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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

• Flexibility

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

• Natural settings

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

• Meaningful insights

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

• Generation of new ideas

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

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

• Unreliability

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

• Subjectivity

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

• Limited generalizability

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

• Labor-intensive

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

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

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

Research bias

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

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

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

There are five common approaches to qualitative research :

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

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

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

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

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

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Qualitative Research : Definition

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

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

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Qualitative study.

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

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

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

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

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

Table of Contents

What is qualitative research? 1

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

Qualitative research methods 2

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

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

Types of qualitative research 3,4

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

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

Qualitative research : Data collection and analysis

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

2. Qualitative data analysis 

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

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

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

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

Characteristics of qualitative research methods 4

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

When to use qualitative research   4

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

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

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

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

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

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

Advantages of qualitative research 1

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

Disadvantages of qualitative research 1

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

Differences between qualitative research and quantitative research 1

Frequently asked questions on qualitative research  

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

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

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

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

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

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

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

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

1. Convenience sampling  

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

2. Purposive sampling  

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

3. Snowball sampling  

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

4. Quota sampling  

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

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

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

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

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

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

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

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

References:  

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

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

Also see Research Methods

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4.2 Definitions and Characteristics of Qualitative Research

Qualitative research aims to uncover the meaning and understanding of phenomena that cannot be broken down into measurable elements. It is based on naturalistic, interpretative and humanistic notions. 5 This research method seeks to discover, explore, identify or describe subjective human experiences using non-statistical methods and develops themes from the study participants’ stories. 5 Figure 4.1 depicts major features/ characteristics of qualitative research. It utilises exploratory open-ended questions and observations to search for patterns of meaning in collected data (e.g. observation, verbal/written narrative data, photographs, etc.) and uses inductive thinking (from specific observations to more general rules) to interpret meaning. 6 Participants’ voice is evident through quotations and description of the work. 6 The context/ setting of the study and the researcher’s reflexivity (i.e. “reflection on and awareness of their bias”, the effect of the researcher’s experience on the data and interpretations) are very important and described as part of data collection. 6 Analysis of collected data is complex, often involves inductive data analysis (exploration, contrasts, specific to general) and requires multiple coding and development of themes from participant stories. 6

Reflexivity- avoiding bias/Role of the qualitative researcher

Qualitative researchers generally begin their work with the recognition that their position (or worldview) has a significant impact on the overall research process. 7 Researcher worldview shapes the way the research is conducted, i.e., how the questions are formulated, methods are chosen, data are collected and analysed, and results are reported. Therefore, it is essential for qualitative researchers to acknowledge, articulate, reflect on and clarify their own underlying biases and assumptions before embarking on any research project. 7 Reflexivity helps to ensure that the researcher’s own experiences, values, and beliefs do not unintentionally bias the data collection, analysis, and interpretation. 7 It is the gold standard for establishing trustworthiness and has been established as one of the ways qualitative researchers should ensure rigour and quality in their work. 8 The following questions in Table 4.1 may help you begin the reflective process. 9

Table 4.1: Questions to aid the reflection process

Philosophical underpinnings to qualitative research

Qualitative research uses an inductive approach and stems from interpretivism or constructivism and assumes that realities are multiple, socially constructed, and holistic. 10 According to this philosophical viewpoint, humans build reality through their interactions with the world around them. 10 As a result, qualitative research aims to comprehend how individuals make sense of their experiences and build meaning in their lives. 10 Because reality is complex/nuanced and context-bound, participants constantly construct it depending on their understanding. Thus, the interactions between the researcher and the participants are considered necessary to offer a rich description of the concept and provide an in-depth understanding of the phenomenon under investigation. 11

An Introduction to Research Methods for Undergraduate Health Profession Students Copyright © 2023 by Faith Alele and Bunmi Malau-Aduli is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

What is Qualitative in Qualitative Research

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• Volume 42 , pages 139–160, ( 2019 )

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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.

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What is Qualitative in Research

Unsettling definitions of qualitative research, what is “qualitative” in qualitative research why the answer does not matter but the question is important.

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If we assume that there is something called qualitative research, what exactly is this qualitative feature? And how could we evaluate qualitative research as good or not? Is it fundamentally different from quantitative research? In practice, most active qualitative researchers working with empirical material intuitively know what is involved in doing qualitative research, yet perhaps surprisingly, a clear definition addressing its key feature is still missing.

To address the question of what is qualitative we turn to the accounts of “qualitative research” in textbooks and also in empirical work. In his classic, explorative, interview study of deviance Howard Becker ( 1963 ) asks ‘How does one become a marijuana user?’ In contrast to pre-dispositional and psychological-individualistic theories of deviant behavior, Becker’s inherently social explanation contends that becoming a user of this substance is the result of a three-phase sequential learning process. First, potential users need to learn how to smoke it properly to produce the “correct” effects. If not, they are likely to stop experimenting with it. Second, they need to discover the effects associated with it; in other words, to get “high,” individuals not only have to experience what the drug does, but also to become aware that those sensations are related to using it. Third, they require learning to savor the feelings related to its consumption – to develop an acquired taste. Becker, who played music himself, gets close to the phenomenon by observing, taking part, and by talking to people consuming the drug: “half of the fifty interviews were conducted with musicians, the other half covered a wide range of people, including laborers, machinists, and people in the professions” (Becker 1963 :56).

Another central aspect derived through the common-to-all-research interplay between induction and deduction (Becker 2017 ), is that during the course of his research Becker adds scientifically meaningful new distinctions in the form of three phases—distinctions, or findings if you will, that strongly affect the course of his research: its focus, the material that he collects, and which eventually impact his findings. Each phase typically unfolds through social interaction, and often with input from experienced users in “a sequence of social experiences during which the person acquires a conception of the meaning of the behavior, and perceptions and judgments of objects and situations, all of which make the activity possible and desirable” (Becker 1963 :235). In this study the increased understanding of smoking dope is a result of a combination of the meaning of the actors, and the conceptual distinctions that Becker introduces based on the views expressed by his respondents. Understanding is the result of research and is due to an iterative process in which data, concepts and evidence are connected with one another (Becker 2017 ).

Indeed, there are many definitions of qualitative research, but if we look for a definition that addresses its distinctive feature of being “qualitative,” the literature across the broad field of social science is meager. The main reason behind this article lies in the paradox, which, to put it bluntly, is that researchers act as if they know what it is, but they cannot formulate a coherent definition. Sociologists and others will of course continue to conduct good studies that show the relevance and value of qualitative research addressing scientific and practical problems in society. However, our paper is grounded in the idea that providing a clear definition will help us improve the work that we do. Among researchers who practice qualitative research there is clearly much knowledge. We suggest that a definition makes this knowledge more explicit. If the first rationale for writing this paper refers to the “internal” aim of improving qualitative research, the second refers to the increased “external” pressure that especially many qualitative researchers feel; pressure that comes both from society as well as from other scientific approaches. There is a strong core in qualitative research, and leading researchers tend to agree on what it is and how it is done. Our critique is not directed at the practice of qualitative research, but we do claim that the type of systematic work we do has not yet been done, and that it is useful to improve the field and its status in relation to quantitative research.

The literature on the “internal” aim of improving, or at least clarifying qualitative research is large, and we do not claim to be the first to notice the vagueness of the term “qualitative” (Strauss and Corbin 1998 ). Also, others have noted that there is no single definition of it (Long and Godfrey 2004 :182), that there are many different views on qualitative research (Denzin and Lincoln 2003 :11; Jovanović 2011 :3), and that more generally, we need to define its meaning (Best 2004 :54). Strauss and Corbin ( 1998 ), for example, as well as Nelson et al. (1992:2 cited in Denzin and Lincoln 2003 :11), and Flick ( 2007 :ix–x), have recognized that the term is problematic: “Actually, the term ‘qualitative research’ is confusing because it can mean different things to different people” (Strauss and Corbin 1998 :10–11). Hammersley has discussed the possibility of addressing the problem, but states that “the task of providing an account of the distinctive features of qualitative research is far from straightforward” ( 2013 :2). This confusion, as he has recently further argued (Hammersley 2018 ), is also salient in relation to ethnography where different philosophical and methodological approaches lead to a lack of agreement about what it means.

Others (e.g. Hammersley 2018 ; Fine and Hancock 2017 ) have also identified the treat to qualitative research that comes from external forces, seen from the point of view of “qualitative research.” This threat can be further divided into that which comes from inside academia, such as the critique voiced by “quantitative research” and outside of academia, including, for example, New Public Management. Hammersley ( 2018 ), zooming in on one type of qualitative research, ethnography, has argued that it is under treat. Similarly to Fine ( 2003 ), and before him Gans ( 1999 ), he writes that ethnography’ has acquired a range of meanings, and comes in many different versions, these often reflecting sharply divergent epistemological orientations. And already more than twenty years ago while reviewing Denzin and Lincoln’ s Handbook of Qualitative Methods Fine argued:

While this increasing centrality [of qualitative research] might lead one to believe that consensual standards have developed, this belief would be misleading. As the methodology becomes more widely accepted, querulous challengers have raised fundamental questions that collectively have undercut the traditional models of how qualitative research is to be fashioned and presented (1995:417).

According to Hammersley, there are today “serious treats to the practice of ethnographic work, on almost any definition” ( 2018 :1). He lists five external treats: (1) that social research must be accountable and able to show its impact on society; (2) the current emphasis on “big data” and the emphasis on quantitative data and evidence; (3) the labor market pressure in academia that leaves less time for fieldwork (see also Fine and Hancock 2017 ); (4) problems of access to fields; and (5) the increased ethical scrutiny of projects, to which ethnography is particularly exposed. Hammersley discusses some more or less insufficient existing definitions of ethnography.

The current situation, as Hammersley and others note—and in relation not only to ethnography but also qualitative research in general, and as our empirical study shows—is not just unsatisfactory, it may even be harmful for the entire field of qualitative research, and does not help social science at large. We suggest that the lack of clarity of qualitative research is a real problem that must be addressed.

Towards a Definition of Qualitative Research

Seen in an historical light, what is today called qualitative, or sometimes ethnographic, interpretative research – or a number of other terms – has more or less always existed. At the time the founders of sociology – Simmel, Weber, Durkheim and, before them, Marx – were writing, and during the era of the Methodenstreit (“dispute about methods”) in which the German historical school emphasized scientific methods (cf. Swedberg 1990 ), we can at least speak of qualitative forerunners.

Perhaps the most extended discussion of what later became known as qualitative methods in a classic work is Bronisław Malinowski’s ( 1922 ) Argonauts in the Western Pacific , although even this study does not explicitly address the meaning of “qualitative.” In Weber’s ([1921–-22] 1978) work we find a tension between scientific explanations that are based on observation and quantification and interpretative research (see also Lazarsfeld and Barton 1982 ).

If we look through major sociology journals like the American Sociological Review , American Journal of Sociology , or Social Forces we will not find the term qualitative sociology before the 1970s. And certainly before then much of what we consider qualitative classics in sociology, like Becker’ study ( 1963 ), had already been produced. Indeed, the Chicago School often combined qualitative and quantitative data within the same study (Fine 1995 ). Our point being that before a disciplinary self-awareness the term quantitative preceded qualitative, and the articulation of the former was a political move to claim scientific status (Denzin and Lincoln 2005 ). In the US the World War II seem to have sparked a critique of sociological work, including “qualitative work,” that did not follow the scientific canon (Rawls 2018 ), which was underpinned by a scientifically oriented and value free philosophy of science. As a result the attempts and practice of integrating qualitative and quantitative sociology at Chicago lost ground to sociology that was more oriented to surveys and quantitative work at Columbia under Merton-Lazarsfeld. The quantitative tradition was also able to present textbooks (Lundberg 1951 ) that facilitated the use this approach and its “methods.” The practices of the qualitative tradition, by and large, remained tacit or was part of the mentoring transferred from the renowned masters to their students.

This glimpse into history leads us back to the lack of a coherent account condensed in a definition of qualitative research. Many of the attempts to define the term do not meet the requirements of a proper definition: A definition should be clear, avoid tautology, demarcate its domain in relation to the environment, and ideally only use words in its definiens that themselves are not in need of definition (Hempel 1966 ). A definition can enhance precision and thus clarity by identifying the core of the phenomenon. Preferably, a definition should be short. The typical definition we have found, however, is an ostensive definition, which indicates what qualitative research is about without informing us about what it actually is :

Qualitative research is multimethod in focus, involving an interpretative, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them. Qualitative research involves the studied use and collection of a variety of empirical materials – case study, personal experience, introspective, life story, interview, observational, historical, interactional, and visual texts – that describe routine and problematic moments and meanings in individuals’ lives. (Denzin and Lincoln 2005 :2)

Flick claims that the label “qualitative research” is indeed used as an umbrella for a number of approaches ( 2007 :2–4; 2002 :6), and it is not difficult to identify research fitting this designation. Moreover, whatever it is, it has grown dramatically over the past five decades. In addition, courses have been developed, methods have flourished, arguments about its future have been advanced (for example, Denzin and Lincoln 1994) and criticized (for example, Snow and Morrill 1995 ), and dedicated journals and books have mushroomed. Most social scientists have a clear idea of research and how it differs from journalism, politics and other activities. But the question of what is qualitative in qualitative research is either eluded or eschewed.

We maintain that this lacuna hinders systematic knowledge production based on qualitative research. Paul Lazarsfeld noted the lack of “codification” as early as 1955 when he reviewed 100 qualitative studies in order to offer a codification of the practices (Lazarsfeld and Barton 1982 :239). Since then many texts on “qualitative research” and its methods have been published, including recent attempts (Goertz and Mahoney 2012 ) similar to Lazarsfeld’s. These studies have tried to extract what is qualitative by looking at the large number of empirical “qualitative” studies. Our novel strategy complements these endeavors by taking another approach and looking at the attempts to codify these practices in the form of a definition, as well as to a minor extent take Becker’s study as an exemplar of what qualitative researchers actually do, and what the characteristic of being ‘qualitative’ denotes and implies. We claim that qualitative researchers, if there is such a thing as “qualitative research,” should be able to codify their practices in a condensed, yet general way expressed in language.

Lingering problems of “generalizability” and “how many cases do I need” (Small 2009 ) are blocking advancement – in this line of work qualitative approaches are said to differ considerably from quantitative ones, while some of the former unsuccessfully mimic principles related to the latter (Small 2009 ). Additionally, quantitative researchers sometimes unfairly criticize the first based on their own quality criteria. Scholars like Goertz and Mahoney ( 2012 ) have successfully focused on the different norms and practices beyond what they argue are essentially two different cultures: those working with either qualitative or quantitative methods. Instead, similarly to Becker ( 2017 ) who has recently questioned the usefulness of the distinction between qualitative and quantitative research, we focus on similarities.

The current situation also impedes both students and researchers in focusing their studies and understanding each other’s work (Lazarsfeld and Barton 1982 :239). A third consequence is providing an opening for critiques by scholars operating within different traditions (Valsiner 2000 :101). A fourth issue is that the “implicit use of methods in qualitative research makes the field far less standardized than the quantitative paradigm” (Goertz and Mahoney 2012 :9). Relatedly, the National Science Foundation in the US organized two workshops in 2004 and 2005 to address the scientific foundations of qualitative research involving strategies to improve it and to develop standards of evaluation in qualitative research. However, a specific focus on its distinguishing feature of being “qualitative” while being implicitly acknowledged, was discussed only briefly (for example, Best 2004 ).

In 2014 a theme issue was published in this journal on “Methods, Materials, and Meanings: Designing Cultural Analysis,” discussing central issues in (cultural) qualitative research (Berezin 2014 ; Biernacki 2014 ; Glaeser 2014 ; Lamont and Swidler 2014 ; Spillman 2014). We agree with many of the arguments put forward, such as the risk of methodological tribalism, and that we should not waste energy on debating methods separated from research questions. Nonetheless, a clarification of the relation to what is called “quantitative research” is of outmost importance to avoid misunderstandings and misguided debates between “qualitative” and “quantitative” researchers. Our strategy means that researchers, “qualitative” or “quantitative” they may be, in their actual practice may combine qualitative work and quantitative work.

In this article we accomplish three tasks. First, we systematically survey the literature for meanings of qualitative research by looking at how researchers have defined it. Drawing upon existing knowledge we find that the different meanings and ideas of qualitative research are not yet coherently integrated into one satisfactory definition. Next, we advance our contribution by offering a definition of qualitative research and illustrate its meaning and use partially by expanding on the brief example introduced earlier related to Becker’s work ( 1963 ). We offer a systematic analysis of central themes of what researchers consider to be the core of “qualitative,” regardless of style of work. These themes – which we summarize in terms of four keywords: distinction, process, closeness, improved understanding – constitute part of our literature review, in which each one appears, sometimes with others, but never all in the same definition. They serve as the foundation of our contribution. Our categories are overlapping. Their use is primarily to organize the large amount of definitions we have identified and analyzed, and not necessarily to draw a clear distinction between them. Finally, we continue the elaboration discussed above on the advantages of a clear definition of qualitative research.

In a hermeneutic fashion we propose that there is something meaningful that deserves to be labelled “qualitative research” (Gadamer 1990 ). To approach the question “What is qualitative in qualitative research?” we have surveyed the literature. In conducting our survey we first traced the word’s etymology in dictionaries, encyclopedias, handbooks of the social sciences and of methods and textbooks, mainly in English, which is common to methodology courses. It should be noted that we have zoomed in on sociology and its literature. This discipline has been the site of the largest debate and development of methods that can be called “qualitative,” which suggests that this field should be examined in great detail.

In an ideal situation we should expect that one good definition, or at least some common ideas, would have emerged over the years. This common core of qualitative research should be so accepted that it would appear in at least some textbooks. Since this is not what we found, we decided to pursue an inductive approach to capture maximal variation in the field of qualitative research; we searched in a selection of handbooks, textbooks, book chapters, and books, to which we added the analysis of journal articles. Our sample comprises a total of 89 references.

In practice we focused on the discipline that has had a clear discussion of methods, namely sociology. We also conducted a broad search in the JSTOR database to identify scholarly sociology articles published between 1998 and 2017 in English with a focus on defining or explaining qualitative research. We specifically zoom in on this time frame because we would have expect that this more mature period would have produced clear discussions on the meaning of qualitative research. To find these articles we combined a number of keywords to search the content and/or the title: qualitative (which was always included), definition, empirical, research, methodology, studies, fieldwork, interview and observation .

As a second phase of our research we searched within nine major sociological journals ( American Journal of Sociology , Sociological Theory , American Sociological Review , Contemporary Sociology , Sociological Forum , Sociological Theory , Qualitative Research , Qualitative Sociology and Qualitative Sociology Review ) for articles also published during the past 19 years (1998–2017) that had the term “qualitative” in the title and attempted to define qualitative research.

Lastly we picked two additional journals, Qualitative Research and Qualitative Sociology , in which we could expect to find texts addressing the notion of “qualitative.” From Qualitative Research we chose Volume 14, Issue 6, December 2014, and from Qualitative Sociology we chose Volume 36, Issue 2, June 2017. Within each of these we selected the first article; then we picked the second article of three prior issues. Again we went back another three issues and investigated article number three. Finally we went back another three issues and perused article number four. This selection criteria was used to get a manageable sample for the analysis.

The coding process of the 89 references we gathered in our selected review began soon after the first round of material was gathered, and we reduced the complexity created by our maximum variation sampling (Snow and Anderson 1993 :22) to four different categories within which questions on the nature and properties of qualitative research were discussed. We call them: Qualitative and Quantitative Research, Qualitative Research, Fieldwork, and Grounded Theory. This – which may appear as an illogical grouping – merely reflects the “context” in which the matter of “qualitative” is discussed. If the selection process of the material – books and articles – was informed by pre-knowledge, we used an inductive strategy to code the material. When studying our material, we identified four central notions related to “qualitative” that appear in various combinations in the literature which indicate what is the core of qualitative research. We have labeled them: “distinctions”, “process,” “closeness,” and “improved understanding.” During the research process the categories and notions were improved, refined, changed, and reordered. The coding ended when a sense of saturation in the material arose. In the presentation below all quotations and references come from our empirical material of texts on qualitative research.

Analysis – What is Qualitative Research?

In this section we describe the four categories we identified in the coding, how they differently discuss qualitative research, as well as their overall content. Some salient quotations are selected to represent the type of text sorted under each of the four categories. What we present are examples from the literature.

Qualitative and Quantitative

This analytic category comprises quotations comparing qualitative and quantitative research, a distinction that is frequently used (Brown 2010 :231); in effect this is a conceptual pair that structures the discussion and that may be associated with opposing interests. While the general goal of quantitative and qualitative research is the same – to understand the world better – their methodologies and focus in certain respects differ substantially (Becker 1966 :55). Quantity refers to that property of something that can be determined by measurement. In a dictionary of Statistics and Methodology we find that “(a) When referring to *variables, ‘qualitative’ is another term for *categorical or *nominal. (b) When speaking of kinds of research, ‘qualitative’ refers to studies of subjects that are hard to quantify, such as art history. Qualitative research tends to be a residual category for almost any kind of non-quantitative research” (Stiles 1998:183). But it should be obvious that one could employ a quantitative approach when studying, for example, art history.

The same dictionary states that quantitative is “said of variables or research that can be handled numerically, usually (too sharply) contrasted with *qualitative variables and research” (Stiles 1998:184). From a qualitative perspective “quantitative research” is about numbers and counting, and from a quantitative perspective qualitative research is everything that is not about numbers. But this does not say much about what is “qualitative.” If we turn to encyclopedias we find that in the 1932 edition of the Encyclopedia of the Social Sciences there is no mention of “qualitative.” In the Encyclopedia from 1968 we can read:

Qualitative Analysis. For methods of obtaining, analyzing, and describing data, see [the various entries:] CONTENT ANALYSIS; COUNTED DATA; EVALUATION RESEARCH, FIELD WORK; GRAPHIC PRESENTATION; HISTORIOGRAPHY, especially the article on THE RHETORIC OF HISTORY; INTERVIEWING; OBSERVATION; PERSONALITY MEASUREMENT; PROJECTIVE METHODS; PSYCHOANALYSIS, article on EXPERIMENTAL METHODS; SURVEY ANALYSIS, TABULAR PRESENTATION; TYPOLOGIES. (Vol. 13:225)

Some, like Alford, divide researchers into methodologists or, in his words, “quantitative and qualitative specialists” (Alford 1998 :12). Qualitative research uses a variety of methods, such as intensive interviews or in-depth analysis of historical materials, and it is concerned with a comprehensive account of some event or unit (King et al. 1994 :4). Like quantitative research it can be utilized to study a variety of issues, but it tends to focus on meanings and motivations that underlie cultural symbols, personal experiences, phenomena and detailed understanding of processes in the social world. In short, qualitative research centers on understanding processes, experiences, and the meanings people assign to things (Kalof et al. 2008 :79).

Others simply say that qualitative methods are inherently unscientific (Jovanović 2011 :19). Hood, for instance, argues that words are intrinsically less precise than numbers, and that they are therefore more prone to subjective analysis, leading to biased results (Hood 2006 :219). Qualitative methodologies have raised concerns over the limitations of quantitative templates (Brady et al. 2004 :4). Scholars such as King et al. ( 1994 ), for instance, argue that non-statistical research can produce more reliable results if researchers pay attention to the rules of scientific inference commonly stated in quantitative research. Also, researchers such as Becker ( 1966 :59; 1970 :42–43) have asserted that, if conducted properly, qualitative research and in particular ethnographic field methods, can lead to more accurate results than quantitative studies, in particular, survey research and laboratory experiments.

Some researchers, such as Kalof, Dan, and Dietz ( 2008 :79) claim that the boundaries between the two approaches are becoming blurred, and Small ( 2009 ) argues that currently much qualitative research (especially in North America) tries unsuccessfully and unnecessarily to emulate quantitative standards. For others, qualitative research tends to be more humanistic and discursive (King et al. 1994 :4). Ragin ( 1994 ), and similarly also Becker, ( 1996 :53), Marchel and Owens ( 2007 :303) think that the main distinction between the two styles is overstated and does not rest on the simple dichotomy of “numbers versus words” (Ragin 1994 :xii). Some claim that quantitative data can be utilized to discover associations, but in order to unveil cause and effect a complex research design involving the use of qualitative approaches needs to be devised (Gilbert 2009 :35). Consequently, qualitative data are useful for understanding the nuances lying beyond those processes as they unfold (Gilbert 2009 :35). Others contend that qualitative research is particularly well suited both to identify causality and to uncover fine descriptive distinctions (Fine and Hallett 2014 ; Lichterman and Isaac Reed 2014 ; Katz 2015 ).

There are other ways to separate these two traditions, including normative statements about what qualitative research should be (that is, better or worse than quantitative approaches, concerned with scientific approaches to societal change or vice versa; Snow and Morrill 1995 ; Denzin and Lincoln 2005 ), or whether it should develop falsifiable statements; Best 2004 ).

We propose that quantitative research is largely concerned with pre-determined variables (Small 2008 ); the analysis concerns the relations between variables. These categories are primarily not questioned in the study, only their frequency or degree, or the correlations between them (cf. Franzosi 2016 ). If a researcher studies wage differences between women and men, he or she works with given categories: x number of men are compared with y number of women, with a certain wage attributed to each person. The idea is not to move beyond the given categories of wage, men and women; they are the starting point as well as the end point, and undergo no “qualitative change.” Qualitative research, in contrast, investigates relations between categories that are themselves subject to change in the research process. Returning to Becker’s study ( 1963 ), we see that he questioned pre-dispositional theories of deviant behavior working with pre-determined variables such as an individual’s combination of personal qualities or emotional problems. His take, in contrast, was to understand marijuana consumption by developing “variables” as part of the investigation. Thereby he presented new variables, or as we would say today, theoretical concepts, but which are grounded in the empirical material.

Qualitative Research

This category contains quotations that refer to descriptions of qualitative research without making comparisons with quantitative research. Researchers such as Denzin and Lincoln, who have written a series of influential handbooks on qualitative methods (1994; Denzin and Lincoln 2003 ; 2005 ), citing Nelson et al. (1992:4), argue that because qualitative research is “interdisciplinary, transdisciplinary, and sometimes counterdisciplinary” it is difficult to derive one single definition of it (Jovanović 2011 :3). According to them, in fact, “the field” is “many things at the same time,” involving contradictions, tensions over its focus, methods, and how to derive interpretations and findings ( 2003 : 11). Similarly, others, such as Flick ( 2007 :ix–x) contend that agreeing on an accepted definition has increasingly become problematic, and that qualitative research has possibly matured different identities. However, Best holds that “the proliferation of many sorts of activities under the label of qualitative sociology threatens to confuse our discussions” ( 2004 :54). Atkinson’s position is more definite: “the current state of qualitative research and research methods is confused” ( 2005 :3–4).

Qualitative research is about interpretation (Blumer 1969 ; Strauss and Corbin 1998 ; Denzin and Lincoln 2003 ), or Verstehen [understanding] (Frankfort-Nachmias and Nachmias 1996 ). It is “multi-method,” involving the collection and use of a variety of empirical materials (Denzin and Lincoln 1998; Silverman 2013 ) and approaches (Silverman 2005 ; Flick 2007 ). It focuses not only on the objective nature of behavior but also on its subjective meanings: individuals’ own accounts of their attitudes, motivations, behavior (McIntyre 2005 :127; Creswell 2009 ), events and situations (Bryman 1989) – what people say and do in specific places and institutions (Goodwin and Horowitz 2002 :35–36) in social and temporal contexts (Morrill and Fine 1997). For this reason, following Weber ([1921-22] 1978), it can be described as an interpretative science (McIntyre 2005 :127). But could quantitative research also be concerned with these questions? Also, as pointed out below, does all qualitative research focus on subjective meaning, as some scholars suggest?

Others also distinguish qualitative research by claiming that it collects data using a naturalistic approach (Denzin and Lincoln 2005 :2; Creswell 2009 ), focusing on the meaning actors ascribe to their actions. But again, does all qualitative research need to be collected in situ? And does qualitative research have to be inherently concerned with meaning? Flick ( 2007 ), referring to Denzin and Lincoln ( 2005 ), mentions conversation analysis as an example of qualitative research that is not concerned with the meanings people bring to a situation, but rather with the formal organization of talk. Still others, such as Ragin ( 1994 :85), note that qualitative research is often (especially early on in the project, we would add) less structured than other kinds of social research – a characteristic connected to its flexibility and that can lead both to potentially better, but also worse results. But is this not a feature of this type of research, rather than a defining description of its essence? Wouldn’t this comment also apply, albeit to varying degrees, to quantitative research?

In addition, Strauss ( 2003 ), along with others, such as Alvesson and Kärreman ( 2011 :10–76), argue that qualitative researchers struggle to capture and represent complex phenomena partially because they tend to collect a large amount of data. While his analysis is correct at some points – “It is necessary to do detailed, intensive, microscopic examination of the data in order to bring out the amazing complexity of what lies in, behind, and beyond those data” (Strauss 2003 :10) – much of his analysis concerns the supposed focus of qualitative research and its challenges, rather than exactly what it is about. But even in this instance we would make a weak case arguing that these are strictly the defining features of qualitative research. Some researchers seem to focus on the approach or the methods used, or even on the way material is analyzed. Several researchers stress the naturalistic assumption of investigating the world, suggesting that meaning and interpretation appear to be a core matter of qualitative research.

We can also see that in this category there is no consensus about specific qualitative methods nor about qualitative data. Many emphasize interpretation, but quantitative research, too, involves interpretation; the results of a regression analysis, for example, certainly have to be interpreted, and the form of meta-analysis that factor analysis provides indeed requires interpretation However, there is no interpretation of quantitative raw data, i.e., numbers in tables. One common thread is that qualitative researchers have to get to grips with their data in order to understand what is being studied in great detail, irrespective of the type of empirical material that is being analyzed. This observation is connected to the fact that qualitative researchers routinely make several adjustments of focus and research design as their studies progress, in many cases until the very end of the project (Kalof et al. 2008 ). If you, like Becker, do not start out with a detailed theory, adjustments such as the emergence and refinement of research questions will occur during the research process. We have thus found a number of useful reflections about qualitative research scattered across different sources, but none of them effectively describe the defining characteristics of this approach.

Although qualitative research does not appear to be defined in terms of a specific method, it is certainly common that fieldwork, i.e., research that entails that the researcher spends considerable time in the field that is studied and use the knowledge gained as data, is seen as emblematic of or even identical to qualitative research. But because we understand that fieldwork tends to focus primarily on the collection and analysis of qualitative data, we expected to find within it discussions on the meaning of “qualitative.” But, again, this was not the case.

Instead, we found material on the history of this approach (for example, Frankfort-Nachmias and Nachmias 1996 ; Atkinson et al. 2001), including how it has changed; for example, by adopting a more self-reflexive practice (Heyl 2001), as well as the different nomenclature that has been adopted, such as fieldwork, ethnography, qualitative research, naturalistic research, participant observation and so on (for example, Lofland et al. 2006 ; Gans 1999 ).

We retrieved definitions of ethnography, such as “the study of people acting in the natural courses of their daily lives,” involving a “resocialization of the researcher” (Emerson 1988 :1) through intense immersion in others’ social worlds (see also examples in Hammersley 2018 ). This may be accomplished by direct observation and also participation (Neuman 2007 :276), although others, such as Denzin ( 1970 :185), have long recognized other types of observation, including non-participant (“fly on the wall”). In this category we have also isolated claims and opposing views, arguing that this type of research is distinguished primarily by where it is conducted (natural settings) (Hughes 1971:496), and how it is carried out (a variety of methods are applied) or, for some most importantly, by involving an active, empathetic immersion in those being studied (Emerson 1988 :2). We also retrieved descriptions of the goals it attends in relation to how it is taught (understanding subjective meanings of the people studied, primarily develop theory, or contribute to social change) (see for example, Corte and Irwin 2017 ; Frankfort-Nachmias and Nachmias 1996 :281; Trier-Bieniek 2012 :639) by collecting the richest possible data (Lofland et al. 2006 ) to derive “thick descriptions” (Geertz 1973 ), and/or to aim at theoretical statements of general scope and applicability (for example, Emerson 1988 ; Fine 2003 ). We have identified guidelines on how to evaluate it (for example Becker 1996 ; Lamont 2004 ) and have retrieved instructions on how it should be conducted (for example, Lofland et al. 2006 ). For instance, analysis should take place while the data gathering unfolds (Emerson 1988 ; Hammersley and Atkinson 2007 ; Lofland et al. 2006 ), observations should be of long duration (Becker 1970 :54; Goffman 1989 ), and data should be of high quantity (Becker 1970 :52–53), as well as other questionable distinctions between fieldwork and other methods:

Field studies differ from other methods of research in that the researcher performs the task of selecting topics, decides what questions to ask, and forges interest in the course of the research itself . This is in sharp contrast to many ‘theory-driven’ and ‘hypothesis-testing’ methods. (Lofland and Lofland 1995 :5)

But could not, for example, a strictly interview-based study be carried out with the same amount of flexibility, such as sequential interviewing (for example, Small 2009 )? Once again, are quantitative approaches really as inflexible as some qualitative researchers think? Moreover, this category stresses the role of the actors’ meaning, which requires knowledge and close interaction with people, their practices and their lifeworld.

It is clear that field studies – which are seen by some as the “gold standard” of qualitative research – are nonetheless only one way of doing qualitative research. There are other methods, but it is not clear why some are more qualitative than others, or why they are better or worse. Fieldwork is characterized by interaction with the field (the material) and understanding of the phenomenon that is being studied. In Becker’s case, he had general experience from fields in which marihuana was used, based on which he did interviews with actual users in several fields.

Grounded Theory

Another major category we identified in our sample is Grounded Theory. We found descriptions of it most clearly in Glaser and Strauss’ ([1967] 2010 ) original articulation, Strauss and Corbin ( 1998 ) and Charmaz ( 2006 ), as well as many other accounts of what it is for: generating and testing theory (Strauss 2003 :xi). We identified explanations of how this task can be accomplished – such as through two main procedures: constant comparison and theoretical sampling (Emerson 1998:96), and how using it has helped researchers to “think differently” (for example, Strauss and Corbin 1998 :1). We also read descriptions of its main traits, what it entails and fosters – for instance, an exceptional flexibility, an inductive approach (Strauss and Corbin 1998 :31–33; 1990; Esterberg 2002 :7), an ability to step back and critically analyze situations, recognize tendencies towards bias, think abstractly and be open to criticism, enhance sensitivity towards the words and actions of respondents, and develop a sense of absorption and devotion to the research process (Strauss and Corbin 1998 :5–6). Accordingly, we identified discussions of the value of triangulating different methods (both using and not using grounded theory), including quantitative ones, and theories to achieve theoretical development (most comprehensively in Denzin 1970 ; Strauss and Corbin 1998 ; Timmermans and Tavory 2012 ). We have also located arguments about how its practice helps to systematize data collection, analysis and presentation of results (Glaser and Strauss [1967] 2010 :16).

Grounded theory offers a systematic approach which requires researchers to get close to the field; closeness is a requirement of identifying questions and developing new concepts or making further distinctions with regard to old concepts. In contrast to other qualitative approaches, grounded theory emphasizes the detailed coding process, and the numerous fine-tuned distinctions that the researcher makes during the process. Within this category, too, we could not find a satisfying discussion of the meaning of qualitative research.

Defining Qualitative Research

In sum, our analysis shows that some notions reappear in the discussion of qualitative research, such as understanding, interpretation, “getting close” and making distinctions. These notions capture aspects of what we think is “qualitative.” However, a comprehensive definition that is useful and that can further develop the field is lacking, and not even a clear picture of its essential elements appears. In other words no definition emerges from our data, and in our research process we have moved back and forth between our empirical data and the attempt to present a definition. Our concrete strategy, as stated above, is to relate qualitative and quantitative research, or more specifically, qualitative and quantitative work. We use an ideal-typical notion of quantitative research which relies on taken for granted and numbered variables. This means that the data consists of variables on different scales, such as ordinal, but frequently ratio and absolute scales, and the representation of the numbers to the variables, i.e. the justification of the assignment of numbers to object or phenomenon, are not questioned, though the validity may be questioned. In this section we return to the notion of quality and try to clarify it while presenting our contribution.

Broadly, research refers to the activity performed by people trained to obtain knowledge through systematic procedures. Notions such as “objectivity” and “reflexivity,” “systematic,” “theory,” “evidence” and “openness” are here taken for granted in any type of research. Next, building on our empirical analysis we explain the four notions that we have identified as central to qualitative work: distinctions, process, closeness, and improved understanding. In discussing them, ultimately in relation to one another, we make their meaning even more precise. Our idea, in short, is that only when these ideas that we present separately for analytic purposes are brought together can we speak of qualitative research.

Distinctions

We believe that the possibility of making new distinctions is one the defining characteristics of qualitative research. It clearly sets it apart from quantitative analysis which works with taken-for-granted variables, albeit as mentioned, meta-analyses, for example, factor analysis may result in new variables. “Quality” refers essentially to distinctions, as already pointed out by Aristotle. He discusses the term “qualitative” commenting: “By a quality I mean that in virtue of which things are said to be qualified somehow” (Aristotle 1984:14). Quality is about what something is or has, which means that the distinction from its environment is crucial. We see qualitative research as a process in which significant new distinctions are made to the scholarly community; to make distinctions is a key aspect of obtaining new knowledge; a point, as we will see, that also has implications for “quantitative research.” The notion of being “significant” is paramount. New distinctions by themselves are not enough; just adding concepts only increases complexity without furthering our knowledge. The significance of new distinctions is judged against the communal knowledge of the research community. To enable this discussion and judgements central elements of rational discussion are required (cf. Habermas [1981] 1987 ; Davidsson [ 1988 ] 2001) to identify what is new and relevant scientific knowledge. Relatedly, Ragin alludes to the idea of new and useful knowledge at a more concrete level: “Qualitative methods are appropriate for in-depth examination of cases because they aid the identification of key features of cases. Most qualitative methods enhance data” (1994:79). When Becker ( 1963 ) studied deviant behavior and investigated how people became marihuana smokers, he made distinctions between the ways in which people learned how to smoke. This is a classic example of how the strategy of “getting close” to the material, for example the text, people or pictures that are subject to analysis, may enable researchers to obtain deeper insight and new knowledge by making distinctions – in this instance on the initial notion of learning how to smoke. Others have stressed the making of distinctions in relation to coding or theorizing. Emerson et al. ( 1995 ), for example, hold that “qualitative coding is a way of opening up avenues of inquiry,” meaning that the researcher identifies and develops concepts and analytic insights through close examination of and reflection on data (Emerson et al. 1995 :151). Goodwin and Horowitz highlight making distinctions in relation to theory-building writing: “Close engagement with their cases typically requires qualitative researchers to adapt existing theories or to make new conceptual distinctions or theoretical arguments to accommodate new data” ( 2002 : 37). In the ideal-typical quantitative research only existing and so to speak, given, variables would be used. If this is the case no new distinction are made. But, would not also many “quantitative” researchers make new distinctions?

Process does not merely suggest that research takes time. It mainly implies that qualitative new knowledge results from a process that involves several phases, and above all iteration. Qualitative research is about oscillation between theory and evidence, analysis and generating material, between first- and second -order constructs (Schütz 1962 :59), between getting in contact with something, finding sources, becoming deeply familiar with a topic, and then distilling and communicating some of its essential features. The main point is that the categories that the researcher uses, and perhaps takes for granted at the beginning of the research process, usually undergo qualitative changes resulting from what is found. Becker describes how he tested hypotheses and let the jargon of the users develop into theoretical concepts. This happens over time while the study is being conducted, exemplifying what we mean by process.

In the research process, a pilot-study may be used to get a first glance of, for example, the field, how to approach it, and what methods can be used, after which the method and theory are chosen or refined before the main study begins. Thus, the empirical material is often central from the start of the project and frequently leads to adjustments by the researcher. Likewise, during the main study categories are not fixed; the empirical material is seen in light of the theory used, but it is also given the opportunity to kick back, thereby resisting attempts to apply theoretical straightjackets (Becker 1970 :43). In this process, coding and analysis are interwoven, and thus are often important steps for getting closer to the phenomenon and deciding what to focus on next. Becker began his research by interviewing musicians close to him, then asking them to refer him to other musicians, and later on doubling his original sample of about 25 to include individuals in other professions (Becker 1973:46). Additionally, he made use of some participant observation, documents, and interviews with opiate users made available to him by colleagues. As his inductive theory of deviance evolved, Becker expanded his sample in order to fine tune it, and test the accuracy and generality of his hypotheses. In addition, he introduced a negative case and discussed the null hypothesis ( 1963 :44). His phasic career model is thus based on a research design that embraces processual work. Typically, process means to move between “theory” and “material” but also to deal with negative cases, and Becker ( 1998 ) describes how discovering these negative cases impacted his research design and ultimately its findings.

Obviously, all research is process-oriented to some degree. The point is that the ideal-typical quantitative process does not imply change of the data, and iteration between data, evidence, hypotheses, empirical work, and theory. The data, quantified variables, are, in most cases fixed. Merging of data, which of course can be done in a quantitative research process, does not mean new data. New hypotheses are frequently tested, but the “raw data is often the “the same.” Obviously, over time new datasets are made available and put into use.

Another characteristic that is emphasized in our sample is that qualitative researchers – and in particular ethnographers – can, or as Goffman put it, ought to ( 1989 ), get closer to the phenomenon being studied and their data than quantitative researchers (for example, Silverman 2009 :85). Put differently, essentially because of their methods qualitative researchers get into direct close contact with those being investigated and/or the material, such as texts, being analyzed. Becker started out his interview study, as we noted, by talking to those he knew in the field of music to get closer to the phenomenon he was studying. By conducting interviews he got even closer. Had he done more observations, he would undoubtedly have got even closer to the field.

Additionally, ethnographers’ design enables researchers to follow the field over time, and the research they do is almost by definition longitudinal, though the time in the field is studied obviously differs between studies. The general characteristic of closeness over time maximizes the chances of unexpected events, new data (related, for example, to archival research as additional sources, and for ethnography for situations not necessarily previously thought of as instrumental – what Mannay and Morgan ( 2015 ) term the “waiting field”), serendipity (Merton and Barber 2004 ; Åkerström 2013 ), and possibly reactivity, as well as the opportunity to observe disrupted patterns that translate into exemplars of negative cases. Two classic examples of this are Becker’s finding of what medical students call “crocks” (Becker et al. 1961 :317), and Geertz’s ( 1973 ) study of “deep play” in Balinese society.

By getting and staying so close to their data – be it pictures, text or humans interacting (Becker was himself a musician) – for a long time, as the research progressively focuses, qualitative researchers are prompted to continually test their hunches, presuppositions and hypotheses. They test them against a reality that often (but certainly not always), and practically, as well as metaphorically, talks back, whether by validating them, or disqualifying their premises – correctly, as well as incorrectly (Fine 2003 ; Becker 1970 ). This testing nonetheless often leads to new directions for the research. Becker, for example, says that he was initially reading psychological theories, but when facing the data he develops a theory that looks at, you may say, everything but psychological dispositions to explain the use of marihuana. Especially researchers involved with ethnographic methods have a fairly unique opportunity to dig up and then test (in a circular, continuous and temporal way) new research questions and findings as the research progresses, and thereby to derive previously unimagined and uncharted distinctions by getting closer to the phenomenon under study.

Let us stress that getting close is by no means restricted to ethnography. The notion of hermeneutic circle and hermeneutics as a general way of understanding implies that we must get close to the details in order to get the big picture. This also means that qualitative researchers can literally also make use of details of pictures as evidence (cf. Harper 2002). Thus, researchers may get closer both when generating the material or when analyzing it.

Quantitative research, we maintain, in the ideal-typical representation cannot get closer to the data. The data is essentially numbers in tables making up the variables (Franzosi 2016 :138). The data may originally have been “qualitative,” but once reduced to numbers there can only be a type of “hermeneutics” about what the number may stand for. The numbers themselves, however, are non-ambiguous. Thus, in quantitative research, interpretation, if done, is not about the data itself—the numbers—but what the numbers stand for. It follows that the interpretation is essentially done in a more “speculative” mode without direct empirical evidence (cf. Becker 2017 ).

Improved Understanding

While distinction, process and getting closer refer to the qualitative work of the researcher, improved understanding refers to its conditions and outcome of this work. Understanding cuts deeper than explanation, which to some may mean a causally verified correlation between variables. The notion of explanation presupposes the notion of understanding since explanation does not include an idea of how knowledge is gained (Manicas 2006 : 15). Understanding, we argue, is the core concept of what we call the outcome of the process when research has made use of all the other elements that were integrated in the research. Understanding, then, has a special status in qualitative research since it refers both to the conditions of knowledge and the outcome of the process. Understanding can to some extent be seen as the condition of explanation and occurs in a process of interpretation, which naturally refers to meaning (Gadamer 1990 ). It is fundamentally connected to knowing, and to the knowing of how to do things (Heidegger [1927] 2001 ). Conceptually the term hermeneutics is used to account for this process. Heidegger ties hermeneutics to human being and not possible to separate from the understanding of being ( 1988 ). Here we use it in a broader sense, and more connected to method in general (cf. Seiffert 1992 ). The abovementioned aspects – for example, “objectivity” and “reflexivity” – of the approach are conditions of scientific understanding. Understanding is the result of a circular process and means that the parts are understood in light of the whole, and vice versa. Understanding presupposes pre-understanding, or in other words, some knowledge of the phenomenon studied. The pre-understanding, even in the form of prejudices, are in qualitative research process, which we see as iterative, questioned, which gradually or suddenly change due to the iteration of data, evidence and concepts. However, qualitative research generates understanding in the iterative process when the researcher gets closer to the data, e.g., by going back and forth between field and analysis in a process that generates new data that changes the evidence, and, ultimately, the findings. Questioning, to ask questions, and put what one assumes—prejudices and presumption—in question, is central to understand something (Heidegger [1927] 2001 ; Gadamer 1990 :368–384). We propose that this iterative process in which the process of understanding occurs is characteristic of qualitative research.

Improved understanding means that we obtain scientific knowledge of something that we as a scholarly community did not know before, or that we get to know something better. It means that we understand more about how parts are related to one another, and to other things we already understand (see also Fine and Hallett 2014 ). Understanding is an important condition for qualitative research. It is not enough to identify correlations, make distinctions, and work in a process in which one gets close to the field or phenomena. Understanding is accomplished when the elements are integrated in an iterative process.

It is, moreover, possible to understand many things, and researchers, just like children, may come to understand new things every day as they engage with the world. This subjective condition of understanding – namely, that a person gains a better understanding of something –is easily met. To be qualified as “scientific,” the understanding must be general and useful to many; it must be public. But even this generally accessible understanding is not enough in order to speak of “scientific understanding.” Though we as a collective can increase understanding of everything in virtually all potential directions as a result also of qualitative work, we refrain from this “objective” way of understanding, which has no means of discriminating between what we gain in understanding. Scientific understanding means that it is deemed relevant from the scientific horizon (compare Schütz 1962 : 35–38, 46, 63), and that it rests on the pre-understanding that the scientists have and must have in order to understand. In other words, the understanding gained must be deemed useful by other researchers, so that they can build on it. We thus see understanding from a pragmatic, rather than a subjective or objective perspective. Improved understanding is related to the question(s) at hand. Understanding, in order to represent an improvement, must be an improvement in relation to the existing body of knowledge of the scientific community (James [ 1907 ] 1955). Scientific understanding is, by definition, collective, as expressed in Weber’s famous note on objectivity, namely that scientific work aims at truths “which … can claim, even for a Chinese, the validity appropriate to an empirical analysis” ([1904] 1949 :59). By qualifying “improved understanding” we argue that it is a general defining characteristic of qualitative research. Becker‘s ( 1966 ) study and other research of deviant behavior increased our understanding of the social learning processes of how individuals start a behavior. And it also added new knowledge about the labeling of deviant behavior as a social process. Few studies, of course, make the same large contribution as Becker’s, but are nonetheless qualitative research.

Understanding in the phenomenological sense, which is a hallmark of qualitative research, we argue, requires meaning and this meaning is derived from the context, and above all the data being analyzed. The ideal-typical quantitative research operates with given variables with different numbers. This type of material is not enough to establish meaning at the level that truly justifies understanding. In other words, many social science explanations offer ideas about correlations or even causal relations, but this does not mean that the meaning at the level of the data analyzed, is understood. This leads us to say that there are indeed many explanations that meet the criteria of understanding, for example the explanation of how one becomes a marihuana smoker presented by Becker. However, we may also understand a phenomenon without explaining it, and we may have potential explanations, or better correlations, that are not really understood.

We may speak more generally of quantitative research and its data to clarify what we see as an important distinction. The “raw data” that quantitative research—as an idealtypical activity, refers to is not available for further analysis; the numbers, once created, are not to be questioned (Franzosi 2016 : 138). If the researcher is to do “more” or “change” something, this will be done by conjectures based on theoretical knowledge or based on the researcher’s lifeworld. Both qualitative and quantitative research is based on the lifeworld, and all researchers use prejudices and pre-understanding in the research process. This idea is present in the works of Heidegger ( 2001 ) and Heisenberg (cited in Franzosi 2010 :619). Qualitative research, as we argued, involves the interaction and questioning of concepts (theory), data, and evidence.

Ragin ( 2004 :22) points out that “a good definition of qualitative research should be inclusive and should emphasize its key strengths and features, not what it lacks (for example, the use of sophisticated quantitative techniques).” 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. Qualitative research, as defined here, is consequently a combination of two criteria: (i) how to do things –namely, generating and analyzing empirical material, in an iterative process in which one gets closer by making distinctions, and (ii) the outcome –improved understanding novel to the scholarly community. Is our definition applicable to our own study? In this study we have closely read the empirical material that we generated, and the novel distinction of the notion “qualitative research” is the outcome of an iterative process in which both deduction and induction were involved, in which we identified the categories that we analyzed. We thus claim to meet the first criteria, “how to do things.” The second criteria cannot be judged but in a partial way by us, namely that the “outcome” —in concrete form the definition-improves our understanding to others in the scientific community.

We have defined qualitative research, or qualitative scientific work, in relation to quantitative scientific work. Given this definition, qualitative research is about questioning the pre-given (taken for granted) variables, but it is thus also about making new distinctions of any type of phenomenon, for example, by coining new concepts, including the identification of new variables. This process, as we have discussed, is carried out in relation to empirical material, previous research, and thus in relation to theory. Theory and previous research cannot be escaped or bracketed. According to hermeneutic principles all scientific work is grounded in the lifeworld, and as social scientists we can thus never fully bracket our pre-understanding.

We have proposed that quantitative research, as an idealtype, is concerned with pre-determined variables (Small 2008 ). Variables are epistemically fixed, but can vary in terms of dimensions, such as frequency or number. Age is an example; as a variable it can take on different numbers. In relation to quantitative research, qualitative research does not reduce its material to number and variables. If this is done the process of comes to a halt, the researcher gets more distanced from her data, and it makes it no longer possible to make new distinctions that increase our understanding. We have above discussed the components of our definition in relation to quantitative research. Our conclusion is that in the research that is called quantitative there are frequent and necessary qualitative elements.

Further, comparative empirical research on researchers primarily working with ”quantitative” approaches and those working with ”qualitative” approaches, we propose, would perhaps show that there are many similarities in practices of these two approaches. This is not to deny dissimilarities, or the different epistemic and ontic presuppositions that may be more or less strongly associated with the two different strands (see Goertz and Mahoney 2012 ). Our point is nonetheless that prejudices and preconceptions about researchers are unproductive, and that as other researchers have argued, differences may be exaggerated (e.g., Becker 1996 : 53, 2017 ; Marchel and Owens 2007 :303; Ragin 1994 ), and that a qualitative dimension is present in both kinds of work.

Several things follow from our findings. The most important result is the relation to quantitative research. In our analysis we have separated qualitative research from quantitative research. The point is not to label individual researchers, methods, projects, or works as either “quantitative” or “qualitative.” By analyzing, i.e., taking apart, the notions of quantitative and qualitative, we hope to have shown the elements of qualitative research. Our definition captures the elements, and how they, when combined in practice, generate understanding. As many of the quotations we have used suggest, one conclusion of our study holds that qualitative approaches are not inherently connected with a specific method. Put differently, none of the methods that are frequently labelled “qualitative,” such as interviews or participant observation, are inherently “qualitative.” What matters, given our definition, is whether one works qualitatively or quantitatively in the research process, until the results are produced. Consequently, our analysis also suggests that those researchers working with what in the literature and in jargon is often called “quantitative research” are almost bound to make use of what we have identified as qualitative elements in any research project. Our findings also suggest that many” quantitative” researchers, at least to some extent, are engaged with qualitative work, such as when research questions are developed, variables are constructed and combined, and hypotheses are formulated. Furthermore, a research project may hover between “qualitative” and “quantitative” or start out as “qualitative” and later move into a “quantitative” (a distinct strategy that is not similar to “mixed methods” or just simply combining induction and deduction). More generally speaking, the categories of “qualitative” and “quantitative,” unfortunately, often cover up practices, and it may lead to “camps” of researchers opposing one another. For example, regardless of the researcher is primarily oriented to “quantitative” or “qualitative” research, the role of theory is neglected (cf. Swedberg 2017 ). Our results open up for an interaction not characterized by differences, but by different emphasis, and similarities.

Let us take two examples to briefly indicate how qualitative elements can fruitfully be combined with quantitative. Franzosi ( 2010 ) has discussed the relations between quantitative and qualitative approaches, and more specifically the relation between words and numbers. He analyzes texts and argues that scientific meaning cannot be reduced to numbers. Put differently, the meaning of the numbers is to be understood by what is taken for granted, and what is part of the lifeworld (Schütz 1962 ). Franzosi shows how one can go about using qualitative and quantitative methods and data to address scientific questions analyzing violence in Italy at the time when fascism was rising (1919–1922). Aspers ( 2006 ) studied the meaning of fashion photographers. He uses an empirical phenomenological approach, and establishes meaning at the level of actors. In a second step this meaning, and the different ideal-typical photographers constructed as a result of participant observation and interviews, are tested using quantitative data from a database; in the first phase to verify the different ideal-types, in the second phase to use these types to establish new knowledge about the types. In both of these cases—and more examples can be found—authors move from qualitative data and try to keep the meaning established when using the quantitative data.

A second main result of our study is that a definition, and we provided one, offers a way for research to clarify, and even evaluate, what is done. Hence, our definition can guide researchers and students, informing them on how to think about concrete research problems they face, and to show what it means to get closer in a process in which new distinctions are made. The definition can also be used to evaluate the results, given that it is a standard of evaluation (cf. Hammersley 2007 ), to see whether new distinctions are made and whether this improves our understanding of what is researched, in addition to the evaluation of how the research was conducted. By making what is qualitative research explicit it becomes easier to communicate findings, and it is thereby much harder to fly under the radar with substandard research since there are standards of evaluation which make it easier to separate “good” from “not so good” qualitative research.

To conclude, our analysis, which ends with a definition of qualitative research can thus both address the “internal” issues of what is qualitative research, and the “external” critiques that make it harder to do qualitative research, to which both pressure from quantitative methods and general changes in society contribute.

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Acknowledgements

Financial Support for this research is given by the European Research Council, CEV (263699). The authors are grateful to Susann Krieglsteiner for assistance in collecting the data. The paper has benefitted from the many useful comments by the three reviewers and the editor, comments by members of the Uppsala Laboratory of Economic Sociology, as well as Jukka Gronow, Sebastian Kohl, Marcin Serafin, Richard Swedberg, Anders Vassenden and Turid Rødne.

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Aspers, P., Corte, U. What is Qualitative in Qualitative Research. Qual Sociol 42 , 139–160 (2019). https://doi.org/10.1007/s11133-019-9413-7

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Qualitative Research Definition

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Table of Contents

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

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

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

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

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Who Uses Qualitative Research?

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

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

Other careers that may involve qualitative research include: 

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

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

Grounded Theory

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

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

Action Research

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

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

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Phenomenological Research

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

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

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Ethnography

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

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

Case Studies

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

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

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

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

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

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

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

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

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

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

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

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Qualitative vs Quantitative Research Methods & Data Analysis

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What is the difference between quantitative and qualitative?

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

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

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

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

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

What Is Qualitative Research?

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

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

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

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

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

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

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

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

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

Qualitative Methods

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

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

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

Here are some examples of qualitative data:

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

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

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

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

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

Qualitative Data Analysis

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

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

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

Key Features

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

Limitations of Qualitative Research

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

Advantages of Qualitative Research

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

What Is Quantitative Research?

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

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

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

Quantitative Methods

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

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

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

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

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

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

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

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

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

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

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

Quantitative Data Analysis

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

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

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

Limitations of Quantitative Research

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

Advantages of Quantitative Research

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

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

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

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

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

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

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

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

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

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

Further Information

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

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Research methods for qualitative research explained.

Home » Research Methods for Qualitative Research Explained

Qualitative Research Techniques focus on understanding human behavior and experiences through in-depth exploration. These techniques allow researchers to delve into individual perspectives, revealing the complexities and nuances of their thoughts and feelings. For instance, conducting interviews or focus groups can unearth insights that traditional quantitative methods may overlook.

By embracing various qualitative approaches, researchers can gather rich, descriptive data that enhances their understanding of social phenomena. This comprehensive perspective not only informs practices but also shapes future inquiries. Understanding these techniques is essential for any researcher aiming to grasp the depth of human experience and contextual relevance in their work.

Understanding the Importance of Qualitative Research Techniques

Qualitative research techniques play a pivotal role in understanding the complexities of human behavior and experiences. Unlike quantitative methods, which may merely present numbers, qualitative research captures the nuances and depths of opinions, motivations, and emotions. This exploration allows researchers to gather rich, detailed insights that can inform decisions and strategies effectively.

Furthermore, utilizing qualitative techniques helps unveil underlying patterns and themes that quantitative data might overlook. Techniques such as interviews, focus groups, and observations provide a platform for participants to share their thoughts in their own words. This narrative approach contributes to a more comprehensive view of the subject matter. In essence, qualitative research techniques not only enhance data reliability but also ensure that the findings are actionable and relevant, fostering informed decisions in various fields.

Historical Context and Evolution

Qualitative research techniques have evolved significantly over the years, reflecting broader societal changes and shifts in research paradigms. Initially, qualitative research emerged from disciplines such as anthropology and sociology, where in-depth understanding of human behavior and cultural contexts was paramount. Early methods focused on observational studies and interviews, aiming to capture the complexities of lived experiences.

As understanding and appreciation of qualitative methods grew, researchers began to innovate, integrating various techniques and frameworks. Notably, approaches like grounded theory and phenomenology emerged, emphasizing participant perspectives and the co-construction of meaning. This evolution has not only enriched qualitative research techniques but also enhanced their relevance across disciplines, including market research and user experience studies. As a result, qualitative research has matured into a robust discipline that continues to adapt to new challenges and opportunities in understanding human behavior.

Core Principles and Objectives

Core principles of qualitative research revolve around understanding the deeper meanings, experiences, and perspectives of respondents. Unlike quantitative methods, qualitative research techniques prioritize context and narrative, allowing researchers to explore complex social phenomena. This approach encourages open-ended inquiry, leading to rich, descriptive data that reveals participants' thoughts, feelings, and motivations.

The objectives of qualitative research include capturing subjective experiences and generating insights into participants' behaviors and beliefs. To achieve these goals, researchers focus on three key aspects:

Flexibility in Research Design : Qualitative studies often adapt as data is collected, allowing researchers to follow unexpected leads or refine questions for clarity.

Interpreting Social Contexts : Recognizing the social and cultural backgrounds of participants enables richer, more relevant interpretations of the data.

Engagement with Participants : Building rapport fosters trust and openness, enhancing the depth of responses and the quality of insights gained.

Emphasizing these principles and objectives ultimately leads to more meaningful understanding in qualitative research.

Major Qualitative Research Techniques Explained

Qualitative Research Techniques are essential for understanding complex human behaviors and social phenomena. Among the primary techniques in qualitative research are interviews, focus groups, ethnography, and content analysis. Each technique offers unique insights and depths of understanding, allowing researchers to explore participants' perspectives and experiences.

Interviews involve direct, in-depth conversations, enabling researchers to probe deeper into individual experiences. Focus groups gather diverse viewpoints in a conversational format, often sparking discussions that reveal group dynamics. Ethnography immerses researchers in a community, providing a holistic view of cultural contexts. Lastly, content analysis systematically evaluates texts and media to identify patterns and themes. Each of these techniques contributes to a nuanced understanding of the subject matter, enriching qualitative research outcomes. Together, they form a robust toolkit for exploring human experiences and social interactions.

Key Qualitative Research Techniques for Data Collection

Qualitative research techniques are essential for effective data collection, providing deep insights into human experiences and behaviors. The primary techniques include in-depth interviews, focus groups, and participant observation. Each technique serves a unique purpose and can significantly enhance the richness of the data gathered.

In-depth interviews foster a one-on-one dialogue, allowing researchers to delve deep into participants' thoughts and feelings. Focus groups facilitate group discussions, generating dynamic interaction and diverse viewpoints. Finally, participant observation immerses researchers in the environment, capturing real-world contexts and behaviors. By employing these key qualitative research techniques, researchers can uncover nuanced perspectives, leading to a more comprehensive understanding of the subject matter. Utilizing these approaches ensures that data collection is both insightful and reflective of the participants' realities.

Interviews and Focus Groups

Interviews and focus groups are essential qualitative research techniques that provide valuable insights into participants' experiences and perspectives. Through one-on-one interviews, researchers can explore individual narratives in depth, allowing for a more detailed understanding of personal motivations and feelings. This approach enables participants to express their thoughts freely, often revealing nuanced information that might remain hidden in quantitative methods.

Focus groups, on the other hand, gather multiple participants to discuss topics collectively. This dynamic encourages interaction, where participants can build on each other’s ideas, leading to richer conversations. During these sessions, researchers observe group dynamics and collective viewpoints, providing a broader context for individual opinions. Both techniques complement each other well, helping to inform research objectives and uncover deeper insights for analysis. Ultimately, employing these qualitative research techniques enriches the overall research findings and aids in decision-making processes.

Observations and Ethnography

Observations and ethnography are essential qualitative research techniques that provide deep insights into human behavior within natural contexts. Through systematic observation, researchers can gather unfiltered data on how individuals interact with their environments. This method captures the nuances of behavior and culture that surveys or interviews might overlook. Ethnography further enriches these observations by immersing researchers in the community being studied, allowing for an in-depth understanding of social norms and practices.

One key aspect is participant observation, where researchers engage with subjects and become part of their daily lives. This approach fosters trust and encourages open dialogue, often revealing rich qualitative data. Another significant method is structured or unstructured observation, which depends on the research goals. Both techniques highlight how lived experiences shape individual perspectives, making them invaluable tools for any qualitative investigation. By utilizing observations and ethnography, researchers can construct a comprehensive narrative that conveys the complex realities of social behaviors.

Qualitative Research Techniques for Data Analysis

Qualitative research techniques for data analysis play a pivotal role in understanding complex human behaviors and experiences. These techniques involve collecting rich, descriptive data through methods such as interviews, focus groups, and observations. Once this data is gathered, various analysis strategies can be employed to reveal key insights and patterns.

Two essential qualitative research techniques are thematic analysis and coding. Thematic analysis allows researchers to identify and analyze themes within the data, ensuring that critical ideas are highlighted. Coding, on the other hand, involves assigning labels to segments of data to categorize and interpret meanings more effectively. By utilizing these methods, researchers can transform raw data into actionable understanding, guiding decision-making and fostering deeper comprehension of the studied phenomenon. Implementing these techniques enhances the integrity and depth of qualitative research outcomes.

Thematic Analysis and Coding

Thematic analysis and coding are fundamental elements in qualitative research techniques. This approach allows researchers to identify, analyze, and report patterns within qualitative data. It transforms raw data, such as interviews or focus groups, into thematic insights that reveal deeper meanings and perspectives. By systematically coding the data, researchers can categorize key themes that emerge across participant responses, providing a clearer understanding of their experiences.

To conduct effective thematic analysis, one may follow several key steps. First, familiarization with the data is critical; this involves reading and re-reading transcripts to understand the context. Next, coding the data using labels allows meaningful segments to be highlighted. After coding, themes are developed by grouping related codes, which leads to the creation of overarching themes. Finally, interpreting and contextualizing these themes enables researchers to draw significant conclusions from the data, enhancing the overall richness and depth of the qualitative findings.

Narrative Analysis

Narrative analysis serves as a powerful qualitative research technique that focuses on the stories people tell. This approach goes beyond simply coding data; it seeks to understand the underlying meanings and themes within these narratives. By exploring how individuals construct their experiences through storytelling, researchers can uncover insights that quantitative methods may overlook.

In narrative analysis, the process often involves several key steps. First, researchers collect narratives through interviews, diaries, or media. Next, they analyze the structure, context, and content of these stories to identify themes and patterns. Finally, understanding the broader social and cultural frameworks helps contextualize how these narratives reflect personal and societal realities. By appreciating the nuances of individual experiences, narrative analysis adds depth to qualitative research, making it a pivotal method for understanding complex human behaviors and beliefs.

Conclusion on Qualitative Research Techniques and Methods

In conclusion, qualitative research techniques provide invaluable insights into human behavior and experiences. Approaches like interviews, focus groups, and case studies allow researchers to explore complex subjects that quantitative methods might overlook. Each technique offers unique benefits, from capturing rich narratives to fostering group discussions that reveal diverse perspectives.

Understanding how to apply these qualitative research techniques effectively is crucial for gathering meaningful data. This knowledge equips researchers to accurately interpret findings and draw actionable conclusions, ultimately contributing to informed decision-making and enhanced understanding in various fields.

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• Published: 11 August 2024

A qualitative study on the disease coping experiences of pancreatic cancer patients and their spouses

• Bo Zhang 1 ,
• Qigui Xiao 1 ,
• Jingtao Gu 1 ,
• Qingyong Ma 1 &
• Liang Han 1  

Scientific Reports volume  14 , Article number:  18626 ( 2024 ) Cite this article

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• Health care

Cancer affects patients as well as their spouses. Patients and their spouses use different strategies to cope with cancer and the associated burden. This study aimed to gain a deeper and more differentiated understanding of support systems for patients and their spouses. This was an exploratory qualitative study conducted in China. The study was based on 20 semistructured face-to-face interviews. Ten pancreatic cancer patients and their spouses were interviewed. The interviews took place at a tertiary hospital from June 2023 to December 2023. The data were analysed using thematic analysis according to Braun and Clarke's methodology. This study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Twenty participants of different ages (patients: range = 49–75 years; spouses: range = 47–73 years) participated. Patients with different cancer stages (e.g., potentially resectable, borderline resectable, locally advanced) and cancer types (initial diagnosis or relapse) participated in the study. Five themes emerged from the data, namely, denial and silence, fear and worry, struggle, coping strategies and cherishing the present. Active dyadic coping is conducive to promoting disease adaptation, and spouses seem to need more psychological support to improve their own well-being. Health care providers should pay attention to pancreatic cancer patients and their spouses in terms of five themes: denial and silence, fear and worry, struggle, coping strategies and cherishing the present. Future studies should use a combination of qualitative and quantitative methods to explore dyadic coping in greater depth.

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Pancreatic cancer is a malignant disease with high morbidity and a high mortality rate 1 . Pancreatic ductal adenocarcinoma (PDAC) accounts for approximately 90% of all cases of pancreatic cancer. Patients often have no obvious symptoms or signs in the early stage of disease, and more than half of patients are in the late stage at the time of diagnosis. According to the latest data of the American Cancer Society published in 2022, the incidence rate of pancreatic cancer ranks 10th among men and 7th among women among all cancer types; however, pancreatic cancer ranks 4th in cancer mortality, and the 5-year survival rate of pancreatic cancer is the lowest among all tumours, at only 11% 2 . Due to the great uncertainty about treatment effectiveness and the risk of cancer, pancreatic cancer causes a great psychological burden for patients’ spouses 3 . These couples face new challenges (e.g., being unable to effectively obtain information about the disease and its treatment, having high medical bills), role function transformation (e.g., having to stop working, managing family affairs) and self-concept changes (e.g., negative emotions, nervous about the future) 4 .

A cancer diagnosis has a profound impact on patients and their spouses, affecting multiple dimensions, such as the emotional, psychological, social, and economic dimensions. A cancer diagnosis often elicits a strong emotional response, encompassing shock, denial, anger, sadness, and fear 5 . Patients, as well as their spouses, may experience symptoms of anxiety and depression, which are normal reactions to the news of a cancer diagnosis. In some cases, professional mental health services may be necessary to help individuals manage these emotions 6 . A cancer diagnosis affects not only patients but also their family members and social networks. Patients’ spouses may need to take on more caregiving responsibilities while also dealing with their own emotional reactions. This additional stress can affect their work performance and social activities and may even lead to increased tension within the family 7 . Cancer itself, as well as its treatment, can have long-term, even permanent, effects on a patient's body. These effects include pain, fatigue, weight changes, skin changes, decreased libido, and fertility issues. Spouses may also neglect their own health while caring for patients. Patients and their spouses must communicate and cooperate when facing complex medical choices due to the diagnosis of cancer 8 . Effective communication can help both parties better understand their condition, treatment options, and potential risks and benefits, thereby helping them make informed decisions.

Some cancer patients also need support to cope with cooccurring mental health issues 9 . The multiple impacts of cancer on patients and their spouses have prompted researchers to conceptualize cancer as a dyadic stressor 10 . Taking spouses as the unit of analysis and considering the interactions that occur in the interdependent system between spouses can provide us with a new perspective on understanding the psychological distress and coping strategies of couples after cancer diagnosis 11 , 12 . How patients and their spouses deal with cancer affects the mental health of both parties and their assessments of relationship satisfaction 13 .

Research on coping styles for individuals with cancer has shifted from the individual level to the couple level 14 . Bodenmann noted that for couples, stress events do not affect the individual reactions of only one party but have common effects on both parties 15 . Coping with cancer and its related burdens requires collaboration, which is called dyadic coping (DC), which refers to the common reactions and strategies of spouses with intimate relationships when facing dual stress events 15 . The couple relationship is one of the most important resources for patients to cope with stressful events. Traditional models such as the systemic transactional model emphasize that both spouses should jointly perceive and evaluate stress, help each other, promote each other’s physical and mental health, and strengthen their intimate relationship 16 , 17 , 18 when coping with stress. Spouses play a key role in treatment decisions and in facilitating disease management 19 . According to dyadic disease management theory 20 , coping behaviour is a factor related to quality of life. The dyadic perspective of couples, focusing on the dyadic response of cancer patients and their spouses, is a new perspective for improving the physical and mental health of both parties and improving quality of life 21 , 22 . Couples facing cancer usually adopt a dyadic response 23 to reduce disease pressure.

Quantitative research on coping with cancer is very extensive, but there have been few qualitative studies in this field. A recent qualitative study of pancreatic cancer patients and their spouses reported coping strategies such as changing roles and identities, managing weight loss and addressing gastrointestinal problems 24 . A systematic review identified coping strategies such as symptom management, better clinical communication, support seeking, and maintaining a good attitude 25 . However, less is known about the use of different types of coping strategies by patients and their spouses and social support styles from outside couples.

In summary, we aimed to explore couples in which one spouse had been diagnosed with pancreatic cancer, including how the couple coped with the disease together and what coping and support strategies they used. In addition, we aimed to identify possible differences in coping behaviour between patients and their spouses. Insight into specific types of coping strategies can improve the development of more tailored and detailed intervention programs for cancer patients and their spouses.

Study design

A qualitative design was used in this study. Reporting was performed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines 26 .

Participants

Participants (patient-spouse dyads) from a tertiary hospital in China were recruited through random sampling from June 2023 to December 2023. The research team identified potential eligible participants through the hospital's patient registration system. Patients who met the preliminary conditions were invited to participate by the research team. Potential spouse participants were identified and recruited through direct communication with patients. Eligibility was based on the following criteria: having a diagnosis of pancreatic ductal adenocarcinoma (PDAC), being aged 18–75 years, being hospitalized for 2 weeks or more, and living with a spouse. The exclusion criteria for patients were severe cognitive impairment; serious heart, lung, kidney or other diseases; and consciousness disorders. The inclusion criterion for spouses was the ability to communicate normally. The exclusion criterion for spouses was cognitive impairment. Both patients and their spouses were required to provide written informed consent prior to enrolment.

Individual, audio-recorded, semistructured in-depth interviews 23 were conducted by creating a space for participants to openly share their perspectives. An interview guide, collaboratively developed after performing a literature review, aimed to explore the research interests of this study. Two participants were selected for a pilot interview, and the interview guide was revised and finalized accordingly (Table 1 ). Those meeting the inclusion criteria were provided with an interview explanatory statement outlining the study's aim and procedures. The statement emphasized voluntary participation, with the option to withdraw at any time without providing a reason. Participants were assured of anonymity, with their personal information remaining confidential and unidentified. Before the interviews, each participant signed an informed consent form.

The interviews were conducted by the first author in the VIP conference room of the hospital department. Patients and their spouses were interviewed separately. During the interviews, participants were encouraged to share their experiences and provide additional comments on the topic. There was no prior relationship between the interviewer and the participants, which helped to reduce bias and ensure the objectivity and accuracy of the research results. The interview ended when no new or surprising information was uncovered during further data collection, that is, when data saturation occurred 27 . The interviews lasted between 20 and 74 min, with an average duration of 30 min.

Data analysis

Sociodemographic information was reported with basic descriptive statistics using IBM SPSS Statistics 24. At the end of each interview, the authors independently transcribed the recordings into text within 24 h, and then imported the text into NVivo 11 software. We used Braun and Clarke's thematic analysis method 28 , 29 . The initial coding was independently carried out by two authors (B. Zhang and Q. Xiao), with a third author regularly monitoring and intervening in case of differing opinions. Encoding attempts to identify and describe aspects and their outcomes were considered to constitute contextual or mechanistic features. Then, the fourth author reviewed all coding results. Group discussions aim to compare, critique, and agree on external or internal factors related to patients and their spouses. In the process of inductive coding and deductive classification, if there was any inconsistency, the researcher discussed the differences with QGX and JTG and reached a consensus. Finally, the research group discussed and reviewed all the identified themes and categories.

After the interview, we transcribed the conversation verbatim and created detailed written records about every interview (i.e., interview memorandum). We also provided interview recordings and transcripts to the interviewees and their spouses for review. The transcripts were then reviewed by the research team to ensure their accuracy. Once research team were confident that the transcripts accurately reflected the interviews, we contacted the interviewees and their spouses to request their feedback. We did this to confirm that they agreed with the transcript's content and that we had not misrepresented any of their words or ideas. If the interviewee and his or her spouse agreed with the content of the transcript, we moved forward with our analysis. However, if there were any discrepancies or errors, research team made the necessary corrections based on their feedback. This ensured that the data we analysed were as accurate and reliable as possible.

The authors are all postgraduate students, who have received systematic training and mastered qualitative research methods and interview skills. During the interviews, voice recorders and field notes were used to ensure the quality of the recordings, questions were asked as neutrally as possible, and the participants' responses were neutral. At the end of each interview, two authors repeatedly listened to the recordings to check for accuracy, and then they encoded and analysed the transcripts. If there were new items or disagreements in the transcribed interview, this will be further elaborated in the next interview.

This study complied with the Declaration of Helsinki, was approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2019LSK086). Written informed consent was obtained from participants included in the study. All participants were informed that any personal information obtained in this study would remain confidential.

Among the 13 potential couples who expressed willingness for interviews, ten couples were included in the final analysis. Three couples refused to participate in the study for various reasons, including scheduling conflicts (n = 1), a lack of interest (n = 1) and unwillingness to discuss this topic (n = 1). Patients with pancreatic cancer had a median age of 62.5 (49–75) years. More than half of the patients were men (n = 7); the majority of patients had a secondary school education or below (n = 9) and all patients were married (n = 10). Approximately 50% (n = 5) of the patients were classified as having borderline resectable disease at the initial diagnosis. The duration of pancreatic cancer ranged from 0.5 to 5 years. The median age of the spouses was 63 years (47–73). The majority of spouses had a secondary school education or below (n = 9). Three individuals had previously worked in the field of nursing. Further characteristics are displayed in Table 2 and Supplementary Material.

Five themes were extracted from the interviews in this study, which described the experiences and perceptions of patients with pancreatic cancer and their spouses in coping with the disease. The five themes were denial and silence, fear and worry, struggle, coping strategies and cherishing the present. Figure  1 and Table 3 present the themes, subthemes, and representative quotes.

The process of participants' coping to illness. Patients and their spouses fell into denial and silence and filled with fear and anxiety at the beginning. As the disease progressed, they gradually struggled to cope with this situation. During this painful journey, they adopted two different coping strategies: one was a negative coexistence approach within couples, while the other involved actively adjusting their mindset and ultimately learning to cherish the present and harmoniously integrate into life.

Denial and silence

Denial and silence meant that the patients with cancer and/or their spouses did not want to communicate regarding any illness-related issues and that they had not communicated. The essential characteristic was the lack of intention to communicate about the illness, which includes denying the disease diagnosis and refusing to talk about the illness.

Denying the disease diagnosis

Patients and their spouses tended to be sceptical of the diagnosis of the illness and denied it through psychological defence mechanisms. Specifically, some patients admitted that they never expected to have cancer and that the unexpected diagnosis triggered strong feelings of disbelief and resistance. Spouses also mentioned that the patient's diagnosis of cancer was unexpected and refused to accept it.

“When I first got my diagnosis, I felt like the sky was falling, my legs were shaking, my heart was panicking…” (P5) “It never occurred to me that this would be my husband’s test result. He was only 54, so young, and in good health before.” (S6)

Refusing to talk about the illness

Some patients and their spouses were afraid to communicate about the malignant disease because they feared that it would cause shock or a psychological burden for their spouse and that they could not control their emotions. As spouses, when faced with sudden negative emotions from patients, some respondents were unsure how to comfort them. Some spouses chose to accommodate and remain silent, internalizing the negative emotions. This led to a certain degree of emotional exhaustion.

“I am afraid to tell my wife that her disease is advanced and incurable. I dare not tell her because I am worried that she cannot bear it.” (S4) “He was in a really bad mood, and I didn’t know how to comfort and console him.” (S1)

Fear and worry

This theme demonstrated participant’s emotion change as they become aware of burden and death as the disease progressed.

Increased family burdens

The diagnosis and treatment of pancreatic cancer had prompted a series of adjustments in family roles to adapt to new responsibilities. Following the diagnosis, the couples bore their respective responsibilities in the dyad and embarked on discussions regarding changes in their roles, considered revising established models for managing household duties, and navigated the interruptions to their life plans. For spouses, the responsibility was to serve the patients wholeheartedly. For patients, the responsibility was to minimize the burden on their spouses as much as possible. Some patients or their spouses also chose to bear pressure alone to alleviate the burden on others. Some families lost their primary sources of income. Additionally, they needed continuous treatment. All these factors increased the financial burden.

“I certainly hope she can help me, but it is already very difficult for her, and I don't want to burden her even more…” (P1) “My husband is the primary source of income in our family, but now he is unable to work…so the financial pressure is quite significant.” (S3) “Before she got sick, she used to do more housework at home. Now that she is ill, I must take care of her and do a lot of things every day. ” (S9)

Worrying about treatment effectiveness and the future

The participants were conflicted between having hope for the effectiveness of treatment and being fearful about the progression of the patient’s disease. In addition, they were conflicted about cancer as a disease and their life as a caregiver. Some spouses themselves had diseases. Therefore, they felt anxious about their health problems worsening and taking care of the patient with their health condition. Spouses reported that taking care of their own physical and emotional needs ensured they could continue to participate in caring for the patient. When they realized their limited emotional resources and time, they consciously chose to reduce their efforts towards others. Spouses reported a range of self-care activities, including exercise, dietary modification, and making time for hobbies.

“I always felt down, and… I also felt that I wanted to have hope.” (P3) “I have to take care of myself before I can start taking care of him.” (S1)

Fear of death

From the moment of diagnosis, the spouse perceived the threat of the patient's death as a real possibility. As they witnessed the changes in their partner's body caused by the disease, this possibility became increasingly concrete. Which prompted them to accept or prepare themselves for their new reality, to anticipate and imagine life without their partner. They accomplished this by seeking out information about the cancer, about the dying process and death. Spouses strived to comprehend the patient's experiences. They hoped that treatment could continue until they no longer felt overwhelmed when considering the remainder of their lives. In other words, their perspectives on life and death deepened when faced with the opportunity to contemplate living until death.

“I was prepared for his death when I discovered his cancer had metastasized. When the doctor told me he had terminal cancer, I knew he would die soon.” (S8) “We were all gradually coming to terms with the arrival of death, though it was a harsh reality (sobbing).” (P8)

At this stage, some patients and their spouses still avoided disease-related topics, and even felt hopelessness.

Avoidance/contradiction

This study showed that many couples tended to cope with stressors by avoiding problems. Some couples had poor adaptation to the diagnosis of the disease, experienced avoidance or contradiction, and perceived minimal dyadic support and greater adaptation difficulties. They rarely or never communicated their feelings about the disease, avoided or retreated from their spouse, and reacted negatively to the pain associated with the disease in others. This included reluctantly providing support, maintaining distance, and even ridiculing each other. Some couples reported that after the onset of illness, both the patient and their spouse prioritized each other's thoughts and feelings over their own in order to maintain normal marital life and avoided increasing the psychological burden on their partner.

“I sometimes look up some information and want to share it with him, but whenever I discuss his condition with him, he pretends to sleep and doesn't want to talk to me (sobbing).” (S6) “She was exhausted from taking care of me, so I silently endured the bad emotions. I don't want her to worry about me. ” (P5)

Hopelessness

Although patients and spouses were well aware of what to do, sometimes they failed to do the right thing and communicate well, resulting in poor adjustment to the disease. The physical condition of some patients was difficult to improve, and in this case, efforts may be futile. In their view, pancreatic cancer is impossible to cure and the disease is equivalent to a death sentence. Therefore, they believed that any effort was useless, which led to hopelessness. However, hope had proven to be a resource for spouses, helping them cultivate meaning and face adversity. Hope flowed with the progression of the disease and feedback from professionals on treatment outcomes, sometimes being strengthened, sometimes being tempered, but always present until the end of the patient's life.

“Treatment is useless. It's not going to get better; I’m just going to die. ” (P8) “I often search for information on others overcoming cancer, which brings us a little more hope in our hearts.” (S5)

Coping strategies

Patients and their spouses adopted two different coping strategies after they experienced heavy burdens and painful struggles: dyadic negative coping or positive coping.

Dyadic negative coping

Upon receiving a cancer diagnosis, patients faced a myriad of challenges including physical, cognitive, and psychological barriers, which were frequently accompanied by fluctuating emotions. The illness advanced swiftly, while the responses and engagement of both institution and the assisting professionals lagged behind, being neither timely nor adequate. This discrepancy resulted in profound hopelessness and a sense of incapacity. Concurrently, their spouses endured immense psychological pressure, rooted in anxiety over the patient's condition and the weight of their commitment to caretaking. Some patients and their spouses opted to manage this stress through evasion of difficult topics or by refraining from communication.

At times, partners transmit their emotions to each other, potentially leading to family crises. Patients or their spouses often hid the true condition of the illness and suppressed their own emotions and thoughts to protect their partner, disregarding their own feelings and health. Over time, some couples were more likely to form an evasive way of communicating with others regarding illness-related issues, which often persisted, thus hindering their adaptation to the disease. This deprived couples of opportunities for emotional and stress relief and had a negative impact on relationship quality and marital satisfaction.

“I dare not tell him the truth, worrying it might make him feel even worse.” (S1) “After my husband got sick, he would often get angry for no reason, and it really weighed on my heart.” (S6) “I felt like I was drowning, fighting for my life, but I didn't want to leave my husband stranded because of my illness.” (P2)

Dyadic positive coping

Some participants were able to face life setbacks and pain with composure and acceptance. The roles of the spouses were adjusted and adapted. Couples who openly communicated their feelings could better adapt to the disease. Nine patients and spouses expressed that they accepted the existence of the disease: some accepted "fate", and some accepted "disease", choosing to face it calmly. Some spouses were hopeful, believing that with the advancement of medical methods, the situation would improve. Information and instrumental support also play important roles. This included taking care of children, doing household chores, and cooking. In addition, participants obtained from medical staff or the internet and shared disease-related information. The patients experienced care and love and expressed great concern for their spouses. The couples achieved positive results in overall relationship satisfaction and intimacy.

Couples support each other in difficult times and live together for a lifetime, which is the concept of marriage. Spouses made their "being there" commitment in words or actions to support their partners with cancer. The couples stated that the disease was a part of their marriage journey and they were committed to supporting each other. Patients received immense emotional support from the verbal commitments of their spouses. Spouses spent more time with patients, which helped to enhance the intimacy between the couples and aided them in coping with the disease more effectively.

Actively seeking external support was also important. The patients reported that understanding and moral support from friendly, patient, and well-trained doctors and nurses was important. The spouses believed that the treatment of a psychological counsellor was equally important. Overall, many people suggested providing psychological support. The spouses expressed a hope for more proactive services in clinical settings.

“Later, I just resigned to fate. Whenever I had a solution, I would try my best to develop in a positive direction. I chose to face and accept reality. I'm already 68 years old now, and it's worth it.” (P3) “However, I am glad to have a psychological counsellor. A person who understands me. Someone said, "Yes, you're facing difficulties right now, but you can do it, you'll get rid of it.” (P2) “My wife gave me tremendous confidence and consistently supported me, affirming that regardless of the illness I had and whatever the outcome, she would always be there to support me in the end. ” (P10)

Cherishing the present

Everything has two sides, and terrible experiences can stimulate positive thinking. After experiencing this significant upheaval, the majority of the participants expressed varying degrees of cherishing the present moment and maintaining a positive outlook towards the future. Some couples came to accept and adapt to the consequences of the disease after receiving chemotherapy. They engaged in discussions about what the experience of cancer signified for themselves individually and for their relationship as a whole. This involved jointly envisioning the future, creating plans, and striving to bring their lives back onto a stable path.

This theme was observed among all participants, who expressed a desire to cherish the present moment and whose marital relationships were strengthened by the caregiving experience. Moreover, to experience prosperity for the rest of their lives, they also needed other significant others to help them live. Therefore, they needed connections with society, including family members. The patients and their spouses appreciated each other more and perceived warmth from family and friends. In the interviews, they all mentioned that the love and support of people around them were important sources of strength for them to deal with the cancer diagnosis. One patient reported that he was particularly grateful for his boss’s support. During his treatment, they also helped him pay for his pension insurance and provided a minimum living allowance of 2000 RMB per month.

“The genuine concern from family and friends that can be felt at all times, everyone is concerned about me…” (P7) “I believe we can move forward. My wife and I are doing everything we can to save money for the next stage of treatment.” (S9) “With the advancement of science and technology, I believe that tomorrow will be better.” (S4)

Characteristics of the DC styles of pancreatic cancer patients and their spouses

The findings of this study indicate that within the DC style of PDAC patients and their spouses, both positive coping and negative coping strategies coexist.

Dyadic coping is beneficial for the adaptation and recovery of patients' physiological functions 30 . Patients and spouses have diverse coping styles, most of which involve positive coping styles. They seek emotional comfort and meaning through their relationships with the present, themselves, and others, achieving personal growth.

Positive binary coping can shape patients’ and spouses’ optimistic attitudes towards the disease, which helps them cope with treatment. Medical staff can carry out interventions, such as life meaning therapy interventions 31 , by promoting an understanding of the present, reviewing life, and facing the future, and patients and spouses can reunderstand their responsibilities, tap into their potential, and find the meaning of life. Training programs such as communication skills training for couples 32 , cognitive-behavioural therapy 33 , and coping enhancement training 34 can also be carried out to improve communication skills and alleviate negative emotions between partners. Therefore, future research should emphasize training plans for pancreatic cancer patients and their spouses to improve their DC ability.

The dyadic relationships between partners influence each other 34 . This study revealed that patients and their spouses have consistent coping strategies for accepting reality and perceiving warmth, while there are differences in coping strategies for harbouring hope. In terms of consistent coping styles, patients’ and spouses’ coping styles resonate with each other and have a positive impact, while tension and pain are mostly related to inconsistent coping styles with coping with or releasing emotions between partners 35 . For example, when facing cancer, patients both avoid and accept it, while their spouses have high levels of anxiety. The anxiety of one partner influences the other partner, indicating that inconsistency in coping styles has an impact on disease management.

A lack of communication or fear of communication has a negative effect on dyadic coping. Open communication is crucial for couples dealing with cancer 36 . A previous study developed a communication skills training program for cancer patients and their spouses 37 , which could improve the avoidance of cancer-related topics and intimate relationships with spouses. This program is an effective intervention to promote communication and expression in couples. Our study reported the relaxing effect of communication about stress, while some spouses could not tolerate patients’ communication about stress. To improve this difference, couple-based supportive interventions should shift general communication to more individual approaches 38 . Because couples with good relationships may be more willing to participate in interviews, there are generally fewer reports of negative dyadic responses. In fact, the interviews were conducted jointly with both partners, which may have reduced the opportunity to observe negative dyadic responses.

Challenges to DC for PDAC patients and their spouses

This study showed that the five couples tended to cope with stressors by avoiding problems. This coping strategy will lower patients’ self-esteem and increase negative emotions. Therefore, healthcare professionals should adopt a comprehensive approach when treating couples, evaluate their attitudes towards the disease in a timely manner, encourage open communication, and cultivate confidence in overcoming the disease.

Most participants said that in addition to guidance from medical staff, the internet was a main source of information. Therefore, comprehensive explanations on disease progression and treatment processes should be provided to patients and spouses who have limited understanding of the disease. In addition, mobile device-based 39 communication and consulting platforms can be established to meet their information needs.

The research results also indicate that spouses have greater anxiety and unease than patients, but this is often overlooked 40 . During the interview process, the spouses mentioned that they always tolerated the patient's uncontrollable emotions. This shows that in the process of taking care of patients, spouses tend to hide their emotions, focus on the patient, and expect improvement of the disease. This suggests that medical personnel should pay attention to the needs of spouses and take effective measures to intervene in a timely manner, such as by providing music therapy 41 , mindfulness stress relief therapy 42 , and cognitive behavioural interventions 43 . This not only has positive effects on the treatment and rehabilitation of cancer patients but also reduces the burden of care, alleviates psychological distress, and improves the quality of life of spouses.

In this study, more than half of the households had a per capita monthly income below 5000 RMB, and the patients were at risk of not being able to resume their work. Economic conditions can affect family relationships, and lower income is associated with reduced intimacy between spouses 44 . This means that when there are multiple treatment options for cancer, health care professionals should fully consider the financial situation of the patient's family and encourage couples to actively participate in medical discussions. The purpose is to minimize treatment costs as much as possible. In addition, promoting public welfare measures can help alleviate the financial burden on patients whose families are facing economic difficulties.

Providing additional support for DC between patients and their spouses

This study indicated that the family is the most reliable resource for patients and spouses. Strong family relationships bring multiple benefits to individuals, including faith, hope, and peace 45 . At the same time, the binary coping styles of patients and spouses towards stress can affect their adjustment to life after illness. Negative binary coping is negatively correlated with the prognosis of patients and their relationship with their spouse 46 . The greater the quality of the relationship between spouses is, the less depressive symptoms they experience. Therefore, family interventions in clinical practice, such as psychological and spiritual integration therapy, meditation, and meaningful therapy, are recommended to alleviate patients’ psychological pain and enhance family relationships and functions 47 . Patients with decent abilities can also be encouraged to actively care for their family members, do what they can, and express their love to their family members more often; they can also give positive encouragement regarding their spouse's efforts, making them feel responsible and willing to maintain their strength and resilience.

During the coping process, the couple's cognition of cancer was self-assessed and restructured. Their trust in doctors could illustrate this. They readily adopted almost all of the doctor's advice, which implied that when they entrusted themselves to the doctor, their belief in the therapeutic effect and control over the disease was strengthened. They also cultivated interests (e.g., mindfulness meditation and watching television) to take their minds off the diagnosis of cancer. Couples dealing with cancer focused on moving forward, striving to improve the consequences and expectations of the disease. With their efforts and positive coping strategies, the threatening disease cognitions that hindered psychological adaptation were gradually replaced by constructive disease perceptions.

Spouses' distress could be indirectly alleviated by instrumental social support for patients 48 . Peer support from other patients (through sharing experiences and communication) and professional psychological counselling can effectively reduce psychological symptoms and improve cognitive abilities 49 . Therefore, health care professionals should recognize the importance of peer support and psychotherapy and encourage patients and their spouses to attend peer support groups for pancreatic cancer survivors to pay timely attention to their psychological status 50 . Psychological and social interventions for cancer patients and their spouses should be adjusted according to their needs and desires, as well as the nature and stage of the disease 51 . For pancreatic cancer, a malignant disease, intervention measures should focus on alleviating depression, demoralization, and distress about dying and death, as well as addressing multiple challenges of disease and treatment. These include making treatment decisions and communicating with healthcare providers; adapting to diseases on self-concept, personal relationships, and sense of meaning in life; and preparing for the end of life. Overall, interventions should be developed to strengthen couples’ social support systems.

Study strengths and limitations

The primary strength of this research is that it addressed an overlooked area in relation to coping experiences in pancreatic cancer patients and their spouses. Braun and Clarke’s thematic analysis method was used for analysis. By adhering to the six steps and closely involving all members of the research team, the quality of the analysis process of this research topic was ensured. This study also has several limitations. Firstly, we recruited a relatively small sample of participants. However, considering the relatively narrow focus of the study, the sample size was considered sufficient to achieve our goals. In addition, the team unanimously believed that the data was already saturated. Secondly, this study only collected data from one tertiary hospital. Therefore, the generalizability of our results might be limited. However, according to the discussion of the research team, the data consulted in this study could represent the views of a considerable number of patients and their spouses.

Clinical implications

The couples are supportive for and to each other. The results of this study revealed that spousal caregivers cared for patients while also experiencing health issues themselves. Healthcare professionals should provide support for couples coping with cancer, especially by focusing on spouses' psychological conditions because their distress is easily overlooked. These new insights can serve as a new direction for couples' interventions in the future. Spousal caregivers need education about the treatment and support in coping with pancreatic cancer. Thus, more attention is needed for awareness of the patient’s medical condition, managing the side effects of treatment, and the support system of the patients and their spouses. Furthermore, healthcare professionals can help in identifying and resolving the unmet needs of patients and their spouses.

This study showed a dynamic and complex picture of the coping experience between people with pancreatic cancer and their spouses. Patients and their spouses experienced diverse emotional changes and coping styles, that was, denial and silence, fear and worry, and struggle. They presented different coping strategies, that was, negative or positive coping, and finally chose to accept reality and cherish the present. A better understanding of the different conditions and experiences of coping with cancer could inform the design of a feasible and effective patient and spouse support program for coping with pancreatic cancer. Future studies should use a combination of qualitative and quantitative methods to explore dyadic coping in greater depth.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors sincerely thank the hospital that provided the research site. We also would like to sincerely thank all patients and spouses who participated in this study.

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Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, 710061, China

Bo Zhang, Qigui Xiao, Jingtao Gu, Qingyong Ma & Liang Han

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Zhang, B., Xiao, Q., Gu, J. et al. A qualitative study on the disease coping experiences of pancreatic cancer patients and their spouses. Sci Rep 14 , 18626 (2024). https://doi.org/10.1038/s41598-024-69599-7

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• Published: 09 August 2024

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

• Surya Surendran 1 ,
• Jaison Joseph 1 ,
• Hari Sankar 1 ,
• Gloria Benny 1 &
• Devaki Nambiar 1 , 2 , 3  

International Journal for Equity in Health volume  23 , Article number:  157 ( 2024 ) Cite this article

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Kerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.

We conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.

A total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.

The ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

Introduction

Kerala, a southern state in India, is known to be an atypical state in the country due to its high literacy rate and advanced social development indicators [ 1 , 2 , 3 ]. Compared to the majority of Indian states, Kerala has continually been a notable exception with better health outcomes and indicators, particularly in relation to Reproductive, Maternal, Newborn, and Child Health (RMNCH) [ 4 ]. This has been possible through the priority given by the state government over the years towards improving health infrastructure, with a special focus on primary care [ 5 ]. The number of Primary Health Centres (PHCs) in the state increased from 369 in 1960 to 1356 in 2004 [ 6 ]. Kerala invested in infrastructure to create a multilayered health system designed to provide basic services in the community and expanded primary health care coverage for the prevention and treatment of diseases [ 7 ]. Various policies have been implemented, especially at the primary level, to improve access to public health care with the more recent one being the Aardram mission [ 8 , 9 ]. The Aardram mission was designed to transform existing PHCs into Family Health Centres (FHCs) providing enhanced facilities and services with an objective to make healthcare more accessible [ 9 , 10 ].

The government, from the time of formation of the state, has placed emphasis on social(ized) welfare, and development. It significantly increased the number of public healthcare institutions between 1961 and 1986 [ 11 ]. The 1982 National Health Policy promoted national regulations that set in motion widespread privatization of healthcare. This led to rapid growth of private institutes ranging from small clinics to high-end institutes having several specialties to cater to in-patient services [ 11 , 12 ]. This was a major shift in the healthcare sector, with private institutes continuously improving the quality of care provided so as to stay in the competition. As the private sector bloomed at the cusp of India’s neoliberal turn in the early 1990s, the public healthcare system began to decline [ 13 ]. Compared to other states, currently, the presence of private healthcare sector in Kerala is high and plays a significant role in the state’s overall healthcare system [ 14 , 15 ]. The private healthcare sector in Kerala dominates in terms of the number of doctors, hospitals, and beds, making it the area with the highest concentration of healthcare facilities in India [ 13 ]. As a result, out-of-pocket expenditure of people across different class groups has increased [ 13 ].

Seeking care at a private health facility is expensive. Poor people in Kerala have been unable to afford treatment at private facilities [ 16 ], and catastrophic health expenditure has been on the rise [ 17 ], leading to increased inequities and medical impoverishment [ 12 ]. With the 1992 decentralization reforms, local self-government bodies were given control over public healthcare facilities with the intention of improving performance [ 16 ]. Reforms focused on improving treatment and access, highlighting the need for equitable coverage [ 18 ]. Multiple improvements had to be brought into the healthcare system including the quality of care provided, and the human and clinical resources within the system. The year 2012 was a milestone year in the state, marking a formal foray into Universal Health Coverage reforms, with an emphasis on upgradation of primary care [ 19 ]. Building on this momentum, in 2017, the Aardam mission was introduced by the incoming government to transform the public healthcare system and provide comprehensive services at the grassroots level [ 20 ].

Marginalized groups, especially the poor, face disadvantages and often rely on the public health system for their needs [ 21 ]. In addition to the financial disadvantage, these groups have restricted access to healthcare due to their gender, age, social status, geographical habitat, physical disabilities, etc. Because they frequently face discrimination, there is a need to exercise measures that prevent them from being exploited [ 22 ]. They are at a disadvantage or ‘left behind’ as compared to others, primarily as a result of their restricted access to medical treatment and the key health determinants, such as clean and hygienic drinking water, nutrition, accommodation, and sanitation [ 2 ]. This is in part why, on the path to UHC, particular emphasis has been placed on health equity and ‘leaving no one behind’ [ 21 , 23 , 24 ].

In India, the National Health Policy of 2017 makes similar pronouncements, calling for equitable and affordable healthcare to all citizens of India, regardless of their socioeconomic status [ 25 ]. Exclusion is a major challenge within and beyond the health sector in India: women, people from minority castes, and from tribal communities have historically faced disadvantage and social exclusion, which has restricted their access to healthcare and education over time [ 26 ]. Reforms like Aardram have implicitly sought to improve health care access and outcomes in groups such as these. In the context of various reform efforts, it is imperative to assess their impact on vulnerable groups in order to ascertain whether the intended beneficiaries are indeed receiving the benefits of these reforms. Therefore, as part of a larger health equity study, we explored the perspectives from the left-behind groups on their health seeking behaviours, and the use of public health facilities.

Study setting and design

We carried out a qualitative study using Focus Group Discussions (FGDs) in four districts of Kerala, India: Trivandrum, Kollam, Alappuzha and Kasaragod. The districts were chosen using random sampling method [ 27 ]: two primary healthcare facilities were chosen in each district and the area (panchayat) these facilities served were chosen as study sites.

Participants

Vulnerable groups at the study sites were identified through previous phase of data collection where secondary analysis of household data was carried out to identify groups left behind, and the local leaders and healthcare workers were interviewed about health system reforms [ 28 ]. Communities identified in our quantitative analysis as well as through the interviews common among all districts were people from Scheduled Caste backgrounds, Scheduled Tribes Footnote 1 , women, the elderly, and palliative care patients. Previous analyses as well as our extensive site visits also pointed towards geographic-specific groups such as fisherfolk, persons affected by Endosulfan exposure and those living with particular disabilities.

Data collection

FGDs were conducted by a team of two female (SS and GB) and two male researchers (JJ, HS) led by a senior researcher (DN) between March and August 2022. A topic guide was developed by the researchers and implemented after initial pilot testing and later tailored according to the type of participant groups in each FGD (Topic guide attached as Supplementary File 1 ). The questions in the topic guide prompted the participants to speak about their healthcare experiences with various facilities that they usually visit. In addition to the tool, any further topics that came up during the discussion were further explored.

Initial permissions were taken from local and district-level authorities. Potential participant groups were identified and organized for discussion with the help of healthcare workers from the primary healthcare facility and local self-government and community leaders. We also contacted NGOs to identify vulnerable groups and for their recruitment. The discussion was conducted at a time and place convenient for the participants. While not completely successful, efforts were made to avoid any form of gatekeeping from the system actors, and any such influence identified was excluded from the transcript during analysis. When the group assembled, detailed information about the purpose of the study, identity of the researchers, and the role of participants were given by the researchers and clarifications required, if any was provided before proceeding towards data collection. Individual verbal consent was taken from all participants included in the audio recording.

All the FGDs were conducted in Malayalam, the local language in the state, and in Hindi with inter-state migrants. The discussions were audio recorded with the permission of participants and stored in a secure local server. The audio recordings were outsourced to a transcription company to transliterate verbatim to English, after signing a confidentiality agreement. Each English translation was then cross-checked by the researchers for fidelity to the original recordings in Malayalam.

Data analysis

A thematic analysis approach was used to analyse the data [ 29 ]. The data was coded line by line using ATLAS.ti software [ 30 ]. An initial set of codes and code groups were formed using the topic guide and one transcript which was discussed among the researchers. The code book was modified based on inputs from team members and finalized for further coding. Regular discussions were held to discuss the codes that emerged through additional analysis. For the purpose of this paper, codes relevant to data on the drivers and barriers to the use of public healthcare facilities and participant narratives of utilizing them were extracted and analyzed. We used the Availability, Accessibility, Acceptability and Quality (AAAQ) framework [ 31 ] to understand the various enablers and barriers to seeking healthcare at public facilities.

Ethics approval was granted by the Institutional Ethics Committee of the George Institute for Global Health (Project Number 05/2019). Informed consent was taken from the participants and their confidentiality maintained. Only researchers had access to the participants’ identifying information.

We conducted 34 FGDs/group interviews Footnote 2 including participants from diverse backgrounds residing in facility catchment areas across four districts in Kerala. The number of participants ranged between 5 and 16 with a majority having 6–8 participants. We tried to segregate the participants by age and gender to make them homogenous, but some groups could not be age and gender-matched due to a lack of turnout/loss to follow up between recruitment and data collection. Table  1 shows the distribution of participant groups across the four districts.

We detail first, the healthcare-seeking preferences of participants; and second, the enablers and barriers that influenced their care-seeking at public facilities.

Preference of healthcare facility

Preference of health facility was governed by type of care needed, the distance and ease of transport to the facility, availability of infrastructure, quality of care, as well as a number of other factors like existing access to social security, insurance and other health-related schemes. These are presented as enablers in the following section.

As part of our parent study, we conducted a quantitative analysis of the discussions within FGDs/ group interviews, specifically focusing on individuals’ mentions of their healthcare-seeking behavior for past illness. These mentions were further categorized based on the type of groups and the nature of illnesses discussed, and the results were visually represented on an alluvial map (Fig.  1 ). Although public healthcare facilities were the preferred choice in over half of the cases, the variation was relatively minimal. The preference for a government facility was for general non-acute ailments such as fever or cold. In times of emergencies or when the need for in-patient care arose, myriad options was considered, with variations between and within the groups: tertiary level of government facility (e.g., medical college) or private hospitals being common choices. Newly upgraded FHCs were commonly utilized for management of long term Non-Communicable Diseases (NCDs), where medication needs were continuous. We found some mention on the utilization of FHC in almost every group with variation in how they were frequented. Some preferred going to a secondary facility (Community Health Centre-CHC, Taluk or district hospital) even for routine consultations. At the time of our fieldwork, Sub-Health Centres (SHC) were rarely utilized and in general, a higher facility was preferred within the government health system even if similar services were available at the lower level. Diagnostic services were an exception: private facilities were approached because of the quick turnaround time for the procedure and receiving the results. The choice of healthcare also depended on the perquisites people had through employment or within their households (like social security, insurance, enrollment in palliative care programs). Migrants in the organized sector we interviewed exclusively consulted a private nursing home which had a tie up with the factory they were working for and provided free healthcare services. Some of the participants had Employee State Insurance (ESI) which covered their and their family’s health expenses at an ESI operated hospital or dispensary.

…the surgery was done in a private hospital. They don’t need money. We gave the papers of ESI and thus they didn’t take any money…. My son works at a private company and there he had ESI card – SC male, Alappuzha.

Sometimes, even though unaffordable, private health facilities were used and expenses were met by borrowing money or pawning gold.

I was admitted in a private hospital in Palakkad for treatment of leg swelling due to diabetes…It costed me around Rs 1.5 lakh! (USD 1880) Footnote 3 … Lives matter, right? So we borrowed money for the treatment.- ST female, Alappuzha

Apart from these, there were condition-specifical preferences which prompted people to choose a healthcare facility based on the illness that they were facing. In such cases, by virtue of non-availability of services, their usual preferred facility was disregarded.

We go to X FHC for common illness… I went to RCC [the Regional Cancer Centre] in Trivandrum for my cancer treatment. – Beedi roller female, Kasargod.

Alluvial map showing the reasons to visit health facilities by sector for hard-to-reach groups across the four study sites

Barriers and enablers of public health facility use

We laid out barriers and enablers of public health facility use using the AAAQ framework.

Availability

The range of services available at primary centres was limited, leading to bypassing to higher levels or private sector usage .

There was a mixed opinion among participants on the availability of services in public healthcare facilities, particularly FHCs and sub centres which by design offered fewer services. Participants felt more services should be offered at the FHC or sub centre level.

If someone here gets a fever, there is no doctor [at sub centre] whom we can consult. So there is no option for us, but to go to CHC or medical college… If this sub centre had any sort of development, then we could go there if there is a need. If there is a doctor, we could have consulted them. But that is not there. They only give care to pregnant women and conduct immunization drives. That too, only sometimes a week. It does not function most times in a week. – Fisherman, Alappuzha.

Considering the fact that higher level of facility meant a wider range of services, the participants bypassed FHCs and sub-centres for CHC or district level hospitals, even if the former were closer to their homes. This saved them the effort and time of travel in case a referral was required, especially for conditions which could be fatal.

Since there are chances that after going to CHC, we will be referred to Medical College, instead of wasting time, we go there directly. – MNREGA female, Alappuzha.

Even when FHCs were the first choice of treatment, in times of emergencies, a private facility was preferred, particularly during the evening and night hours when FHC was not functional.

A drawback with the hospital is that during night there is absence of facility for all [acute] diseases. So, people are made to depend on nearby private hospitals during the night. -Elderly male, Kasaragod.

Medicines were constantly referred to as being unavailable at public facilities. In a Thiruvananthapuram FGD with Scheduled Caste women, one noted:

Medicines are never available there and I have to always buy from outside. Only paracetamol is available there. That’s why we are consulting private hospitals. It’s not because we are financially capable to go there, but we have to go there if we want a quick cure… Expensive medicines won’t be there.- SC female, Trivandrum.

Accessibility

Physical inaccessibility was a barrier to public service utilization.

Even though an FHC was planned to service all members in the panchayat, all communities could not access FHCs due to their location. While within walking distance for some people, others had to travel long distances, change buses, or pay large amounts to hire autorickshaws that would drop them at FHCs. Therefore, even if the care received was free, the additional cost incurred in the process of reaching there made it unaffordable.

In some areas, a higher-level facility was closer than the FHC. For example, all groups in one facility area of Kasaragod mentioned that they preferred going to the CHC, which was only a short distance away from their home and had direct bus access. An elderly person in Kasaragod explained:

I only go to CHC. The government hospital I used to and still go to is CHC. There is no [direct] bus to FHC. We won’t get a bus. It’s difficult. -Elderly mixed, Kasaragod.

In other cases, where a public healthcare facility was unavailable close by, private clinics and hospitals were depended upon, which were closer to home.

There is no travel facility to Perumon [FHC]. We can go there only by auto. It cost over Rs. 100. Another hundred for coming back. So, it will cost Rs.200 for the whole trip; that is the problem… hence we go to private hospital which is nearby. – Elderly men, Kollam.

In times of emergencies, a facility in close proximity was preferred. Since many private hospitals with in-patient facilities were located in areas with good road and transport access, they were the default choice.

We prefer private hospitals in emergency situations. There was this incident when she cut her hand and because the blood was flowing, and the nearest hospital was [name of the private hospital]. We usually prefer the nearby hospital and after dressing the wound, if they recommend us to visit the government hospital, then we’ll go there. -Coir factory workers female, Kollam.

Autos were the most commonly used means of transport. They were seen to be relatively cheap and provide the comfort of travel which would not be possible through the public bus where one may or may not get a seat during travel.

The moment that we get a hint of physical ailment coming up, we would have an auto-rickshaw at our doorstep. We would rush to the hospital. In most houses, there is an autorickshaw. Regardless of night or day, an auto would be available. Our houses are situated on the roadside, just like where we are right now, and they would take us to the CHC or wherever we need for treatment.- MNREGA female, Alappuzha.

Buses were considered unreliable due to their unavailability at the required hour. This was especially true in remote areas where bus thoroughfare would be sparse and infrequent. Hence, people relied on autos which could be summoned at any time. They were considered more expensive than bus travel but economical when compared to other available options, like taxis.

Even for taking an X-ray, we have to travel the same distance. If the total cost [of treatment] is Rs.1000, around Rs. 800 will be for travel charges alone. We use the bus rarely; we use it mainly if we are going to the OP. There is a bus at 9 am [but] if we have to reach there on time, we will have to go in an auto. If we go by bus, we will be late. There will be a rush. So, we call an auto- ST male, Thiruvananthapuram.

Some communities felt cut off from access to healthcare itself because of where they were located geographically. The SC community in Thiruvananthapuram lived on a hill which was not fully connected by road; therefore, the sick had to be carried by fellow members until the point where there was road access. Similarly, the SC community in Alappuzha lived in flood prone area which made commuting difficult, especially during the monsoon season. Tribal communities in Thiruvananthapuram were sparsely distributed in forest areas: the closest health facility was 15 km away and they end up spending Rs 600 (USD 7.5) Footnote 4 for the commute.

During rainy season, the roads are flooded. Maybe they will find a way to carry the ill person if an emergency arises. The rain is not light nor is the water feeble, it is harsh and heavy. There was a situation where the waterflow was so heavy that our vehicle could not even move. We had to wait for hours [until the water level decreased]. -MNREGA female, Thiruvananthapuram.

Financial accessibility (i.e. Affordability) was an enabler of public sector utilization, enhanced by use of publicly funded insurance .

The most common reason for choosing a public health facility was the availability of care for a very low or no expense from the people’s side. Since public healthcare facilities are funded by the state, the out-of-pocket expenditure for patients was relatively very low with some services costing less than 1% of what was charged by private hospitals.

My wife had cancer and was taken to a private hospital. She required radiation and chemotherapy they said it would cost Rs. 25000 and Rs. 75000 (USD 313 and USD 940) 4 for each respectively. We could not afford it so they suggested we go to a public hospital where it would be cheaper. The next day we went to General Hospital where my niece arranged everything and they started the radiation right away. Each radiation cost only Rs 50 (USD 0.6) 4 and the chemotherapy was done for free. They did 23 radiations and 5 sessions of chemotherapy- SC male, Alappuzha.

Most services were free or offered at a nominal charge. For example, a blood test at an FHC cost around Rs.15 (USD 0.18) 6 , an amount which almost equalled the minimum charge for travelling on a public bus.

I go to [name of the CHC] hospital for sugar test, it will be open till noon. Post-noon it is closed. The charge is Rs. 10 (USD 0.12) 4 . Whereas in a private clinic, they took around Rs. 90 (USD 1.1) 4 from me. The same Rs. 10 test is Rs. 90 there. -ST female, Kasaragod.

In addition to the almost free healthcare facilities, the state also provided public insurance to the poorest of the poor. This could be used while availing in patient services at any public healthcare facility. Having an insurance, however, meant that their choice of healthcare facility was restricted by that. The recipients of public insurance were forced to use public facilities (and some private facilities where it was accepted) for treatment. Therefore, they preferred to go to a public facility even if they were not happy with the treatment there.

I had surgery for Hernia at General hospital… Only expense was for the medicines that we bought from outside. As we were having the [insurance] card, other [expenses] were provided by the hospital itself. -SC male, Alappuzha.

Information inaccessibility was a barrier to public sector utilization .

As aforementioned, the government was providing insurance for poor populations which covered any in-patient care service availed by them. These insurance schemes were available at all in-patient government facilities. While these insurance schemes were valid for services in some private hospitals, there was relative lack of clarity on this.

We can use the public insurance card only for impatient treatment, what about for other things? We have received an [insurance] card from the health department. But where to use it… we are not sure- ST female, Kasaragod.

Information on services was not widespread in groups we spoke with. Many participant groups reported that they never had any awareness sessions from the health system. Occupational groups that had stronger ties to LSG and already availing of government entitlements, like MGNREGA and organized sector workers, were aware and had better access to these facilities while other groups like the fisherfolk were not.

Last month, the JHI [Junior Health Inspector] and others came took a class on TB. -Beedi worker female, Kasaragod.

Although social media was used to spread and receive updates on medical services, there was no system in place for regular updates.

Getting treatment at a public hospital involved running around to different departments and it was noted in an FGD that knowing someone from inside the hospital would help facilitate the process-

They will make us go in circles [vattam karakum]. My father’s sister’s daughter was the duty nurse there. And so because we knew someone there… -SC male, Alappuzha.

Acceptability

Special treatment was an enabler of public sector utilization, while language was a barrier for some .

Some of the groups mentioned during FGDs that they received preferential treatment at the FHC because of their “vulnerability status”. This positive discrimination allowed the participants to avail healthcare at a faster rate as they could jump the queue. These groups included palliative caretakers, the elderly who could not wait for a long time, and the tribal community who needed to travel long distances to reach the FHC.

For migrants who came to Kerala from other language-speaking states (mostly the North Indian states), conversing in Malayalam and letting the doctor know their issue was a challenge. However, in Alappuzha, at the private nursing home where they were treated as per company policy, the migrants were provided with Hindi-speaking doctors and staff; therefore, enabling conversations between them.

Additionally, even though doctors in the public health facilities were forbidden from practicing privately, some doctors had clinics at their home and to receive proper treatment at the hospital, the patients were required to consult the doctors with a fee at their private clinic. These instances were recalled with dissatisfaction by participants.

Higher perceived quality of private sector, alongside long waiting times and treatment delays in the public sector were barriers to public sector utilization .

There was a mixed opinion on the quality of services provided by public facilities. Tertiary hospitals were considered to have good healthcare service: perceived quality reduced as the facility level lowered. It was felt that FHCs and SHCs did not have the infrastructure and resources for providing treatment. Participants expressed experiences of being referred from one hospital to the other for lack of services, hence thought it is best to directly visit a higher-level facility.

Since there are chances that after going to [name of CHC], we will be referred to [name of public Medical College], instead of wasting time, we go there directly – MNREGA female, Alappuzha.

There was a general perception that the basic quality of services was adequate in private facilities, even with (or perhaps because of) higher costs. This was a major reason that participants reported use of private facilities even though it was not considered affordable. As a fisherman in Kollam said:

If we go to private hospitals, even if the cost is high, we will get adequate care in time. -Fisherfolk male, Kollam.

Participants who went to private hospitals chose it because the turnaround time for consulting and treatment was less when compared to public facility.

Whatever reason we say, government hospitals are the best. But the drawback is that we have to wait a lot. In private hospitals, nurses will come [take care of us quickly] since it is a business. -Elderly male, Kollam.

Government health facilities catered to a large number of patients in the area. As the level of the facility increased, the number of patients seeking treatment also increased. Since people visited secondary and tertiary level hospitals even for small ailments, the waiting time also correspondingly increased. People had to wait hours to get a doctor’s appointment, days and weeks to get scanning done and months before their surgery could be scheduled. Getting a doctor’s consultation meant spending a day at the hospital: people had to miss out on work with possible loss of pay. This was seen as an inconvenience and therefore private hospitals were chosen to get the consultation done in an hour or two after which participants could go on with their regular life.

We have to wait in the queue in the early morning. The OP starts at 8 o’clock but we have to set off at 6:30 or 7 o clock in the morning if we are going from here, then only we can get in firstly in the queue. After consulting the doctor and buying medicine… Some of the doctors are only available till afternoon but OP doctors may be available till evening. We have to depart from here at between 6:30 am and 7:00 am in the morning, wait to take the OP ticket and then wait in the queue for the medicines. Medicine is available at two to three points. The thing is that we will have set off in the morning itself– - ST female, Alappuzha.

The waiting time to consult at public facilities was reported to be too long as there are more patients and fewer doctors. Even for a minor illness, participants had to spend the whole day at the facility waiting for their turn to be treated.

The problem is that it takes a lot of time [at Taluk hospital]. Because there are a lot of people, we have to wait for a long time in the OP itself. The hospital functions based on a token system. We go in the morning and take a token and have to wait till our turn comes. So it will take a whole day. Sometimes it’ll be 2 pm when we are called. Effectively a whole day will be spent there. If we arrive there a bit late, we can only come back by 4pm. If an emergency case comes, the doctor will go to attend it. We will have to wait for the doctor to come back. Since we don’t have to pay any money, everyone will wait there patiently. -2 Lower income group females, Thiruvananthapuram.

Diagnostic services in public healthcare facilities were delayed- sometimes the scheduled date for testing would go beyond a month time. Therefore, even though doctors from a public facility would be consulted, the diagnostics are usually done at private centres so as to not waste time. It was noted that many privately owned diagnostic centres have been set up outside major tertiary care public hospitals.

In the medical college if there is a rush, we would be given dates to come and take a scan… It can be after 1–2 weeks, or after days… So instead of wasting time, we would resort to private institutions- If we spare some Rs. 500 or so, we could get our fix from a private establishment.- 2 fisherfolk male, Alappuzha.

At a micro level, the competence and compassion of individual staff members determined why they preferred a particular facility. Based on experience and hearsay, the quality of the doctor was concluded and if they were good, the facility was visited irrespective of other barriers

A hospital like this is a blessing for this place. All the nurses standing there and all the field workers are available whenever we need any help. I have a bedridden patient and I myself have sugar and pressure. They look after all that although’they don’t have to do it. -Palliative caretakers, Kollam.

The availability of quality services including consulting, diagnostics and medicines at a single facility was considered favorable for the participants. While it was acceptable to have diagnostics and medicines not available at the facility, when it was coupled with improper treatment at the facility, participants chose to go to a private facility instead even though it would be very costly.

[In the public hospital], while examining us they don’t check us with their stethoscope, they just only ask about the illness while sitting on the other side and they prescribe medicine on the basis of the thing we said to them. They don’t examine us properly. Also, if we need to test our blood, most of the time the lab is closed and when we give it for testing, they ask us to come back one or two days later. So we take a test from a private lab, get the result and consult the doctor about it the next day. That’s why we are dependent upon private institutions. Whatever it is, we have to go to private labs, so it’s better to go to a private hospital because everything is available there. The only difficulty is you need money for everything. Everything will get done in half an hour or an hour. -2 ST female, Alappuzha.

One caveat applies. With the Aardram mission of health reforms in place, there were some positive changes noted by participants in the FHC, which reinstated hope for a better service at public facilities.

Things are not like before. There is a lot of change. Doctors will ask us in detail about our problems and explain the reasons. They will tell us that a particular medicine is not in stock, so they will prescribe a different medicine. They don’t prescribe medicines from outside, they prescribe what is available and tell us that will also be effective and to continue that. Now things have changed drastically.- Elderly male, Kollam.

Our analysis sought to characterize the experiences and opinions of the ‘hard-to-reach’ groups on the utilization of public healthcare institutes in Kerala. We saw that their preference of a healthcare facility depended on a range of factors like cost and distance. The limited range of services available at primary centres often led individuals to seek care at higher-level public facilities or in the private sector. Physical inaccessibility served as a significant barrier to accessing public services, while financial accessibility, particularly affordability and the presence of publicly funded insurance facilitated the use of public healthcare. India’s national public health insurance scheme, the Pradhan Mantri Ayushman Bharat Jan Arogya Yojana (PM-JAY) provides cover for in-patient care on a family floater basis and has high public sector empanelment of facilities [ 35 ]. In Kerala, our findings suggest that public sector empanelment has incentivized the usage of government services. Information inaccessibility presented challenges to accessing public services. Furthermore, some individuals were encouraged to use the public sector due to the perception of receiving special treatment, while language barriers deterred others. Notably, a preference for the perceived higher quality of private healthcare, coupled with concerns about long waiting times and treatment delays in the public sector, acted as barriers to its utilization.

The recently published India brief from People’s Voice Survey showed 25% of people using public hospitals as their usual source of care and 24% for private, while others did not have a preference [ 36 ]. We also found that their preference changed as per need. For example, even though public institutes were chosen for small or chronic ailments, in times of emergencies, private health facilities were used, even if expensive. This preference was probably due to the lack of proper emergency care services in the state, as highlighted in a recently published systematic review [ 15 ].

We found that the different enablers and barriers as reflected through the AAAQ framework were influencing each other. The participants often preferred higher level facilities, even for minor illness because of their close proximity and a general perception that services were not available at lower-level facilities. This meant there was a greater patient load at high-level facilities, which would in turn result in long waiting times and treatment delays, another barrier to use of public health facilities reported by the participants.

In order to reduce the delay in treatment, in addition to increasing the health staff as recommended by the participants, the focus also needs to be on improving lower-level facilities such that the visits to public healthcare facility are redistributed. This has been seen in a number of studies in India and globally on bypassing of primary care [ 37 , 38 , 39 ]. A study conducted in Northern India found that he ability of healthcare providers to deliver quality clinical care had a more significant impact in reducing bypassing than the physical conditions of PHC facilities, such as building maintenance and availability of medication [ 39 ]. In our study, the non-availability of doctors at the SHC prompted people to use higher facilities like the FHC and CHC.

Although the public sector provided medical healthcare at free or nominal cost, expenses still emerged. Even after availing public health insurance, patients incurred expenses related to drugs and diagnostics that were not available – as seen in other studies [ 40 ]- as well as transportation costs.

Insurance coverage also affected utilization. Results from a systematic review indicate a positive effect of insurance on healthcare utilization in India, but no clear evidence yet on reducing OOP expenditures or increasing financial risk protection [ 41 ]. Our findings suggest that even though the public facilities or empaneled private facilities were preferred as a result of the availability of public insurance, the additional costs associated with hospitalization, such as transport and food, still posed a financial burden on patients. A recent publication highlighted that there was 20% higher healthcare expenses among members covered under the public insurance as compared to nonmembers which can be attributed to their preference for private hospitals over public hospitals [ 41 ]. While insurance schemes offered coverage, it still left members with significant out-of-pocket expenses. This unintended effect of health coverage resulted in members spending more on healthcare rather than less [ 41 ].

Many reported incomplete information on the schemes and services provided by the public sector. This is an important finding because while literacy levels in Kerala are high, it appears health literacy may not be. Gaps in health literacy have been found in India and the region, and stand in the way of effective coverage and service utilization in both the public and private sector [ 42 ]. The use of WhatsApp for dissemination of information has been growing, especially since the COVID 19 pandemic hit [ 43 , 44 ]. With the rampant access and recent attempts by local stakeholders to improve digital literacy [ 45 ], there is a potential for official dissemination of information through social media and improving patient information [ 46 ]. This could help bridge the gap of knowledge between those with closer relations with and access to government services and those who are more distant. A study conducted in central and Eastern India found that awareness of public welfare schemes (not including insurance) was greater among self help group members [ 47 ]. Therefore, Kerala’s thriving Kudumbashree self help group programme could be a launch-pad to promote health literacy; this is an area warranting further exploration.

Apart from tackling just the clinical assessment and treatment of diseases, there is a need to look at the determinants of health, ensuring everyone has access to them [ 48 ]. We saw that the inequity in access to health was further impeded by their access to proper infrastructure such as roads, etc. The socially excluded groups have been seen to live remotely in hills or disconnected to the roads. Tribal groups have traditionally inhabited hill tract areas [ 49 ], or sea-faring fisherfolk who live on the coast are often cut off from the main centre, thereby impeding their access to timely healthcare intervention. Even though access was considered a major issue among the groups, this did not come through in the recommendation for specific occupational groups like fisherfolk or factory workers. This could be because their occupation itself provided them the mobility that was not available for the other groups- partnerships with employers can play a major role in helping address healthcare needs, although such arrangements are less clear in the informal sector. Further, even some formal sector groups faced barriers that were particular to the group which obstructed their use of public healthcare facilities. For example, migrants working in the formal sector in Alappuzha did not like going to the public facility as providers there could not communicate in Hindi. Further studies looking at particular groups in-depth could understand the difference in needs which could have been missed in our study.

The ‘Kerala Model of Development’ has been applauded internationally for its success in the recent years. While it leads in the public healthcare activities, there still exist various barriers to accessing healthcare at public funded facilities. Our study highlights the complex and interrelated factors influencing the utilization of public healthcare institutes by ‘hard to reach’ groups in Kerala. The AAAQ framework revealed that enablers and barriers were influencing each other, with higher-level facilities being preferred for minor ailments due to their availability and perception of limited services at lower-level facilities. Gaps in health literacy, particularly among socially excluded groups, hindered effective coverage and service utilization. To address these challenges, there is a need to focus on improving lower-level facilities, promoting health literacy through digital channels and community-based programs such as the Kudumbashree self-help group program. In its mission to provide free public healthcare of quality, the State must look at the various challenges faced by marginalized groups in accessing healthcare, to ensure no one is left behind. Our findings call for an integrated change not just within the healthcare system but also associated facilitators to access such as the public transport, calling for a multisectoral plan for addressing healthcare challenges to ensure equitable access to healthcare services for all.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We express our gratitude to our interview participants who shared their thoughtful reflections with us and for making time out from their busy schedule. We are also grateful for the support of the Kerala Department of Health and Family Welfare as well as various Local Self Government Institutions in Kerala. The support of Wellcome Trust/DBT India Alliance is also gratefully acknowledged. We also acknowledge the support of Mr Raghav Krishnappa Ramesh and Prof Leon Morenas, who developed the figure included in this article.

This project was funded by Wellcome Trust/DBT India Alliance Fellowship ( https://www.indiaalliance.org ) (Grant number IA/CPHI/16/1/502653) awarded to Dr. Devaki Nambiar.

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SS contributed to data collection, analysis, original draft, subsequent editing and final draft. JJ, HS, GB contributed to data collection, analysis, revision of drafts. DN is the principal investigator and contributed to study inception, design, data analysis, subsequent editing and final draft.

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Surendran, S., Joseph, J., Sankar, H. et al. Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India. Int J Equity Health 23 , 157 (2024). https://doi.org/10.1186/s12939-024-02191-7

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Received : 31 March 2023

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DOI : https://doi.org/10.1186/s12939-024-02191-7

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