What is qualitative research?

‘Qualitative research’ is an umbrella term for a broad range of different approaches and methods, which vary considerably in terms of focus, assumptions about the nature of knowledge and the role of the researcher.

Despite their diversity, Mason (2002: 3) describes qualitative research approaches as all having the following in common:

• Being grounded in an ‘interpretivist’ position i.e. they are concerned with how the phenomena of interest are interpreted, understood, experienced, produced or constituted
• Based on research methods which are flexible and sensitive to social context
• Based on analytic methods which take account of complexity, detail and context.

Ref: Mason J (2002) Qualitative Researching (2nd edn) London: Sage Publications.

What sorts of questions does qualitative research address?

Qualitative research is good at answering ‘How?’ and ‘What?’ questions (in contrast to the ‘Whether’ or ‘If’ queries commonly addressed by quantitative research).  Examples of such questions include:

• How has the meaning and practice of informed consent in research changed over the last 35 years? Miller T and Boulton M (2007) ‘Changing constructions of informed consent: Qualitative research and complex social worlds’ Social Science and Medicine 65 (11) 2199-2211.
• How do children with speech, language and communication needs describe their quality of life? Markham C, van Laar D, Gibbard D, Dean T (2009) ‘Children with speech, language and communication needs: their perceptions of their quality of life’ International Journal of Language and Communication Disorders 44 (5) 748-68.
• What factors can help injecting drug users to seek and secure support? Neale J, Sheard L and Tomkins CNE (2007) ‘Factors that help injecting drug users to access and benefit from services:  A qualitative study’ Substance Abuse Treatment, Prevention and Policy 2 (31)
• What are the views of older Australians about community falls prevention? Ballinger C and Clemson L (2006) ‘Older people’s views about community falls prevention:  An Australian perspective’ British Journal of Occupational Therapy 69 (6) 263-270.

What are its limitations?

The limitations of qualitative approaches often become apparent when they are adopted to address inappropriate research aims, or when they are used by researchers inexperienced in their use.  Key problems (derived from Pope and May’s Qualitative Research in Health Care) include:

• Qualitative research generates a lot of complex data, requiring skill and time to analyse
• Typically small sample sizes limit the extent to which findings can be statistically representative, and generalised
• The criteria for determining good quality in qualitative research are at best unclear, and at worst non-existent

The last two issues in particular have been acknowledged and discussed by many qualitative scholars:

For a discussion about sample size and the concept of ‘theoretical generalisation’ (as opposed to empirical generalisation), see Mason 2002 (ref above) and chapter 10 in Ritchie and Lewis (2003) (ref included at end of page)

For considerations about quality in qualitative research, see Barbour (2001), Finlay (2006) and Mays and Pope (2006)

References:

• Barbour R (2001) ‘Checklists for improving rigour in qualitative research: A case of the tail wagging the dog?’ British Medical Journal 322, 1115-7.
• Finlay L (2006) ‘”Rigour”, “Ethical integrity” or ‘”Artistry”? Reflexively reviewing criteria for evaluating qualitative research’ British Journal of Occupational Therapy 69 (7) 319-26,
• Mays N and Pope C (2006) Ch 8 ‘Quality in qualitative health research’ in C Pope and N Mays (eds) 2006 Qualitative Research in Health Care (3rd edn) London: BMJ books.
• Pope C and Mays N (eds) 2006 Qualitative Research in Health Care (3rd edn) London: BMJ books.

How can qualitative methods be used in health research?

1: As a stand-alone piece of work?

A stand-alone qualitative study can contribute to greater understanding about, and appreciation of, the complexity of issues relating to health and illness.  This can lead to improved ways of working with health service users.

For example, Ballinger and Payne (2000; 2002) found that older health service users constructed meaning about falling in very different ways from occupational therapists and physiotherapists.  This helped to produce recommendations for promoting the engagement of older people in fall prevention activities (Yardley et al 2007).

References

• Ballinger C and Payne S (2000) ‘Falling from grace or into expert hands?  Alternative accounts about falling in older people’ British Journal of Occupational Therapy 63 (12) 573-9.
• Ballinger C and Payne S (2002) ‘The construction of the risk of falling among and by older people’ Ageing and Society 22 (3) 305-24.
• Yardley L, Beyer N, Hauer K, McKee K, Ballinger C and Todd C (2007) ‘Recommendations for promoting the engagement of older people in activities to prevent falls’ Quality and Safety in Health Care 16 (3) 230-4.

2: As a component of a multi-methods study?

Qualitative research studies conducted within the context of a multi-methods research design are particularly helpful in contributing to a holistic picture of the phenomenon under investigation, often by incorporating the perspectives of particular stakeholders, such as service users.

Qualitative studies within multi-method research designs are sometimes additionally used to ‘triangulate’ findings (that is, to help validate findings through confirmation via different methods or sources).

An example is provided by Boulton et al (2006). Here qualitative research was conducted as part of a larger study exploring continuity of care (Baker et al 2001) that also included: a longitudinal component investigating patterns of GP use, a stated preference discrete choice experiment and a cross sectional survey.

Boulton et al (2006) showed that for many patients, access to their ‘own’ GP was a primary concern.  Not all who wanted to access their own GP were able to, but those who succeeded had learnt to overcome obstacles, and found a sensitive and understanding GP.

References

• Baker R, Freeman G, Boulton M et al (2001) Continuity of Care: Patients’ and carers’ views and choices in their use of primary care services Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation
• R & D (NCCSDO).  Available at: http://www.sdo.nihr.ac.uk/files/project/13b-final-report.pdf.  Accessed on: 11.01.10.
• Boulton M, Tarrant C, Windridge K, Baker R and Freeman GK (2006) ‘How are different types of continuity achieved?’ British Journal of General Practice 56 749-55.

3: As part of a larger quantitative study, such as a randomised controlled trial?

Applications for funding of randomised controlled trials are increasingly including a smaller qualitative element in order to provide additional explanatory information about the findings of the main trial.  Additionally, patient or service user involvement in research is becoming mandatory for many funding bodies, for example the Research for Patient Benefit programme funded by NIHR. A recent INVOLVE publication (INVOLVE 2009) highlights how patient or service user involvement is often addressed through a qualitative component.

An example of a smaller qualitative component nested within a larger randomised controlled trial can be found in Wiles et al (2001).  The larger trial (Steiner et al 2001) aimed to compare intermediate care within a nurse-led unit and care on general medical wards and to examine the model of care on the nurse-led unit.  In interviews with patients and carers on the nurse-led unit, Wiles et al (2001) found that while patients viewed the model of care as acceptable, they reported great variation in their perceptions of the unit’s purpose, and had inconsistent experiences of care.

References

• Steiner A, Walsh B, Pickering R, Wiles R, Ward J and Brooking J (2001) ‘Therapeutic nursing or unblocking beds? A randomised controlled trial of a post­acute intermediate care unit’ British Medical Journal 32, 453-60.
• Wiles R, Postle K, Steiner A and Walsh B (2003) ‘Nurse-led intermediate care: patients’ perceptions’ International Journal of Nursing Studies 40 (1) 61-71.

What are qualitative research designs?

The concept of ‘research design’ within qualitative research is more problematic than within quantitative research, with alternative terms including (but not limited to) ‘research methodology’, ‘research approach’ and ‘research type’.  Reflecting on qualitative research, Cheek (2008: 761) initially describes ‘research design’ as ‘the way in which a research idea is transformed into a research project or plan that can then be carried out in practice by a research or research team’.

In this section, examples of different ‘qualitative research designs’ are presented and discussed in the form of methodologies or approaches.  Recommended text books providing a good overview of qualitative research are listed below.

References

• Cheek J (2008) ‘Research Design’ in LM Given (Ed) The Sage Encyclopedia of Qualitative Research Methods Vol 2 London: Sage, p761-3.

Recommended textbooks providing an overview of qualitative research

• Finlay L and C Ballinger (Eds) Qualitative Resesearch for Allied Health Professionals Chichester: John Wiley and Sons Ltd.
• Green J and Thorogood N 2004) Qualitative Methods for Health Research London: Sage.
• Mason J (2002) Qualitative Researching (2nd edn) London: Sage Publications.
• Neale J (Ed) (2009) Research Methods for Health and Social Care Basingstoke: Palgrave.
• Ritchie J and Lewis J (Eds) (2003) Qualitative Research Practice: A Guide for Social Science Students and Researchers London: Sage.
• Robson C (2002) Real World Research: A Resource for Social  Scientists and Practitioner-Researchers, 2nd edn Oxford: Blackwell.