimize or even abolish policies that allow coercive treatment and other coercive measures within the psychiatric services. However, in Sweden as in most Western countries, legislation still enables the use of coercive measures when certain criteria are deemed to be present [ 4 ]. Although often controversial, the aim of these pieces of legislation is to prevent harm, initiate necessary treatment and allow the patient to recover and accept continuous care on a voluntary basis.

Patients have often experienced psychiatric wards as unsafe places with shortcomings in therapeutic relationships and strict but unpredictable rules [ 5 , 6 , 7 ]. Patients have also reported being exposed to harm and re-traumatization during care episodes, which jeopardizes the recovery process [ 6 , 8 , 9 , 10 ]. For staff, working in an environment that includes violence and coercive measures can cause emotional and psychological problems as well as an increased risk of long-term sick leave [ 11 , 12 ]. There is a relationship between the use of coercive measures and violence in psychiatric services that has been suggested to create a negative spiral of risk and incident escalation in which patient aggression may lead to restrictive practices, which in turn may trigger further patient aggression [ 13 ]. However, the incidence of violence and coercive measures can be prevented by, for example, the use of therapeutic relationship strategies and improving the ward culture [ 14 ].

Historically, Sweden has employed more coercive measures in psychiatric care compared to many other European countries [ 15 ]. The Swedish government has faced criticism from the Committee of the Convention on the Rights of Persons with Disabilities for its excessive use of coercive measures [ 16 ]. During recent decades, several nationwide projects aimed at reducing violence and restrictive practices in inpatient psychiatry have been initiated and funded by the Swedish government. Nevertheless, according to national registers, coercive measures such as the use of seclusion, restraint and involuntary medication have not been reduced [ 17 ]. Internationally, various promising alternative interventions have been developed for psychiatric in-patient services. Most countries do not have any mandatory legislation or policies to ensure that these interventions are implemented, and they are rarely evaluated on a large scale [ 18 , 19 ]. Currently, one of the best known hospital-based programmes is the Safewards model [ 13 , 18 ]. Safewards, which includes ten interventions, focuses on preventing conflict and the use of containment (Table  1 ) [ 5 , 20 , 21 ]. However, implementation is complex, as in order to change the service culture, the model comprises several parallel interventions involving both staff and patients [ 14 , 18 , 19 ].

Patient participation is an important part of the Safewards implementation, preferably in the form of a continuous co-creation process between staff and patients [ 22 , 23 , 24 ]. In cases where Safewards was successfully implemented, patients reported a stronger sense of community, safety and calm [ 5 , 25 ]. They also described feeling less isolated, more hopeful and positive about their stay in addition to experiencing increased respect on the part of staff. In a study by Kennedy et al. [ 26 ], the implementation and possible improvement of the ten Safewards interventions were discussed from the perspective of consumers. It was concluded that although the model does not address important issues regarding the nature of involuntary treatment, the interventions may minimize harm and increase safety. Staff perceptions of Safewards have varied, from high and enthusiastic acceptance along with the belief that the model has a positive impact on conflict and containment, to poor participation and negative perceptions [ 21 ]. Staff working with patients who have intellectual disabilities reported positive experiences, such as fewer violent incidents and feeling safer [ 27 ]. They also described an increased sense of community with patients and were more positive about being part of the ward community. Several studies, including a randomized controlled trial, demonstrated a reduced incidence of violence and coercive measures after implementation of Safewards, while others did not show any significant effects [ 28 ]. In some studies, the extent of the reduction was attributed to the high fidelity of the implementation, which means that to a great degree the interventions were delivered by staff as intended [ 29 , 30 , 31 ].

Implementation fidelity is often measured to evaluate outcomes and better understand why an intervention is successful or unsuccessful [ 32 ]. It can be defined as to what degree an intervention or program is implemented as intended by those who developed it [ 32 ]. If an intervention lacks the expected outcomes, an evaluation of fidelity can indicate whether this is due to poor implementation or an inadequate intervention. In a complex intervention such as Safewards, the level of implementation fidelity can be influenced by many factors. Therefore, it is often recommended that those involved in implementation research and clinical development should collaborate with staff and patients within the healthcare system [ 33 ]. In a conceptual framework, Carroll [ 34 ] suggests that when evaluating implementation fidelity the focus should be on adherence. Adherence refers to the implementation adherence to the content, coverage, dose and duration of the intervention. Four potential modifiers will have an impact on the level of adherence: intervention complexity, facilitation strategies, quality of delivery, and participant responsiveness and capacity. The four adherence modifiers influence each other and there is evidence that for example quality of delivery is associated with participant responsiveness [ 35 ]. Participant responsiveness includes both those delivering and receiving the intervention and, in a health care context, refers to the willingness and ability of staff and patients to be involved and engaged. High patient responsiveness is achieved when patients are positive about and actively involved in the intervention. Furthermore, it entails patients’ positive perceptions of the acceptability, relevance, usefulness and outcomes of the intervention [ 32 ]. Given that many Safewards interventions require active patient participation, patient responsiveness is a crucial modifier for adherence and, consequently, the evaluation of implementation fidelity. For example, for Safewards to be implemented as intended and reach expected positive outcomes, the intervention ‘Discharge messages’ requires patients to write messages to other patients, ‘Mutual help meetings’ requires patients to actively participate and thank other patients, and ‘Know each other’ requires patients to write something about their personal hobbies and interests. At the same time, patient responsiveness and the quality of staff delivery of the interventions are mutually reinforcing adherence modifiers, in which high quality delivery by staff enhances patient responsiveness, and engaged patients contribute to better delivery quality by staff [ 36 , 37 ].

The implementation fidelity of Safewards is often assessed by using the Safewards Fidelity Checklist (SFC), an instrument that mainly examines the number of interventions implemented by staff. In addition, there is an open text box in the SFC used for documenting the most significant staff responses to Safewards [ 38 ]. However, concerns have been raised about the SFC’s focus on objective and visible implementation evidence [ 29 , 39 , 40 ]. Moreover, the SFC does not include aspects of patient responsiveness, or patients’ perceptions of how Safewards interventions are implemented by staff [ 13 , 32 ]. This may reflect a general lack of the patient perspective in the research on Safewards [ 21 ]. In one study however, the open text box in the SFC was modified to collect responses from both staff and patients [ 25 ]. Fidelity evaluation development is vital for the Safewards evidence base, as high-quality fidelity assessments affect study validity and can provide a deeper understanding of why Safewards is effective or not [ 40 ]. In this development, it is necessary to include patient responsiveness as an important fidelity modifier. The aim of the present study was therefore to investigate the Safewards implementation fidelity on an acute psychiatric ward from the perspective of patient responsiveness.

Setting and sample

The study was conducted in a 13-bed acute psychiatric inpatient ward, mainly for patients with affective disorders. The ward was chosen because the ward manager and team there had reported the successful implementation of the Safewards intervention. Coercive measures decreased by 75% and short-term sick leave among staff by 30%. Common diagnoses/syndromes were mood disorders, anxiety disorders, crises, personality disorders and neuropsychiatric conditions. The duration of care episodes averaged 11 days. The professional categories at the ward included specialized psychiatric nurses, registered nurses, assistant nurses, a psychiatrist, an assistant physician and a social worker. On the ward, patients received acute psychiatric care including psychiatric nursing, medical treatment, one-to-one support, psychoeducation and basic Dialectical Behavioral Therapy. Patients could also participate in activities such as walks, games and art. The psychiatric care at the ward focused on empowering people to take responsibility for their own abilities to deal with difficulties. Safewards supported the nursing staff in these efforts. The care was also moving towards a more person-centred approach during the implementation of Safewards.The ward manager was highly committed to the implementation of Safewards, and the team saw themselves as stable with positive group dynamics. At the time of our data collection they had implemented eight of the ten Safewards interventions over an almost three-year period in a co-creation process where they were divided into five groups. Each group was responsible for the implementation of two interventions.

Participants for the interviews were recruited by KC and GB, registered nurses at the ward at the time of the interviews and master students of psychiatric nursing, to become specialized psychiatric nurses. They wrote a master’s thesis in which they inductively analysed the interviews from a nursing perspective. The inclusion criteria were that the patient could speak Swedish, was able to provide informed consent to participate and should have been in the ward for at least five days in order to have experience of the care and interventions. First, general information about the study was presented by KC and GB to patients at a Mutual help meeting. No patient signed up for an interview after the information. The interviewers then recruited patients face-to-face at the ward after consultation with the ward manager to assess that the patients were capable to give their informed consent. Patients were provided with both verbal and written information regarding the study. This included details about the voluntary nature of participation, the purpose of the study, and the intended use of the data. Specifically, it was explained that the data would be utilized by students (the interviewers) for their master’s theses as well as by researchers for publications. The face-to-face recruitment resulted in ten people agreeing to participate, while three declined. No questions were posed about the reason for declining. We interviewed ten patients, one man and nine women, of whom four were aged 30 years or younger, four were between 31 and 40 and two 61–70 years.

Data collection

KC and GB collected the data. As a first step, a modified version of the SFC (see Supplementary Material 1 ) [ 38 ] was used in order to assess the general implementation fidelity of Safewards on the ward. The SFC was filled in along with a detailed ward walkthrough observation of visible signs of Safewards, which were documented and commented on separately.

Subsequently, patient interviews were conducted over a 20-day period based on an interview guide that contained questions about seven of the ten interventions. The Positive words intervention was excluded due to the focus on the quality of staff handover content, which cannot be observed by patients.

The Soft words and Reassurance interventions are not reported in this article because they were not implemented at the time of the interviews. The patients were asked about their observations of manifest signs of Safewards as well as quality aspects of the interventions. Each intervention was briefly explained, and the participants were asked: (1) what they thought of the intervention, (2) about positive and negative experiences and (3) how the intervention could be improved (see Supplementary Material 2 ). The interviewers were instructed to use prompting, for example asking the patient to clarify what they meant by a statement, to obtain in-depth information. The interview guide functioned as intended at the first interview and no changes were made to it.

Seven of the patients were interviewed on the ward during their stay, and three who had been discharged agreed to be interviewed in a separate room next to the ward. The interviews, which lasted 26–85 min, were audio recorded and transcribed verbatim. They were performed in a single session, seven interviews were done by two interviewers and three interviews with only one interviewer present. Field notes were not taken as it was anticipated that the interviewers, who were actively working in the environment, would find it challenging to document these observations. The transcripts were not returned to the participants for comment. After ten interviews, patients gave similar information about how they perceived Safewards and enough of various kinds of events where Safewards had played a role.

Analysis and interpretation

The Safewards interventions were used as categories. Within these categories, a qualitative descriptive text was written about the SFC and the walkthrough, while a qualitative descriptive analysis of the interview content was conducted [ 41 , 42 , 43 ]. We used the qualitative descriptive analysis method, as we aimed to obtain a straightforward qualitative description of patients’ responsiveness to the Safewards interventions [ 42 ]. The analysis started with GB and VP reading the transcripts to gain an overview of the content of the interviews. GB summarized every patient’s view of the seven interventions based on the interview guide. VP merged these summaries into a single summary, which was discussed with AB and LK. VP read through all the interviews to add more relevant information and suitable quotations to the result section. All co-authors commented on the results section and which quotations were the most relevant. The names in the quotations were changed and the pronoun ”she” was used for all participants to protect their identity. The participants were not asked to provide feedback on the findings.

In general, the findings indicated that the patients had noted the implementation of Safewards and were positive about it. Some gave examples of improvements that had happened over time or of the ward being better than other wards. They expressed that staff now had a more positive attitude when interacting with patients. The ward and staff were perceived as welcoming, familiar, supportive and felt safer. The patients felt respected, less alone and more hopeful. All these perceptions seemed to contribute to the patients’ experiences of the ward as a safe environment. They also expressed taking responsibility for other patients and the ward climate in general.

In this section, we first provide a brief description of the Safewards implementation fidelity as revealed by the SFC and the walkthrough. Thereafter we present the patients’ responsiveness to Safewards. A summary of the findings is presented in Table 2 .

Discharge messages

Sfc/walkthrough.

There was a big tree painted on the wall with discharge messages in the corridor opposite the ward entrance. Patients were asked to leave a message in connection with their discharge. At the time of the fidelity check, there were 27 discharge messages and a brochure with information about the intervention.

Patient responsiveness

It was great, it’s the first thing you [as a patient] see, there were so many beautiful leaves, just being able to read it when you’re standing outside the nurses’ station waiting …. That was also something that I noticed right away when I walked in, literally the first thing… Pat. 7.

Most patients considered the location of the discharge tree to be appropriate, that it was aesthetically beautiful, and that they took the time to read the messages. A patient described how she “naturally” drawn towards the tree because of its location and often stood there waiting for medicine or staff. The tree gave comfort during bad days, as it was hopeful and invigorating to read that others had received help from staff and recovered, which created a sense of safety. It also sparked a curiosity about previous patients: What happened after discharge? Some gained a new perspective on how to approach their problems, while others just learned to accept the situation, trusting that it will improve and letting their recovery take time. It was important for patients that the messages were positive and encouraging. Sometimes they could think long and hard about what they wanted to convey when it was time for discharge.

Some felt that the environment around the discharge tree was often too noisy, a lot of people passing by all the time, which made it difficult to absorb the messages. One patient thought that her fellow patients should thank themselves and not the staff.

Know each other

There were two folders in the common area of the ward presenting each of the 23 staff members on a separate page. Patients had a small whiteboard with pre-defined suggested categories outside their rooms where they could write about themselves. However, there were no written know-each-other messages from patients at the time of the walkthrough. The reason for using a board instead of pages in a folder was that for most patients the care episodes were relatively short.

It gave more hope in a way …. That you [staff members] really show who you are and that you are passionate about your work. Yes, I really felt like I had come to the right ward when I read your folder [with presentations]. Pat. 3.

It felt welcoming that staff had made an effort to create the folder with information about their interests and other personal details. Knowing something about the staff members who were working at the ward contributed to safety. It also facilitated daily communication and made it easier to ask for help. The fact that the presentations were always available meant that patients could learn about staff members and fellow patients at their own pace. Some had read the staff presentations several times. The intervention reduced the power difference between staff and patients because staff members became persons and not “just their nursing scrubs”. A patient reported feeling touched by the fact that staff presented themselves. It felt familiar and positive.

At the time of the interviews, some patients had written about themselves on the whiteboard outside their room. They thought that it was especially fun and interesting to read about fellow patients. A patient who presented herself on the whiteboard felt respected and appreciated reading others’ presentations. Even those who wanted “to be a little anonymous” or did not consider it necessary to write about themselves appreciated the possibility. They thought it was good that patients could write about how they, for example, wanted to be treated by others. Some patients considered that it was difficult to expose oneself in a presentation when feeling unwell and could be reluctant to present themselves “fully” because of the risk of prejudice.

At times it felt a little less safe to be able to do it, there can be a lot of prejudice about me because …. I do this and I do that. I sometimes felt a little …. tingle in my stomach maybe, but then I thought – No, to hell with it, I can be myself and it may seem very crazy and all. I care less about that because I’m here to help as well, to improve this system. Pat. 6.

There were several similar statements where patients expressed that they wanted to take responsibility for the ward climate and safety. Patients had ideas about how to improve the intervention, for example by providing more information about the intervention and its purpose, that it had too many pre-defined suggested categories to choose from and that the folders should be updated with new information about and pictures of those staff members who were not yet included in the presentations. A patient thought that the staff only revealed “their good side” and should also inform about their weaknesses.

Clear mutual expectations

There were several posters in the ward pertaining to Clear mutual expectations. Before the implementation started, interviews were conducted by a Peer support person focusing on this topic with patients.

Patients had seen the poster and been informed about the intervention. They expressed that the expectations promoted mutual respect and taking responsibility for the ward environment without aggressive behaviour. Several patients mentioned that they could go to the poster when they lacked information and could also help their fellow patients to adhere to rules so as not to annoy staff. Some were of the opinion that everyone must take responsibility and that some people may need to be reminded of it. They thought that the mutual expectations contributed to a good and safe environment and appreciated that the staff had made an effort to create the expectations, which gave them hope.

I have both good and bad experiences of inpatient care and care in general, but it was hopeful because it has been difficult to be cared for as an inpatient, but this was like physical evidence that you [staff members] actively work to make it better, somehow. And it gave me hope …., it made me a bit calmer that “Okay, maybe this time it can be different” so …. to make changes in health care is quite (laughter) difficult and big, so just managing to get the posters printed and put them up means a hell of work. So .... that was helpful.

Patients also pointed out that it can be difficult to have clear mutual expectations in an environment where people are so sick, but that it is a good strategy to encourage everyone to take responsibility. The intervention reduced the power difference between staff members and patients.

Patients made some suggestions for improvement, for example keeping promises, as staff members sometimes made promises that were either fulfilled late or not at all. Other suggestions were using a different font to make the poster easier to read and making patients aware of the intervention by providing more information about it at the Mutual help meetings. 

You [staff] could show it differently, not just text. I don’t know what it could be but something, pictures, photographs …. Yes, a picture and text I think, because a picture can be associated with [something] and I will be more likely to remember it. Pat. 10.

Mutual help meetings

The staff arranged Mutual help meetings every weekday morning after breakfast in the dining room. There was a folder for staff use in which the structure of the meetings was described. Patient information was also displayed prominently in the ward.

A number of patients found the morning meetings beneficial and helpful, as they provided an overview of the day. At the meeting, everyone was given the opportunity to talk about issues that felt difficult but also to express positive feelings. It was a good forum for asking about something or gaining information about what would happen during the day. The opportunity to express gratitude at the meeting was considered a good start to the day.

…and it was great that the staff brought up, for example, “It was really hard to get to work because it was raining …. but I’m grateful that I’m here now”. And it felt great that they are grateful that they are here …. And I thought that was among the best things I experienced in the ward. Pat. 6.

The fact that the staff dared to bring up subjects that they thought were problematic and what they were grateful for made it easier for patients to become more communicative. It was difficult for patients to know what was appropriate and how much to open up and communicate about their personal life. Some of them stated that they wished to remain anonymous during their stay in the ward. Talking to other patients made it easier to be open, which could be especially difficult on days when they felt very unwell. They reported that they sat relatively quietly and just listened at the first few meetings, but later became more communicative. Patients thought that the meetings motivated them and made them feel less alone. It felt positive that everyone wished each other a good day. These meetings helped to create a social community in the ward.

Yes, often it is …. you [the chair, a staff member] present which day it is and the date and who has a name day …. And then there is a round where everyone gets to express what they think, that they wish everyone a good day, that they are grateful to be here …. or you can say that you would like help to withdraw money. And then it’s written down and …. it feels good that everyone wishes each other a good day, I think, it’s a nice little start to the day. Pat. 9.

Having the meeting early in the morning was experienced as both positive and negative. It was nice to sit and have breakfast in peace and quiet, hence attending the meeting was an effort but at the same time it was positive to obtain information about the day. As a patient, there was a risk of feeling pressurized into participating when the meeting started immediately after breakfast in the common dining room. There were patients who often overslept and therefore did not attend many meetings.

Patients had suggestions for improvements. They noted that each chairperson structured the meeting differently, which was frustrating. They wanted the structure of the meetings to remain more or less the same. Hearing about other people’s problems could be negative for their own well-being and therefore they stated that the meetings should mainly focus on positive aspects.

Bad news mitigation

One of the headings in the digital agenda for handover reports was Bad news mitigation aimed at routinely raising the question of whether any patients had received or might receive bad news. A laminated information sheet about how patients who had received bad news should be dealt with was on the table in the conference room where the handovers took place. There was also a box of “treats”, such as tea and biscuits, which could be used during Bad news mitigation meetings with patients.

Some patients reported receiving bad news that was difficult to handle, but that they had received good support from staff.

Well, when I was hospitalized last time, my grandfather was very, very ill and …. Then I got support from the staff when, when I was informed about that …. Yes, we sat and talked and so …. Yes, it was good. Pat. 10.

There were also patients who did not receive any bad news themselves but who observed others having done so. They stated that their fellow patients had received compassionate and empathetic care. Patients experienced that staff noticed when they needed to talk about something or required support in a tricky situation. Staff support made them feel safe, more communicative and less lonely.

I experienced that you [staff members] are present when, for instance, you speak in a way that the person really understands and that you are really there, also some minutes afterwards, so that the person calms down and really understands what has happened and you speak in a calm voice. Pat. 2.

According to the patients, an example of bad news was that relatives were not welcome at the ward during the Covid-19 pandemic. It was difficult for staff to explain why friends and family were not allowed to visit patients. In such a case, it would have been helpful to receive accurate information about the situation; otherwise, patients might think that it was their own fault and would develop “dark thoughts”.

Calm down methods

The ward had a sensory room and a calm down cabinet, with many different sensory items and equipment that could be used for calming purposes, like hug chair, weight vest and blanket, ice pack and a Star Projector. In addition, there was an “emotion-map” on the wall containing a description of emotions and their functions as well as suggestions for calming strategies that could be used to cope with various emotions.

I was stressed and then I was given a heated cushion, because it could help me handle anxiety, and it did, I never thought of that myself before. Pat. 5.

The calm down methods were appreciated by patients, many of whom perceived that the intervention worked well and created a feeling of safety. Patients expressed that they had been helped by the sensory room, a quiet place to calm down in, or by items from the calm down cabinet. They also reported that staff helped them to find strategies to deal with anxiety and emotions. Some patients also noticed that staff members helped fellow patients to calm down. They found it positive that staff noticed patients who were having a hard time and tried to find ways to help them calm down.

Patients considered the activities organized in the ward, including playing games, going for walks together and music quizzes, as very helpful ways to handle difficult emotions. The activities made patients feel seen, heard, and less alone in difficult situations. Patients described working on their crisis plan together with staff. Even before admission some had several strategies for independently managing to calm challenging emotions. They felt that staff respected them, listened, reminded them about their strategies and provided support for finding new strategies. In some situations, patients could find receiving help difficult and frustrating, although it was often perceived as valuable. Below is a quotation from a patient who received help from staff to write a list of strategies she could use when needing to calm down.

I thought it was very good that when I had a very severe anxiety attack, someone asked “Okay, but where are you on your list?” …. I had a copy by my bed so I could check it …. and it was very nice that, for instance, I was allowed to go out and smoke even though it wasn’t smoking time because a cigarette calms me down, like, that someone took the time to do it. I think that I was listened to and the staff reminded me of skills that I know work for me. Pat. 7.

One patient did not seem to know about the intervention. She said that patients must not show emotions in psychiatry because of the risk of being medicated, instead of being offered a chat or a hug. The need for social distancing during the pandemic was difficult for those who liked getting a hug. This patient used her own strategies without talking to staff. Another patient had sometimes wished to receive support more quickly but said that she understood that staff had a lot to do.

A Talk Down poster was visible to staff. Every two weeks staff members practised the talk down intervention in training sessions with role play.

So, I noticed that staff knew exactly what to do when it happened, … trying to punch or break free from a hold, when everyone joins up and helps, talks calmly and methodically to the person and then someone tells everyone else to go to their rooms while you [staff member] help to calm that person down. Pat. 2.

While the participants did not report being involved in a de-escalation process, they described how staff members managed aggressive behaviour from patients as well as an accident. Staff members did so calmly and efficiently to ensure that the situation would not escalate. Patients also observed that staff sometimes restricted patients in order to prevent them from creating trouble for other patients.

So, there are many situations all the time. It’s good that you [staff] try to be as flexible as possible so that it doesn’t create chain reactions …. That we kind of feel worse as a result. For instance, if someone has to be put in restraints, that it is not …. It may not be very dignified and therefore better that others don’t see it. Pat. 10.

The patients’ care episodes differed, for some it was chaotic, and they had seen events that were difficult or unpleasant, which created a feeling of lack of safety. Even if they themselves could handle their emotions, they found it difficult to witness when others felt unwell. Some patients described that the ward was calm during their own care episode, while others only experienced a single situation where a fellow patient was aggressive.

To summarize, the findings indicate high implementation fidelity, both in terms of the SFC and the patients’ responsiveness to Safewards. The seven interventions implemented were all clearly observable at the SFC/walkthrough. Evaluation of patient responsiveness to the implementation of Safewards may differ from that of patients’ experiences of Safewards in general. This is because responsiveness more specifically refers to patients’ enthusiasm and engagement, in addition to their perception of the acceptability, usefulness and relevance of Safewards. The results of the present study contain many examples of how patients describe responsiveness based on these attributes. For example, patients expressed that the discharge tree provided comfort during bad days, as it created hope (usefulness). The attached Know each other folder could also make them familiar with staff members at their own pace (acceptability) and one patient heard a staff member at a Mutual help meeting saying that she was grateful to be on the ward, which was described as one of the best things that particular patient had experienced on the ward (enthusiasm).

The patients described staff behaviour and the ward climate as positive, and that the interventions and other activities involving staff members created a feeling of safety and could distract from difficult thoughts and feelings. They felt respected, less alone, hopeful and safe. This is similar to the results of Maguire et al. [ 25 ] and Fletcher et al. [ 5 ], who described patients’ feelings of hope, safety, respectful relationships and sense of community on wards in which Safewards was implemented. In our study, the patients more clearly emphasized that they took responsibility for others and the ward environment than was the case in the aforementioned studies. Some patients were surprised that they were expected to take responsibility, while others considered it a matter of course. Although not fully clear, it is possible that the interventions involving Clear mutual expectations and Mutual help meetings could have encouraged patients to take a more active role in ward responsibilities and supporting others, or to realize that such behaviours were appreciated on the ward. There is a lack of research on assuming responsibility and naturally occurring peer support among patients [ 44 ]. However, our study indicates that patient engagement in Safewards may enhance opportunities for self-help and peer support, both within Safewards interventions (e.g., Calm Down methods and Mutual Help Meetings) and through spontaneous initiatives. In this way, active patient participation in the implementation of Safewards appears to encourage empowerment and support recovery processes which in turn may reduce conflict and containment [ 45 ].

Several participants experienced it as challenging being in a ward where so much communication between patients and staff as well as among the patients themselves was expected, for example through Mutual help meetings and Discharge messages. Patient engagement was demonstrated by several communication related improvement suggestions made about Safewards, such as more accessible information by means of simplified text or use of pictures. Similarly, an important factor in implementation is dosage, meaning patients’ level of exposure to the interventions [ 46 ]. A participant in this study had previously experienced that it was necessary to adapt to the ward rules and routines and not show negative emotions to avoid the risk of coercive measures. As this patient did not exhibit anxiety to staff members, no Calm down methods were used. Several studies indicate that many patients have similar thoughts [ 6 , 47 , 48 , 49 , 50 ]. Therefore, it is important to ensure that the interventions are sensitive to individual patient needs and that person centredness is not compromised.

The present study is a first attempt to examine implementation fidelity to Safewards interventions by focusing on patient responsiveness. Including participant responsiveness when measuring implementation fidelity is important especially in complex interventions. In a review of complex rehabilitation interventions that examined 43 studies from a theoretical implementation perspective, the responsiveness of the participants, both staff and patients, was the most frequently mentioned factor affecting fidelity [ 51 ]. In research on Safewards, the focus has often been on the general response of staff and sometimes patients, as opposed to their response to specific interventions. When focusing on the responsiveness to the different interventions, we also gained information about strategies to facilitate implementation, delivery quality and adherence [ 32 ]. It became clear that despite Safewards, staff occasionally seemed to have difficulties dealing with certain situations. Patients who observed this could perceive the ward as an unsafe environment.

According to the patients, inconsistencies in staff behaviour and different ways of implementing the interventions affected the quality of delivery; this was particularly obvious in the Mutual help meeting intervention. Hence, staff responsiveness to, and way of working with, the Safewards interventions had a direct impact on patients’ responsiveness to them and whether or not they perceived them as helpful. It has been suggested that participant responsiveness may have a major impact on fidelity, and the connection between staff and patient responsiveness has been described by Carroll et al. [ 32 ] as a key aspect of implementation. This connection may be of particular importance when implementing an intervention such as Safewards, which aims at reducing levels of conflict and containment. Providing a therapeutic ward environment, including therapeutic engagement by staff in collaboration with patients, have been described as central to the reduction of conflict and restrictive practices, as well as to the quality of mental health nursing practice [ 52 , 53 ]. Therefore, for staff to implement Safewards in a task-orientated and instrumental fashion without positive responsiveness is unlikely to be successful.

An important determinant of successful implementation of an intervention is local and organizational leadership [ 54 ]. Findings from our study suggest that leaders responsible for the implementation of Safewards, need to recognize the importance of facilitating for a positive patient and staff responsiveness. For example, they should be aware of any negative conclusions about the effectiveness of Safewards based solely on observations of staff performing Safewards activities without identifying a lack of positive responsiveness. Therefore, it is likely that the implementation of Safewards would benefit from leaders actively supporting this aspect in their implementation strategies.

Strengths and limitations

Our study adds to the sparse literature on patient experiences of the Safewards model. The results are relevant for clinical practice when implementing Safewards, as they provide insights into patient responsiveness to and suggestions about how to improve specific Safewards interventions. Possible pitfalls in the implementation process may thereby be avoided.

A main limitation is that the study was conducted at only one ward, mainly comprising patients treated for affective disorders. Interviews from other wards with different patient profiles may have contributed more knowledge about patient responsiveness and further suggestions for improvement. Another limitation is that observations, recruitment of participants and interviews were conducted by staff employed at the ward, possibly leading to bias in observations, selection of patients, and their responses to the interview questions. As the interviewers had been engaged in the implementation of Safewards at the ward, they may have reported more observations on the SFC than an independent researcher would have done and may also have selected favourably disposed patients for interview. Some patients were interviewed while still on the ward in a dependent situation. We handled this bias by giving clear instructions to the interviewers and the ward manager about which patients could be interviewed, how to use the SFC and the interview guide. Clear questions in the interview guide were posed to encourage patients to be critical and make suggestions for improvement. These were single session interviews. We did not contact the patients again, even though it could have provided valuable knowledge. We saw it as both ethically and practically problematic. Reminding people of their time on a psychiatric ward can arouse many emotions and it is often difficult to get in touch with former patients. On the other hand, it is a strength that the interviewers were very familiar with the work at the ward and had wide experience of communicating with patients, possibly leading to richer responses. After the information at the Help meeting no patient immediately signed up for an interview. Some patients may have a lack of energy, and some may not dare to speak or ask questions in front of others in a group. However, the interviewers noticed that all participating patients wanted to take part of the study and express their thoughts about their stay at the ward. Despite the shift in direction towards becoming a more patient-centred ward, many suggestions for improvement emerged that the staff had not previously received from patients. To increase trustworthiness all authors took part in the analysis. The authors possess diverse backgrounds, including mental health nursing, social work, and psychiatric health services research. The primary author also has personal experience with psychiatric inpatient care as a patient. These varied competencies and experiences enhance the potential for multiple perspectives in analysing the interview material.

This study confirms previous research that patient responsiveness is an important factor in the assessment of fidelity in prevention programs, such as Safewards. The patients’ descriptions of the acceptability, relevance and usefulness of the specific interventions, to a high degree reflected the objective visual observations made through the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions in order to make them more useful and accessible. This shows a potential to obtain valuable input from patients when implementing and adapting Safewards in a ward and to achieve high quality implementation and levels of fidelity. This study is also clinically relevant as it presents many examples of practical work with these interventions and their effects on patients’ experiences of care.

Data availability

The data are not available because it could compromise the individual privacy of participants. They are stored at the University Health Care Research Center, Region Örebro County, and may be requested by other researchers.

Abbreviations

United Nations

European Union

Pro Re Nata. A medication prescribed to treat short term or intermittent medical conditions, not to be taken regularly

The Safewards Fidelity Checklist

World Health Organization

UN General Assembly. Convention on the Rights of Persons with Disabilities. 2007. https://www.refworld.org/docid/45f973632.html . Accessed 18 Oct 2023.

UN General Assembly, Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. 1984. https://www.refworld.org/docid/3ae6b3a94.html . Accessed 18 Oct 2023.

Turnpenny A, Petri G, Finn A, Beadle-Brown J, Nyman M. Mapping and understanding exclusion: Institutional, coercive and community-based services and practices across Europe. (Mental Health Europe). Kent:University of Kent; 2018.

Sveriges riksdag. Lag (1991:1128) om psykiatrisk tvångsvård (The Compulsory Mental Care Act). Stockholm; 1991.

Fletcher J, Buchanan-Hagen S, Brophy L, Kinner SA, Hamilton B. Consumer perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia. Front Psychiatry. 2019;10:461.

Article   PubMed   PubMed Central   Google Scholar  

Pelto-Piri V, Wallsten T, Hylen U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst. 2019;13:23.

Molin J, Graneheim UH, Lindgren BM. Quality of interactions influences everyday life in psychiatric inpatient care–patients’. Perspect Int J Qual Stud Health Well-being. 2016;11:29897.

Article   Google Scholar  

Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc sci med. (1982) 2001;52:3.

Robins CS, Sauvageot JA, Cusack KJ, Suffoletta-Maierle S, Frueh BC. Special section on Seclusion and Restraint: consumers’ perceptions of negative experiences and Sanctuary Harm in Psychiatric Settings. Psychiatr Serv. 2005;56:9.

Cusack KJ, Frueh BC, Hiers T, Suffoletta-Maierle S, Bennett S. Trauma within the Psychiatric setting: a preliminary empirical report. Adm Policy Ment Health. 2003;30:5.

Pelto-Piri V, Warg LE, Kjellin L. Violence and aggression in psychiatric inpatient care in Sweden: a critical incident technique analysis of staff descriptions. BMC Health Serv Res. 2020;20:362.

Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of sickness absence: a three month prospective study of nurses’ aides. Occup Environ Med. 2003;60:4.

Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21:6.

Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting Inpatient Psychiatric Unit Violence: implications for Relational and Unit Cultural improvements. Issues Ment Health Nurs. 2009;30:4.

Bak J, Aggernæs H. Coercion within Danish psychiatry compared with 10 other European countries. Nord J Psychiatry. 2012;66:5.

Nilsson A. Unlocking the impact of the CRPD on Swedish mental health law. Int J Law Psychiatry. 2024 Mar-Apr;93:101966. https://doi.org/10.1016/j.ijlp.2024.101966 . Epub 2024 Mar 1. PMID: 38430626.

Statistikdatabas för tvångsvård. Socialstyrelsen, Stockholm. https://sdb.socialstyrelsen.se/if_tvangsvard/val.aspx . Accessed 18 Oct 2023.

Gooding P, McSherry B, Roper C. Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English-language studies. Acta Psychiatr Scand. 2020;142:1.

Gooding P, McSherry B. Alternatives to Compulsory Detention and Treatment and Coercive practices in Mental Health settings. J Law Med. 2018;26:2.

Google Scholar  

Safewards homepage. http://www.safewards.net/ . Accessed 18 Oct 2023.

Mullen A, Browne G, Hamilton B, Skinner S, Happell B. Safewards: an integrative review of the literature within inpatient and forensic mental health units. Int J Ment Health Nurs. 2022;31:5.

Voorberg WH, Bekkers VJJM, Tummers LG. A systematic review of Co-creation and Co-production: embarking on the social innovation journey. Public Adm Rev. 2015;17:9.

Clifton A, Repper J, Banks D, Remnant J. Co-producing social inclusion: the structure/agency conundrum. J Psychiatr Ment Health Nurs. 2013;20:6.

Kipping SM, De Souza JL, Marshall LA. Co-creation of the safewards Model in a forensic Mental Health Care Facility. Issues Ment Health Nurs. 2019;40:1.

Maguire T, Ryan J, Fullam R, McKenna B. Evaluating the introduction of the safewards Model to a medium- to Long-Term Forensic Mental Health Ward. J Forensic Nurs. 2018;14:4.

Kennedy H, Roper C, Randall R, Pintado D, Buchanan-Hagen S, Fletcher J, Hamilton B. Consumer recommendations for enhancing the safewards model and interventions. Int J Ment Health Nurs. 2019;28:2.

Davies B, Silver J, Josham S, Grist E, Jones L, Francis N, Truelove C, Shindler M, Jones S, Gwatkin A. An evaluation of the implementation of safewards on an assessment and treatment unit for people with an intellectual disability. JOID. 2011;25:3.

Ward-Stockham K, Kapp S, Jarden R, Gerdtz M, Daniel C. Effect of safewards on reducing conflict and containment and the experiences of staff and consumers: a mixed-methods systematic review. Int J Ment Health Nurs. 2022;31:1.

Baumgardt J, Jäckel D, Helber-Böhlen H, Stiehm N, Morgenstern K, Voigt A, et al. Preventing and reducing coercive Measures—An evaluation of the implementation of the safewards Model in two locked wards in Germany. Front Psychiatry. 2019;10:340.

Bowers L, James K, Quirk A, Simpson A, Stewart D, Hodsoll J. Reducing conflict and containment rates on acute psychiatric wards: the safewards cluster randomised controlled trial. Int J Nurs Stud Int J Nurs Stud. 2015;52:9.

Fletcher J, Spittal M, Brophy L, Tibble H, Kinner S, Elsom S, Hamilton B. Outcomes of the victorian safewards trial in 13 wards: impact on seclusion rates and fidelity measurement. Int J Ment Health Nurs. 2017;26:5.

Carroll C. Fidelity. In: Nilsen P, Birken S, editors. Handbook on implementation science. Cheltenham: Edward Elgar Publishing Ltd; 2020. pp. 291–316.

Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. IS. 2017;12:150.

PubMed   PubMed Central   Google Scholar  

Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. IS. 2007;2:40.

Berkel C, Mauricio A, Schoenfelder E, Sandler I. Putting the pieces together: an integrated model of program implementation. Prev Sci. 2011;12(1):23–33.

Sutherland KS, McLeod BD, Conroy MA, Cox JR. Measuring implementation of evidence based programs targeting young children at risk for emotional/behavioral disorders: conceptual issues and recommendations. JEI. 2013;35:2.

Mihee A, Dusing S, Harbourne R, Sheridan S, START-Play Consortium. (2020). What really work in Intervention? Using fidelity measures to support optimal outcomes. Phys Ther. 2020;18:100(5).

Safewards Fidelity Checklist. http://www.safewards.net/images/pdf/Organisational%20fidelity%20final.pdf . Accessed 18 Oct 2023.

Dickens GL, Tabvuma T, Frost SA, SWSLHD Safewards Steering Group. Safewards. Changes in conflict, containment, and violence prevention climate during implementation. Int J Ment Health Nurs. 2020;29:6.

James K, Quirk A, Patterson S, Brennan G, Stewart D. Quality of intervention delivery in a cluster randomised controlled trial: a qualitative observational study with lessons for fidelity. Trials. 2017;18:1.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2007;62:1.

Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurs Health. 2010;33:1.

Article   PubMed   Google Scholar  

Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:4.

Cooper A, Jenkin G, Morton E, Peterson D, McKenzie SK. We have to band together’: service user experiences of naturally occurring peer support on the acute mental health unit. KOTUITUI. 2023;18:2.

Lim E, Wynaden D, Heslop K. Recovery-focussed care: how it can be utilized to reduce aggression in the acute mental health setting. Int J Ment Health Nurs. 2017;26(5):445–60.

Berkel C, Mauricio AM, Schoenfelder E, Sandler IN. Putting the pieces together: an integrated model of program implementation. Prev Sci. 2011;12:1.

Molin J, Graneheim UH, Lindgren B-M. Quality of interactions influences everyday life in psychiatric inpatient care—patients’ perspectives. Int J Qual Stud Health Well-being. 2016;11:29897.

Shattell MM, Andes M, Thomas SP. How patients and nurses experience the acute care psychiatric environment. Nurs Inq. 2008;15:3.

Meehan T, Bergen H, Fjeldsoe K. Staff and patient perceptions of seclusion: has anything changed? J Adv Nurs. 2004;47:1.

Olofsson B, Jacobsson L. A plea for respect: involuntarily hospitalized psychiatric patients’ narratives about being subjected to coercion. J Psychiatr Ment Health Nurs. 2001;8:4.

Holmes JA, Logan P, Morris R, Radford K. Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review. Syst Rev. 2020;9:268.

McAllister S, Simpson A, Tsianakas V, Robert G. What matters to med: a multi-method qualitative study exploring service users’, carers’ and clinicians’ needs and experiences of therapeutic engagement on acute mental health wards. IJMH. 2021;30:701–12. https://doi.org/10.1111/inm.12835 .

Bennetts S, Pepin G, Moylan S, Carolin R, Lucas J. Elimination of restrictive practices from acute adult mental health care services: a qualitative evidence synthesis of the lived experience literature. SSM-Mental Health. 2004;5:100305.

Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11:33. https://doi.org/10.1186/s13012-016-0398-2 .

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Acknowledgements

The authors extend their gratitude to all the patients who participated in this study, to the ward manager who made it possible to conduct the study and to Gullvi Nilsson who was the language proofreader of this script.

The study was funded by AFA Insurance (No. 190272) and Region Örebro County. The funding bodies have not influenced the research design, the procedure or work on the manuscript.

Open access funding provided by Örebro University.

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Veikko Pelto-Piri & Lars Kjellin

Psychiatric outpatient clinic, Region Värmland, Kristinehamn, Sweden

Gabriella Backman

Psychiatric Outpatient Clinic, Västra Götalandsregionen, Alingsås, Sweden

Karoline Carlsson

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

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Contributions

VP (male, PhD, social worker, investigator at organizational level in psychiatry and research supervisor), LK (male, PhD, psychiatric health services researcher and research supervisor) and AB (female, PhD, specialized psychiatric nurse, investigator at organizational level and researcher) designed and planned the study. GB (female, specialized psychiatric nurse) and KC (female, specialized psychiatric nurse) conducted the interviews. The analysis was performed by VP and GB with the support of all co-authors. VP wrote a first draft of the manuscript, after which all authors contributed to the various revisions and approved the final draft.

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Correspondence to Veikko Pelto-Piri .

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Written information about the study was provided with the invitation to participate. Those who agreed to participate received both oral and written information from the interviewer and written informed consent was obtained. We were careful to emphasize that participation was voluntary and that their decision whether or not to participate would not affect their care. The study was approved by The Swedish Ethical Review Authority, Uppsala, Sweden, No. 2020–03881.

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Pelto-Piri, V., Kjellin, L., Backman, G. et al. Patient responsiveness as a safewards fidelity indicator: a qualitative interview study on an acute psychiatric in-patient ward. BMC Health Serv Res 24 , 922 (2024). https://doi.org/10.1186/s12913-024-11326-z

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Received : 05 February 2024

Accepted : 17 July 2024

Published : 12 August 2024

DOI : https://doi.org/10.1186/s12913-024-11326-z

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