qualitative research 7

Designing Qualitative Research

Qualitative Inquiry | Qualitative Research in Education | Research Design | Research Methods in Sociology | Introduction to Qualitative Research Methods

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Chapter 1. Introduction

Chapter 2. qualitative research genres, chapter 3. credibility, trustworthiness, and ethics, chapter 4. the what of the study: building the conceptual framework, chapter 5. the how of the study: building the research design, chapter 6. basic data collection methods, chapter 7. specialized and focused data collection methods, chapter 8. managing, analyzing, and interpreting data, chapter 9. arguing the merits of your proposal and moving forward.

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• A sustained and deeper focus on the burgeoning use of social media and internet applications in conducting qualitative research brings the book up to date.
• New questions for the new century—one now dominated by social networking—explore the issues and design dilemmas of today’s qualitative researchers .
• New vignettes cover such topics as researchers’ challenges in designing research with homeless, refugee, and immigrant populations; the interplay between ethics and trustworthiness; and exquisite sensitivity in research on sexual harassment.
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• Ways that research can be attuned to policy and practice —from problem identification to formatting the presentation of findings to the explicit focus on trustworthiness, credibility, and ethics—prepare students to do their own research.
• The personal, ethical, and political dilemmas that the researcher may face are emphasized throughout the book.
• Examples and vignettes are current , especially in terms of cross-national research and the issues that arise.
• Extended discussions cover strategies researchers can use to address the challenges posed by postmodernists, feminists, and critical race theorists, as well as others who interrogate historical qualitative inquiry.
• Inspiring potential “Aha!” moments and opportunities to do research in close connection with people and communities bring topics to life.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Qualitative study.

Steven Tenny ; Janelle M. Brannan ; Grace D. Brannan .

Affiliations

Last Update: September 18, 2022 .

• Introduction

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 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." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [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 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. [4] 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.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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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.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Brannan JM, Brannan GD. Qualitative Study. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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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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What is Qualitative in Qualitative Research

Affiliations.

• 1 1Department of Sociology, Uppsala University, Uppsala, Sweden.
• 2 2Seminar for Sociology, Universität St. Gallen, St. Gallen, Switzerland.
• 3 3Department of Media and Social Sciences, University of Stavanger, Stavanger, Norway.
• PMID: 31105362
• PMCID: PMC6494783
• DOI: 10.1007/s11133-019-9413-7

What is qualitative research? If we look for a precise definition of qualitative research, and specifically for one that addresses its distinctive feature of being "qualitative," the literature is meager. In this article we systematically search, identify and analyze a sample of 89 sources using or attempting to define the term "qualitative." Then, drawing on ideas we find scattered across existing work, and based on Becker's classic study of marijuana consumption, we formulate and illustrate a definition that tries to capture its core elements. We define qualitative research as an iterative process in which improved understanding to the scientific community is achieved by making new significant distinctions resulting from getting closer to the phenomenon studied. This formulation is developed as a tool to help improve research designs while stressing that a qualitative dimension is present in quantitative work as well. Additionally, it can facilitate teaching, communication between researchers, diminish the gap between qualitative and quantitative researchers, help to address critiques of qualitative methods, and be used as a standard of evaluation of qualitative research.

Keywords: Epistemology; Methods; Phenomenology; Philosophy of science; Qualitative research.

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The Oxford Handbook of Qualitative Research (2nd edn)

Patricia Leavy Independent Scholar Kennebunk, ME, USA

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The Oxford Handbook of Qualitative Research, second edition, presents a comprehensive retrospective and prospective review of the field of qualitative research. Original, accessible chapters written by interdisciplinary leaders in the field make this a critical reference work. Filled with robust examples from real-world research; ample discussion of the historical, theoretical, and methodological foundations of the field; and coverage of key issues including data collection, interpretation, representation, assessment, and teaching, this handbook aims to be a valuable text for students, professors, and researchers. This newly revised and expanded edition features up-to-date examples and topics, including seven new chapters on duoethnography, team research, writing ethnographically, creative approaches to writing, writing for performance, writing for the public, and teaching qualitative research.

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview

Basics of qualitative research

Types, aspects, examples, benefits and challenges, how qualitative research complements quantitative research, how is qualitative research reported.

• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews
• Research question
• Conceptual framework
• Conceptual vs. theoretical framework
• Data collection
• Qualitative research methods
• Focus groups
• Observational research
• Case studies
• Ethnographical research

Ethical considerations

• Confidentiality and privacy
• Power dynamics
• Reflexivity

What is qualitative research?

Qualitative research is an essential approach in various academic disciplines and professional fields, as it seeks to understand and interpret the meanings, experiences, and social realities of people in their natural settings. This type of research employs an array of qualitative methods to gather and analyze non-numerical data, such as words, images, and behaviors, and aims to generate in-depth and contextualized insights into the phenomena under study.

Qualitative research is designed to address research questions that focus on understanding the "why" and "how" of human behavior, experiences, and interactions, rather than just the "what" or "how many" that quantitative methods typically seek to answer. The main purpose of qualitative research is to gain a rich and nuanced understanding of people's perspectives, emotions, beliefs, and motivations in relation to specific issues, situations, or phenomena.

Characteristics of qualitative research

Several key characteristics distinguish qualitative research from other types of research, such as quantitative research:

Naturalistic settings : Qualitative researchers collect data in the real-world settings where the phenomena of interest occur, rather than in controlled laboratory environments. This allows researchers to observe and understand the participants' behavior, experiences, and social interactions in their natural context.

Inductive approach : Unlike quantitative research, which often follows a deductive approach , qualitative research begins with the collection of data and then seeks to develop theories, concepts, or themes that emerge from the data. This inductive approach enables researchers to stay open to new insights and unexpected findings.

Holistic perspective : Qualitative research aims to provide a comprehensive understanding of the phenomena under study by considering multiple dimensions, such as the social, cultural, historical, and psychological aspects that shape people's experiences and behavior.

Subjectivity and interpretation : Epistemology plays a crucial role in qualitative research. Researchers are encouraged to reflect on their biases, assumptions, and values , and to consider how these may influence their data collection, analysis, and interpretation.

Flexibility : Qualitative research methods are often flexible and adaptable, allowing researchers to refine their research questions , sampling strategies, or data collection techniques as new insights and perspectives emerge during the research process.

Key principles of qualitative research

Qualitative research is guided by several fundamental principles that shape its approach, methods, and analysis:

Empathy and reflexivity : Qualitative researchers strive to empathize with the participants and to understand their perspectives, experiences, and emotions from their viewpoint. This requires researchers to be attentive, open-minded, and sensitive to the participants' verbal and non-verbal cues. At the same, qualitative researchers critically reflect on their participants’ perspectives, experiences, and emotions to develop their findings and conclusions, instead of taking these at face value. In addition, it is important for the researcher to reflect on how their own role and viewpoint may be shaping the research.

Trustworthiness : Establishing trustworthiness in qualitative research involves demonstrating credibility, transferability, dependability, and confirmability. Researchers can enhance trustworthiness by using various strategies, such as triangulation, member checking , peer debriefing , and reflexivity .

Iterative analysis : Qualitative data analysis is an ongoing and iterative process, in which researchers continually review, compare, and revise their interpretations as they collect and analyze more data. This iterative process allows researchers to refine their understanding of the phenomena and to develop more robust and nuanced theories, concepts, or themes.

Rich description : Providing detailed, vivid, and context-sensitive descriptions of the data is essential in qualitative research. Rich descriptions help convey the complexity and nuances of the phenomena under study, and enable readers to assess the relevance and transferability of the findings to other settings or populations.

What are the common types of qualitative research?

Qualitative research is an umbrella term for various methodologies that focus on understanding and interpreting human experiences, behaviors, and social phenomena within their context. These approaches seek to gather in-depth, rich data through the analysis of language, actions, and expressions. Five common types of qualitative research are narrative research , phenomenology , grounded theory , ethnography , and case study .

Narrative research : This approach focuses on the stories and experiences of individuals, aiming to understand their lives and personal perspectives. Researchers can collect data through interviews, letters, diaries, or autobiographies, and analyze these narratives to identify recurring themes, patterns, and meanings . Narrative research can be valuable for exploring individual identities, cultural beliefs, and historical events.

Phenomenology : Phenomenology seeks to understand the essence of a particular phenomenon by analyzing the experiences and perceptions of individuals who have gone through that phenomenon . Researchers can explore participants' thoughts, feelings, and experiences through in-depth interviews, observations, or written materials. The goal is to describe the commonalities and variations in these experiences, ultimately revealing the underlying structures and meaning of the phenomenon under study.

Grounded theory : This inductive research method aims to generate new theories by systematically collecting and analyzing data. Researchers begin with an open-ended research question and gather data through observations, interviews, and document analysis . They then use a process of coding and constant comparison to identify patterns, categories, and relationships in the data. This iterative process continues until a comprehensive, grounded theory emerges that is based in the recollected data and explains the topic of interest.

Ethnography : Ethnographic research involves the in-depth study of a specific cultural or social group, focusing on understanding its members' behaviors, beliefs, and interactions. Researchers immerse themselves in the group's environment, often for extended periods, to observe and participate in daily activities. They can collect data through field notes, interviews, and document analysis, aiming to provide a holistic and nuanced understanding of the group's cultural practices and social dynamics.

Case study : A case study is an in-depth examination of a specific instance, event, organization, or individual within its real-life context. Researchers use multiple sources of data, such as interviews, observations, documents, and artifacts to build a rich, detailed understanding of the case. Case study research can be used to explore complex phenomena, generate new hypotheses , or evaluate the effectiveness of interventions or policies.

What are the purposes of qualitative research?

Qualitative research presents outcomes that emerge from the process of collecting and analyzing qualitative data. These outcomes often involve generating new theories, developing or challenging existing theories, and proposing practical implications based on actionable insights. The products of qualitative research contribute to a deeper understanding of human experiences, social phenomena, and cultural contexts. Qualitative research can also be a powerful complement to quantitative research.

Generating new theory : One of the primary goals of qualitative research is to develop new theories or conceptual frameworks that help explain previously unexplored or poorly understood phenomena. By conducting in-depth investigations and analyzing rich data, researchers can identify patterns, relationships, and underlying structures that form the basis of novel theoretical insights.

Developing or challenging existing theory : Qualitative research can also contribute to the refinement or expansion of existing theories by providing new perspectives, revealing previously unnoticed complexities, or highlighting areas where current theories may be insufficient or inaccurate. By examining the nuances and context-specific details of a phenomenon, researchers can generate evidence that supports, contradicts, or modifies existing theoretical frameworks .

Proposing practical implications : Qualitative research often yields actionable insights that can inform policy, practice, and intervention strategies. By delving into the lived experiences of individuals and communities, researchers can identify factors that contribute to or hinder the effectiveness of certain approaches, uncovering opportunities for improvement or innovation. The insights gained from qualitative research can be used to design targeted interventions, develop context-sensitive policies, or inform the professional practices of practitioners in various fields.

Enhancing understanding and empathy : Qualitative research promotes a deeper understanding of human experiences, emotions, and perspectives, fostering empathy and cultural sensitivity. By engaging with diverse voices and experiences, researchers can develop a more nuanced appreciation of the complexities of human behavior and social dynamics, ultimately contributing to more compassionate and inclusive societies.

Informing mixed-methods research : The products of qualitative research can also be used in conjunction with quantitative research, as part of a mixed-methods approach . Qualitative findings can help generate hypotheses for further testing, inform the development of survey instruments , or provide context and explanation for quantitative results. Combining the strengths of both approaches can lead to more robust and comprehensive understanding of complex research questions .

What are some examples of qualitative research?

Qualitative research can be conducted across various scientific fields, exploring diverse topics and phenomena. Here are six brief descriptions of qualitative studies that can provide researchers with ideas for their own projects:

Exploring the lived experiences of refugees : A phenomenological study could be conducted to investigate the lived experiences and coping strategies of refugees in a specific host country. By conducting in-depth interviews with refugees and analyzing their narratives , researchers can gain insights into the challenges they face, their resilience, and the factors that contribute to successful integration into their new communities.

Understanding the dynamics of online communities : An ethnographic study could be designed to explore the culture and social dynamics of a particular online community or social media platform. By immersing themselves in the virtual environment, researchers can observe patterns of interaction, communication styles, and shared values among community members, providing a nuanced understanding of the factors that influence online behavior and group dynamics.

Examining the impact of gentrification on local communities : A case study could be conducted to explore the impact of gentrification on a specific neighborhood or community. Researchers can collect data through interviews with residents, local business owners, and policymakers, as well as analyzing relevant documents and media coverage. The study can shed light on the effects of gentrification on housing affordability, social cohesion, and cultural identity, informing policy and urban planning decisions.

Studying the career trajectories of women in STEM fields : A narrative research project can be designed to investigate the career experiences and pathways of women in science, technology, engineering, and mathematics (STEM) fields. By collecting and analyzing the stories of women at various career stages, researchers can identify factors that contribute to their success, as well as barriers and challenges they face in male-dominated fields.

Evaluating the effectiveness of a mental health intervention : A qualitative study can be conducted to evaluate the effectiveness of a specific mental health intervention, such as a mindfulness-based program for reducing stress and anxiety. Researchers can gather data through interviews and focus groups with program participants, exploring their experiences, perceived benefits, and suggestions for improvement. The findings can provide valuable insights for refining the intervention and informing future mental health initiatives.

Investigating the role of social media in political activism : A qualitative study using document analysis and visual methods could explore the role of social media in shaping political activism and public opinion during a specific social movement or election campaign. By analyzing user-generated content, such as tweets, posts, images, and videos, researchers can examine patterns of communication, mobilization, and discourse, shedding light on the ways in which social media influences political engagement and democratic processes.

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What are common qualitative research methods?

Qualitative research methods are techniques used to collect, analyze, and interpret data in qualitative studies. These methods prioritize the exploration of meaning, context, and individual experiences. Common qualitative research methods include interviews, focus groups, observations, document analysis, and visual methods.

Interviews : Interviews involve one-on-one conversations between the researcher and the participant. They can be structured, semi-structured, or unstructured, depending on the level of guidance provided by the researcher. Interviews allow for in-depth exploration of participants' experiences, thoughts, and feelings, providing rich and detailed data for analysis.

Focus groups : Focus groups are group discussions facilitated by a researcher, usually consisting of 6-12 participants. They enable researchers to explore participants' collective perspectives, opinions, and experiences in a social setting. Focus groups can generate insights into group dynamics, cultural norms, and shared understandings, as participants interact and respond to each other's viewpoints.

Observations : Observational research involves the systematic collection of data through watching and recording people, events, or behaviors in their natural settings. Researchers can take on different roles, such as participant-observer or non-participant observer, depending on their level of involvement. Observations provide valuable information about context, social interactions, and non-verbal communication, which can help researchers understand the nuances of a particular phenomenon.

Document analysis : Document analysis is the examination of written or visual materials, such as letters, diaries, reports, newspaper articles, photographs, or videos. This method can provide insights into historical or cultural contexts, individual perspectives, and organizational processes. Researchers may use content analysis, discourse analysis, or other analytic techniques to interpret the meaning and significance of these documents.

Visual methods : Visual methods involve the use of visual materials, such as photographs, drawings, or videos, to explore and represent participants' experiences and perspectives. Techniques like photo elicitation, where participants are asked to take or select photographs related to the research topic and discuss their meaning, can encourage reflection and stimulate discussion. Visual methods can be particularly useful in capturing non-verbal information, promoting cross-cultural understanding, and engaging with hard-to-reach populations.

Importance of qualitative research and qualitative data analysis

Qualitative research and qualitative data analysis play a vital role in advancing knowledge, informing policies, and improving practices in various fields, such as education, healthcare, business, and social work. The unique insights and in-depth understanding generated through qualitative research can accomplish a number of goals.

Inform decision-making

Qualitative research helps decision-makers better understand the needs, preferences, and concerns of different stakeholders, such as customers, employees, or community members. This can lead to more effective and tailored policies, programs, or interventions that address real-world challenges.

Enhance innovation

By exploring people's experiences, motivations, and aspirations, qualitative research can uncover new ideas, opportunities, and trends that can drive innovation in products, services, or processes.

Foster empathy and cultural competence

Qualitative research can increase our empathy and understanding of diverse populations, cultures, and contexts. This can enhance our ability to communicate, collaborate, and work effectively with people from different backgrounds.

Complement quantitative research

Qualitative research can complement quantitative research by providing rich contextual information and in-depth insights into the underlying mechanisms, processes, or factors that may explain the patterns or relationships observed in quantitative data.

Facilitate social change

Qualitative research can give voice to marginalized or underrepresented groups, highlight social injustices or inequalities, and inspire actions and reforms that promote social change and well-being.

Challenges of conducting qualitative research

While qualitative research offers valuable insights and understanding of human experiences, it also presents some challenges that researchers must navigate. Acknowledging and addressing these challenges can help ensure the rigor, credibility, and relevance of qualitative research. In this section, we will discuss some common challenges that researchers may encounter when conducting qualitative research and offer suggestions on how to overcome them.

Subjectivity and bias

One of the primary challenges in qualitative research is managing subjectivity and potential biases that may arise from the researcher's personal beliefs, values, and experiences. Since qualitative research relies on the researcher's interpretation of the data , there is a risk that the researcher's subjectivity may influence the findings.

Researchers can minimize the impact of subjectivity and bias by maintaining reflexivity , or ongoing self-awareness and critical reflection on their role, assumptions, and influences in the research process. This may involve keeping a reflexive journal, engaging in peer debriefing , and discussing potential biases with research participants during member checking .

Data collection and quality

Collecting high-quality data in qualitative research can be challenging, particularly when dealing with sensitive topics , hard-to-reach populations, or complex social phenomena. Ensuring the trustworthiness of qualitative data collection is essential to producing credible and meaningful findings.

Researchers can enhance data quality by employing various strategies, such as purposive or theoretical sampling, triangulation of data sources, methods or researchers, and establishing rapport and trust with research participants.

Data analysis and interpretation

The analysis and interpretation of qualitative data can be a complex, time-consuming, and sometimes overwhelming process. Researchers must make sense of large amounts of diverse and unstructured data, while also ensuring the rigor, transparency, and consistency of their analysis.

Researchers can facilitate data analysis and interpretation by adopting systematic and well-established approaches, such as thematic analysis , grounded theory , or content analysis . Utilizing qualitative data analysis software , like ATLAS.ti, can also help manage and analyze data more efficiently and rigorously.

Qualitative research often involves exploring sensitive issues or working with vulnerable populations, which raises various ethical considerations , such as privacy, confidentiality , informed consent , and potential harm to participants.

Researchers should be familiar with the ethical guidelines and requirements of their discipline, institution, or funding agency, and should obtain ethical approval from relevant review boards or committees before conducting the research. Researchers should also maintain open communication with participants, respect their autonomy and dignity, and protect their well-being throughout the research process.

Generalizability and transferability

Qualitative research typically focuses on in-depth exploration of specific cases or contexts, which may limit the generalizability or transferability of the findings to other settings or populations. However, the goal of qualitative research is not to produce statistically generalizable results but rather to provide a rich, contextualized, and nuanced understanding of the phenomena under study.

Researchers can enhance the transferability of their findings by providing rich descriptions of the research context, participants, and methods, and by discussing the potential applicability or relevance of the findings to other settings or populations. Readers can then assess the transferability of the findings based on the similarity of their own context to the one described in the research.

By addressing these challenges and adopting rigorous and transparent research practices, qualitative researchers can contribute valuable and meaningful insights that advance knowledge, inform policies, and improve practices in various fields and contexts.

Qualitative and quantitative research approaches are often seen as distinct and even opposing paradigms. However, these two approaches can be complementary, providing a more comprehensive understanding of complex social phenomena when combined. In this section, we will discuss how qualitative research can complement quantitative research and enhance the overall depth, breadth, and rigor of research findings.

Exploring and understanding context

Quantitative research excels at identifying patterns, trends, and relationships among variables using numerical data, while qualitative research provides rich and nuanced insights into the context, meaning, and underlying processes that shape these patterns or relationships. By integrating qualitative research with quantitative research, researchers can explore not only the "what" or "how many" but also the "why" and "how" of the phenomena under study.

For example, a quantitative study in health services research might reveal a correlation between social media usage and mental health outcomes, while a qualitative study could help explain the reasons behind this correlation by exploring users' experiences, motivations, and perceptions of social media. Qualitative and quantitative data in this case complement each other to contribute to a more robust theory and more informed policy implications.

Generating and refining hypotheses

Qualitative research can inform the development and refinement of hypotheses for quantitative research by identifying new concepts, variables, or relationships that emerge from the data. This can lead to more focused, relevant, and innovative quantitative research questions and hypotheses. For instance, a qualitative study on employee motivation might uncover the importance of meaningful work and supportive relationships with supervisors as key factors influencing motivation. These findings could then be incorporated into a quantitative study to test the relationships between these factors and employee motivation.

Validating and triangulating findings

Combining qualitative and quantitative research methods can enhance the credibility and trustworthiness of research findings through validation and triangulation. Validation involves comparing the findings from different methods to assess their consistency and convergence, while triangulation involves using multiple methods, data sources, or researchers to gain a more comprehensive understanding of the phenomena under study.

For example, a researcher might use both quantitative surveys and qualitative interviews in a mixed methods research design to assess the effectiveness of a health intervention. If both methods yield similar findings, this can increase confidence in the results. If the findings differ, the researcher can further investigate the reasons for these discrepancies and refine their understanding of the intervention's effectiveness.

Enhancing communication and dissemination

Qualitative research can enhance the communication and dissemination of quantitative research findings by providing vivid narratives, case studies, or examples that bring the data to life and make it more accessible and engaging for diverse audiences, such as policymakers, practitioners, or the public.

For example, a quantitative study on the impact of a community-based program might report the percentage of participants who experienced improvements in various outcomes. By adding qualitative data, such as quotes or stories from participants, the researcher can illustrate the human impact of the program and make the findings more compelling and relatable.

In conclusion, qualitative research can complement and enrich quantitative research in various ways, leading to a more comprehensive, contextualized, and rigorous understanding of complex social phenomena. By integrating qualitative and quantitative research methods, researchers can harness the strengths of both approaches to produce more robust, relevant, and impactful findings that inform theory, policy, and practice.

Qualitative research findings are typically reported in various formats, depending on the audience, purpose, and context of the research. Common ways to report qualitative research include dissertations, journal articles, market research reports, and needs assessment reports. Each format has its own structure and emphasis, tailored to meet the expectations and requirements of its target audience.

Dissertations and theses : Doctoral,master's, or bachelor students often conduct qualitative research as part of their dissertation or thesis projects. In this format, researchers provide a comprehensive account of their research questions , methodology, data collection , data analysis , and findings. Dissertations are expected to make a significant contribution to the existing body of knowledge and demonstrate the researcher's mastery of the subject matter.

Journal articles : Researchers frequently disseminate their qualitative research findings through articles published in academic journals . These articles are typically structured in a way that includes an introduction, literature review, methodology, results, and discussion sections. In addition, articles often undergo a peer-review process before being published in the academic journal. Journal articles focus on communicating the study's purpose, methods, and findings in a concise and coherent manner, providing enough detail for other researchers to evaluate the rigor and validity of the research so that they can cite the article and build on it in their own studies.

Market research reports : Market research often employs qualitative methods to gather insights into consumer behavior, preferences, and attitudes. Market research reports present the findings of these studies to clients, typically businesses or organizations interested in understanding their target audience or market trends. These reports focus on providing actionable insights and recommendations based on the qualitative data, helping clients make informed decisions and develop effective marketing strategies.

Needs assessment reports : Needs assessment is a process used to identify gaps or areas of improvement in a specific context, such as healthcare, education, or social services. Qualitative research methods can be used to collect data on the needs, challenges, and experiences of the target population. Needs assessment reports present the findings of this research, highlighting the identified needs and providing recommendations for addressing them. These reports are used by organizations and policymakers to inform the development and implementation of targeted interventions and policies.

Other formats : In addition to the aforementioned formats, qualitative research findings can also be reported in conference presentations, white papers, policy briefs, blog posts, or multimedia presentations. The choice of format depends on the target audience and the intended purpose of the research, as well as the researcher's preferences and resources. Regardless of the format, it is important for researchers to present their findings in a clear, accurate, and engaging manner, ensuring that their work is accessible and relevant to their audience.

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Qualitative Research: Characteristics, Design, Methods & Examples

Lauren McCall

MSc Health Psychology Graduate

MSc, Health Psychology, University of Nottingham

Lauren obtained an MSc in Health Psychology from The University of Nottingham with a distinction classification.

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Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Qualitative research is a type of research methodology that focuses on gathering and analyzing non-numerical data to gain a deeper understanding of human behavior, experiences, and perspectives.

It aims to explore the “why” and “how” of a phenomenon rather than the “what,” “where,” and “when” typically addressed by quantitative research.

Unlike quantitative research, which focuses on gathering and analyzing numerical data for statistical analysis, qualitative research involves researchers interpreting data to identify themes, patterns, and meanings.

Qualitative research can be used to:

• Gain deep contextual understandings of the subjective social reality of individuals
• To answer questions about experience and meaning from the participant’s perspective
• To design hypotheses, theory must be researched using qualitative methods to determine what is important before research can begin. 

Examples of qualitative research questions include: 

• How does stress influence young adults’ behavior?
• What factors influence students’ school attendance rates in developed countries?
• How do adults interpret binge drinking in the UK?
• What are the psychological impacts of cervical cancer screening in women?
• How can mental health lessons be integrated into the school curriculum? 

Characteristics 

Naturalistic setting.

Individuals are studied in their natural setting to gain a deeper understanding of how people experience the world. This enables the researcher to understand a phenomenon close to how participants experience it. 

Naturalistic settings provide valuable contextual information to help researchers better understand and interpret the data they collect.

The environment, social interactions, and cultural factors can all influence behavior and experiences, and these elements are more easily observed in real-world settings.

Reality is socially constructed

Qualitative research aims to understand how participants make meaning of their experiences – individually or in social contexts. It assumes there is no objective reality and that the social world is interpreted (Yilmaz, 2013). 

The primacy of subject matter 

The primary aim of qualitative research is to understand the perspectives, experiences, and beliefs of individuals who have experienced the phenomenon selected for research rather than the average experiences of groups of people (Minichiello, 1990).

An in-depth understanding is attained since qualitative techniques allow participants to freely disclose their experiences, thoughts, and feelings without constraint (Tenny et al., 2022). 

Variables are complex, interwoven, and difficult to measure

Factors such as experiences, behaviors, and attitudes are complex and interwoven, so they cannot be reduced to isolated variables , making them difficult to measure quantitatively.

However, a qualitative approach enables participants to describe what, why, or how they were thinking/ feeling during a phenomenon being studied (Yilmaz, 2013). 

Emic (insider’s point of view)

The phenomenon being studied is centered on the participants’ point of view (Minichiello, 1990).

Emic is used to describe how participants interact, communicate, and behave in the research setting (Scarduzio, 2017).

Interpretive analysis

In qualitative research, interpretive analysis is crucial in making sense of the collected data.

This process involves examining the raw data, such as interview transcripts, field notes, or documents, and identifying the underlying themes, patterns, and meanings that emerge from the participants’ experiences and perspectives.

Collecting Qualitative Data

There are four main research design methods used to collect qualitative data: observations, interviews,  focus groups, and ethnography.

Observations

This method involves watching and recording phenomena as they occur in nature. Observation can be divided into two types: participant and non-participant observation.

In participant observation, the researcher actively participates in the situation/events being observed.

In non-participant observation, the researcher is not an active part of the observation and tries not to influence the behaviors they are observing (Busetto et al., 2020). 

Observations can be covert (participants are unaware that a researcher is observing them) or overt (participants are aware of the researcher’s presence and know they are being observed).

However, awareness of an observer’s presence may influence participants’ behavior. 

Interviews give researchers a window into the world of a participant by seeking their account of an event, situation, or phenomenon. They are usually conducted on a one-to-one basis and can be distinguished according to the level at which they are structured (Punch, 2013). 

Structured interviews involve predetermined questions and sequences to ensure replicability and comparability. However, they are unable to explore emerging issues.

Informal interviews consist of spontaneous, casual conversations which are closer to the truth of a phenomenon. However, information is gathered using quick notes made by the researcher and is therefore subject to recall bias. 

Semi-structured interviews have a flexible structure, phrasing, and placement so emerging issues can be explored (Denny & Weckesser, 2022).

The use of probing questions and clarification can lead to a detailed understanding, but semi-structured interviews can be time-consuming and subject to interviewer bias. 

Focus groups 

Similar to interviews, focus groups elicit a rich and detailed account of an experience. However, focus groups are more dynamic since participants with shared characteristics construct this account together (Denny & Weckesser, 2022).

A shared narrative is built between participants to capture a group experience shaped by a shared context. 

The researcher takes on the role of a moderator, who will establish ground rules and guide the discussion by following a topic guide to focus the group discussions.

Typically, focus groups have 4-10 participants as a discussion can be difficult to facilitate with more than this, and this number allows everyone the time to speak.

Ethnography

Ethnography is a methodology used to study a group of people’s behaviors and social interactions in their environment (Reeves et al., 2008).

Data are collected using methods such as observations, field notes, or structured/ unstructured interviews.

The aim of ethnography is to provide detailed, holistic insights into people’s behavior and perspectives within their natural setting. In order to achieve this, researchers immerse themselves in a community or organization. 

Due to the flexibility and real-world focus of ethnography, researchers are able to gather an in-depth, nuanced understanding of people’s experiences, knowledge and perspectives that are influenced by culture and society.

In order to develop a representative picture of a particular culture/ context, researchers must conduct extensive field work. 

This can be time-consuming as researchers may need to immerse themselves into a community/ culture for a few days, or possibly a few years.

Qualitative Data Analysis Methods

Different methods can be used for analyzing qualitative data. The researcher chooses based on the objectives of their study. 

The researcher plays a key role in the interpretation of data, making decisions about the coding, theming, decontextualizing, and recontextualizing of data (Starks & Trinidad, 2007). 

Grounded theory

Grounded theory is a qualitative method specifically designed to inductively generate theory from data. It was developed by Glaser and Strauss in 1967 (Glaser & Strauss, 2017).

This methodology aims to develop theories (rather than test hypotheses) that explain a social process, action, or interaction (Petty et al., 2012). To inform the developing theory, data collection and analysis run simultaneously. 

There are three key types of coding used in grounded theory: initial (open), intermediate (axial), and advanced (selective) coding. 

Throughout the analysis, memos should be created to document methodological and theoretical ideas about the data. Data should be collected and analyzed until data saturation is reached and a theory is developed. 

Content analysis

Content analysis was first used in the early twentieth century to analyze textual materials such as newspapers and political speeches.

Content analysis is a research method used to identify and analyze the presence and patterns of themes, concepts, or words in data (Vaismoradi et al., 2013). 

This research method can be used to analyze data in different formats, which can be written, oral, or visual. 

The goal of content analysis is to develop themes that capture the underlying meanings of data (Schreier, 2012). 

Qualitative content analysis can be used to validate existing theories, support the development of new models and theories, and provide in-depth descriptions of particular settings or experiences.

The following six steps provide a guideline for how to conduct qualitative content analysis.

• Define a Research Question : To start content analysis, a clear research question should be developed.
• Identify and Collect Data : Establish the inclusion criteria for your data. Find the relevant sources to analyze.
• Define the Unit or Theme of Analysis : Categorize the content into themes. Themes can be a word, phrase, or sentence.
• Develop Rules for Coding your Data : Define a set of coding rules to ensure that all data are coded consistently.
• Code the Data : Follow the coding rules to categorize data into themes.
• Analyze the Results and Draw Conclusions : Examine the data to identify patterns and draw conclusions in relation to your research question.

Discourse analysis

Discourse analysis is a research method used to study written/ spoken language in relation to its social context (Wood & Kroger, 2000).

In discourse analysis, the researcher interprets details of language materials and the context in which it is situated.

Discourse analysis aims to understand the functions of language (how language is used in real life) and how meaning is conveyed by language in different contexts. Researchers use discourse analysis to investigate social groups and how language is used to achieve specific communication goals.

Different methods of discourse analysis can be used depending on the aims and objectives of a study. However, the following steps provide a guideline on how to conduct discourse analysis.

• Define the Research Question : Develop a relevant research question to frame the analysis.
• Gather Data and Establish the Context : Collect research materials (e.g., interview transcripts, documents). Gather factual details and review the literature to construct a theory about the social and historical context of your study.
• Analyze the Content : Closely examine various components of the text, such as the vocabulary, sentences, paragraphs, and structure of the text. Identify patterns relevant to the research question to create codes, then group these into themes.
• Review the Results : Reflect on the findings to examine the function of the language, and the meaning and context of the discourse. 

Thematic analysis

Thematic analysis is a method used to identify, interpret, and report patterns in data, such as commonalities or contrasts. 

Although the origin of thematic analysis can be traced back to the early twentieth century, understanding and clarity of thematic analysis is attributed to Braun and Clarke (2006).

Thematic analysis aims to develop themes (patterns of meaning) across a dataset to address a research question. 

In thematic analysis, qualitative data is gathered using techniques such as interviews, focus groups, and questionnaires. Audio recordings are transcribed. The dataset is then explored and interpreted by a researcher to identify patterns. 

This occurs through the rigorous process of data familiarisation, coding, theme development, and revision. These identified patterns provide a summary of the dataset and can be used to address a research question.

Themes are developed by exploring the implicit and explicit meanings within the data. Two different approaches are used to generate themes: inductive and deductive. 

An inductive approach allows themes to emerge from the data. In contrast, a deductive approach uses existing theories or knowledge to apply preconceived ideas to the data.

Phases of Thematic Analysis

Braun and Clarke (2006) provide a guide of the six phases of thematic analysis. These phases can be applied flexibly to fit research questions and data. 

Template analysis

Template analysis refers to a specific method of thematic analysis which uses hierarchical coding (Brooks et al., 2014).

Template analysis is used to analyze textual data, for example, interview transcripts or open-ended responses on a written questionnaire.

To conduct template analysis, a coding template must be developed (usually from a subset of the data) and subsequently revised and refined. This template represents the themes identified by researchers as important in the dataset. 

Codes are ordered hierarchically within the template, with the highest-level codes demonstrating overarching themes in the data and lower-level codes representing constituent themes with a narrower focus.

A guideline for the main procedural steps for conducting template analysis is outlined below.

• Familiarization with the Data : Read (and reread) the dataset in full. Engage, reflect, and take notes on data that may be relevant to the research question.
• Preliminary Coding : Identify initial codes using guidance from the a priori codes, identified before the analysis as likely to be beneficial and relevant to the analysis.
• Organize Themes : Organize themes into meaningful clusters. Consider the relationships between the themes both within and between clusters.
• Produce an Initial Template : Develop an initial template. This may be based on a subset of the data.
• Apply and Develop the Template : Apply the initial template to further data and make any necessary modifications. Refinements of the template may include adding themes, removing themes, or changing the scope/title of themes. 
• Finalize Template : Finalize the template, then apply it to the entire dataset. 

Frame analysis

Frame analysis is a comparative form of thematic analysis which systematically analyzes data using a matrix output.

Ritchie and Spencer (1994) developed this set of techniques to analyze qualitative data in applied policy research. Frame analysis aims to generate theory from data.

Frame analysis encourages researchers to organize and manage their data using summarization.

This results in a flexible and unique matrix output, in which individual participants (or cases) are represented by rows and themes are represented by columns. 

Each intersecting cell is used to summarize findings relating to the corresponding participant and theme.

Frame analysis has five distinct phases which are interrelated, forming a methodical and rigorous framework.

• Familiarization with the Data : Familiarize yourself with all the transcripts. Immerse yourself in the details of each transcript and start to note recurring themes.
• Develop a Theoretical Framework : Identify recurrent/ important themes and add them to a chart. Provide a framework/ structure for the analysis.
• Indexing : Apply the framework systematically to the entire study data.
• Summarize Data in Analytical Framework : Reduce the data into brief summaries of participants’ accounts.
• Mapping and Interpretation : Compare themes and subthemes and check against the original transcripts. Group the data into categories and provide an explanation for them.

Preventing Bias in Qualitative Research

To evaluate qualitative studies, the CASP (Critical Appraisal Skills Programme) checklist for qualitative studies can be used to ensure all aspects of a study have been considered (CASP, 2018).

The quality of research can be enhanced and assessed using criteria such as checklists, reflexivity, co-coding, and member-checking. 

Co-coding 

Relying on only one researcher to interpret rich and complex data may risk key insights and alternative viewpoints being missed. Therefore, coding is often performed by multiple researchers.

A common strategy must be defined at the beginning of the coding process  (Busetto et al., 2020). This includes establishing a useful coding list and finding a common definition of individual codes.

Transcripts are initially coded independently by researchers and then compared and consolidated to minimize error or bias and to bring confirmation of findings. 

Member checking

Member checking (or respondent validation) involves checking back with participants to see if the research resonates with their experiences (Russell & Gregory, 2003).

Data can be returned to participants after data collection or when results are first available. For example, participants may be provided with their interview transcript and asked to verify whether this is a complete and accurate representation of their views.

Participants may then clarify or elaborate on their responses to ensure they align with their views (Shenton, 2004).

This feedback becomes part of data collection and ensures accurate descriptions/ interpretations of phenomena (Mays & Pope, 2000). 

Reflexivity in qualitative research

Reflexivity typically involves examining your own judgments, practices, and belief systems during data collection and analysis. It aims to identify any personal beliefs which may affect the research. 

Reflexivity is essential in qualitative research to ensure methodological transparency and complete reporting. This enables readers to understand how the interaction between the researcher and participant shapes the data.

Depending on the research question and population being researched, factors that need to be considered include the experience of the researcher, how the contact was established and maintained, age, gender, and ethnicity.

These details are important because, in qualitative research, the researcher is a dynamic part of the research process and actively influences the outcome of the research (Boeije, 2014). 

Reflexivity Example

Who you are and your characteristics influence how you collect and analyze data. Here is an example of a reflexivity statement for research on smoking. I am a 30-year-old white female from a middle-class background. I live in the southwest of England and have been educated to master’s level. I have been involved in two research projects on oral health. I have never smoked, but I have witnessed how smoking can cause ill health from my volunteering in a smoking cessation clinic. My research aspirations are to help to develop interventions to help smokers quit.

Establishing Trustworthiness in Qualitative Research

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability.

1. Credibility in Qualitative Research

Credibility refers to how accurately the results represent the reality and viewpoints of the participants.

To establish credibility in research, participants’ views and the researcher’s representation of their views need to align (Tobin & Begley, 2004).

To increase the credibility of findings, researchers may use data source triangulation, investigator triangulation, peer debriefing, or member checking (Lincoln & Guba, 1985). 

2. Transferability in Qualitative Research

Transferability refers to how generalizable the findings are: whether the findings may be applied to another context, setting, or group (Tobin & Begley, 2004).

Transferability can be enhanced by giving thorough and in-depth descriptions of the research setting, sample, and methods (Nowell et al., 2017). 

3. Dependability in Qualitative Research

Dependability is the extent to which the study could be replicated under similar conditions and the findings would be consistent.

Researchers can establish dependability using methods such as audit trails so readers can see the research process is logical and traceable (Koch, 1994).

4. Confirmability in Qualitative Research

Confirmability is concerned with establishing that there is a clear link between the researcher’s interpretations/ findings and the data.

Researchers can achieve confirmability by demonstrating how conclusions and interpretations were arrived at (Nowell et al., 2017).

This enables readers to understand the reasoning behind the decisions made. 

Audit Trails in Qualitative Research

An audit trail provides evidence of the decisions made by the researcher regarding theory, research design, and data collection, as well as the steps they have chosen to manage, analyze, and report data. 

The researcher must provide a clear rationale to demonstrate how conclusions were reached in their study.

A clear description of the research path must be provided to enable readers to trace through the researcher’s logic (Halpren, 1983).

Researchers should maintain records of the raw data, field notes, transcripts, and a reflective journal in order to provide a clear audit trail. 

Discovery of unexpected data

Open-ended questions in qualitative research mean the researcher can probe an interview topic and enable the participant to elaborate on responses in an unrestricted manner.

This allows unexpected data to emerge, which can lead to further research into that topic. 

The exploratory nature of qualitative research helps generate hypotheses that can be tested quantitatively (Busetto et al., 2020).

Flexibility

Data collection and analysis can be modified and adapted to take the research in a different direction if new ideas or patterns emerge in the data.

This enables researchers to investigate new opportunities while firmly maintaining their research goals. 

Naturalistic settings

The behaviors of participants are recorded in real-world settings. Studies that use real-world settings have high ecological validity since participants behave more authentically. 

Limitations

Time-consuming .

Qualitative research results in large amounts of data which often need to be transcribed and analyzed manually.

Even when software is used, transcription can be inaccurate, and using software for analysis can result in many codes which need to be condensed into themes. 

Subjectivity 

The researcher has an integral role in collecting and interpreting qualitative data. Therefore, the conclusions reached are from their perspective and experience.

Consequently, interpretations of data from another researcher may vary greatly. 

Limited generalizability

The aim of qualitative research is to provide a detailed, contextualized understanding of an aspect of the human experience from a relatively small sample size.

Despite rigorous analysis procedures, conclusions drawn cannot be generalized to the wider population since data may be biased or unrepresentative.

Therefore, results are only applicable to a small group of the population. 

While individual qualitative studies are often limited in their generalizability due to factors such as sample size and context, metasynthesis enables researchers to synthesize findings from multiple studies, potentially leading to more generalizable conclusions.

By integrating findings from studies conducted in diverse settings and with different populations, metasynthesis can provide broader insights into the phenomenon of interest.

Extraneous variables

Qualitative research is often conducted in real-world settings. This may cause results to be unreliable since extraneous variables may affect the data, for example:

• Situational variables : different environmental conditions may influence participants’ behavior in a study. The random variation in factors (such as noise or lighting) may be difficult to control in real-world settings.
• Participant characteristics : this includes any characteristics that may influence how a participant answers/ behaves in a study. This may include a participant’s mood, gender, age, ethnicity, sexual identity, IQ, etc.
• Experimenter effect : experimenter effect refers to how a researcher’s unintentional influence can change the outcome of a study. This occurs when (i) their interactions with participants unintentionally change participants’ behaviors or (ii) due to errors in observation, interpretation, or analysis. 

What sample size should qualitative research be?

The sample size for qualitative studies has been recommended to include a minimum of 12 participants to reach data saturation (Braun, 2013).

Are surveys qualitative or quantitative?

Surveys can be used to gather information from a sample qualitatively or quantitatively. Qualitative surveys use open-ended questions to gather detailed information from a large sample using free text responses.

The use of open-ended questions allows for unrestricted responses where participants use their own words, enabling the collection of more in-depth information than closed-ended questions.

In contrast, quantitative surveys consist of closed-ended questions with multiple-choice answer options. Quantitative surveys are ideal to gather a statistical representation of a population.

What are the ethical considerations of qualitative research?

Before conducting a study, you must think about any risks that could occur and take steps to prevent them. Participant Protection : Researchers must protect participants from physical and mental harm. This means you must not embarrass, frighten, offend, or harm participants. Transparency : Researchers are obligated to clearly communicate how they will collect, store, analyze, use, and share the data. Confidentiality : You need to consider how to maintain the confidentiality and anonymity of participants’ data.

What is triangulation in qualitative research?

Triangulation refers to the use of several approaches in a study to comprehensively understand phenomena. This method helps to increase the validity and credibility of research findings. 

Types of triangulation include method triangulation (using multiple methods to gather data); investigator triangulation (multiple researchers for collecting/ analyzing data), theory triangulation (comparing several theoretical perspectives to explain a phenomenon), and data source triangulation (using data from various times, locations, and people; Carter et al., 2014).

Why is qualitative research important?

Qualitative research allows researchers to describe and explain the social world. The exploratory nature of qualitative research helps to generate hypotheses that can then be tested quantitatively.

In qualitative research, participants are able to express their thoughts, experiences, and feelings without constraint.

Additionally, researchers are able to follow up on participants’ answers in real-time, generating valuable discussion around a topic. This enables researchers to gain a nuanced understanding of phenomena which is difficult to attain using quantitative methods.

What is coding data in qualitative research?

Coding data is a qualitative data analysis strategy in which a section of text is assigned with a label that describes its content.

These labels may be words or phrases which represent important (and recurring) patterns in the data.

This process enables researchers to identify related content across the dataset. Codes can then be used to group similar types of data to generate themes.

What is the difference between qualitative and quantitative research?

Qualitative research involves the collection and analysis of non-numerical data in order to understand experiences and meanings from the participant’s perspective.

This can provide rich, in-depth insights on complicated phenomena. Qualitative data may be collected using interviews, focus groups, or observations.

In contrast, quantitative research involves the collection and analysis of numerical data to measure the frequency, magnitude, or relationships of variables. This can provide objective and reliable evidence that can be generalized to the wider population.

Quantitative data may be collected using closed-ended questionnaires or experiments.

What is trustworthiness in qualitative research?

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability. 

Credibility refers to how accurately the results represent the reality and viewpoints of the participants. Transferability refers to whether the findings may be applied to another context, setting, or group.

Dependability is the extent to which the findings are consistent and reliable. Confirmability refers to the objectivity of findings (not influenced by the bias or assumptions of researchers).

What is data saturation in qualitative research?

Data saturation is a methodological principle used to guide the sample size of a qualitative research study.

Data saturation is proposed as a necessary methodological component in qualitative research (Saunders et al., 2018) as it is a vital criterion for discontinuing data collection and/or analysis. 

The intention of data saturation is to find “no new data, no new themes, no new coding, and ability to replicate the study” (Guest et al., 2006). Therefore, enough data has been gathered to make conclusions.

Why is sampling in qualitative research important?

In quantitative research, large sample sizes are used to provide statistically significant quantitative estimates.

This is because quantitative research aims to provide generalizable conclusions that represent populations.

However, the aim of sampling in qualitative research is to gather data that will help the researcher understand the depth, complexity, variation, or context of a phenomenon. The small sample sizes in qualitative studies support the depth of case-oriented analysis.

What is narrative analysis?

Narrative analysis is a qualitative research method used to understand how individuals create stories from their personal experiences.

There is an emphasis on understanding the context in which a narrative is constructed, recognizing the influence of historical, cultural, and social factors on storytelling.

Researchers can use different methods together to explore a research question.

Some narrative researchers focus on the content of what is said, using thematic narrative analysis, while others focus on the structure, such as holistic-form or categorical-form structural narrative analysis. Others focus on how the narrative is produced and performed.

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Choosing a Qualitative Research Approach

Arianne teherani , phd, tina martimianakis , phd, terese stenfors-hayes , phd, anupma wadhwa , md, lara varpio , phd.

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Corresponding author: Arianne Teherani, PhD, University of California, San Francisco, School of Medicine, Office of Research and Development in Medical Education, Box 3202, 1855 Folsom Avenue, Suite 200, San Francisco, CA 94143-3202, 415.509.4988, [email protected]

Editor's Note: The online version (29KB, doc) of this article contains a list of further reading resources and the authors' professional information .

The Challenge

Educators often pose questions about qualitative research. For example, a program director might say: “I collect data from my residents about their learning experiences in a new longitudinal clinical rotation. If I want to know about their learning experiences, should I use qualitative methods? I have been told that there are many approaches from which to choose. Someone suggested that I use grounded theory, but how do I know this is the best approach? Are there others?”

What Is Known

Qualitative research is the systematic inquiry into social phenomena in natural settings. These phenomena can include, but are not limited to, how people experience aspects of their lives, how individuals and/or groups behave, how organizations function, and how interactions shape relationships. In qualitative research, the researcher is the main data collection instrument. The researcher examines why events occur, what happens, and what those events mean to the participants studied. 1 , 2

Qualitative research starts from a fundamentally different set of beliefs—or paradigms—than those that underpin quantitative research. Quantitative research is based on positivist beliefs that there is a singular reality that can be discovered with the appropriate experimental methods. Post-positivist researchers agree with the positivist paradigm, but believe that environmental and individual differences, such as the learning culture or the learners' capacity to learn, influence this reality, and that these differences are important. Constructivist researchers believe that there is no single reality, but that the researcher elicits participants' views of reality. 3 Qualitative research generally draws on post-positivist or constructivist beliefs.

Qualitative scholars develop their work from these beliefs—usually post-positivist or constructivist—using different approaches to conduct their research. In this Rip Out, we describe 3 different qualitative research approaches commonly used in medical education: grounded theory, ethnography, and phenomenology. Each acts as a pivotal frame that shapes the research question(s), the method(s) of data collection, and how data are analyzed. 4 , 5

Choosing a Qualitative Approach

Before engaging in any qualitative study, consider how your views about what is possible to study will affect your approach. Then select an appropriate approach within which to work. Alignment between the belief system underpinning the research approach, the research question, and the research approach itself is a prerequisite for rigorous qualitative research. To enhance the understanding of how different approaches frame qualitative research, we use this introductory challenge as an illustrative example.

The clinic rotation in a program director's training program was recently redesigned as a longitudinal clinical experience. Resident satisfaction with this rotation improved significantly following implementation of the new longitudinal experience. The program director wants to understand how the changes made in the clinic rotation translated into changes in learning experiences for the residents.

Qualitative research can support this program director's efforts. Qualitative research focuses on the events that transpire and on outcomes of those events from the perspectives of those involved. In this case, the program director can use qualitative research to understand the impact of the new clinic rotation on the learning experiences of residents. The next step is to decide which approach to use as a frame for the study.

The table lists the purpose of 3 commonly used approaches to frame qualitative research. For each frame, we provide an example of a research question that could direct the study and delineate what outcomes might be gained by using that particular approach.

Methodology Overview

How You Can Start TODAY

Examine the foundations of the existing literature: As part of the literature review, make note of what is known about the topic and which approaches have been used in prior studies. A decision should be made to determine the extent to which the new study is exploratory and the extent to which findings will advance what is already known about the topic.

Find a qualitatively skilled collaborator: If you are interested in doing qualitative research, you should consult with a qualitative expert. Be prepared to talk to the qualitative scholar about what you would like to study and why . Furthermore, be ready to describe the literature to date on the topic (remember, you are asking for this person's expertise regarding qualitative approaches—he or she won't necessarily have content expertise). Qualitative research must be designed and conducted with rigor (rigor will be discussed in Rip Out No. 8 of this series). Input from a qualitative expert will ensure that rigor is employed from the study's inception.

Consider the approach: With a literature review completed and a qualitatively skilled collaborator secured, it is time to decide which approach would be best suited to answering the research question. Questions to consider when weighing approaches might include the following:

Will my findings contribute to the creation of a theoretical model to better understand the area of study? ( grounded theory )

Will I need to spend an extended amount of time trying to understand the culture and process of a particular group of learners in their natural context? ( ethnography )

Is there a particular phenomenon I want to better understand/describe? ( phenomenology )

What You Can Do LONG TERM

Develop your qualitative research knowledge and skills : A basic qualitative research textbook is a valuable investment to learn about qualitative research (further reading is provided as online supplemental material). A novice qualitative researcher will also benefit from participating in a massive online open course or a mini-course (often offered by professional organizations or conferences) that provides an introduction to qualitative research. Most of all, collaborating with a qualitative researcher can provide the support necessary to design, execute, and report on the study.

Undertake a pilot study: After learning about qualitative methodology, the next best way to gain expertise in qualitative research is to try it in a small scale pilot study with the support of a qualitative expert. Such application provides an appreciation for the thought processes that go into designing a study, analyzing the data, and reporting on the findings. Alternatively, if you have the opportunity to work on a study led by a qualitative expert, take it! The experience will provide invaluable opportunities for learning how to engage in qualitative research.

Supplementary Material

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Navy, the Department of Defense, or the US government.

References and Resources for Further Reading

• 1. Bogdan R, Biklen SK. Qualitative Research for Education: An Introduction to Theories and Methods. 5th ed. London, UK: Pearson;; 2006. [ Google Scholar ]
• 2. Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 3rd ed. Thousand Oaks, CA: SAGE Publications;; 2008. eds. [ Google Scholar ]
• 3. Bergman E, de Feijter J, Frambach J, Godefrooij M, Slootweg I, Stalmeijer R, et al. AM last page: a guide to research paradigms relevant to medical education. Acad Med. 2012;87(4):545. doi: 10.1097/ACM.0b013e31824fbc8a. [ DOI ] [ PubMed ] [ Google Scholar ]
• 4. Howell KE. An Introduction to the Philosophy of Methodology. Thousand Oaks, CA: SAGE Publications;; 2013. [ Google Scholar ]
• 5. Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. 4th ed. Thousand Oaks, CA: SAGE Publications;; 2011. eds. [ Google Scholar ]

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• Published: 22 October 2024

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

• Madelyn Whyte 1 ,
• Emily Nichol 2 ,
• Lisa D. Hawke 2 , 3 ,
• Kelli Wuerth 1 ,
• Meaghen Quinlan-Davidson 2 ,
• Aileen O’Reilly 4 , 5 ,
• Joseph Duffy 4 ,
• Steve Mathias 1 , 6 , 8 , 9 ,
• JL Henderson 2 , 3 &
• Skye Pamela Barbic 1 , 6 , 7 , 8 , 9 , 10  

BMC Health Services Research volume  24 , Article number:  1266 ( 2024 ) Cite this article

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Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15–26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n  = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

Conclusions

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Peer Review reports

Researchers have long studied the relationship between risk and resilience to determine ways to promote positive health outcomes in trauma-exposed youth [ 1 ]. Literature exploring the impacts of terrorism and natural disasters has uncovered ripple effects for those exposed to traumatic events in history. Studies on youth mental health symptomology following the 9/11 terrorist attacks revealed links between direct exposure and heightened rates of post-traumatic stress disorder [ 2 , 3 , 4 ]. Similarly, data on youth affected by Hurricane Katrina found higher rates of depression and anxiety in the years following the disaster, with secondary stressors of loss of home and financial strain compounding mental turmoil [ 5 , 6 ].

As with discrete traumatic events, the COVID-19 pandemic presented unique challenges for youth (defined here as ages 15–26 years) [ 7 ]. Youth reported disruptions in accessing social and recreational services and services for their mental and physical health [ 8 ]. For example, while mental health and substance use services quickly pivoted to virtual service delivery modalities, many end users reported not receiving needed services [ 8 , 9 ]. Acute effects of the COVID-19 pandemic on youth include high rates of stress [ 10 , 11 , 12 ] and interpersonal challenges [ 13 ], gendered differences in mental health status [ 12 , 14 , 15 , 16 , 17 ], and mixed effects on substance use [ 18 , 19 , 20 ]. Youth also experienced hardships with schooling and academic performance [ 21 , 22 , 23 , 24 ], with the transition to virtual learning posing challenges for many young people who had difficulties adjusting to a self-directed learning style and lack of supports [ 24 ]. Furthermore, the pandemic-related restrictions resulted in increased unemployment rates for youth ages 15–24 in all countries including Canada and Ireland, leading to financial strain and concerns about the future [ 8 , 25 ]. Exposure to heightened stress through sudden risk of infection, school closures, financial strain, isolation, and an increasingly polarized political climate in the early stages of the pandemic created a tumultuous environment with the potential to affect lifetime developmental trajectories [ 10 , 11 , 26 ].

Quantitative longitudinal studies of youth mental health and wellbeing during the COVID-19 pandemic have suggested ongoing negative impacts of the pandemic as a whole and across many mental health and wellbeing variables [ 16 , 17 , 20 , 27 , 28 , 29 ]. Stress, anxiety, and depression increased among youth during the pandemic, while general wellness and positive health behaviors such as physical activity declined [ 27 , 28 ]. However, there is a lack of qualitative, longitudinal literature examining youth experiences during and perceptions of the COVID-19 pandemic and response. An in-depth exploration of youth experiences during the pandemic is required to gain insight into their mental health experiences, perspectives on public health measures, hopes and aspirations for the future, and recommendations for the post-pandemic recovery and future outbreaks, pandemics, and public health crises.

To gain insights into the ongoing experiences of youth during the pandemic internationally and understand how to best meet their needs going forward, we conducted a longitudinal qualitative study during the pandemic. Our objectives were to (1) explore youth experiences during COVID-19 at three time points and in three regions (two provinces in Canada: British Columbia and Ontario, and the country of Ireland) to determine ongoing impacts of the pandemic on mental health and wellbeing, and (2) offer youth-oriented recommendations for government and service response.

This qualitative study aims to explore youth perceptions of the COVID-19 pandemic across three regions: British Columbia, Ontario, and Ireland and three time points. Employing a phenomenological approach, we sought to capture the lived experiences of young people and understand the meanings they ascribe to these experiences during this unprecedented time.

Study sample

We recruited participants for this multi-phase longitudinal study from three geographic locations: Ireland and two Canadian provinces [British Columbia (BC) and Ontario (ON)]. Recruitment procedures varied slightly by site as described below. The selection of the three geographical locations was predicated on three key criteria: (1) each location implemented a comparable model of care tailored to youth; (2) established research infrastructure existed to facilitate a rapid response to the pandemic-related needs of youth; and (3) the sites shared analogous policies pertinent to pandemic management. We selected participants using purposive sampling to ensure representation across different demographics, including age, gender, and cultural backgrounds. Ethical approval for this study was provided by Jigsaw’s Research Ethics Committee (JREC/2020/004), the Centre for Addiction and Mental Health Research Ethics Board (046-2020), and the University of British Columbia Behavioural Ethics Research Board (H20-01537).

In Ireland, a mental health seeking sample was recruited from Jigsaw services. Jigsaw – the National Centre for Youth Mental Health is an early intervention integrated mental health service in Ireland that aims to support youth aged 12 to 25 with their mental health and wellbeing [ 30 ]. Clinicians invited youth ages 16–25 (with consent from parents/guardians, if under 18) who resided in Ireland and used Jigsaw’s brief intervention services to participate in the study, and, with consent, youths’ contact details were shared with a member of the research team. An invitation to take part in the study was also emailed to all youth registered for Jigsaw’s online synchronous chat support service who had provided consent to be contacted for research purposes. As per the protocol at Jigsaw, no honorarium was offered to participants recruited from the clinical sites. The rationale was that the payment could influence their help-seeking behaviours.

Ontario (ON), Canada

In ON, youth ages 14–28 who were participating in a larger longitudinal quantitative study on mental health and COVID-19 at the Centre of Mental Health and Addictions (CAMH) [ 31 ] were asked for consent to be contacted for this sub-study. CAMH is the largest mental health teaching hospital in Canada, providing a range of clinical services for all ages. The study included youth recruited from three clinical studies and one non-clinical study [ 32 , 33 , 34 ]. Among those who provided consent, emails were sent to potential participants, and purposive sampling was carried out to include a diverse sample of youth in this sub-study. Thirty participants were recruited from the clinical sample, and thirty-one participants were recruited from the non-clinical sample, with the goal of representing both cohorts and a wide range of demographic characteristics. Participants received an email message inviting them to participate. Participants were paid a $30 honorarium for each interview.

British Columbia (BC), Canada

In BC, a Foundry-led social media campaign was developed with youth and launched to recruit diverse youth ages 16–24 who resided in BC. Foundry is an integrated youth services initiative for youth ages 12–24 that provides support in person and virtually through a single access point for multiple service streams, including mental health [ 35 ]. Among those who indicated interest in the study, purposive sampling was carried out, and a diverse sample of youth from across the province was invited to the consent phase of the study. Two groups were recruited: A clinical group ( n  = 30) who had accessed Foundry services in the past 12 months, and a non-clinical group ( n  = 30) who had not accessed Foundry services. As with ON, participants in BC were paid a $30 honorarium for each interview.

Consent and interview procedures

Data collection procedures at each site varied slightly. All procedures were conducted in English. Youth provided verbal or written informed assent/consent to their data being collected and stored for research purposes. In cases where youth could not legally consent due to jurisdictional laws, consent was received from their parent/guardian. Participants were informed that all questions were optional, and that they could end the interview at any time. Participants were followed up with via email. The interview schedule is reported in Table  1 . Our research team comprises individuals both within and outside the gender binary.

In ON, demographic data (e.g., age, gender identity, race/ethnicity, employment status) and psychosocial data were collected from the initial quantitative survey [ 31 ]. Interviews were conducted by phone or through a secure video conferencing system, WebEx (Cisco Systems, San Jose, California), hosted on a secure institutional server. Interviews were digitally recorded and transcribed verbatim by either a research staff member or a professional transcription agency. Participants were assigned unique participant IDs, and identifying information was removed during transcription. In Ireland and BC, demographic surveys were completed electronically at the start of all three time points. In BC, psychosocial questions were completed as part of this survey. Semi-structured interviews were conducted through Zoom (Zoom Video Corporation, San Jose, California) by a member of the research team. In BC, this research team for interviews consisted of a research coordinator and seven youth research assistants, and in Ireland the team consisted of two youth research assistants. Youth research assistants were between the ages of 16–24 years, who received training and supervision from the study leads (SB, JH/LH, AO) to conduct interviews and support analyses. Interviews were recorded and transcribed verbatim by two youth research assistants in BC and two youth research assistants in Ireland. Unique participant IDs were given and identifying information was removed from the transcripts to maintain confidentiality. A copy of the semi-structured interview guides used across all sites is contained in Appendix A.

The engagement of youth was a core component of this study. One to two youth co-researchers were employed at each site to support all elements of the research process and were provided with training and supervision by the site lead researchers. Youth co-researchers were aged 18–24 years, had lived and living experience of mental health challenges and accessing the system, had past research experience in health services research about youth, and were hired by the local site leads. Youth co-researcher groups were consulted on various aspects of the project across the three study sites, including co-developing the recruitment materials and research and interview questions, interpreting and validating the findings, and contributing to other knowledge translation materials [ 36 , 37 ].

We employed inductive content analysis, which involved reading and re-reading the data (familiarisation); identifying broad categories; developing and refining subcategories and fine-grained codes; and collating and interpreting the data to generate succinct categories and subcategories [ 38 ]. We used NVivo 12 Software [ 39 ] to support data analysis. This process was iterative, with many drafts of refinements until an accurate depiction of the data was captured [ 38 ]. At the intra-site level, the research team met weekly to ensure a mutual understanding of code definitions and coded two transcripts together for each time point. At these meetings, study site leads (MW/SB, AO, LH) reviewed the codes and resolved conflicts if they occurred. At the inter-site level, all team members met weekly to discuss discrepancies and refine codes and the coding framework. For this paper, we present site differences over time. A future analysis is planned to explore differences in age, gender, and race/ethnicity amongst the categories and will be reported elsewhere.

Demographics

As shown in Table  2 , a total of 141 participants ages 14–26 years took part in the study at T1 (BC n  = 59, ON n  = 61, Ireland n  = 21). Retention was 87% at T2 ( n  = 123 total; BC n  = 50, ON n  = 56, Ireland n  = 17), and 78% at T3 ( n  = 110 total; BC n  = 43, ON n  = 53, Ireland n  = 14). The interview times ranged from 20 to 120 min. On average, participants from Ireland were younger, with 33.3% of youth aged 14–17, compared to BC (20.3%) and Ontario (6.6%). Participants from Ontario had more gender diversity (26.1% boys/men, 47.5% girls/women, 16.3% outside the gender binary) compared to BC (72.9% girls/women) and Ireland (85.7% girls/women).

Table  3 outlines psychosocial factors documented across time-points in BC and ON. Due to resource limitations, participants from Ireland did not complete the psychosocial surveys.

Content categories

Table 4 outlines seven primary categories and multiple subcategories uncovered during analysis. Interviews at different time points and sites were analyzed separately and trends over time and across sites were documented, capturing shifts in health and wellness, personal circumstance, and perception of policy response. These findings are discussed together when consistent across sites and time points, and differences are described when applicable. These categories and subcategories are described in the following sections and include verbatim supporting quotes

Category 1. Coping with hardship

The study revealed a range of pandemic-related hardships that contributed to significant cumulative stress over the course of the investigation. Participants articulated a multitude of challenges, including the loss of cherished experiences, strained interpersonal relationships, disruptions to education and professional development, financial setbacks, deteriorating mental health, and increased xenophobia fueled by rising political tensions. These interconnected issues are described in seven sub-categories.

Experiences of loss and missed opportunities

Youth reported experiencing loss of important childhood and adolescent milestones, describing missing out on their “prime years” (BC, T1) due to lockdowns and restrictions. Youth expressed awareness for how their generation has been impacted in unique ways due to the transitional nature of the participants’ ages, with one participant saying, “I’ve been a lot more lonely … it feels like a ton of my prime-time – my prime years are being wasted” (BC, T1). For some, these disruptions felt like a disadvantage in terms of emotional and professional development, with one participant saying, “It affects our generation a lot , just because … these are our prime years to meet new people and gain new experiences and stuff like that. I feel like we have … a disadvantage” (BC, T1).

Youth were also impacted by missing out on important events to celebrate achievements such as graduation, birthdays, and other moments of significance. These missed opportunities to recognize pivotal moments of accomplishment in a public forum were realized in the early days of the pandemic: “I didn’t have a graduation ceremony , so I didn’t get to celebrate or take pictures with my parents. Didn’t get to walk with my diploma or say goodbye to my friends , or do any form of partying or celebrating finishing school” (BC, T1).

No longer able to engage in typical activities as an adolescent, youth suffered erasure of formative experiences, reporting, “you’re never going to get the year back” (Ireland, T2). Lost time and missed opportunities contributed to a collective sense of grief.

Isolation, cohabitation, and interpersonal challenges

Across regions, interpersonal challenges became apparent due to lockdown and restrictions on social gatherings, where connections became strained due to diminished contact: “It is almost like a whole year of bonding is gone” (Ireland, T1). Warmer weather acted as a buffer against isolation, since participants had more freedom to engage with others safely outside. During colder months, as case numbers rose and restrictions tightened, participants expressed increased feelings of loneliness:

Different views on policy guidelines and pandemic restrictions contributed to relational disconnect. The strain on relationships was most apparent at T2 as restrictions tightened, and friends and family members had differing views on vaccinations and following guidelines:

“ I still feel kind of disconnected from a lot of my friends , just because of the pandemic , and everyone’s different ways that they feel about the restrictions. A lot of my friends are , maybe , more open , and maybe not following the rules as much as myself” (BC, T2).

Many participants expressed technology fatigue over time, where communicating in the form of texting or video chatting could not replace the in-person connection: “That’s a big part of it , not being able to just hug people” (Ireland, T2). For some, maintaining virtual relationships was a daunting task, described more like a chore than an opportunity for social interaction: “ You kind of can only keep so many relationships going virtually” (ON, T2). As one participant described the trials and tribulations of virtual communication:

“I just have a lot of troubles with calls , maybe not calls , but texting people … I just don’t think you can maintain any sort of social relationship just on social media. ” (ON, T1).

In contrast, too much time with family was also reported by some participants to fuel conflict due to a lack of personal space, with youth noting the adverse effects on their mental health as a result. “Family issues spiked up” (Ireland, T1) during lockdown, when family members were living, working, and attending school under one roof, the effects of which were felt most among youth with challenging dynamics with their parents: “My parents weren’t very supportive of me and I kind of had to stay in that house , and you know , get talked down to and belittled every single day , but also my anxiety from not going out really anywhere skyrocketed” (ON, T1). Confined by the inability to seek refuge in safe relationships, feelings of isolation were compounded for youth in challenging family dynamics.

Disruption to education and professional development

Youth described how online learning was an adjustment. Difficulties associated with abrupt changes in educational formats were most apparent at T1. Youth experienced obstacles managing a self-directed learning style, feeling distracted and less productive at home. Some students with disabilities experienced challenges navigating a new way of learning without the necessary infrastructure to provide accommodations in virtual course formats:

“A lot of institutions took the opportunity of digital and online services to mean that they no longer had to provide specific disability services , which , had they talked to students , would know that’s not acceptable nor equitable access … online does not mean accessible” (BC, T1).

Technical issues compounded by adjusting to an online format while at home posed several learning barriers:

“I find it very hard it’s like school online takes a huge toll on like me personally I find it extremely stressful to keep up with it. It’s given me a couple of like breakdowns especially in the last couple of weeks … it doesn’t feel like you’re actually in school like or in college. You’re just in a room watching things” (Ireland, T1).

For those experiencing greater mental health problems due to pandemic-related challenges, academic performance declined. Students described heightened stress, lower mood, lack of focus, an inability to complete course work, and an overall work environment not conducive to productivity. Teacher-student communication issues emerged, where students needing extra assistance were unable to receive proper support virtually. Managing questions over email was not adequate for those requiring clarity and a fluid back-and-forth dialogue on an academic issue:

“We used to speak with the teacher , we used to be in a classroom , you could talk to them. But now everything’s online , and learning online is a lot harder , ‘cause you can’t really ask questions the way you could in class sitting in front of the teacher” (ON, T1).

In applied programs and career paths requiring more technical training among college- and university-aged students, educational progress slowed. Without adequate hands-on experience, youth felt they were not receiving the same type of education they would have had if the pandemic had not happened. In some cases, youth worried how lacking such skills would affect future career prospects, feeling “ripped off in terms of professional development” (BC, T2).

“Starting a brand-new program , especially one that’s super hands-on learning , it was really difficult to find times and opportunities to practice hands-on skills that I need to develop” (BC, T2).

Employment and financial setbacks

Job loss or reduced “COVID hours” (BC, T2) led to financial stress that was particularly noted in T1. Fear surrounding being able to find a new job and afford the cost of living took a toll emotionally, adding new stress for some on relationships:

“It was the end of my school term , so I had no money left , and it was definitely pretty scary , so I don’t want to be in that situation where I was floundering , looking for money , and I ended up having to rely on my boyfriend a lot. Which , this is my ex-boyfriend , but it kind of created this weird power imbalance in our relationship , where I had to rely on him for everything” (BC, T1).

As an age group that occupies a large portion of customer service and hospitality positions, youth expressed concern about returning to a work environment with potentially increased exposure to COVID-19: “[Working in retail is] absolutely terrifying , to be exposed to that many people every day , like , you know , how many people come through to shop which is something that we’ve all been avoiding over the past couple months” (Ireland, T1). Fear of contracting COVID-19 arose, along with challenges dealing with the public with the implementation of new public health mandates requiring masks and vaccination in certain establishments:

“Since everything was opening up , the public seemed a little more lax in terms of some of the public health restrictions. So , you know getting into disagreements over , you know if they should wear a mask and stuff like that , and having to explain that the pandemic is still going on. It is a customer service job , so I’d get yelled at quite a lot this summer [2021] over that , as well as you know trying to enforce public health recommendations” (ON, T3).

Mental health challenges presented in the form of disrupted sleep schedules, increased substance use and social anxiety, and decreased motivation. Youth described how prior stressors were exacerbated by pandemic-related stress, with symptoms most prevalent during lockdown periods and winter months.

With online school and reduced work hours or job loss, maintaining a routine became difficult, which perpetuated mental health challenges: “I have trouble with maintaining a regular sleep schedule. And so that’s exacerbated by not having a schedule – like during the pandemic there’s more onus on me to schedule things and there’s less outside – outside factors for me to rely on as a schedule” (ON, T2). Youth described reliance on unhealthy coping mechanisms and increased substance use to mitigate mental health challenges: “When I feel like that [out of control] , then that’s when I start to smoke and do a lot of other things to keep myself distracted and mellow it out” (ON, T1). Unable to turn to typical coping strategies such as leaning on friends, youth struggled to find ways to support their wellbeing:

“My substance use has definitely gone up or it has become more frequent , like quite dramatically. And that’s in part because I , again , I live alone , I work from home , so there’s a lot more opportunity sort of for me to engage with substance use. (ON, T2).

Over time, youth described how isolation heightened social anxiety: “You’re always on edge , everything seems like we’re in war or something and you have to stay inside ‘cause there’s curfews and danger and everything all the time” (Ireland, T2). Living in a perpetual state of fear when interacting with others and experiencing lockdowns led to difficulties socializing: “Being cooped up inside 24/7 isn’t good for anybody … You stay inside , you’re going to develop different problems socially” (Ireland, T2). Everyday tasks such as going to the grocery store or seeing friends became associated with fear:

“I’m afraid of going into public places like Costco , or being in a bigger group of friends. If there’s ten people – even if we’re social distancing , I still feel uncomfortable if someone’s gone somewhere , and I know where they’ve gone , or I don’t know where they’ve gone even , I feel uncomfortable” (BC, T2).

Motivation to learn, work, or complete typical tasks decreased while navigating life through the mundaneness of the pandemic: “I can’t bring myself to do anything … If I tried to do school , I couldn’t do school , even one course. I can barely take care of myself throughout the day. I just don’t have any motivation to do anything” (ON, T3).

For many, winter months intensified boredom, where shorter days and colder weather negatively impacted mental health. Youth described feeling like they were living the same day on repeat:

“It definitely got worse in the winter. …I kind of started to feel like I was living the same day over and over again , especially in , like January , February , like I was living the same week because it would be like I have the exact same worries on Monday and then that’s done. And then I have the exact same worries again and again and again and again” (Ireland, T2).

In instances where youth contextualized prior difficulties with mental health problems, COVID-19 added “this extra layer of anxiety and stress that’s just been coated across everything … It feels like it’s just blanketed the whole thing , and it’s added more weight to everything” (BC, T1). Youth described feeling a “constant high state of alert and stress” (BC, T2), with little to no relief: “It’s just something that’s always there and I feel like it kind of accentuates whenever something that you do have that’s more negative on your life … It kind of compounds with anything negative in your life , and so it’s very easy to kind of wear down on you” (ON, T2).

In addition to negative mental health impacts of the pandemic, youth experienced physical health declines due to closure of gyms and recreation centres, colder weather making it difficult to exercise outdoors, and inaccessible physical health services, including doctors, physiotherapy, and other health services: “I loved going to the gym but I have not been to a gym since probably December” (ON, T2).

However, improved mental and physical wellbeing were often observed in summer months, where youth had opportunities to get outside, exercise, and safely interact with peers in a physically distanced manner: “I think summer is also a big factor , like weather. It changes everyone’s mood. So I think it’s definitely more hopeful when the summer comes. Everyone will be more happier and more hopeful” (BC, T2).

Youth living in urban vs. rural settings

COVID-19 experiences differed for youth depending on their community. Those in rural areas expressed gratitude for more open space to get outside and physically distance:

“If I was to live in town in the city , I wouldn’t be going out for a walk , because I’d be more likely to bump into people … I’d be inside more , and then I’d be driven more crazy. I really do need those walks every now and again , and just get out of the house. And I don’t know if I would be confident enough to do that in town” (Ireland, T2).

However, misinformation and people not following guidelines was a reported concern, with one youth in a rural community reporting, “I think in terms of the general attitude around COVID , it’s maybe a bit more … Uneducated , than in a city” (BC, T2). In urban spaces, greater population density led to an increase in fear and added challenges getting around the city:

“If we had enough money to afford a car , we wouldn’t have to worry about catching COVID from public transit. Wouldn’t have to get in that sardine bus. We’d be able to go and visit friends without worrying about , like , OK , I am exposing myself to , like , hundreds of people” (ON, T3).

Experiences of xenophobia

Asian-Canadians experienced a “big increase in harassment and racism” (BC, T2) noted midway through the study period. Instances of hateful rhetoric became more commonplace, and as a BC participant recalled, “I did get some of the racist comments when I was at Costco , because of being Asian. I did receive a lot of comments about it , so I think those did affect me , and I think it’s going to affect me after the pandemic , as well” (BC, T2). Because of these experiences, as well as seeing cases of racism and xenophobia on the news, some described feeling unsafe in public settings:

“I guess it’s important to stay more vigilant now. (…) [S]ometimes there’s those kind of creepy looking [people] who you don’t know if they’re going to start verbally harassing you on the subway and stuff because you’re alone and there’s not people around to kind of protect you anymore” (ON, T3).

In Ireland, one participant spoke about how xenophobia is resulting in a “ divide in society ”, citing a mentality in Irish society of “‘No Chinese , no Brazilians , no Brits’ , because like they brought the new variants” (Ireland, T2). They also spoke about their family members experiences’ “getting abused on the bus” and being told “ you brought COVID here ” (Ireland, T2).

Category 2. Opportunities for growth

This category emerged consistently among youth across all three recruitment locations. At Times 1 and 2 (T1 and T2), participants expressed a strong appreciation for the opportunity to acquire new skills and engage in a more measured approach to goal-setting and personal development. As the study progressed, youth participants articulated a growing sense of gratitude for previously taken-for-granted resources (T3), such as the re-opening of schools and recreational centers. Additionally, they acknowledged the adaptive measures their networks implemented during the pandemic, notably highlighting the efforts of teachers in developing innovative online curricula.

Learning new skills and hobbies

The pandemic presented an opportunity to develop new hobbies and skills. Honing a craft, indulging in creative endeavors, and exercising buffered against stressors in the early days of quarantine during T1 interviews:

“During the first lockdown , I actually picked up the hobby of running , because I didn’t have anything else to do. And I always wanted to try running , but I never really got the chance to” (Ireland, T1).

With newfound leisure time, youth were able to put their energy towards activities that would otherwise not be prioritized, which improved mental health:

“Especially during the early days of quarantine , that was pretty helpful , being able to create something , or lots of people got into baking. I don’t know , I think little things like that , like being able to acquire a new skill that you didn’t have before , I think that’s important for your mental health , and just feeling like you are accomplishing something , even when everything else is kind of at a standstill” (BC, T1).

Slower pace of life and commitment to personal development

Many used their newfound free time to slow down, self-reflect, and “build better habits” (ON, T3). The impacts of a slower pace of life were particularly apparent during T1 interviews, as some youth experienced reduced responsibilities because of changes in employment and education. This gave youth time to reflect: “It’s forced me to slow down , in a way , and to spend more time with myself , and learn more about myself” (BC, T1). Others were able to recover from burnout: “I was running at such a high level , and burning a lot of steam and not giving myself that time to reflect on situations and myself , and COVID kind of forced me to do that , because I had the literal time to do it” (BC, T1).

Despite hardship during the pandemic, more time alone acted as a catalyst for change: “It taught me a lot about my mental health … how to take care of myself , and how to practice self-care” (BC, T1). Several youth took initiative to understand themselves better and begin a journey of healing during this time.

In some instances, youth noted an increase in help-seeking behaviour, declaring, “If it wasn’t for the pandemic , I think I’d still probably be suffering from mental health [problems]” (Ireland, T3). These participants practiced self-care by confronting their mental health issues and reaching out for support instead of suppressing emotions.

“The thing about being stuck in your house is that you can’t escape anything. Like all of your issues , you have to deal with them right now because there’s no going anywhere… I’m at a point now where I’m being forced to make life changes and I’m being forced to actively confront my life and my issues” (Ireland, T2).

Gratitude for re-opening and life prior to the pandemic

Gratitude and appreciation toward returning to a“normal” life as restrictions lifted were noted across all time points: "I think it kind of just made me appreciate everything, kind of more. Like even whenever I was able to see my granny for the first time, I just would be something so normal to me and then it was just like this whole big thing” (Ireland, T1). For some, the pandemic served as a reminder to “[have] gratitude for what’s happening in the present cause you don’t really know what’s going to happen in the future” (ON, T3).

Positive experiences with remote education and employment

While some youth experienced a multitude of difficulties adjusting to remote education and employment, others found they were able to excel with the shift to virtual. Positive attitudes towards remote education and employment increased in T2 and T3 as rocky transitions passed. Virtual education and employment were valued for accessibility reasons for individuals who live in rural regions and/or have certain disabilities or physical or mental health conditions that limit their ability to participate in in-person activities: “I also have a chronic illness , which affects fatigue and mobility , so being able to have class online was really helpful , as well” (BC, T1).

Category 3. Adapting to new ways of accessing services

Physical health, mental health, and substance use services had to quickly shift from in-person to virtual care. During this transition period, youth experienced service disruptions, noted in T1 interviews. Barriers to accessing services improved with time as adaptations to online service delivery developed. However, concerns including prolonged wait times, not feeling prioritized in the mental health sector, and hesitancy to seek help persisted through all time points.

Difficulties seeking support in the midst of health service disruptions

For many, wait times were an obstacle prior to the COVID-19 pandemic, made worse by service closures during lockdowns. Such disruptions left youth with few resources to manage their mental health: “There was no options. There was no Skype call offered to me. There was literally nothing. I was lucky to receive a text message at one stage” (Ireland, T2).

With nowhere to turn, several youth noticed a decline in health:

“For myself , though … Maybe some worsened health , just because appointments have taken so long to get to , and I haven’t been able to see in-person doctors” (BC, T1).

Getting comfortable with virtual services

Once virtual services were implemented, some youth expressed preference for in-person support, though many acknowledged benefits of virtual appointments. One was using virtual services for general health concerns and prescription refills:

“It’s been working well , for me. Most of the time , it’s just for a prescription refill or an update on how my health has been , so it’s pretty convenient to just call and expect a phone call , like I can be at home , and I don’t have to go anywhere and wait for too long” (BC, T1).

Another benefit was that many participants felt more comfortable accessing virtual supports than in-person supports due to the online disinhibition effect:

“When I was doing it face to face I would shy away from a lot of conversations because I’d feel embarrassed or I’d get distracted. Where now on a Zoom call it just kind of feels like a normal phone call.” (Ireland, T1).

By T3, the convenience and accessibility aspects of virtual services were acknowledged as something that should be continued: “I think online services can be great , more accessibility for people in remote locations. Jobs that don’t conform to like business hours for therapists … I think it’s better than only in person , because in person is just not accessible” (BC, T3).

On the other hand, some participants had ongoing negative experiences with virtual services. The effects of their day-to-day life being virtual began to take a toll: “I’m so fatigued from all the virtual stuff that it would just drive me crazy if I tried to use virtual services for mental health” (ON, T3).

For some participants in both countries, technology problems created fractures in the flow of appointments, negatively impacting the overall quality and experience of services:

“When the network is cut off or the internet’s lagging or you’re having a hard time hearing the other person , that interrupts the intervention. That interrupts the mindfulness practice that you were just in the middle of and kind of taints the experience” (ON, T3).

Disrupted continuity impacted client satisfaction, reducing desire to access services in this way. Participants described virtual counselling as “totally disconnected” (BC, T1). Lack of a personal connection to establish a rapport contributed to hesitation attending more intimate appointments over phone or video: “I feel discouraged to go up to these online sessions. It still feels like you’re talking to the computer. It’s not the same” (Ireland, T1).

For youth living with family or roommates, they felt the lack of privacy led them to be hesitant to access virtual services and inhibited from maximizing their therapeutic experience:

“I wasn’t sure about [virtual services]… if I was able to do that in the home , because as I said before , like , everybody’s at home. It’s hard to find a space where it’s quiet and nobody can hear you. A space where you can really be vulnerable with the person that you’re talking to and trust that it’s only them that can hear the information and all that” (Ontario, T1).

With regards to synchronous chat, the depersonalization aspect of texting was a concern due to inability to convey the full range of expression during diagnostic procedures: “A lot of emotions and undertones aren’t really gotten across with text … from a diagnostic perspective , it’s probably not the best because people can really fake things via text , like , you could lie your way out of anything on text message , and nobody would know” (ON, T1). For others, synchronous chat provided an alternative option when coping with anxiety due to flexibility of communicating in times of need without a scheduled appointment and no pressure: “It’s not invasive or anything , and you can say as much as you want or stop replying when you want” (Ireland, T1).

Category 4. Mixed views on the pandemic over time: Attitudes, behaviour, and perception of policy response

This category summarizes how attitudes, behaviors, and perceptions of policy responses to the pandemic evolved over time among youth across the three recruitment locations. Initially, participants expressed mixed feelings about the pandemic, highlighting both concerns and adaptations in their daily lives. As time progressed, a shift in perceptions emerged, with some individuals recognizing the necessity of certain policies and their effectiveness, while others maintained skepticism about government responses. The way in which guidelines were poorly communicated to youth during the pandemic shaped youth in both countries in a similar way, leading to a nuanced interpretation of adhering and accepting the measures.

Adherence to guidelines

Notable observations were made regarding how youth and other generations reacted to the pandemic over time. Fear of the unknown meant a greater willingness to follow public health guidelines such as physical distancing, wearing a mask, and frequently using hand sanitizer in the early days of the pandemic:

“I think initially everyone was [taking it seriously] , young and old , were petrified , when we didn’t know. I think fear of the unknown at the start was why the first lockdown worked so well. Because everyone was really adhering , because like , no one knew how it [COVID-19] was going to affect you , you’d see the awful things on the TV and you didn’t know that sometimes you could literally have nothing [no symptoms]” (Ireland, T1).

Others expressed willingness to adhere to public health guidelines in service of collective responsibility: “I think that their role , like our role , everybody’s role is to try and stop the spread. So everybody has a responsibility to limit their contact” (Ireland, T1).

Several youth expressed discontent regarding others not taking guidelines seriously, impacting how youth perceived the longevity of the pandemic: “I also do see people around me that are not taking the pandemic very seriously … I just have frustrations with the current situation that make me not very optimistic about it” (BC, T1). Social media became a space where youth could check in on what their peers were doing, influencing feelings of hope during this time: “I see a lot of Instagram posts , social media posts where people are all together without a mask on , without anything , large group of people. That definitely brings down the hope a little bit … Situations like that can really set back the progress that’s been made” (ON, T1).

Youth perceived their peer groups as adhering to guidelines more than older generations in terms of physical distancing: “ I feel like it’s usually the middle-aged people who are more not following the policies and rules of outdoor places , or even restaurants and whatnot. I think that for the most part , youth are being pretty respectful of that” (BC, T1). Potential reasons for this difference were explored:

“I think that teenagers as a whole have actually handled it very , very well. Because we’re so young , we’re like a sponge. We soak things up. We’re still being taught things. We’re still being told how to do things , as where , somebody in their 30s are kind of set in their ways” (Ireland, T1).

Over time, youth demonstrated a declining adherence to public health guidelines, as one participant articulated: “ The fed-upness has taken over the wanting to be safe ” (Ireland, T3). Participants conveyed a sense of fatigue stemming from the frequency of lockdowns and the continually evolving nature of public health directives. Additionally, they noted a lack of targeted communication over time aimed at youth, which hampered their understanding of these changes and the shifting objectives associated with them.

“I think , in the beginning we all saw how serious it was and we all kind of knew it was our , not job , but aim , to keep other people safe , so that’s why we were sticking to all the guidelines and we were doing what we were told and things like that. But in the past three months , being stuck at home , back lockdown again , school. I’ve seen a lot of people , and it shocked me , that have just completely given up on it , and just don’t want to do it anymore … I think they’ve kind of given up hope a little bit” (Ireland, T2).

In this context, youth from all three geographical locations and across various genders articulated that the observed change in behavior should not be interpreted as a lack of concern. Rather, they attributed this shift to the cumulative effects of the pandemic on lifestyle changes and mental health. Participants noted that the escalating impact of these factors contributed to a growing sense of indifference toward compliance with established guidelines in each country. Despite the disillusionment with policy guidelines, increased anxiety about getting COVID-19 was also noted over time, across participants of all ages, genders, and geographical locations:

“I think I’m more actively worried than I was previously. Before , I just kind of took my precautions – I did my best to stay out and that kind of thing. But now , I find myself getting stressed out at the grocery store when people are too near me. And I find myself actively avoiding certain situations , even more so than I did before … So it’s just – I feel a lot more anxious , right now , when I’m out in public” (BC, T2).

Such concerns were worsened by the rise of new strains of COVID-19, reigniting fear of uncertainty of the severity of the disease and risk of a greater spread: “Everyone now is talking about the Delta variant and it’s just so mentally draining” (ON, T3). These fears led to participants experiencing a greater sense of hopelessness due to concern that the current resources to combat COVID-19 would not be effective long-term:

“Just hearing that it is more deadly and more contagious , is definitely a worry. Because I know before people were thinking , well , you know , there are the vaccines coming out , so once I get it I’ll be fine. But you know , the findings that maybe it doesn’t work completely against the variants , that kind of makes it seem like there is no solution in place” (ON, T2).

Perception of policy response

Participants had mixed reactions to government policy response in all three regions. In Canada, the Canada Emergency Response Benefit (CERB) program, which provided financial support to Canadians whose employment income was affected by COVID-19, was viewed overwhelmingly as having a positive impact by alleviating financial strain. For students in college and university, having the financial support allowed youth to focus on their education and limit additional stressors:

“I think the government definitely did help , especially with CERB cheques and things like that … having the government step in and financially assist me during this time was hugely beneficial , and allowing me to continue with my education , and not be stressed about money” (BC, T1).

On the other hand, some participants in Ireland felt the COVID-19 Pandemic Unemployment Payments (PUP) were a source of stress, with some young person worrying “that they’re going to make everyone pay back for COVID pay in tax” (Ireland T3). Others felt frustrated by “COVID pay” (Ireland T3), causing tensions between those who received it and those who did not: “My friend signed on to the COVID pandemic payment … I stopped talking to her for about four days , I was like … ‘I have to do 20 hours in three days. I am exhausted and you’re rubbing it in my face’” (Ireland, T2).

While youth expressed contentment with restrictions implemented to keep people safe, a number of concerns were also raised. Over time, dissatisfaction centred around issues of changing guidelines and continuous lockdowns put in place by each region’s government: “I think the way they’re going about it , as in a little-by-little , and then they open it a little bit and then they go back again , think that’s doing a lot of damage to people’s mental health” (ON, T2).

Absent youth voice in policymaking

A growing concern raised across sites and timeframes was a consistent lack of youth voice. Youth did not see themselves reflected in policy or feel they had an impact to steer outcomes, though they noted the importance of their voice for realising change for the youth population. In terms of policy decisions, youth expressed discontent with “no youth at that table” (BC, T1) and felt “brushed to the side” (Ireland, T3), describing, “I feel like we have no say and we’re just following what other people are telling us to do” (ON, T2). Lack of attention to youth issues contributed to a sense of invisibility: “It’s like we don’t exist” (Ireland, T2).

Despite desire to be involved in government and decision-making processes, youth noted minimal opportunity to engage: “To a person who is young , them being able to put their voices out , that ability is very much hampered down , just because of these systemic barriers that are happening , and forces that work against young people” (BC, T1). The absence of youth participation was most apparent concerning decisions around education. Many felt dissatisfied with schools closing and re-opening:

“Being a student is unique , because I feel like most students were placed in a position where they didn’t really have a lot of power and we felt really passive in how we were receiving information and how decisions were being made in terms of our education ” (ON, T3).

As the last group to get the vaccine, youth raised concerns about returning to school: “My university has mentioned that we would be opening up in September [2021] despite the fact basically no one would be up for vaccination until October at the earliest. I feel like that’s something someone could have pointed out” (ON, T2). Lack of choice regarding decisions to continue school virtually or in-person created strife among university-aged students: “Going back to campus full time without any online options , I don’t think that a young person would necessarily make that decision” (BC, T3). Frustration continued to grow over time as the perception of neglect persisted: “There’s been such a lack of concern for university age people , you know? That I think people are getting a bit disgruntled” (Ireland, T3).

Youth recognized the value in having their opinion shared despite being young: “Just because you’re 20 doesn’t mean your experience is worth less” (BC, T3). Desire for involvement stemmed from an understanding of being future decision makers: “We’ll be the next people in-charge of things. Every generation can build on the last generation … I think that’s what makes young people in the world so important , because we can all learn from people’s past mistakes and build on that and stuff” (Ireland, T2). With this mindset, youth described the importance of engaging in activism and online petitions and voting when of age in order to effect change.

Unfair judgement of youth role in the pandemic

A recurring sentiment among participants was the perception that youth were being disproportionately blamed for the spread of infection in the media. Youth described feeling “unfairly targeted” (BC, T1) upon experiencing criticism for breaking rules and not taking the pandemic seriously:

“We’ve all been labelled like this , you know , ‘it’s the young spreading the virus’ , ‘it’s the young that don’t care’ , but it’s not like that , that’s not true , like I’m taking all this very serious. It’s affected my life in ways that I could never have even imagined” (Ireland, T1).

In light of these accusations, youth countered such blame by pointing out how they are vulnerable to infection as the last age group to be eligible for the vaccine, as well as a demographic notably on the front lines of customer service and hospitality jobs, placing them at increased risk compared to those with the option to work from home:

“… [Young people] are sort of being blamed for a lot of the spread , but also , that age category is probably a lot of the people who’re working minimum-wage , front-line jobs , being forced to be out in places , taking public transit , living with roommates … And we’re going to be the last to be vaccinated which is , again , frustrating” (ON, T2).

Vaccination in the face of hesitation

Overall, youth expressed willingness to get a COVID-19 vaccine. For those with concerns, hesitancy was raised surrounding uncertainty about the speed at which the vaccines were developed and rolled out in addition to not knowing the long-term impacts. Such concerns were most commonly raised at T1, prior to vaccines becoming available: “I’m not anti-vaccine , but I feel like they are rushed … You never know what the side effects are in a year or ten years from that vaccine , right? That’s something that I worry about” (BC, T1). Some youth felt like the misinformation online contributed to their uncertainty about the vaccine:

“I have mixed feelings about [the vaccine] … I feel like I feed in to Facebook been like , oh , it will make you have a brain damage … don’t take it , [you’ll] never have children and stuff like that. But I feel like if it was that bad , they wouldn’t be giving it to people. So , I just look at actual scientific side of it rather than feed into random people on Facebook” (Ireland, T2).

To address these concerns, youth described needing more information, presented in a way that explains how the vaccine works:

“I want to know information and I want to learn about it. I wouldn’t let anyone put any vaccine into me without knowing about it. So , I think what has really worried me is that the information and the responses have been so , so vague to a point where it seems really shady” (ON, T2).

Despite hesitation, youth discussed several motivating factors that led them to get a COVID-19 vaccine, primarily for functional reasons and as a means to return to normalcy by T2 and T3. Youth noted how a vaccine would provide a sense of safety: “I am at ease that something is protecting me” (ON, T3). More than just in a practical sense, vaccines gave participants a renewed sense of optimism:

“What is exciting about the vaccine is the potential to dream about the future again in a meaningful capacity. In a way , COVID took away the ability to conceive of any future because the future became indistinct , right. But having the vaccine allows you to go back to imagining a future that is with other people which is important” (ON, T2).

Category 5. Navigating COVID-19 information

In this category, participants reported the complexity involved with navigating COVID-19 information and the associated confusion with content posted on social networks, news articles, and within their own personal networks. Youth across all three countries relied on social media and online platforms for updates, which sometimes led to misinformation and uncertainty, and an overall feeling that the content was not developed for youth by youth. To counter this, many actively sought reliable information from trusted sources, such as health organizations and educational institutions. Peer discussions, primarily online through platforms such as TikTok, also played a crucial role in shaping their understanding, as youth shared insights and strategies to cope with the evolving situation. Youth emphasized the need to develop their own approach to critically engage with information, despite the challenges posed by the rapidly changing landscape of the pandemic.

Confusion around pandemic information presented by the government

Youth found pandemic information confusing and containing too much jargon: “It was not easy to understand. Just a lot of big words and government words” (BC, T1). As a result of inaccessible language, youth were deterred from seeking out information: “I don’t listen to it anymore because it’s too confusing , it’s too much information being thrown out in 5-minute speeches” (Ireland, T1). Over time, as guidelines changed, participants felt it was hard to follow and keep up to date with current guidelines: “I think maybe the government could’ve done a bit better of mitigating some of that ambiguity and uncertainty , and helping people cope with the ever-changing guidelines and protocols” (BC, T1). The need for youth-friendly information was addressed:

“I feel like they should have like some younger people on the government’s team just to like explain what some things mean to the younger generations … me and some of my friends have read some stuff from the government website , and we’re just like , ‘what does even half of this mean?’” (ON, T1).

Accessing COVID-19 information through multiple forms of media

The primary sources where youth accessed pandemic information were the government and news media’s social media, webpages, and daily addresses. Having options tailored to the needs of the individual was beneficial:

“I really like the Prime Minister’s address …because I have dyslexia , I don’t really like reading , I don’t like going through long articles. I need to just hear it … So , I just appreciated someone putting everything into a concise press conference so I don’t have to go hunting for all the articles , hunting for the information and everything” (ON, T1).

Social media was commonly discussed, as participants described using various platforms such as verified news outlets and government run Instagram, TikTok, Twitter, Reddit, and YouTube to access information from people or organizations whom they trust:

“I think the government actually did a decent job of putting things on Instagram. I wasn’t really active on any other platform , but just seeing like , you know , the infographics about , here’s what you’re allowed to do” (BC, T3).

Youth were astutely aware of the need to find reliable sources and wade through misinformation, citing the spread of false information as a barrier to staying informed:

“It’s very hard to avoid any kind of misinformation or just complete lies about it. That’s kind of a difficult thing , and I’d say that’s where a lot of difficulty in miscommunication comes from is just because people’s primary new source is the internet , which is not always very reliable” (Ireland, T3).

Category 6. Transitioning to life after the pandemic

This category summarized how youth across the two countries experienced the complex transition back to a “new normal”. This transition reflected fear, resilience and adaptability, as young people worked to rebuild their lives in a changed world. This is described in more detail in three sub-categories described in detail below.

Cautious readjustment to a new normal

Young people anticipated challenges with re-adjusting to life after the pandemic with years of diminished social interaction and physical distancing, particularly felt in the midst of lockdowns: “Everyone’s afraid of each other” (Ireland, T2). Participants described a persistent cautious outlook when attending public events or gatherings, with one participant saying, “I think immediately after the pandemic , there’s going to be a lot of people who are a little skittish about re-integration into crowds and restaurants” (ON, T2). Such challenges with reintegration were recognized “as almost a trauma response , where if someone gets too close to you , you feel unsafe” (BC, T1).

Some participants grew comfortable with spending time alone, with long-lasting impacts on their desire for socialization: “I’ve gotten used to my own company and I’m starting to enjoy just being with myself but that’s also a negative” (Ireland, T2). Participants recognized the importance of social interaction, though felt as though transitioning from spending time alone to engaging with others in person might be challenging: “I feel like it’s going to be hard to go back to real life , because I’m so used to not leaving my house , now , and I’m kind of like a bear in hibernation , now. I don’t know if that’s going to be an easy transition” (BC, T1). Balancing the needs for social interaction with the comfort of spending time alone was thought to be a difficult balance to navigate, with concerns for long-term mental health impacts. Participants recognized these challenges as collective trauma: “Some people will be traumatized by it and may never heal from it” (ON, T2). Without adequate supports in place, youth feared for their ability to heal moving forward.

Concerns for the future

When considering their futures in a post-pandemic world, participants expressed concern for the state of the economy as well as their own job prospects: “I think economically Ireland will have a long time recovering and especially for when I’m older and I’m buying a house. I feel like the prices will still be really high” (Ireland, T1). In light of these concerns, several youth noted that they re-evaluated their plans and goals for the future to adjust to a new world and changes to their own self, considering, “What is post-COVID for me now , because I am in a much different place than I thought I would be” (ON, T3). In light of these fears, youth described the need for support, though had concerns that their needs would not be met, particularly for those without a strong social support network:

“I do think [young people] face unique circumstances and I think because of a lot of income inequality , like the general expectations for new graduates , I think young people have a lot of challenges that have been exacerbated by the pandemic , and I feel like if there aren’t the correct social safety nets in place. It can leave a lot of young people behind … You know , not everyone has a family that they can rely upon during these sorts of times , and I think we just have to make sure that we’re looking out for everyone” (BC, T1).

Optimism about positive social changes

Despite hardships endured during the pandemic, youth were able to identify unseen benefits and potentially positive long-term changes in terms of the workplace, education, hygienic practices, and social justice. Youth hoped to see flexibility regarding work-from-home policies, “where workplaces are more lenient , [and] people understand things like childcare” (BC, T1), with improved accommodations for employee needs: “I think more people are going to be opting to work from home if they’re allowed to because commuting to work doesn’t really do much for them” (ON, T2).

Youth were optimistic about improved health beyond the pandemic. Continued hygienic practices to prevent spread of illness beyond COVID-19 were discussed in a positive light: “Sanitizing , washing our hands , wearing masks when we’re sick , taking time off to stay at home when we’re sick , I feel like those are going to have long-term affects within the workplace , and within school” (BC, T2). While exacerbated mental health challenges were noted as a continued uphill battle to address, the pandemic sparked more conversation around mental health, trauma, and help-seeking that resulted in de-stigmatization, which was thought to be a step in the right direction:

“I hope in the recovery of Ireland and the economy of Ireland and stuff , they don’t forget about mental health because it was such an important thing during COVID and I hope that’s , that slowly doesn’t fade away” (Ireland , T1).

Because of the political discourse throughout the pandemic with attention to social justice issues, youth were optimistic that some of the structural inequities brought to light would be addressed in society: “I think that will be the big frontier , because I think the pandemic , for all the bad , does provide an opportunity to rectify some of the inequalities we’ve seen exposed through it” (BC, T1). Inherently tied to these changes was a developed sense of compassion and empathy among youth and others, and the belief that change is possible:

“I’m hoping this period helps develop empathy and kindness in people … I’m hoping that this is an opportunity for people to kind of reflect on the skills that they offer in that sense and hopefully grow in that sense , and using those newfound skills and newfound parts of themselves to engage with their communities and to take care of their communities , whether that’s physically or by leading it on a kind of social change front or whatever that may look like” (ON, T1).

In this sense, youth expressed actionable strategies to use their voice through social media and partaking in social justice movements to pressure policymakers: “ We deserve health and equity , and we have the resources and the capability to have those things , we just need to make it happen” (ON, T3). Participants found hope in this belief, with the change starting within themselves: “I know me , for one , I’ve come out of it a better person” (Ireland, T2).

Category 7. Youth-led recommendations for government and service response

Four subcategories about key recommendations for government and service response were generated from the data over time, which related to strategies for amplifying youth voice, communicating public health information effectively to youth and combatting misinformation, optimizing services post-pandemic, and planning for future pandemics.

Youth voice needed in decision-making

Participants raised the importance of incorporating youth voices in policy decisions, particularly when directly impacted by the outcome. Youth articulated the need for their voices to shine through research so that policymakers understand their needs, with attention to questions such as, “How are you living your life? What are your priorities? What are your concerns?” (ON, T3). School was recognized as the best way to reach a broad spectrum of youth: “I feel like the only way you could really collect information from a bunch of young people is through school” (ON, T3).

In addition to research, youth expressed desire for more opportunities for leadership to develop skills in advocacy and bridge the gap between youth and those in charge. Participants noted that adults in positions of power have an important role in creating such opportunities, where leaders “who have paved the way for other youth to use their voice [are] really important” (BC, T1). Opportunities at school for youth to address issues were discussed: “I feel like there could be maybe like a group of students and young people who can kind of just voice the opinions of everyone on their behalf and stuff and maybe just offer up suggestions” (Ireland, T1). On a broader level, the establishment of a youth advocate role within government was suggested as a means to effectively communicate the specific needs of young people, rather than relying on assumptions made by adults who may not fully understand their perspectives (Ireland, T1, BC T3).

The importance of diversity in youth experiences was recognized, with understanding that historically, persistently, or systemically marginalized youth with important stories to share may be ostracized from participation in research and decision-making:

“I feel like there are definitely people who should be involved but the people who should be involved are not usually the people who can be involved. Like if you are poor and in an immigrant household you are probably at home taking care of you siblings and have no time to sit on committee meetings” (ON, T2).

Communicating public health information effectively to youth and combatting misinformation

Youth discussed the need to continue to “use social media in a way that you promote responsible information or reliable information” (ON, T3) because “that’s where a lot of young people spend a lot of their time” (BC, T3). Concise, digestible content in the form of infographics was said to be an effective way to disseminate information, promote services, and encourage service uptake: “None of the BS , you know … cut all the medical jargon out … explain it simply” (Ireland, T1).

With regard to sharing COVID-19 information, youth thought it “would be helpful if there was more clarity as to why each restriction was put in place” (Ireland, T1) to combat frustrations with fluctuating and sometimes contradictory restrictions and to improve adherence to guidelines.

“I think it would be helpful if there was more kind of like clarity as to why each restriction is put in place, because people would be like ‘Hang on. So we can’t do this, but people can like, come into the country and leave the country.’ And like ‘We can do this at school, but we can’t do this in shops’. And they’ll be like, why is that? And they kind of get frustrated and be like, I’m not listening to them anymore. So I think it would be helpful if there is more thorough explanations as to why, like maybe you can do this, but not that, and stuff. " [el].

Aiming information at parents is another way to spark dialogue between parents and their children about mental health: “I think by targeting adults , that would help the situation for younger people to feel more comfortable talking about their issues” (BC, T3).

Aside from social media, school was reiterated as a means to convey information to youth, teach emotional literacy, and provide resources: “I think getting information to students through institutions; I think it’s a very smart move. Like keeping up with your school’s newsletter” (ON, T3).

Creating visibility surrounding resources and mental health can promote help-seeking, as recognized by a university student in BC: “I feel like sometimes it’s like you have to go out and seek it , but it’d be nice if universities sent out emails midway through the semester , just to tell people about that” (BC, T2).

A key issue raised by participants regarding accessibility of virtual information was the prevalence of misinformation and knowing how to identify reliable sources. As a generation who grew up with social media, the need for strategies to address these issues was apparent. Youth expressed desire to learn about internet literacy and critical thinking skills in the classroom:

“I think internet literacy , where if people grow up and they learn , OK , not everything on the internet is true … If that thought process was taught in school , then it wouldn’t really be as big a problem as it is today” (ON, T2).

Similarly, accountability within the platforms themselves and in government was suggested as a welcomed solution:

“I think holding the people accountable that spread misinformation will help and there being less bots or problematic ideas going … tech companies holding people accountable , or governments holding people accountable” (ON, T3).

Post-pandemic services: enhancing service delivery to improve outcomes

An issue brought to light during the pandemic was the lack of affordable and accessible mental health services, worsened by intensifying mental health problems experienced during this time. For youth, the pandemic presented an opportunity to address some of the issues faced within the system that impact youth specifically. Despite a desire to seek help, lack of affordable and timely services created a major barrier to care:

“A lot of people want mental health services and either they can’t afford it or they’re on like a six-month , one-year waiting list” (ON, T3).

To address this issue, youth recommended expanding social safety nets to cater to the needs of this population:

“Starting with the expansion of disability benefits , making it so that people who are on disability are not living in poverty , that would be a good start , because we are going to have a fall out in terms of the people who have been affected by COVID” (ON, T3).

In the aftermath of COVID-19, there was an expressed desire for priority to be given to mental health services to counterbalance the mental health challenges that were worsened by increased stress and decreased access to services:

“The government’s definitely going to have to implement some sort of strategy , like for aftercare , I feel. I just feel like it’s going to be a domino effect and it’s going to go on for years to come … You just don’t know what kind of effect that would have on somebody” (Ireland, T2).

Post-pandemic services should also continue to offer virtual care according to participants. While many youth declared a preference for in-person services, there was recognition of the value in having options:

“[Services should] still be definitely available online , especially because some people , you know , maybe aren’t comfortable [with] the face-to-face environment yet , or maybe are immunocompromised or just physically can’t get there” (BC, T3).

Planning for future pandemics

In a future pandemic, youth emphasized that personalizing messaging to all demographics is important. In the youth context, this can be seen as communicating information regarding an infectious disease in a way that is easy to understand, digestible, and does not instill fear and prioritizes facts:

“I really like simplicity , like getting to the point. Easy facts. Anything factual information that has key points and bolded and have diagrams , pictures , or even , like , an example , analogies , et cetera , would be really important to understand” (BC, T1).

Ensuring resources and funding are available would help youth feel supported in times of crisis. Not all youth have strong familial relationships to provide safety and protection, requiring implementation of safety nets:

“Far too often , the young-person demographic , so like not a minor , but not a middle-aged person , is often ignored in planning stages. It’s assumed that we can operate as those people have , but I think we have a much less robust support system , and even just crisis funds and things like that. I think that needs to be accounted for” (ON, T2).

In light of these recommendations, it is evident that the COVID-19 pandemic constitutes not merely an acute public health crisis but a historical event with enduring implications for youth health and wellness for many years to come. The pandemic has revealed significant gaps in service delivery for this population, highlighting the necessity for a comprehensive approach to address their ongoing needs, ideally with diverse youth at the centre of all decision making, knowledge sharing, and future planning.

This study examined youth experiences during COVID-19 over an extended period, providing valuable, youth-generated recommendations for government and service responses to pandemics and other public health emergencies. Our longitudinal qualitative analysis revealed critical trends that demonstrate the multifaceted impact of COVID-19 on participants at various stages of the pandemic, with consistent findings across regions, including BC and Ontario in Canada, as well as Ireland. These insights underscore the necessity of incorporating youth perspectives into future public health strategies. Youth described their experiences of coping with the many hardships of the pandemic and adapting to new ways of accessing services, but they also identified areas for personal growth through the hardship. Challenges with transitioning to a post-pandemic life were similar across both countries. Youth leveraged their experiences to provide recommendations for responses by governments and service-providing organizations for future pandemics and public health emergencies.

Findings were consistent at each time point, despite some small differences in the cohorts. This may be due to the similar COVID-19 responses in these regions, including lockdown measures, vaccination rollout, testing, and contact tracing [ 40 ]. Their adaptive responses all included a series of lockdowns comprising of stay-at-home orders, school and non-essential business closures, a vaccination strategy that prioritized vulnerable populations and essential workers, mandatory use of face coverings, and providing income support to affected workers [ 40 ]. Furthermore, ON, BC, and Ireland have integrated youth services that provided virtual mental health services to youth throughout the pandemic [ 30 , 35 , 41 ]. While Ireland had more confirmed COVID-19 cases per capita than ON and BC, this did not seem to influence the impacts on youth [ 42 ]. The sample of youth from Ireland were younger on average, and more focus on school and family was found in the data. These findings align with observations in similar populations in other high-income countries [ 40 ]. Nevertheless, it is crucial to acknowledge that further research on the impacts of the COVID-19 pandemic on youth in areas with lower income, a varied COVID-19 response, and/or without integrated youth services would be beneficial to assess the applicability of these findings across wider regions.

The challenges encountered in response to the COVID-19 pandemic are multifaceted and align with emerging literature. For instance, the loss of significant life experiences has been identified as a critical factor impacting young people in profound ways during the pandemic [ 43 , 44 ]. Additionally, educational challenges arose, particularly in the form of difficulties adjusting to online learning environments [ 24 , 45 , 46 , 47 ]. Job loss and financial instability contributed to cumulative stress over time, driven by sudden economic disruptions and uncertainty about the future [ 48 , 49 ]. Essential workers faced heightened risks upon returning to work, grappling with the dual pressures of potential COVID-19 exposure and the new responsibilities associated with enforcing public health guidelines [ 50 ]. Furthermore, there was a notable increase in incidents of racism and xenophobia, compounding the adversities faced by many individuals. Anti-Asian attitudes in the age of COVID-19 have been documented in the American context [ 51 , 52 , 53 ], noting higher rates of harassment and health disparities throughout the pandemic due to harmful rhetoric regarding COVID-19 origins. Difficult-to-follow public health information was an additional challenge, as was initial vaccine hesitancy [ 54 , 55 , 56 , 57 , 58 ] (Everest L, Henderson J, Prebeg M, Relihan J, Ma C, Hawke LD: Relationship between mental health on COVID-19 vaccine hesitancy in youth: a mixed methods longitudinal cohort study, Under review), although attitudes shifted toward favouring vaccines with time. With the myriad of challenges came a decline in mental health and mixed effects on substance use behaviors, particularly noted in T1 and T2, as is documented in the literature cross-sectionally and longitudinally [ 16 , 17 , 18 , 19 , 20 , 29 , 59 , 60 , 61 ].

With the complex changes in contexts, environments, and lifestyle, youth also experienced disruptions in health service accessibility, including mental health service access. These disruptions may have further constituted a barrier to health and wellness [ 31 , 62 ], although acceptance of virtual services seemed to increase with time. Isolation, financial strain, and setbacks in educational and professional development in the context of reduced service accessibility may be contextual factors that led to the short-term impacts on mental health; this trajectory could also extend into long-term impacts on mental health and substance use, which is an important area for ongoing research as the pandemic resolves [ 63 ].

Despite the hardships experienced, youth also identified several strengths and opportunities for growth during the COVID-19 pandemic. Youth in both countries described picking up new skills and hobbies such as cooking, exercise, and creative endeavors, which helped with overall wellness. In some cases, mental health improved due to reduced demands on time and increased time to self-reflect, slow down, and recover from burnout. In this sense, the pandemic was a catalyst for change where help-seeking and engagement in services were realized for the first time. Access to green spaces was a positive factor; indeed, this has been shown to reduce symptoms of depression, anxiety, and stress [ 64 , 65 , 66 ]. A small body of research discusses the positive developmental opportunities, strengths, and effective coping strategies leveraged by youth during the changes in the pandemic [ 8 , 67 ]. Another body of research outlines post-traumatic growth in various populations during this time [ 67 , 68 ]. Together, these findings can serve to identify strengths, protective factors, and resiliencies that can be harnessed to support mental health and wellbeing during challenging periods in history, from a pragmatic and strengths-based lens. Indeed, youth remained optimistic about the potential for the pandemic to act as a catalyst for positive social change.

Youth expressed concerns regarding the insufficient attention given to their needs, the unique adversities they faced, and their lack of engagement and leadership in formulating solutions during the pandemic response. Consistent with existing literature [ 69 , 70 ], it is imperative to prioritize youth involvement in research and policymaking by centering their issues and recognizing them as equal stakeholders and rights holders. The Children and Youth in Challenging Contexts (CYCC) Network report (2013) outlines best practices for engaging youth to combat social exclusion and mitigate power imbalances, emphasizing the necessity of collaboration [ 71 ]. Organizations, educational institutions, and governmental bodies at all levels should enhance their capacity to create platforms that enable youth to voice their concerns on pertinent issues and ensure that their perspectives are actively considered. Establishing student and youth advocacy groups, along with dedicated government liaison positions, can facilitate the bridging of gaps and foster increased political participation among young people.

Based on the current findings and the emerging literature, examples of solutions that youth might propose to better address future pandemics and public health emergencies include the use of verified, fact-checked social media posts to clearly communicate public health information in a consistent manner [ 72 , 73 ], together with strategies to eliminate help-seeking barriers and support system navigation [ 74 , 75 ]. Incorporating age-appropriate internet literacy into school curricula to help cultivate critical thinking skills and discern factual information from unreliable sources was also discussed. Free or affordable mental health services are needed, as well as attention to accessibility needs. Attention should be given to enhancing access for those with minimal technological literacy skills [ 76 ]. Financial supports and means to safely socialize, exercise, and alleviate symptoms of mental illness are additional youth priorities. In a similar vein, resources should be distributed to address safety concerns for those in unsafe households, who may be at risk of emotional or physical abuse during periods of lockdown. Additional novel goals and solutions may be proposed through ongoing and appropriate youth engagement in policy, service, and research design.

Strengths and limitations

This study provided longitudinal insights that capture a substantial period of change during the evolving COVID-19 pandemic. Spanning multiple jurisdictions with large samples, the study identified similar cross-cutting experiences reported by a wide variety of youth. With youth engagement throughout, the research questions and approaches were informed by youth voices. However, limitations of this study include response bias, varied sampling strategies and timelines across study sites, complicating comparisons between sites, as well as attrition. While flexibility in sampling strategies is a strength of qualitative longitudinal research design for reasons including enhancing generalizability of findings, comparability can also be a limitation. The variability in recruitment approaches across different sites may have hindered the ability to discern consistent patterns and trends over time. Future research is needed to distinguish patterns amongst different groups (e.g., gender, age, race/ethnicity). Given the longitudinal nature of this study, participant numbers declined over time. As the findings suggest, “COVID fatigue” may have contributed to study drop-out. Those who chose to remain in the study may differ from those who did not complete all three timelines. The use of virtual means to recruit and conduct the interviews expanded the geographical reach of the study, but limited it to youth with online access.

This is the first known international longitudinal qualitative study to describe youth experiences during the COVID-19 pandemic across two Canadian jurisdictions and Ireland, with implications for policy and practice. Despite the many challenges encountered over the course of the pandemic, youth reported aspects of growth. For this population, pre-existing stressors were compounded by pandemic-related challenges and reduced access to care, signifying the importance of prioritizing youth mental health moving forward. Areas of need highlighted throughout the pandemic have implications for future policy decisions, with an opportunity to enhance health and social service delivery. Investment in resources rooted in youth-identified needs and priorities is vital to mitigate the long-term challenges associated with pandemic trauma among youth.

Data availability

Due to multiple sites participating, the data sets generated during the current study are not publicly available but are available from the corresponding author under reasonable request.

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Acknowledgements

We are grateful to have conducted our research on the ancestral lands of many different Indigenous Nations and Peoples across what we now call British Columbia and Ontario. We would like to thank the youth participants, advisors, and research staff, who contributed valuable insights and shared their experiences throughout the duration of this project. We would also like to acknowledge with gratitude the research teams at Jigsaw, the Centre for Addictions and Mental Health, Foundry, and the University of British Columbia.

This study was funded by the Canadian Institutes of Health Research Operating Grant #172661: COVID-19 Rapid Research FO - Social Policy and Public Health Responses.

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Contributions

SB, JH, and AO conceptualized the study. JH and SB obtained funding for the study. SB, MW, LH, AO, JD, and LH supported project data collection and activities. EN, MW, LH, and SB drafted the manuscript and JH, SM, MQ, KW, JD, AO reviewed the manuscript.

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Correspondence to Skye Pamela Barbic .

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Ethical approval for this study was provided by Jigsaw’s Research Ethics Committee (JREC/2020/004), the Centre for Addiction and Mental Health Research Ethics Board (046-2020), and the University of British Columbia Behavioural Ethics Research Board (H20-01537). Consent to participate was obtained from all subjects.

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Whyte, M., Nichol, E., Hawke, L.D. et al. Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study. BMC Health Serv Res 24 , 1266 (2024). https://doi.org/10.1186/s12913-024-11752-z

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DOI : https://doi.org/10.1186/s12913-024-11752-z

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