what is the importance of qualitative research in academic studies

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• 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.

Prevent plagiarism. Run a free check.

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

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

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

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

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

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 .

Cite this Scribbr article

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

Bhandari, P. (2023, June 22). What Is Qualitative Research? | Methods & Examples. Scribbr. Retrieved June 26, 2024, from https://www.scribbr.com/methodology/qualitative-research/

Is this article helpful?

Pritha Bhandari

Other students also liked, qualitative vs. quantitative research | differences, examples & methods, how to do thematic analysis | step-by-step guide & examples, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

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).   

Events and Workshops

• Introduction to NVivo Have you just collected your data and wondered what to do next? Come join us for an introductory session on utilizing NVivo to support your analytical process. This session will only cover features of the software and how to import your records. Please feel free to attend any of the following sessions below: April 25th, 2024 12:30 pm - 1:45 pm Green Library - SVA Conference Room 125 May 9th, 2024 12:30 pm - 1:45 pm Green Library - SVA Conference Room 125
• Next: Choose an approach >>
• Choose an approach
• Find studies
• Learn methods
• Getting Started
• Get software
• Get data for secondary analysis
• Network with researchers

• Last Updated: May 23, 2024 1:27 PM
• URL: https://guides.library.stanford.edu/qualitative_research

Last updated 20/06/24: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website: https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > BJPsych Bulletin
• > The Psychiatrist
• > Volume 37 Issue 6
• > Qualitative research: its value and applicability

Article contents

What questions are best answered using qualitative research, countering some misconceptions, in conclusion, qualitative research: its value and applicability.

Published online by Cambridge University Press:  02 January 2018

Qualitative research has a rich tradition in the study of human social behaviour and cultures. Its general aim is to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of individuals, and the meanings attached to them. The effective application of qualitative methods to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. Qualitative approaches have particular potential in psychiatry research, singularly and in combination with quantitative methods. This article outlines the nature and potential application of qualitative research as well as attempting to counter a number of misconceptions.

Qualitative research has a rich tradition in the social sciences. Since the late 19th century, researchers interested in studying the social behaviour and cultures of humankind have perceived limitations in trying to explain the phenomena they encounter in purely quantifiable, measurable terms. Anthropology, in its social and cultural forms, was one of the foremost disciplines in developing what would later be termed a qualitative approach, founded as it was on ethnographic studies which sought an understanding of the culture of people from other societies, often hitherto unknown and far removed in geography. Reference Bernard 1 Early researchers would spend extended periods of time living in societies, observing, noting and photographing the minutia of daily life, with the most committed often learning the language of peoples they observed, in the hope of gaining greater acceptance by them and a more detailed understanding of the cultural norms at play. All academic disciplines concerned with human and social behaviour, including anthropology, sociology and psychology, now make extensive use of qualitative research methods whose systematic application was first developed by these colonial-era social scientists.

Their methods, involving observation, participation and discussion of the individuals and groups being studied, as well as reading related textual and visual media and artefacts, form the bedrock of all qualitative social scientific inquiry. The general aim of qualitative research is thus to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of those studied, and the meanings attached to them. Reference Bryman 2 Researchers interested in finding out why people behave the way they do; how people are affected by events, how attitudes and opinions are formed; how and why cultures and practices have developed in the way they have, might well consider qualitative methods to answer their questions.

It is fair to say that clinical and health-related research is still dominated by quantitative methods, of which the randomised controlled trial, focused on hypothesis-testing through experiment controlled by randomisation, is perhaps the quintessential method. Qualitative approaches may seem obscure to the uninitiated when directly compared with the experimental, quantitative methods used in clinical research. There is increasing recognition among researchers in these fields, however, that qualitative methods such as observation, in-depth interviews, focus groups, consensus methods, case studies and the interpretation of texts can be more effective than quantitative approaches in exploring complex phenomena and as such are valuable additions to the methodological armoury available to them. Reference Denzin and Lincoln 3

In considering what kind of research questions are best answered using a qualitative approach, it is important to remember that, first and foremost, unlike quantitative research, inquiry conducted in the qualitative tradition seeks to answer the question ‘What?’ as opposed to ‘How often?’. Qualitative methods are designed to reveal what is going on by describing and interpreting phenomena; they do not attempt to measure how often an event or association occurs. Research conducted using qualitative methods is normally done with an intent to preserve the inherent complexities of human behaviour as opposed to assuming a reductive view of the subject in order to count and measure the occurrence of phenomena. Qualitative research normally takes an inductive approach, moving from observation to hypothesis rather than hypothesis-testing or deduction, although the latter is perfectly possible.

When conducting research in this tradition, the researcher should, if possible, avoid separating the stages of study design, data collection and analysis, but instead weave backwards and forwards between the raw data and the process of conceptualisation, thereby making sense of the data throughout the period of data collection. Although there are inevitable tensions among methodologists concerned with qualitative practice, there is broad consensus that a priori categories and concepts reflecting a researcher's own preconceptions should not be imposed on the process of data collection and analysis. The emphasis should be on capturing and interpreting research participants' true perceptions and/or behaviours.

Using combined approaches

The polarity between qualitative and quantitative research has been largely assuaged, to the benefit of all disciplines which now recognise the value, and compatibility, of both approaches. Indeed, there can be particular value in using quantitative methods in combination with qualitative methods. Reference Barbour 4 In the exploratory stages of a research project, qualitative methodology can be used to clarify or refine the research question, to aid conceptualisation and to generate a hypothesis. It can also help to identify the correct variables to be measured, as researchers have been known to measure before they fully understand the underlying issues pertaining to a study and, as a consequence, may not always target the most appropriate factors. Qualitative work can be valuable in the interpretation, qualification or illumination of quantitative research findings. This is particularly helpful when focusing on anomalous results, as they test the main hypothesis formulated. Qualitative methods can also be used in combination with quantitative methods to triangulate findings and support the validation process, for example, where three or more methods are used and the results compared for similarity (e.g. a survey, interviews and a period of observation in situ ).

‘There is little value in qualitative research findings because we cannot generalise from them’

Generalisability refers to the extent that the account can be applied to other people, times and settings other than those actually studied. A common criticism of qualitative research is that the results of a study are rarely, if ever, generalisable to a larger population because the sample groups are small and the participants are not chosen randomly. Such criticism fails to recognise the distinctiveness of qualitative research where sampling is concerned. In quantitative research, the intent is to secure a large random sample that is representative of the general population, with the purpose of eliminating individual variations, focusing on generalisations and thereby allowing for statistical inference of results that are applicable across an entire population. In qualitative research, generalisability is based on the assumption that it is valuable to begin to understand similar situations or people, rather than being representative of the target population. Qualitative research is rarely based on the use of random samples, so the kinds of reference to wider populations made on the basis of surveys cannot be used in qualitative analysis.

Qualitative researchers utilise purposive sampling, whereby research participants are selected deliberately to test a particular theoretical premise. The purpose of sampling here is not to identify a random subgroup of the general population from which statistically significant results can be extrapolated, but rather to identify, in a systematic way, individuals that possess relevant characteristics for the question being considered. Reference Strauss and Corbin 5 The researchers must instead ensure that any reference to people and settings beyond those in the study are justified, which is normally achieved by defining, in detail, the type of settings and people to whom the explanation or theory applies based on the identification of similar settings and people in the study. The intent is to permit a detailed examination of the phenomenon, resulting in a text-rich interpretation that can deepen our understanding and produce a plausible explanation of the phenomenon under study. The results are not intended to be statistically generalisable, although any theory they generate might well be.

‘Qualitative research cannot really claim reliability or validity’

In quantitative research, reliability is the extent to which different observers, or the same observers on different occasions, make the same observations or collect the same data about the same object of study. The changing nature of social phenomena scrutinised by qualitative researchers inevitably makes the possibility of the same kind of reliability problematic in their work. A number of alternative concepts to reliability have been developed by qualitative methodologists, however, known collectively as forms of trustworthiness. Reference Guba 6

One way to demonstrate trustworthiness is to present detailed evidence in the form of quotations from interviews and field notes, along with thick textual descriptions of episodes, events and settings. To be trustworthy, qualitative analysis should also be auditable, making it possible to retrace the steps leading to a certain interpretation or theory to check that no alternatives were left unexamined and that no researcher biases had any avoidable influence on the results. Usually, this involves the recording of information about who did what with the data and in what order so that the origin of interpretations can be retraced.

In general, within the research traditions of the natural sciences, findings are validated by their repeated replication, and if a second investigator cannot replicate the findings when they repeat the experiment then the original results are questioned. If no one else can replicate the original results then they are rejected as fatally flawed and therefore invalid. Natural scientists have developed a broad spectrum of procedures and study designs to ensure that experiments are dependable and that replication is possible. In the social sciences, particularly when using qualitative research methods, replication is rarely possible given that, when observed or questioned again, respondents will almost never say or do precisely the same things. Whether results have been successfully replicated is always a matter of interpretation. There are, however, procedures that, if followed, can significantly reduce the possibility of producing analyses that are partial or biased. Reference Altheide, Johnson, Denzin and Lincoln 7

Triangulation is one way of doing this. It essentially means combining multiple views, approaches or methods in an investigation to obtain a more accurate interpretation of the phenomena, thereby creating an analysis of greater depth and richness. As the process of analysing qualitative data normally involves some form of coding, whereby data are broken down into units of analysis, constant comparison can also be used. Constant comparison involves checking the consistency and accuracy of interpretations and especially the application of codes by constantly comparing one interpretation or code with others both of a similar sort and in other cases and settings. This in effect is a form of interrater reliability, involving multiple researchers or teams in the coding process so that it is possible to compare how they have coded the same passages and where there are areas of agreement and disagreement so that consensus can be reached about a code's definition, improving consistency and rigour. It is also good practice in qualitative analysis to look constantly for outliers – results that are out of line with your main findings or any which directly contradict what your explanations might predict, re-examining the data to try to find a way of explaining the atypical finding to produce a modified and more complex theory and explanation.

Qualitative research has been established for many decades in the social sciences and encompasses a valuable set of methodological tools for data collection, analysis and interpretation. Their effective application to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. The use of qualitative approaches to research in psychiatry has particular potential, singularly and in combination with quantitative methods. Reference Crabb and Chur-Hansen 8 When devising research questions in the specialty, careful thought should always be given to the most appropriate methodology, and consideration given to the great depth and richness of empirical evidence which a robust qualitative approach is able to provide.

Declaration of interest

This article has been cited by the following publications. This list is generated based on data provided by Crossref .

• Google Scholar

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Volume 37, Issue 6
• Steven J. Agius (a1)
• DOI: https://doi.org/10.1192/pb.bp.113.042770

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed, qualitative study, affiliations.

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

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

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

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

Copyright © 2024, StatPearls Publishing LLC.

PubMed Disclaimer

Conflict of interest statement

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

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

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

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

Similar articles

• Invited review: Qualitative research in dairy science-A narrative review. Ritter C, Koralesky KE, Saraceni J, Roche S, Vaarst M, Kelton D. Ritter C, et al. J Dairy Sci. 2023 Sep;106(9):5880-5895. doi: 10.3168/jds.2022-23125. Epub 2023 Jul 18. J Dairy Sci. 2023. PMID: 37474366 Review.
• Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P. Crider K, et al. Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
• The future of Cochrane Neonatal. Soll RF, Ovelman C, McGuire W. Soll RF, et al. Early Hum Dev. 2020 Nov;150:105191. doi: 10.1016/j.earlhumdev.2020.105191. Epub 2020 Sep 12. Early Hum Dev. 2020. PMID: 33036834
• Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence. Husk K, Lovell R, Cooper C, Stahl-Timmins W, Garside R. Husk K, et al. Cochrane Database Syst Rev. 2016 May 21;2016(5):CD010351. doi: 10.1002/14651858.CD010351.pub2. Cochrane Database Syst Rev. 2016. PMID: 27207731 Free PMC article. Review.
• Macromolecular crowding: chemistry and physics meet biology (Ascona, Switzerland, 10-14 June 2012). Foffi G, Pastore A, Piazza F, Temussi PA. Foffi G, et al. Phys Biol. 2013 Aug;10(4):040301. doi: 10.1088/1478-3975/10/4/040301. Epub 2013 Aug 2. Phys Biol. 2013. PMID: 23912807
• Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 1: Introduction. Eur J Gen Pract. 2017 Dec;23(1):271-273. - PMC - PubMed
• Cleland JA. The qualitative orientation in medical education research. Korean J Med Educ. 2017 Jun;29(2):61-71. - PMC - PubMed
• Foley G, Timonen V. Using Grounded Theory Method to Capture and Analyze Health Care Experiences. Health Serv Res. 2015 Aug;50(4):1195-210. - PMC - PubMed
• Devers KJ. How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research. Health Serv Res. 1999 Dec;34(5 Pt 2):1153-88. - PMC - PubMed
• Huston P, Rowan M. Qualitative studies. Their role in medical research. Can Fam Physician. 1998 Nov;44:2453-8. - PMC - PubMed

Publication types

• Search in PubMed
• Search in MeSH
• Add to Search

Related information

• Cited in Books

LinkOut - more resources

Full text sources.

• NCBI Bookshelf

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• General & Introductory Religion & Theology

The Wiley Blackwell Companion to Theology and Qualitative Research

ISBN: 978-1-119-75693-4

Wiley-Blackwell

Knut Tveitereid , Pete Ward

A unique introduction to the developing field of Theology and Qualitative Research

In recent years, a growing number of scholars within the field of theological research have adopted qualitative empirical methods. The use of qualitative research is shaping the nature of theology and redefining what it means to be a theologian. Hence, contemporary scholars who are undertaking empirical fieldwork across a range of theological subdisciplines require authoritative guidance and well-developed frameworks of practice and theory.

The Wiley Blackwell Companion to Theology and Qualitative Research outlines the challenges and possibilities for theological research that engages with qualitative methods. It reflects more than 15 years of academic research within the Ecclesiology and Ethnography Network, and features an international group of scholars committed to the empirical and theological study of the Christian church.

Edited by world-renowned experts, this unprecedented volume addresses the theological debates, methodological complexities, and future directions of this emerging field. Contributions from both established and emerging scholars describe key theoretical approaches, discuss how different empirical methods are used within theology, explore the links between qualitative researchand adjacent scholarly traditions, and more. The companion:

• Discusses how qualitative empirical work changes the practice of theology, enabling a disciplined attention to the lived social realities of Christian religion and what theologians do
• Introduces theoretical and methodological debates in the field, as well as central epistemological and ontological questions
• Presents different approaches to Theology and Qualitative research, highlighting important issues and developments in the last decades
• Explores how empirical insights are shaping areas such as liturgics, homiletics, youth ministry, and Christian education
• Includes perspectives from scholars working in disciplines other than theology

The Wiley Blackwell Companion to Theology and Qualitative Research is essential reading for graduate students, postgraduates, PhD students, researchers, and scholars in Christian Ethics, Systematic Theology, Practical Theology, Contemporary Worship, and related disciplines such as Ecclesiology, Mission Studies, World Christianity, Pastoral Theology, Political Theology, Worship Studies, and all forms of contextual theology.

Pete Ward is Professor of Practical Theology at Durham University, UK, and NLA University College, Bergen, Norway. He founded, together with Christian Scharen, the Ecclesiology and Ethnography (E&E) Network and served as Editor of the journal Ecclesial Practices . He is the author of Introducing Practical Theology: Mission Ministry and the Life of the Church, Liquid Ecclesiology: Gospel and Church, and the editor of Perspectives on Ecclesiology and Ethnography.

Knut Tveitereid is Associate Professor of Practical Theology and Head of Ministry Training at MF Norwegian School of Theology, Religion and Society in Oslo, Norway. He is closely involved with the Ecclesiology and Ethnography (E&E) Network and serves as Academic Coordinator for the E&E Network’s annual Durham Conference.

What is Qualitative in Qualitative Research

• Open access
• Published: 27 February 2019
• Volume 42 , pages 139–160, ( 2019 )

Cite this article

You have full access to this open access article

• Patrik Aspers 1 , 2 &
• Ugo Corte 3  

611k Accesses

305 Citations

24 Altmetric

Explore all metrics

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.

Similar content being viewed by others

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.

Avoid common mistakes on your manuscript.

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.

Åkerström, Malin. 2013. Curiosity and serendipity in qualitative research. Qualitative Sociology Review 9 (2): 10–18.

Google Scholar  

Alford, Robert R. 1998. The craft of inquiry. Theories, methods, evidence . Oxford: Oxford University Press.

Alvesson, Mats, and Dan Kärreman. 2011. Qualitative research and theory development. Mystery as method . London: SAGE Publications.

Book   Google Scholar  

Aspers, Patrik. 2006. Markets in Fashion, A Phenomenological Approach. London Routledge.

Atkinson, Paul. 2005. Qualitative research. Unity and diversity. Forum: Qualitative Social Research 6 (3): 1–15.

Becker, Howard S. 1963. Outsiders. Studies in the sociology of deviance . New York: The Free Press.

Becker, Howard S. 1966. Whose side are we on? Social Problems 14 (3): 239–247.

Article   Google Scholar  

Becker, Howard S. 1970. Sociological work. Method and substance . New Brunswick: Transaction Books.

Becker, Howard S. 1996. The epistemology of qualitative research. In Ethnography and human development. Context and meaning in social inquiry , ed. Jessor Richard, Colby Anne, and Richard A. Shweder, 53–71. Chicago: University of Chicago Press.

Becker, Howard S. 1998. Tricks of the trade. How to think about your research while you're doing it . Chicago: University of Chicago Press.

Becker, Howard S. 2017. Evidence . Chigaco: University of Chicago Press.

Becker, Howard, Blanche Geer, Everett Hughes, and Anselm Strauss. 1961. Boys in White, student culture in medical school . New Brunswick: Transaction Publishers.

Berezin, Mabel. 2014. How do we know what we mean? Epistemological dilemmas in cultural sociology. Qualitative Sociology 37 (2): 141–151.

Best, Joel. 2004. Defining qualitative research. In Workshop on Scientific Foundations of Qualitative Research , eds . Charles, Ragin, Joanne, Nagel, and Patricia White, 53-54. http://www.nsf.gov/pubs/2004/nsf04219/nsf04219.pdf .

Biernacki, Richard. 2014. Humanist interpretation versus coding text samples. Qualitative Sociology 37 (2): 173–188.

Blumer, Herbert. 1969. Symbolic interactionism: Perspective and method . Berkeley: University of California Press.

Brady, Henry, David Collier, and Jason Seawright. 2004. Refocusing the discussion of methodology. In Rethinking social inquiry. Diverse tools, shared standards , ed. Brady Henry and Collier David, 3–22. Lanham: Rowman and Littlefield.

Brown, Allison P. 2010. Qualitative method and compromise in applied social research. Qualitative Research 10 (2): 229–248.

Charmaz, Kathy. 2006. Constructing grounded theory . London: Sage.

Corte, Ugo, and Katherine Irwin. 2017. “The Form and Flow of Teaching Ethnographic Knowledge: Hands-on Approaches for Learning Epistemology” Teaching Sociology 45(3): 209-219.

Creswell, John W. 2009. Research design. Qualitative, quantitative, and mixed method approaches . 3rd ed. Thousand Oaks: SAGE Publications.

Davidsson, David. 1988. 2001. The myth of the subjective. In Subjective, intersubjective, objective , ed. David Davidsson, 39–52. Oxford: Oxford University Press.

Denzin, Norman K. 1970. The research act: A theoretical introduction to Ssociological methods . Chicago: Aldine Publishing Company Publishers.

Denzin, Norman K., and Yvonna S. Lincoln. 2003. Introduction. The discipline and practice of qualitative research. In Collecting and interpreting qualitative materials , ed. Norman K. Denzin and Yvonna S. Lincoln, 1–45. Thousand Oaks: SAGE Publications.

Denzin, Norman K., and Yvonna S. Lincoln. 2005. Introduction. The discipline and practice of qualitative research. In The Sage handbook of qualitative research , ed. Norman K. Denzin and Yvonna S. Lincoln, 1–32. Thousand Oaks: SAGE Publications.

Emerson, Robert M., ed. 1988. Contemporary field research. A collection of readings . Prospect Heights: Waveland Press.

Emerson, Robert M., Rachel I. Fretz, and Linda L. Shaw. 1995. Writing ethnographic fieldnotes . Chicago: University of Chicago Press.

Esterberg, Kristin G. 2002. Qualitative methods in social research . Boston: McGraw-Hill.

Fine, Gary Alan. 1995. Review of “handbook of qualitative research.” Contemporary Sociology 24 (3): 416–418.

Fine, Gary Alan. 2003. “ Toward a Peopled Ethnography: Developing Theory from Group Life.” Ethnography . 4(1):41-60.

Fine, Gary Alan, and Black Hawk Hancock. 2017. The new ethnographer at work. Qualitative Research 17 (2): 260–268.

Fine, Gary Alan, and Timothy Hallett. 2014. Stranger and stranger: Creating theory through ethnographic distance and authority. Journal of Organizational Ethnography 3 (2): 188–203.

Flick, Uwe. 2002. Qualitative research. State of the art. Social Science Information 41 (1): 5–24.

Flick, Uwe. 2007. Designing qualitative research . London: SAGE Publications.

Frankfort-Nachmias, Chava, and David Nachmias. 1996. Research methods in the social sciences . 5th ed. London: Edward Arnold.

Franzosi, Roberto. 2010. Sociology, narrative, and the quality versus quantity debate (Goethe versus Newton): Can computer-assisted story grammars help us understand the rise of Italian fascism (1919- 1922)? Theory and Society 39 (6): 593–629.

Franzosi, Roberto. 2016. From method and measurement to narrative and number. International journal of social research methodology 19 (1): 137–141.

Gadamer, Hans-Georg. 1990. Wahrheit und Methode, Grundzüge einer philosophischen Hermeneutik . Band 1, Hermeneutik. Tübingen: J.C.B. Mohr.

Gans, Herbert. 1999. Participant Observation in an Age of “Ethnography”. Journal of Contemporary Ethnography 28 (5): 540–548.

Geertz, Clifford. 1973. The interpretation of cultures . New York: Basic Books.

Gilbert, Nigel. 2009. Researching social life . 3rd ed. London: SAGE Publications.

Glaeser, Andreas. 2014. Hermeneutic institutionalism: Towards a new synthesis. Qualitative Sociology 37: 207–241.

Glaser, Barney G., and Anselm L. Strauss. [1967] 2010. The discovery of grounded theory. Strategies for qualitative research. Hawthorne: Aldine.

Goertz, Gary, and James Mahoney. 2012. A tale of two cultures: Qualitative and quantitative research in the social sciences . Princeton: Princeton University Press.

Goffman, Erving. 1989. On fieldwork. Journal of Contemporary Ethnography 18 (2): 123–132.

Goodwin, Jeff, and Ruth Horowitz. 2002. Introduction. The methodological strengths and dilemmas of qualitative sociology. Qualitative Sociology 25 (1): 33–47.

Habermas, Jürgen. [1981] 1987. The theory of communicative action . Oxford: Polity Press.

Hammersley, Martyn. 2007. The issue of quality in qualitative research. International Journal of Research & Method in Education 30 (3): 287–305.

Hammersley, Martyn. 2013. What is qualitative research? Bloomsbury Publishing.

Hammersley, Martyn. 2018. What is ethnography? Can it survive should it? Ethnography and Education 13 (1): 1–17.

Hammersley, Martyn, and Paul Atkinson. 2007. Ethnography. Principles in practice . London: Tavistock Publications.

Heidegger, Martin. [1927] 2001. Sein und Zeit . Tübingen: Max Niemeyer Verlag.

Heidegger, Martin. 1988. 1923. Ontologie. Hermeneutik der Faktizität, Gesamtausgabe II. Abteilung: Vorlesungen 1919-1944, Band 63, Frankfurt am Main: Vittorio Klostermann.

Hempel, Carl G. 1966. Philosophy of the natural sciences . Upper Saddle River: Prentice Hall.

Hood, Jane C. 2006. Teaching against the text. The case of qualitative methods. Teaching Sociology 34 (3): 207–223.

James, William. 1907. 1955. Pragmatism . New York: Meredian Books.

Jovanović, Gordana. 2011. Toward a social history of qualitative research. History of the Human Sciences 24 (2): 1–27.

Kalof, Linda, Amy Dan, and Thomas Dietz. 2008. Essentials of social research . London: Open University Press.

Katz, Jack. 2015. Situational evidence: Strategies for causal reasoning from observational field notes. Sociological Methods & Research 44 (1): 108–144.

King, Gary, Robert O. Keohane, S. Sidney, and S. Verba. 1994. Designing social inquiry. In Scientific inference in qualitative research . Princeton: Princeton University Press.

Chapter   Google Scholar  

Lamont, Michelle. 2004. Evaluating qualitative research: Some empirical findings and an agenda. In Report from workshop on interdisciplinary standards for systematic qualitative research , ed. M. Lamont and P. White, 91–95. Washington, DC: National Science Foundation.

Lamont, Michèle, and Ann Swidler. 2014. Methodological pluralism and the possibilities and limits of interviewing. Qualitative Sociology 37 (2): 153–171.

Lazarsfeld, Paul, and Alan Barton. 1982. Some functions of qualitative analysis in social research. In The varied sociology of Paul Lazarsfeld , ed. Patricia Kendall, 239–285. New York: Columbia University Press.

Lichterman, Paul, and Isaac Reed I (2014), Theory and Contrastive Explanation in Ethnography. Sociological methods and research. Prepublished 27 October 2014; https://doi.org/10.1177/0049124114554458 .

Lofland, John, and Lyn Lofland. 1995. Analyzing social settings. A guide to qualitative observation and analysis . 3rd ed. Belmont: Wadsworth.

Lofland, John, David A. Snow, Leon Anderson, and Lyn H. Lofland. 2006. Analyzing social settings. A guide to qualitative observation and analysis . 4th ed. Belmont: Wadsworth/Thomson Learning.

Long, Adrew F., and Mary Godfrey. 2004. An evaluation tool to assess the quality of qualitative research studies. International Journal of Social Research Methodology 7 (2): 181–196.

Lundberg, George. 1951. Social research: A study in methods of gathering data . New York: Longmans, Green and Co..

Malinowski, Bronislaw. 1922. Argonauts of the Western Pacific: An account of native Enterprise and adventure in the archipelagoes of Melanesian New Guinea . London: Routledge.

Manicas, Peter. 2006. A realist philosophy of science: Explanation and understanding . Cambridge: Cambridge University Press.

Marchel, Carol, and Stephanie Owens. 2007. Qualitative research in psychology. Could William James get a job? History of Psychology 10 (4): 301–324.

McIntyre, Lisa J. 2005. Need to know. Social science research methods . Boston: McGraw-Hill.

Merton, Robert K., and Elinor Barber. 2004. The travels and adventures of serendipity. A Study in Sociological Semantics and the Sociology of Science . Princeton: Princeton University Press.

Mannay, Dawn, and Melanie Morgan. 2015. Doing ethnography or applying a qualitative technique? Reflections from the ‘waiting field‘. Qualitative Research 15 (2): 166–182.

Neuman, Lawrence W. 2007. Basics of social research. Qualitative and quantitative approaches . 2nd ed. Boston: Pearson Education.

Ragin, Charles C. 1994. Constructing social research. The unity and diversity of method . Thousand Oaks: Pine Forge Press.

Ragin, Charles C. 2004. Introduction to session 1: Defining qualitative research. In Workshop on Scientific Foundations of Qualitative Research , 22, ed. Charles C. Ragin, Joane Nagel, Patricia White. http://www.nsf.gov/pubs/2004/nsf04219/nsf04219.pdf

Rawls, Anne. 2018. The Wartime narrative in US sociology, 1940–7: Stigmatizing qualitative sociology in the name of ‘science,’ European Journal of Social Theory (Online first).

Schütz, Alfred. 1962. Collected papers I: The problem of social reality . The Hague: Nijhoff.

Seiffert, Helmut. 1992. Einführung in die Hermeneutik . Tübingen: Franke.

Silverman, David. 2005. Doing qualitative research. A practical handbook . 2nd ed. London: SAGE Publications.

Silverman, David. 2009. A very short, fairly interesting and reasonably cheap book about qualitative research . London: SAGE Publications.

Silverman, David. 2013. What counts as qualitative research? Some cautionary comments. Qualitative Sociology Review 9 (2): 48–55.

Small, Mario L. 2009. “How many cases do I need?” on science and the logic of case selection in field-based research. Ethnography 10 (1): 5–38.

Small, Mario L 2008. Lost in translation: How not to make qualitative research more scientific. In Workshop on interdisciplinary standards for systematic qualitative research, ed in Michelle Lamont, and Patricia White, 165–171. Washington, DC: National Science Foundation.

Snow, David A., and Leon Anderson. 1993. Down on their luck: A study of homeless street people . Berkeley: University of California Press.

Snow, David A., and Calvin Morrill. 1995. New ethnographies: Review symposium: A revolutionary handbook or a handbook for revolution? Journal of Contemporary Ethnography 24 (3): 341–349.

Strauss, Anselm L. 2003. Qualitative analysis for social scientists . 14th ed. Chicago: Cambridge University Press.

Strauss, Anselm L., and Juliette M. Corbin. 1998. Basics of qualitative research. Techniques and procedures for developing grounded theory . 2nd ed. Thousand Oaks: Sage Publications.

Swedberg, Richard. 2017. Theorizing in sociological research: A new perspective, a new departure? Annual Review of Sociology 43: 189–206.

Swedberg, Richard. 1990. The new 'Battle of Methods'. Challenge January–February 3 (1): 33–38.

Timmermans, Stefan, and Iddo Tavory. 2012. Theory construction in qualitative research: From grounded theory to abductive analysis. Sociological Theory 30 (3): 167–186.

Trier-Bieniek, Adrienne. 2012. Framing the telephone interview as a participant-centred tool for qualitative research. A methodological discussion. Qualitative Research 12 (6): 630–644.

Valsiner, Jaan. 2000. Data as representations. Contextualizing qualitative and quantitative research strategies. Social Science Information 39 (1): 99–113.

Weber, Max. 1904. 1949. Objectivity’ in social Science and social policy. Ed. Edward A. Shils and Henry A. Finch, 49–112. New York: The Free Press.

Download references

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.

Author information

Authors and affiliations.

Department of Sociology, Uppsala University, Uppsala, Sweden

Patrik Aspers

Seminar for Sociology, Universität St. Gallen, St. Gallen, Switzerland

Department of Media and Social Sciences, University of Stavanger, Stavanger, Norway

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Patrik Aspers .

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

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

Download citation

Published : 27 February 2019

Issue Date : 01 June 2019

DOI : https://doi.org/10.1007/s11133-019-9413-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Qualitative research
• Epistemology
• Philosophy of science
• Phenomenology
• Find a journal
• Publish with us
• Track your research

• Introduction
• Conclusions
• Article Information

eAppendix. Interview Guide

Data Sharing Statement

• Preventing the Demise of Diversity, Equity, and Inclusion JAMA Network Open Invited Commentary June 13, 2024 Kathie-Ann Joseph, MD, MPH; Renee Williams, MD, MHPE

See More About

Sign up for emails based on your interests, select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing

Get the latest research based on your areas of interest.

Others also liked.

• Download PDF
• X Facebook More LinkedIn

Esparza CJ , Simon M , London MR , Bath E , Ko M. Experiences of Leaders in Diversity, Equity, and Inclusion in US Academic Health Centers. JAMA Netw Open. 2024;7(6):e2415401. doi:10.1001/jamanetworkopen.2024.15401

Manage citations:

© 2024

• Permissions

Experiences of Leaders in Diversity, Equity, and Inclusion in US Academic Health Centers

• 1 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
• 2 School of Medicine, University of California, Davis
• 3 Storywalkers Consulting, Davis, California
• 4 Division of Population Behavioral Health, UCLA Health, Los Angeles, California
• Invited Commentary Preventing the Demise of Diversity, Equity, and Inclusion Kathie-Ann Joseph, MD, MPH; Renee Williams, MD, MHPE JAMA Network Open

Question   What are the experiences of leaders in diversity, equity, and inclusion (DEI) at US academic health centers?

Findings   In this qualitative study, 32 leaders described a considerable range of expected responsibilities. Institutional resources rarely matched stated goals, with limited use of evidence or standards, and participants from marginalized backgrounds expressed strong motivation coupled with exhaustion from the mismatch between demands and support.

Meaning   The findings of this study suggest that leaders charged with promoting diverse, inclusive, and equitable environments in academic health centers would benefit from direct investment in their efforts, guidance from policymakers and organizations, and assessment and dissemination of best practices.

Importance   The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI).

Objective   To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges.

Design, Setting, and Participants   This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021.

Exposure   Formal DEI role.

Main Outcomes and Measures   Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office.

Results   A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support.

Conclusions and Relevance   In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.

Following the murder of George Floyd, leaders in academic medicine announced new initiatives related to advancing diversity, equity, and inclusion (DEI). The Association of American Medical Colleges (AAMC) found that the percentage of institutions with dedicated DEI staff and offices rose from 75% in 2018 to 97% in 2021. 1 Nearly all (96%) reported having a senior-level DEI administrator (eg, assistant dean, chief diversity officer). 1

Despite the growth in DEI efforts, evidence on the expectations of, support for, or standards for DEI in academic medicine remains limited. A 2015 AAMC survey of DEI leaders found that more than half held a dean title, although their positions varied across units, from student and faculty affairs to community engagement and outreach. 1 Most reported they had less than 50% of their time allocated to DEI work, with budgetary support ranging from $0 to $1 million. Their main priorities included student diversity, meeting Liaison Committee on Medical Education (LCME) diversity standards, institutional climate, and culturally competent care. 2 In a smaller 2018 survey, most focused on student recruitment and retention. 3 The LCME and the Accreditation Council on Graduate Medical Education (ACGME) have instituted diversity-related accreditation standards but not specifically for DEI administrators. The AAMC Group on Diversity and Inclusion published a toolkit to support new DEI leaders, and the National Association of Diversity Officers in Higher Education developed professional standards, but it is unclear whether academic medicine institutions incorporate these guidelines for diversity leaders. 4 - 6

Researchers in higher education have found that diversity initiatives are often broad in scope, unclear in meaning, and limited in their effectiveness. Following legal and political constraints on affirmative action policies, university leaders embraced the cause of diversity rather than racial justice. 1 Subsequently, universities more often tasked diversity administrators with the discussion of diversity, including publishing statements and missions, rather than pursuing meaningful systems change. 5 Furthermore, repeatedly launching new initiatives can displace substantive reforms by rearranging priorities and failing to invest in existing work. 6 DEI leaders are often scattered in silos that preclude collaboration and communication. To work effectively, DEI leaders require equity-focused directives, sustained investment, organizational authority, coordination across units, and a commitment to reforming existing institutional structures. 7 - 9

Our objective for this study was to describe the experiences of leaders in US academic medicine who have a formal DEI (or similar) position, particularly in the context of the renewed calls for attention to racial justice in medicine. We conducted key informant interviews to explore participants’ motivations, responsibilities, and their experiences in conducting DEI work. In the absence of a clear understanding of what DEI leaders can or should do, academic medicine cannot evaluate the impact of these initiatives. Consequently, schools and health systems run the risk of expending opportunities without advancing structural change. 10 By exploring perspectives from DEI leaders, we can offer insights on strategies to support their success.

We used the Standards for Reporting Qualitative Research ( SRQR ) reporting guideline to prepare this manuscript. The protocol was approved by the institutional review board of the University of California, Davis. We provided participants with a letter of information upon scheduling the interview, reviewed the document with participants, and obtained verbal consent.

The lead author (C.J.E.) identifies as a Chicane nonbinary medical student at the time of the study, who has created and participated in institutional DEI and racial equity initiatives. The primary interviewer (M.S.) identifies as a White cisgender man and professional facilitator with expertise in diversity in higher education. Coinvestigator (E.B.) identifies as a Black cisgender woman physician researcher with expertise in racism in medical education and currently serves as a senior DEI leader for an academic medical center. The senior investigator (M.K.) identifies as an Asian American cisgender woman researcher who has served in multiple DEI positions. Coinvestigator (M.R.L.) identifies as a White cisgender woman medical student. The collective team background and experience fostered planning, analysis, and discussion from multiple perspectives. Our status as a multiracial, multi-ethnic team enabled inquiry and analyses that included racial and ethnic positionality-specific examination.

We used a phenomenographic approach to construct a representation of the variation in nature, positionality, and experience of those with DEI roles. We analyzed our topic within the multilayered context of academic medical institutions. 11

We recruited participants from US medical schools and academic medical centers who held, or recently held, formal leadership roles in an office of Diversity, Equity, and/or Inclusion, which referred to all administrative units whose primary intent is to foster 1 or more of these goals at their respective program or institution. Although we used the term offices, we noted potential participants held titled roles over many types of structures, eg, committee, division, or center.

At the time of the study, there was no national directory of DEI leaders, and as noted previously, this population was rapidly changing. We conducted initial recruitment via email through professional networks, the UC Davis Center for a Diverse Healthcare Workforce, and contacts from prior studies conducted by the team. We supplemented with snowball sampling and purposive sampling to ensure we obtained perspectives from different geographic regions (West, Midwest, South, and Northeast) and types of institutions (public and private; schools and health systems). Participants were assigned an alphanumeric study identifier (ID) at recruitment.

We conducted video interviews from December 2020 to September 2021. Interviews lasted approximately 1 hour and were digitally recorded and transcribed using Zoom services. We labeled speakers with participant study ID prior to recording and labeled files by study ID. Two authors (M.R.L. and C.J.E.) then reviewed transcripts to correct errors and remove identifying information, including regional (eg, city, county, and state), institutional, and programmatic details.

No interviews were discarded. We were unable to collect data on nonparticipants, other than name and institution, so we were unable to discern patterns of nonparticipants related to individual characteristics.

Critically, we conducted interviews early in the COVID-19 pandemic, shortly following the murder of George Floyd in the summer of 2020. Therefore, our data and analyses reflected the co-occurrence with these events. Discussions explored DEI structures (eg, roles, placement within institutions, formal resources, and level of influence) as well as participants’ personal experiences (eg, motivations, challenges, and emotional hurdles). The full interview guide is provided as the eAppendix in Supplement 1 .

We used a phenomenographic approach with concurrent analysis to identify thematic categories across participants, rather than a focused analysis of singular experiences. Two authors conducted preliminary independent review of 5 transcripts (C.J.E and M.K.) to identify initial categories. Following review and full team discussion, 1 author (C.J.E.) reviewed the remaining transcripts to further develop and revise codes. In instances of differences of opinion, the team discussed and developed an agreed-on code and/or set of codes for the lead author to review and apply. The full team reevaluated the subsequent coding structure an additional 2 times, and then 1 reviewer (C.J.E.) conducted the final analysis and coding to produce final themes. We used Dedoose version 9.0.107 for initial code development, followed by hand-coding of transcripts to produce final themes. To enhance trustworthiness, we created an audit trail of detailed memos and used investigator triangulation of experiences in DEI roles for verification and context.

Our final sample consisted of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions ( Table 1 ). More than half held a dean position (17 [53%]), and several held 2 or more DEI roles (4 [13%]). Two-thirds identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Regional distribution somewhat favored the eastern United States, with more than one-third of participants in the South.

Participants described responsibilities spanning clinical to biomedical to public health areas ( Table 2 ). All reported formal goals of increasing workforce diversity and improving institutional climate. Many shared overlapping objectives, such as increasing capacity, broadening reach, and building credibility.

Responses indicated a broad range in authority, leadership endorsement, and resources, even when participants held seemingly similar roles. For example, among 3 participants with associate dean titles, ID62 reported 20% full-time equivalent (FTE) allocation to chair the antiracism task force and conduct oversight of medical school metrics, training, and policies, with 4 staff and a $1 million budget. ID11 had 30% FTE to oversee undergraduate medical school curriculum as well as recruitment and retention of trainees, faculty, and department chairs, with no staff or budget. Meanwhile, ID94 described their time as 20% or 50%, depending on their leadership’s perspective, and supervised undergraduate pathway programs, curriculum, LCME and ACGME accreditation, and faculty diversity, with the assistance of 1 staff coordinator and federal grants. Those working at the department level had no staff and minimal compensation and funding.

Many reported a high level of autonomy, but nearly all preferred clearer, more structured expectations from leadership ( Table 2 ). Participants regularly juggled informal on-demand requests, such as providing emotional support following incidents of discrimination and crafting rapid institutional response statements. They described how complex reporting structures (eg, reporting simultaneously to school, health system, and university leadership) required them to expend time and energy developing and maintaining a broad network of connections.

Participants with longer tenure described institutional volatility in commitment and resources. Many reported that expectations increased following the renewed racial justice movement but questioned whether these changes merely reflected a temporary institutional response vs sustained effort. Furthermore, institutions hired underrepresented individuals for DEI positions; this offered needed perspective but placed these individuals at heightened vulnerability: DEI failures could also be blamed on leaders from marginalized racial, ethnic, income, or gender groups.

Two participants (ID48 and ID62) expressed optimism because they had received new directives with clear expectations, appropriate staffing and budget, and institutional accountability. Their institutions required department chairs and division chiefs to prepare detailed faculty DEI plans and accountability incorporated into performance reviews, signaling DEI as an institutional priority. The DEI office provided data and programming support for these leaders, positioning the DEI administrator as a collaborative, rather than adversarial, partner.

Participants consistently described insufficient investment relative to institutional expectations ( Table 2 ). Investment consisted of both tangible resources, eg, budget, staff, time, and compensation, as well as intangible resources, such as authority and leadership endorsement. Most felt that senior leadership did not understand the level of support needed to pursue DEI goals effectively. Participant ID224 summarized, “They have high expectations, and the reality is that I am only one person.… Diversity is seen as compliance accreditation. [If] you’re really interested in changing the landscape… then you have to put money where your mouth is, to move the needle.”

Furthermore, participants had no consistent positioning within their organizations and often occupied a place in parallel to (rather than integrated in) main organizational units (eg, medical education, faculty development). Without the ability to directly guide operations, participants struggled to meet expectations. One participant (ID207) explained that they “do not have true power” but rather “power… by proxy.” Many characterized their institutional leadership as verbally supportive without concomitant sponsorship, thus hampering their abilities to advance organizational accountability ( Table 2 ).

The mismatch between institutional expectations and resources, particularly relative to investments in research and clinical activities, undermined participants’ trust in their institution’s commitment to DEI. They questioned whether they played superficial, rather than substantive, roles. One (ID11) worried that the creation of the DEI office allowed their institution to absolve other units of accountability. Institutional devaluation further amplified racial prejudice from peers and staff, who perceived DEI leaders as less capable.

Participants felt that the absence of structured institutional expectations increased the difficulty of their work ( Table 2 ). They perceived that leadership frequently operated by reactionary response to an event, such as LCME accreditation or a major news crisis, that resulted in “clamoring for activities, statements, and webinars” rather than addressing “real concerns [such as] structural racism” (ID239). Participants noted the lack of root-cause analysis also contributed to the perception of institutional DEI as performative rather than substantive. As ID236 explained, DEI work required new expertise—otherwise, there would be no need for change. Several endorsed “that nobody knows how to do it” and wished for more scholarship on DEI practice in academic medicine.

The limited evidence base contributed to inconsistency in measurement and accountability. Participants expressed uncertainty around how to demonstrate success, which undermined their confidence and ability to advocate for DEI to institutional leadership. Some perceived LCME and ACGME accreditation as diversity compliance, but others felt the threat of losing accreditation at least motivated small steps toward reform.

Without a strong base of theory and scholarship, participants described a vacuum in expertise to assess qualifications for DEI positions. Participants explained that given that the majority of academic medicine faculty are physicians, most lack training on organizational development theory, implementation science, and historical and current systems of oppression in medicine. Instead, ID236 reflected, the lack of physicians with appropriate training contributes to the problems that DEI work is supposed to fix.

Participants referenced personal sources of motivation, often arising from their own lived experiences with tokenism, discrimination, and mistreatment in academic medicine ( Table 2 ). Thus, despite the challenges described in the preceding themes, they held a strong commitment to support trainees and faculty from marginalized groups. As ID83 noted, “I understand the importance of my own presence in the territory, and try to share the values that I have developed over time with others, in a way that’s not combative but hopefully compelling.” Some reported leveraging their own marginalized identity to educate peers and leadership, putting a “personal spin on it” for people “to see the humanness.”

Many reported that the combination of personal and institutional marginalization contributed to deep professional isolation. Their DEI roles required them to serve as the face of their institutions in managing internal incidents of interpersonal discrimination and abuse yet also supporting trainees and peers. They also described the toll of leading institutional responses following highly publicized cases of racial and gender-based violence, while being chronically undersupported and unrecognized for their emotional labor. Participants reported growing burnout from the pressure of navigating the narrow space between institutional and community demands. Participant ID207 shared, “My job is to have hope, to absorb for everybody else, figure out what I can do after every kaboom to help the community heal…. But [I] don’t have time to heal or process [myself].”

Our findings offer insights into the experiences of DEI leaders in academic medicine during a period of heightened attention to racial injustices. The variability in roles and institutional investment reveal an overall lack of clarity on the aims and implementation of DEI initiatives. Furthermore, DEI work can occur at high personal cost to the individuals tasked with carrying it through.

Our findings are consistent with earlier studies that have found high variability in titles, scope, role, authority, and resources. 3 , 12 The ambiguity of DEI roles and responsibilities, and the mismatch between expectations and investment, are emblematic of decentralization, described by sociologist James Thomas as: “1) lack of/slow coordination; 2) absence of regulations and/or enforcement; 3) unresponsiveness; 4) poor observational capabilities; 5) shared belief that no matter what organizational actors do, the same outcome persists.” 6 Our participants’ guarded perceptions of new antiracism initiatives reflect the concern that academic medicine will remain unchanged. Recognizing this pattern is crucial, because some may conclude that the lack of progress suggests that DEI work cannot, or should not, be done.

Participants believed their challenges arose partly due to the absence of theories of change within academic medicine. Institutional leaders reference business and management fields to pursue clinical and educational reforms, but not for DEI work. 12 For example, the field of implementation science applies organizational behavior knowledge, yet no participants reported using implementation science in DEI. This may reflect institutional oversight, but diversity scholars argue that the overall lack of strategy is a feature, rather than a bug, in the system. 7 , 8 Under these conditions, DEI leaders run the risk of being perceived as ineffectual, and their own work as performative. 5

Our participants expressed exhaustion and burnout from compensating for DEI decentralization, which was further amplified participants from minoritized racial and ethnic groups by staging difference: “the constant push for new programs, managed by men and women of color,” to signal a “new” effort by the university. 6 Feminist scholar Sara Ahmed 5 raised the cautionary warning that racially and ethnically minoritized DEI professionals then embody DEI for the institution, at a steep cost to their personal health. Black DEI professionals are particularly exploited by institutions to address systemic problems (without systemic resources), serve as a buffer between leadership and their constituents, and use their own identity as a stand-in for entire communities. 13 , 14 Our participants detailed the fatigue that arises when they selectively express and repress aspects of their identities, without the structural or material support to change the very institutions that continue to harm them. Thomas 6 cautions that “rather than addressing structural inequalities, the performative culture of diversity reproduces and exaggerates them.” Staging difference reproduces DEI leadership churn, leading to failed initiatives and repeated calls for minoritized workers to lead the next new initiative.

Our study offers rich detail on how DEI leaders may be stymied in academic medicine; however, they also suggest opportunities for change. First, organizations such as the AAMC can support developing specific guidelines on DEI objectives and resources and invest in successful programs. Second, the LCME and the ACGME can institute detailed DEI standards, including requirements for clear expectations, measurement, and institutional investment in monitoring and evaluation. 15 The current diversity and inclusion accreditation standards created a theoretical structure for assessment, but measurement and evaluation remain vague and limited in fostering accountability. 16 , 17 Third, institutions can establish professional expectations for DEI leaders, such as training and experience in organizational behavior, power assessment, critical race theory, and historical understanding of structural inequities. Fourth, DEI leaders must be granted resources—including staff, budgets, and authority—concomitant with their objectives and scope.

These recommendations may be particularly challenging to enact as policymakers in multiple states have terminated DEI funding, programming, and positions. The current climate further demonstrates the need for greater specificity and understanding of DEI objectives in academic medicine. DEI work that is valued only for its appearance, and not the design and impact, cannot produce the changes necessary to create diverse, equitable, or inclusive systems of care for our communities.

The limitations of this study include the timing, in a period when medical institutions and organizations increased DEI resources. 18 However, as higher education and health care institutions experience growing staff shortages and public attention to racial justice wanes, institutional investment may be declining. Second, our recruitment process and stated aims may have selected for participants who were motivated to participate due to their personal challenges at work. As a qualitative study, we aimed for range and depth of experiences, rather than generalizability to the entire academic medicine population. We could not recruit from a national directory of DEI offices, leaders, or administrators in academic medicine. In 2018, Chen et al 3 identified 112 offices in 148 allopathic schools, but since then, institutions have created multiple offices and positions within schools and across departments. Third, we focused on those with formal titles, but effective DEI initiatives rely on the broader campus community, so our findings do not capture the experiences of other important actors. We interviewed only 7 participants with departmental-level roles, and thus may not sufficiently capture how these positions have expanded recently; systematic documentation is needed.

In this qualitative study, DEI leaders described multiple institution-level challenges to their work, including limited resources, unclear expectations, and a lack of evidence-based practices. While the transformation of academic medicine is long overdue, dismantling systems requires large-scale, sustained investment, grounded in theories of change, supported by evidence, and constantly interrogated for purpose, operationalization, and impact. Relegating the work to a handful of siloed individuals can set DEI leaders up for burnout and perceived failures. Recent events—from litigation against affirmative action to states’ efforts to eliminate DEI offices and related work on university campuses—reflect societal pushback against the (small) gains of the racial justice movements of 2020. 19 - 21 Sustained commitment to health equity, including the training and membership of the medical profession, is more important than ever.

Accepted for Publication: March 17, 2024.

Published: June 13, 2024. doi:10.1001/jamanetworkopen.2024.15401

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Esparza CJ et al. JAMA Network Open .

Corresponding Author: Michelle Ko, MD, PhD, University of California, Davis, One Shields Avenue, Medical Sciences 1C, Davis, CA 95616 ( [email protected] ).

Author Contributions: Drs Ko and Esparza had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Esparza, London, Bath, Ko.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Esparza, London.

Obtained funding: Ko.

Administrative, technical, or material support: Esparza, Simon, London, Ko.

Supervision: Bath, Ko.

Conflict of Interest Disclosures: Dr Esparza reported receiving grants from Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) during the conduct of the study. Mr Simon reported receiving grants from HRSA during the conduct of the study and outside the submitted work. Ms London reported receiving grants from HRSA during the conduct of the study. Dr Ko reported receiving grants from HRSA during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by the HRSA of the HHS as part of an award totaling $3 791 026 with 0% financed with nongovernmental sources.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The contents are those of the authors and do not necessarily represent the official views of HRSA, HHS, or the US government.

Data Sharing Statement: See Supplement 2 .

• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• Open access
• Published: 25 June 2024

Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses

• Wei-dan Wu 1 , 2 , 3   na1 ,
• Yi Wang 1 , 2 , 3   na1 ,
• Xin-yu Fu 4   na1 ,
• Jin-hua Zhang 1 ,
• Chen-yang Zhang 4 ,
• Xin-Li Mao 1 , 2 , 3 &
• Shao-wei Li 1 , 2 , 3  

BMC Nursing volume  23 , Article number:  431 ( 2024 ) Cite this article

Metrics details

To explore the perception of good death of patients with end-stage cancer by nurses in the oncology department.

In the study we used a phenomenological approach and semi-structured interviews. A total of 11 nurses from the oncology department of a Grade A hospital in Taizhou were interviewed on the cognition of good death from July 1 to September 30, 2022. Colaizzi’s analysis method was used to analyse the interview data. This study followed the consolidated criteria for reporting qualitative research (COREQ).

Four themes were identified: a strong sense of responsibility and mission; To sustain hope and faith; The important role of family members; Improve patients’ quality of life.

The nurses in the department of oncology have a low level of knowledge about the “good death”, and the correct understanding and view of the “good death” is the premise of the realization of " good death”. The ability of nursing staff to improve the “good death”, attention, and meet the needs and wishes of individuals and families, is the guarantee of the realization of “good death”.

Peer Review reports

Introduction

The 2020 Global Cancer Statistics, published by the American Cancer Society shows that there were 10 million cancer deaths worldwide in 2020, and the global cancer burden is projected to reach 28.4 million by 2040, a 47% increase over 2020 [ 1 ]. Our country leads the world in cancer incidence and mortality [ 1 ], and the health damage caused by cancer is almost twice the world average [ 2 , 3 ].

Patients with end-stage cancer are defined as those who have no hope of a cure in modern medicine and are expected to survive for 3–6 months [ 4 , 5 ]. The terminal cancer patient’s condition can not be reversed, and has not yet effectively alleviated the pain, and the use of life support measures such as breathing machines to some extent prolonged the pain, resulting in patients can not die in comfort and dignity [ 6 ]. Death represents a significant and inevitable stage in the cycle of life, marking its final chapter for all living beings. It is a profound and crucial period that holds tremendous significance in the grand scheme of existence [ 7 ]. Hospice care is a holistic approach aimed at addressing the physical, psychosocial, and spiritual needs of individuals with a terminal illness and their family members. It provides comprehensive support and services to ensure comfort, dignity, and quality of life during this challenging time [ 8 ]. There is substantial evidence demonstrating the positive impacts of hospice care. It has been shown to enhance the quality of end-of-life (EoL) care, reduce medical costs, align with individuals’ preferences for comfort-focused care, and minimize the use of burdensome therapies. These findings support the value and effectiveness of hospice care in providing appropriate and compassionate support to patients and their families during the terminal stages of illness [ 9 , 10 ].

Hospice care in China is still in its early stages compared to certain Western countries. Efforts are being made to expand access to hospice services, raise awareness about the benefits of palliative care, and improve the quality of care provided to individuals with life-limiting illnesses in China [ 11 ]. As the concept of “eugenics” and “optimal parenting” gains popularity, the idea of a “good death” is gradually being brought to the forefront. It not only reflects the respect for life but also signifies the progress of society and civilization. The hospice concept was introduced in China in the 1980s. The concept and characteristics of a “good death” originated from early end-of-life care, with the ultimate goal of advocating for people’s support in the field of end-of-life care and drawing attention to the well-being of terminally ill patients. In 1998, Emanuel et al. proposed the framework for a good death, providing a comprehensive explanation of the multidimensional personal experience encompassed by death. Researchers divided the process of death into four key components: the inherent characteristics of the patient, the variable factors within the patient’s experience, the interventions by the healthcare system, and the outcomes. A “good death” can be described as one that occurs without the knowledge of the exact time of death, enables the individual to bid farewell to loved ones, avoids unnecessary interventions, allows the person to have some control over the place of death, minimizes distress and suffering, respects the patient’s and their family’s wishes, and aligns reasonably with clinical, cultural, and ethical standards. This comprehensive definition encompasses multiple aspects that contribute to a positive and meaningful end-of-life experience for both the individual and their loved ones [ 12 , 13 ].

Across different cultures, certain attributes of a good death are often emphasized. These include maintaining a pain-free status through effective pain management, providing emotional comfort and support to the person and their loved ones, and ensuring that individuals are prepared for the inevitability of death through open communication and appropriate end-of-life planning. These attributes are recognized as important factors in promoting a more peaceful and dignified transition at the end of life, regardless of cultural backgrounds [ 14 , 15 ]. Nurses who have a good understanding of the concept of a “good death” are better equipped to provide more effective end-of-life care to patients [ 16 ]. When providing care to individuals who are dying, nurses may experience a range of emotions, including anger, despair, distress, and guilt [ 17 , 18 ]. Understanding the concept of a good death and accepting the inevitability of death can aid nurses in coping with these complex emotions. However, it is worth noting that the acceptance of hospice care in Chinese society has been relatively slow, despite its introduction to mainland China as early as 1988 [ 19 ]. With the aging population, there is an increasing demand for end-of-life care. To measure this demand, an index system can be used, taking into account factors such as the burden caused by diseases, the dependency ratio of the elderly population, and the speed of aging [ 20 ]. In China, the objective demand for end-of-life care is indeed increasing. However, traditional cultural influences often make discussions about death taboo, and the concept of a “good death” is not widely accepted by most people [ 19 ].

Good Death (GD) is one of the core objectives of hospice care [ 21 , 22 ]. This study conducted in-depth interviews with nurses in the department of oncology to understand the current implementation of good death technology, the cognitive status of medical staff on good death, and the clinical coping strategies for patients with end-stage cancer, to determine the cognitive deficiencies of medical staff in good death and the aspects of continuous learning. The study mentioned focused on oncology inpatient unit nurses because they are frequently involved in providing end-of-life care. As patients with cancer often face end-of-life issues, it is important to understand the experiences and perspectives of nurses working in this specific setting.

Study design

We used phenomenological qualitative research and face-to-face semi-structured interviews to explore the perception of good death of patients with end-stage cancer by nurses in the oncology department in Taizhou Hospital of Zhejiang Province from July 1 to September 30, 2022. In qualitative research, phenomenological methods focus on describing common experiences shared by the entirepopulation, which also helps researchers to engage with participants from an in-depth perspective and to understand their experiences. Our research team has extensive experience in qualitative research.

Participants and ethical considerations

Purposive sampling was employed to select the participants who were eligible and could provide rich information about the research question.

Inclusion criteria: (1) Nurses with a license to practice nursing; (2) Oncology nurses with a minimum of 6 months of clinical nursing experience; (3) Providing care services to terminally ill cancer patients, and have work experience in hospice; (4) Ability to clearly articulate their views; (5) Providing informed consent and voluntary participation in this study. Exclusion criteria: (1) Nurses who withdrew from the interview process; (2) Nurses who were on leave or engaged in training, resulting in an absence from their position for more than 3 months; (3) Nurses who were unwilling to discuss their experiences in caring for terminally ill cancer patients.

In this study, the report will replace each participant with a code, and the interviewee’s identity, contact information will not be disclosed to others. Sound content is also used only in this study. The study was reviewed and approved by the Ethics Committee of Taizhou Hospital, Zhejiang Province, China (approval number: K20220789).

The qualitative data collection method employed for this study involved semi-structured, face-to-face interviews. Prior to the start of each interview, all nurses were provided with written informed consent to participate in the research. All interviews were digitally recorded, assigned pseudonyms, and transcribed verbatim. We took measures to ensure that the participants understood the purpose and process of the study, and we emphasized the privacy of the interview environment and the confidentiality of the data. The interviews will take place within the confines of the hospital’s designated conversational chambers, ensuring utmost privacy for the participants. Saturation was considered to be reached when no new themes emerged from the inductive content analysis. In total, we conducted interviews with 11 members of the oncology nursing team (See Table  1 ).

Data collection

During the interview, subjects were also given the opportunity to read the consent form, confirm understanding, and ask questions. Verbal consent was obtained to preserve the anonymity of the subjects. During the interviews, participants were offered explanations for any inquiries they had. Additionally, participants had the option to refuse further interviews and withdraw from the study for any reason. In addition, two oncology nurses were selected for a pre-interview prior to data collection to ensure the clarity of the questions and to identify any potential problems. The data from preliminary interviews was not included in this study but was utilized to modify the interview structure based on the preliminary findings. The preinterviews were treated as tests and were excluded from the analysis. The final interview used in this study included the items are listed in Table  2 . Interviews were conducted in a quiet consultation room at the hospital between July 1 and September 30, 2022. Each person was interviewed one time, and each interview lasted approximately 30–50 min. All the interviews were conducted by a nurse with master who was trained in qualitative research. A research assistant played an auxiliary role which included recording the interviews.

The investigator audio recorded with permission, and participants’ responses, including nonverbal cues and body language during the interviews, were noted. The results will be returned to each participant within 24 h of each interview, to verify the interview details, thus ensuring the accuracy and credibility of the analysis. Before this interview, investigators were trained in interview and communication skills, including effective listening and giving positive feedback, establishing good relationships with interviewees, maintaining eye contact, not interrupting interviewees, not judging their views, etc.

Data analysis

Audio recordings were transcribed verbatim and checked for accuracy by repeated listening within 24 h of the interviews. After the interview, the data were analysed separately and immediately by two researchers with skilled analysis experience. Interview data was analysed using Nvivo12.0, a computer-assisted qualitative data management software. Colaizzi’s phenomenological seven-stepmethod was used for data analysis to complete theextraction of themes and sub-themes regarding the perception of good death of patients with end-stage cancer among oncology nurses (see Table  3 ). Any disagreement between researchers was resolved by making decisions through discussion until a consensus was reached. The final transcribed data, as well as the extracted themesand sub-themes, were sent to the participants simultaneously, and all participants agreed to be contacted again. This study met the criteria of Consolidated Criteria for Reporting Qualitative Studies (COREQ).

Rigor and trustworthiness

To ensure the study’s dependability, the methods and analyses used were described in detail. The study interviewer was a master’s degree student in nursing. The interviewer received systematic qualitative training to master qualitative research methods, was experienced in oncology practices, and established a good relationship with the participants before the interviews commenced. This facilitated the acquisition of real information. The researcher maintained a neutral attitude during the interview, did not lead or hint, did not interrupt the interviewee at will, and only asked timely follow-up questions, rhetorical questions, and clarifications until no new information emerged. Therefore, credibility was ensured. The collection, analysis, and interpretation of data were continually reviewed and detailed to ensure its dependability. The data extracted from the survey results were described in detail to achieve confirmability. Regarding transferability, this study described in detail the inclusion criteria, exclusion criteria, and demographic characteristics involved. Simultaneously, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the findings (See Appendix I for details).

Characteristics of the 11 participants are shown in Table  1 . All eleven participants were female. The shortest term of employment as a Registered Nurse was one and a half years, and the longest was 17 years (Fig.  1 ). Four distinct themes emerged from analysis of the interview data: (1) A strong sense of responsibility and mission; (2) Sustaining hope and faith; (3) The important role of family members; and (4) Improving patients’ quality of life. Each theme included three–four subthemes (see Table  4 ).

A visual analysis of the working years of the 11 participants included

Theme one: a strong sense of responsibility and mission

Most respondents said that when they realized that a patient was dying, their presence was more important than ever, triggering a strong sense of responsibility and mission. “End-stage patients will leave at any time, when in the dying patient evaluation period, I will often ward, observe the patient’s vital signs, keep the comfort of family members, at this time of the patients and family members are in great need of medical personnel to accompany and support, especially families, at this point the heart is very fragile, especially need a psychological support.” (A5, female, 28 y.o) “For the families of the patients whose death is imminent, I will tell them to tell the patients as soon as possible if there is anything they need to tell them. If there is anything that needs the help of our doctors and nurses, they can tell us at any time. We will do our best to help.” (A7, female, 39 y.o).

Theme two: sustaining hope and faith

Patient confidentiality.

Under the influence of traditional Chinese culture, when patients enter the terminal stage of cancer, considering the patients’ physical and psychological conditions and psychological acceptance of the disease, medical staff needs to inform the patients’ families and seek treatment advice, whether to conceal the true condition of patients [ 23 ], whether to continue treatment or give up treatment and so on so that the whole family is faced with a major choice. In this interview, the interviewees discussed their views on the confidentiality of the patient’s condition from the point of view of good death, and the nurses had better cognition of the confidentiality of the patient’s condition. “We have a lot of family members who are concerned about the patient’s ability to cope. They tell us in advance not to discuss the patient’s condition in front of the patient, and they ask us to keep it confidential when the patient asks. We usually comply with their request at this time. “(A9, female, 32 y.o).

“A lot of family members ask for the patient’s condition to be kept confidential. Our doctors and nurses usually communicate on how to settle accounts with patients in a unified way. “(A3, female, 42 y.o).

Moral support

Patients and family members experience a complex range of emotions after being informed of a cancer diagnosis, and how to make patients and family members accept the reality that cancer is incurable is a challenge for healthcare professionals [ 24 , 25 , 26 , 27 ]. In the interview, the interviewees mentioned the importance of spiritual support for cancer families. “Many patients have no faith. I have seen many patients who have been in a period of anger after learning that they have cancer. They think why they are so unlucky. They have this disease and have no interest in doing anything. They think that the world is unfair and cruel to them. If we can help them to seek their faith, such as religion, it may have some spiritual comfort for them. " (A8, female, 37 y.o) “I met a retired civil servant in my work who, after learning that he had cancer, organized his years of Work Records and compiled a memoir by year. I think he would review his experiences and values when he read these memoirs, and his heart would be at peace for a while. I got an idea from him that I could use a similar approach to help other patients and their families find value in their lives and live more peacefully in the final stages of their lives. " (A6, female, 29 y.o).

Theme three: the important role of family members

The accompanying role of family members.

Influenced by our traditional culture, most terminal cancer patients want their closest family members to be with them at the end of their lives. Most of the interviewees indicated that the accompany of family members is a comfort to the patients, which makes them feel that they are loved and meets their psychological needs [ 28 ]. “Patients at this stage are more psychologically vulnerable than those with other diseases. At the end of their lives, the company of their family members is a great psychological comfort to them. Although I can’t have a lot of company during an epidemic, I usually ask one of the family members to stay here to accompany the patient. “(A2, female, 36 y.o) “At this time, the family member will stay by the patient’s side. Even if they don’t do anything or say anything, the patient will feel that they are cared for by someone and feel that they are still loved. “(A10, female, 30 y.o).

The communication role of family members

Under the influence of the Chinese traditional concept of life and death, there are still some difficulties in implementing and promoting euthanasia, especially for cancer patients, whose families often choose to hide the true situation from them, medical staff can only discuss it with their families [ 29 , 30 ]. The nurses mentioned that most of the family members lack the methods of psychological care and the experience of taking care of terminal cancer patients, do not know the psychological needs of the terminal cancer patients, and can not do the psychological work of the patients in time and effectively. “During the work process, some patients’ psychological needs are very high, but the family members accompanying them don’t understand the patients’ psychological needs. The two of them can’t chat together and have nothing to say for a whole day. “(A4, female, 26 y.o).

The caregiving role of family members

Family members accompany patients for a long time, know the daily living habits of patients best, can provide wholehearted care, and can timely detect and feedback on the symptoms of patients and changes in their condition, the care of family members for patients is an important component of the medical staff to evaluate the patient’s good death. “Many patients at this stage due to pain and other effects, the ability to move limited, and many daily activities need family care.” (A11, female, 25 y.o) “Terminally ill patients, ECG monitoring everyday detection of vital signs, we usually also one hour patrol, family members beside can pay attention to the patient’s vital signs changes. " (A1, female, 33 y.o).

Theme four: improving patients’ quality of life

Symptom control.

Most interviewees believed that end-stage patients should focus on symptom control and pain relief. “In the end, the most uncomfortable thing for many patients is the cancer pain, which makes them unable to move when they turn over. Taking painkillers and injecting painkillers can no longer control the pain. If it can reduce their pain, it is very meaningful for good death.” (A8, female, 37 y.o) “When patients enter the terminal stage, some other treatments are meaningless and try not to disturb them, so that patients can quietly go through the final stage of life.” (A7, female, 39 y.o).

Palliative care

During the interview, most interviewees expressed that they should try their best to meet the reasonable requirements of patients, reduce invasive operations on patients, listen to the voice of patients and their families more, improve the comfort level of patients, and give more tolerance and understanding to patients and their families. “During the epidemic, patients and their families are required to reduce going out and order meals in the department. However, patients with advanced stage do have a poor appetite. Some of their families will prepare meals and send them to the first floor of the hospital building. (A9, female, 32 y.o) “When I perform a blood gas analysis or an infusion on this type of patient, if I feel that I cannot successfully puncture the vein on the first try, I will seek assistance from other colleagues to avoid subjecting the patient to the pain of a second puncture.” (A1, female, 33 y.o).

The aim of this study was to explore the perceptions of oncology nurses regarding end-of-life care for patients with advanced-stage cancer in China. The interviews conducted in this study revealed that oncology nurses have generated numerous ideas and understandings about end-of-life care for patients. This demonstrates their strong concern for end-of-life care issues and their utmost efforts to help patients achieve a good death. The cognition of healthcare professionals regarding a good death is influenced by traditional cultural factors, and their ability to assist patients in achieving a good death is also limited by their level of knowledge and skills.

In contemporary times, the majority of individuals pass away within the confines of a hospital setting, necessitating the presence of nurses during their final days. As patients approach the end of their lives, nurses provide companionship and support throughout this significant transition [ 31 ]. The attitudes exhibited by nurses play a pivotal role in shaping the quality of end-of-life care. A positive attitude towards death can signify that nurses possess a more effective adaptation to the practices related to end-of-life care. This also implies that they are better equipped to provide compassionate and supportive care to patients during this sensitive stage [ 32 , 33 ]. By fostering positive attitudes towards the dying, nurses can overcome their own fears of death. This allows them to create a safe and supportive environment where patients can experience a peaceful and dignified process of dying. Such an atmosphere fosters a sense of respect and enables patients to feel valued as individuals during this vulnerable time [ 34 ]. The research conducted by Ceyhan et al. revealed a positive correlation between the perception of a good death and the attitudes of intensive care nurses towards providing care for patients in their final moments. These nurses exhibited favorable attitudes towards end-of-life care and possessed a strong belief in the concept of a good death. The study suggests that nurses in the intensive care setting are more inclined to embrace and prioritize the well-being and comfort of dying patients [ 35 ].

The correct understanding and view of “good death” is the premise to realize “good death”

This is similar to the findings of Hilal Türkben Polat and others [ 34 ]. The concept of death often evokes negative emotions in patients, patient relatives, and nurses. Consequently, it is typically avoided and sometimes even considered a taboo in certain regions. Patients in Eastern countries encounter unique challenges when it comes to preparing for death. This is primarily due to lower frequencies of receiving bad news, such as diagnoses and prognoses, as well as cultural practices that discourage discussions about death. Moreover, stronger taboos surrounding death discussions exist in Eastern countries compared to Western countries [ 36 ]. In western countries, the disclosure of diagnoses is regarded as a fundamental patient right and an essential practice. Within the western ethical tradition, there is significant emphasis on providing patients with truthful information. Medical practitioners have a responsibility to respond to patients’ questions regarding their diagnosis in an honest and forthright manner [ 37 ].

Under the influence of Eastern philosophy, the challenges related to diagnosis disclosure are further magnified in Eastern countries. Traditional Eastern philosophical beliefs, such as the emphasis on harmony, collective well-being, and the idea of protecting patients from distress, can create barriers to open and direct communication about diagnoses. Balancing the values of truthfulness and preserving emotional well-being becomes a particular challenge within the Eastern cultural context [ 38 ]. In China, it is common for family members to withhold cancer diagnoses from the patient, as they believe it may help protect the patient from potential emotional distress and depression. This practice stems from a desire to shield loved ones from the potentially negative impact of such news. However, it is important to note that this approach may differ from the Western emphasis on patient autonomy and the right to access complete information about one’s own health condition [ 26 ]. As highlighted by Jiang Yu et al., the decision to withhold cancer diagnoses in China is often a collective consensus among family members. This collective decision-making process is influenced by cultural norms, where the family plays a central role in matters of health and well-being. In such cases, the family members believe that keeping the diagnosis concealed is in the best interest of the patient, aiming to maintain emotional well-being and alleviate potential distress. It is important to recognize and respect these cultural differences and the role of familial decision-making in the context of healthcare practices [ 39 ].

The concept of “Avoid death” in our traditional culture will affect the expression of the needs of terminal cancer patients. Compared with patients, their families have more difficulty accepting the concept of good death, which they believe means giving up treatment, waiting for death, and being difficult to accept psychologically [ 40 ]. The medical personnel should strengthen the family members’ correct understanding of good death and make them realize the importance of respecting the patient’s right to know and independent decision-making to realize good death, it is suggested that family decision-making should be gradually changed into a way of discussion between patients and their families, to lighten the psychological burden of both sides and let patients realize their wishes. Fully pay attention to the needs of end-stage patients and their families, and take targeted measures to help patients to achieve good death [ 41 ].

The good death ability of nursing staff needs to be improved

The attitude of professional nurses to death greatly influences the treatment decision of terminal cancer patients and affects the quality of patients’ death. The more skilled the nursing skills, the better the communication skills, and the terminal attitude of terminal cancer patients, the better the quality of life of the patients.

Based on the interview results, it is evident that nurses have insufficient competency in implementing end-of-life care. They make efforts to help patients manage clinical symptoms and enhance the caregiving abilities of family members through their own capabilities, aiming to assist patients in a better end-of-life experience. However, the nurses’ level of competence directly affects the patient’s experience of end-of-life care. They have limited opportunities for formal end-of-life care training and education, resulting in a relative lack of knowledge in this area. The end-of-life experience is unique and personal for each individual, with most people desiring to avoid pain during this period, while others may prioritize prolonging life at any cost. End-of-life care may be provided by doctors, physicians, nurses, emergency personnel, or volunteers. However, nurses play a significant role and bear primary responsibilities in this regard [ 14 ]. A study indicated that nurses, as moral agents, possess a profound commitment to upholding the moral integrity of end-of-life care, particularly when it involves assisted death. This suggests that nurses play a crucial role in ensuring that ethical principles and values are upheld throughout the process. Their dedication to promoting the well-being and dignity of patients in these complex situations highlights their ethical and moral responsibility in providing compassionate and supportive end-of-life care [ 15 ]. In addition, another research study highlighted the indispensable role of nurses in providing compassionate care to patients in their final stages of life [ 16 ]. Nurses are entrusted with the responsibility to deliver exceptional care to terminally ill patients and their families. Insufficient knowledge has been identified as a major obstacle in providing optimal care for individuals nearing the end of their lives [ 18 ]. A lack of education and training in end-of-life care has been recognized as a significant contributing factor to insufficient recognition and management of symptoms, as well as challenges in effective communication with patients and their families [ 17 ].

At present, the level of knowledge and skills of our palliative care is not high, and they lack the skills of psychological, social, and spiritual support and are difficult to implement skillfully [ 42 ]. The limited awareness of hospice care in Mainland China can be attributed to various factors, such as the absence of systematic policy support, limited public educational campaigns, and the lack of comprehensive academic and practical curricula and training programs on hospice care. These factors have collectively contributed to the insufficient understanding and recognition of hospice care among the general public and healthcare professionals in Mainland China [ 43 ].

Healthcare professionals need professional knowledge and skills should use a variety of ways to educate professionals, and guide them not only care about patient survival rate, and quality of life, at the same time, we should also pay attention to the physical and psychological needs of incurable patients [ 44 ], educate patients with end-stage cancer and their families, provide a suitable environment and the necessary help, improve the quality of patient’s death, and meeting the needs of patients who are nearing the end of life. By enhancing the medical curriculum to include comprehensive education on hospice care and establishing hospice care programs within hospitals, opportunities can be increased for physicians, nurses, patients, and their family members to enhance their awareness and utilization of hospice care services. This would ultimately contribute to improving end-of-life care and ensuring that individuals receive the support and comfort they need during this crucial time [ 45 ]. In addition, the whole society should widely carry out life education and Death Education, guide people to look at life and death correctly, a planned, leisurely life with, a good start, and a good finish.

Paying attention to and meeting the needs and wishes of individuals and families is the guarantee of achieving “good death”

In the Chinese cultural context, there is a strong emphasis on the centrality of the family and social relationships [ 12 ]. Family dynamics are considered crucial for a good death, and Asian populations, influenced by Confucian teachings, place great importance on the cohesion of the family and the significance of familial relationships [ 46 ]. Nurses take care of terminal cancer patients for a long time, and they are familiar with the patients and their families. Clinical nurses should play an active role as a good communication bridge, which can help them communicate their needs or promote communication among themselves, at the same time, teach family members to play a better role in family support to meet the needs of patients with end-stage cancer to receive family warmth and care [ 47 , 48 , 49 ].

This study still has some limitations. Primarily, the participants were confined exclusively to a solitary tertiary hospital, thereby potentially limiting the generalizability of the findings. To augment representativeness, future investigations could contemplate sampling participants from nontertiary hospitals. Furthermore, the inclusion of solely female nurses in the analysis neglects male nurses, thus introducing a predisposed bias into the results. Within the targeted population of this inquiry, the dearth of male nurses serving escalates the complexity of ameliorating this bias. Secondly, the study lacked the amalgamation of quantitative research, impeding the determination of specific domains and the magnitude of improvement required in nurses’ competencies. To rectify this, future research endeavors should endeavor to broaden the sample size and scope, employing quantitative research methods to scrutinize the precise cognitive facets and knowledge modules necessitating enhancement in nurses. Additionally, there exists a demand for further exploration of culturally tailored competency models in the Chinese context. This would assist in confronting and resolving the challenges impeding the current competency development process. Furthermore, interviews were conducted in Chinese and subsequently analyzed and translated into English. Despite efforts by professional English editors to guarantee accurate translation, there remains a small risk that the translation process may have influenced the study outcomes. Lastly, further exploration is still required to ascertain the appropriate cultural backdrop of our model, and to refine and address the prevailing complications encountered in the euthanasia procedure.

This study explored the general cognition of nurses in the oncology department about good death from the perspective of Chinese nurses. The results showed that nurses in the oncology department had a low level of knowledge about good death, and had a correct understanding and view of “good death”. Indeed, strengthening hospice education is crucial to improve public awareness and acceptance of hospice care, leading to better quality end-of-life care. To enhance public education on hospice care, it is essential to develop and implement culturally appropriate educational programs systematically. By tailoring these programs to the specific cultural context, we can effectively address the barriers and taboos surrounding discussions about death and promote understanding and acceptance of hospice care [ 50 ]. It is the premise of realizing “good death”, and the ability of nurses should be improved. It is the guarantee of realizing “good death” to pay attention to and satisfy the needs and wishes of individuals and families.

Data availability

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

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.

Article   PubMed   Google Scholar  

Wei W, Zeng H, Zheng R, Zhang S, An L, Chen R, Wang S, Sun K, Matsuda T, Bray F, He J. Cancer registration in China and its role in cancer prevention and control. Lancet Oncol. 2020;21:e342–9.

Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018 Global Cancer statistics? Cancer Commun (Lond). 2019;39:22.

PubMed   Google Scholar  

Roger C, Morel J, Molinari N, Orban JC, Jung B, Futier E, Desebbe O, Friggeri A, Silva S, Bouzat P, Ragonnet B, Allaouchiche B, Constantin JM, Ichai C, Jaber S, Leone M, Lefrant JY, Rimmelé T. Practices of end-of-life decisions in 66 southern French ICUs 4 years after an official legal framework: a 1-day audit. Anaesth Crit Care Pain Med. 2015;34:73–7.

Kawasaki Y. Consultation techniques using shared decision making for patients with cancer and their families. Clin J Oncol Nurs. 2014;18:701–6.

Ho AH, Leung PP, Tse DM, Pang SM, Chochinov HM, Neimeyer RA, Chan CL. Dignity amidst liminality: healing within suffering among Chinese terminal cancer patients. Death Stud. 2013;37:953–70.

Joarder T, Cooper A, Zaman S. Meaning of death: an exploration of perception of elderly in a Bangladeshi village. J Cross Cult Gerontol. 2014;29:299–314.

Kumar P, Wright AA, Hatfield LA, Temel JS, Keating NL. Family perspectives on Hospice Care experiences of patients with Cancer. J Clin Oncol. 2017;35:432–9.

Huang YT, Wang YW, Chi CW, Hu WY, Lin R Jr., Shiao CC, Tang WR. Differences in medical costs for end-of-life patients receiving traditional care and those receiving hospice care: a retrospective study. PLoS ONE. 2020;15:e0229176.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Shen VW, Yang C, Lai LL, Chen YJ, Huang HH, Tsai SH, Hsu TF, Yen DH. (2021) Emergency Department Referral for Hospice and Palliative Care Differs among patients with different end-of-life trajectories: a retrospective cohort study. Int J Environ Res Public Health 18.

Cheng Q, Duan Y, Zheng H, Xu X, Khan K, Xie J, Chen Y. Knowledge, attitudes and preferences of palliative and end-of-life care among patients with cancer in mainland China: a cross-sectional study. BMJ Open. 2021;11:e051735.

Article   PubMed   PubMed Central   Google Scholar  

Krikorian A, Maldonado C, Pastrana T. Patient’s perspectives on the notion of a good death: a systematic review of the literature. J Pain Symptom Manage. 2020;59:152–64.

Üzen Cura Ş. Nursing students’ spiritual orientations and their attitudes toward the principles of dying with dignity: a sample from Turkey. J Relig Health. 2021;60:221–31.

Noome M, Dijkstra BM, van Leeuwen E, Vloet LCM. Effectiveness of supporting intensive care units on implementing the guideline ‘End-of-life care in the intensive care unit, nursing care’: a cluster randomized controlled trial. J Adv Nurs. 2017;73:1339–54.

Ghezelsefli Z, Ahmadi F, Mohammadi E. End-of-Life Care provided for Cancer patients: a Metasynthesis Study. Holist Nurs Pract. 2020;34:210–20.

Mahan P, Taggart H, Knofczynski G, Warnock S. Transforming nursing students’ attitudes toward End-of-Life Care. J Hosp Palliat Nurs. 2019;21:496–501.

McIlfatrick S, Connolly M, Collins R, Murphy T, Johnston B, Larkin P. Evaluating a dignity care intervention for palliative care in the community setting: community nurses’ perspectives. J Clin Nurs. 2017;26:4300–12.

Aslakson RA, Wyskiel R, Thornton I, Copley C, Shaffer D, Zyra M, Nelson J, Pronovost PJ. Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: a qualitative exploration. J Palliat Med. 2012;15:910–5.

Colaizzi PF. Psychological research as the phenomenologist views it. In: Valle RS, King M, editors. Existential-phenomenological Alternatives for psychology. Oxford University Press; 1978. p. 6.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.

Gurdogan EP, Aksoy B, Kinici E. The Concept of a good death from the perspectives of Family caregivers of Advanced Cancer patients. Omega (Westport). 2022;85:303–16.

Lyerly HK, Fawzy MR, Aziz Z, Nair R, Pramesh CS, Parmar V, Parikh PM, Jamal R, Irumnaz A, Ren J, Stockler MR, Abernethy AP. Regional variation in identified cancer care needs of early-career oncologists in China, India, and Pakistan. Oncologist. 2015;20:532–8.

Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997;278:733–8.

Article   CAS   PubMed   Google Scholar  

Hahne J, Liang T, Khoshnood K, Wang X, Li X. Breaking bad news about cancer in China: concerns and conflicts faced by doctors deciding whether to inform patients. Patient Educ Couns. 2020;103:286–91.

Ling DL, Yu HJ, Guo HL. Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China. Nurs Ethics. 2019;26:1000–8.

Liu Y, Yang J, Huo D, Fan H, Gao Y. Disclosure of cancer diagnosis in China: the incidence, patients’ situation, and different preferences between patients and their family members and related influence factors. Cancer Manag Res. 2018;10:2173–81.

Rao A, Ekstrand M, Heylen E, Raju G, Shet A. Breaking Bad News: patient preferences and the role of Family members when delivering a Cancer diagnosis. Asian Pac J Cancer Prev. 2016;17:1779–84.

Griggs C. Community nurses’ perceptions of a good death: a qualitative exploratory study. Int J Palliat Nurs. 2010;16:140–9.

Yamagishi A, Morita T, Miyashita M, Igarashi A, Akiyama M, Akizuki N, Shirahige Y, Eguchi K. Pain intensity, quality of life, quality of palliative care, and satisfaction in outpatients with metastatic or recurrent cancer: a Japanese, nationwide, region-based, multicenter survey. J Pain Symptom Manage. 2012;43:503–14.

Miyashita M, Morita T, Sato K, Hirai K, Shima Y, Uchitomi Y. Factors contributing to evaluation of a good death from the bereaved family member’s perspective. Psychooncology. 2008;17:612–20.

Loerzel VW, Conner N. Advances and challenges: student reflections from an online death and dying course. Am J Hosp Palliat Care. 2016;33:8–15.

Gillan PC, van der Riet PJ, Jeong S. End of life care education, past and present: a review of the literature. Nurse Educ Today. 2014;34:331–42.

Henoch I, Browall M, Melin-Johansson C, Danielson E, Udo C, Johansson Sundler A, Björk M, Ek K, Hammarlund K, Bergh I, Strang S. The Swedish version of the Frommelt attitude toward care of the dying scale: aspects of validity and factors influencing nurses’ and nursing students’ attitudes. Cancer Nurs. 2014;37:E1–11.

Türkben Polat H. Nurses’ Perceptions on Good Death and Their Attitudes Towards the Care of Dying Individuals. Omega (Westport; 2022. p. 302228221100638.

Ceyhan Ö, Özen B, Zincir H, Şimşek N, Başaran M. How intensive care nurses perceive good death. Death Stud. 2018;42:667–72.

Xiao J, Ding J, Huang C. Notion of a good death for patients with cancer: a qualitative systematic review protocol. BMJ Open. 2022;12:e056104.

Zolkefli Y. The Ethics of Truth-Telling in Health-Care settings. Malays J Med Sci. 2018;25:135–9.

PubMed   PubMed Central   Google Scholar  

Beyraghi N, Mottaghipour Y, Mehraban A, Eslamian E, Esfahani F. Disclosure of Cancer Information in Iran: a perspective of patients, Family Members, and Health professionals. Iran J Cancer Prev. 2011;4:130–4.

CAS   PubMed   PubMed Central   Google Scholar  

Jiang Y, Liu C, Li JY, Huang MJ, Yao WX, Zhang R, Yao B, Du XB, Chen J, Xie K, Zhao X, Wei YQ. Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer. Psychooncology. 2007;16:928–36.

Emanuel EJ, Emanuel LL. The promise of a good death. Lancet. 1998;351(Suppl 2):Sii21–29.

Cipolletta S, Oprandi N. What is a good death? Health care professionals’ narrations on end-of-life care. Death Stud. 2014;38:20–7.

van Laarhoven HW, Schilderman J, Verhagen CA, Vissers KC, Prins J. Perspectives on death and an afterlife in relation to quality of life, depression, and hopelessness in cancer patients without evidence of disease and advanced cancer patients. J Pain Symptom Manage. 2011;41:1048–59.

Ni K, Gong Y, Li F, Cao X, Zhang H, Chu H, Li T, Mairipaiti A, Zhao Y, Li N. Knowledge and attitudes regarding hospice care among outpatients and family members in two hospitals in China. Med (Baltim). 2019;98:e15230.

Article   Google Scholar  

Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, McIlwane J, Hillary K, Gonzalez J. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55:993–1000.

Yin Z, Li J, Ma K, Ning X, Chen H, Fu H, Zhang H, Wang C, Bruera E, Hui D. Development of Palliative Care in China: a tale of Three cities. Oncologist. 2017;22:1362–7.

Li J. Chinese conceptualization of learning. Ethos. 2001;29:111–37.

Article   CAS   Google Scholar  

Walczak A, Butow PN, Tattersall MH, Davidson PM, Young J, Epstein RM, Costa DS, Clayton JM. Encouraging early discussion of life expectancy and end-of-life care: a randomised controlled trial of a nurse-led communication support program for patients and caregivers. Int J Nurs Stud. 2017;67:31–40.

Hattori K, McCubbin MA, Ishida DN. Concept analysis of good death in the Japanese community. J Nurs Scholarsh. 2006;38:165–70.

Becker CL, Arnold RM, Park SY, Rosenzweig M, Smith TJ, White DB, Smith KJ, Schenker Y. A cluster randomized trial of a primary palliative care intervention (CONNECT) for patients with advanced cancer: protocol and key design considerations. Contemp Clin Trials. 2017;54:98–104.

Lin H, Ko E, Wu B, Ni P. (2022) Hospice Care preferences and its Associated factors among Community-Dwelling residents in China. Int J Environ Res Public Health 19.

Download references

This work was supported in part by Medical Science and Technology Project of Zhejiang Province (2024KY1788), Major Research Program of Taizhou Enze Medical Center Grant (19EZZDA2), Program of Taizhou Enze Medical Center Grant (22EZD06), Open Project Program of Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province (21SZDSYS01), Program of Taizhou Science and Technology Grant (23ywa33).

Author information

Wei-dan Wu, Yi Wang and Xin-yu Fu contributed equally to this work.

Authors and Affiliations

Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China

Wei-dan Wu, Yi Wang, Jin-hua Zhang, Xin-Li Mao & Shao-wei Li

Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China

Wei-dan Wu, Yi Wang, Xin-Li Mao & Shao-wei Li

Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China

Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China

Xin-yu Fu & Chen-yang Zhang

You can also search for this author in PubMed   Google Scholar

Contributions

W-D W, W Y, X-L M and S-W L identified the research topic and designed the research process; W-D W, W Y, X-Y F were involved in writing the article; W-D W, J-H Z, X-Y F, W Y and C-Y Z were involved in interviewing and summarizing; W-D W, X-Y F, X-L M and S-W L were involved in correcting and revising the article.

Corresponding authors

Correspondence to Xin-Li Mao or Shao-wei Li .

Ethics declarations

Ethics approval and consent to participate.

All methods were carried out in accordance with the Declaration of Helsinki. The study was reviewed and approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University Institutional Review Board (approval No. K20220789). Researchers contacted and explained the research procedures and recruitment criteria to the participants and emphasised that participants’ responses would remain anonymous and confidential. Informed consent was obtained from all study participants.

Consent to publish

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Wu, Wd., Wang, Y., Fu, Xy. et al. Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses. BMC Nurs 23 , 431 (2024). https://doi.org/10.1186/s12912-024-02081-x

Download citation

Received : 28 July 2023

Accepted : 06 June 2024

Published : 25 June 2024

DOI : https://doi.org/10.1186/s12912-024-02081-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Oncology department
• Qualitative research

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

• DOI: 10.1177/02692163241259667
• Corpus ID: 270616343

Development of the TIFFIN recommendations for co-producing palliative and end-of-life care research with individuals with lived experience of homelessness: A qualitative study.

• Jodie Crooks , Kate Flemming , +2 authors Briony Hudson
• Published in Palliative Medicine 19 June 2024
• Medicine, Sociology

25 References

Involving people with lived experience of homelessness in palliative and end of life care research: key considerations from experts in the field, “you can’t die here”: an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in british columbia, canada, opportunities and challenges in involving people with lived experience of inclusion health as co-researchers in palliative and end of life research: a rapid review and thematic synthesis, the patients changing things together (patchatt) ethics pack: a tool to support inclusive ethical decision-making in the development of a community-based palliative care intervention, capturing learning from public involvement with people experiencing homelessness to help shape new physiotherapy research: utilizing a reflective model with an under‐served, vulnerable population, patient and public involvement in research: a journey to co-production., palliative care for homeless and vulnerably housed people: scoping review and thematic synthesis, patient and public involvement in palliative care research: what works, and why a qualitative evaluation, one size fits all what counts as quality practice in (reflexive) thematic analysis, co-producing knowledge through documentary film: a community-based participatory study with older adults with homeless histories, related papers.

Showing 1 through 3 of 0 Related Papers

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Can J Hosp Pharm
• v.68(3); May-Jun 2015

Qualitative Research: Data Collection, Analysis, and Management

Introduction.

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

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

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

THE PARTICIPANT’S VIEWPOINT

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

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

DATA COLLECTION

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

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

DATA ANALYSIS AND MANAGEMENT

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

Interpretation of Data

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

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

Transcribing and Checking

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

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

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

Reading between the Lines

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

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

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

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

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

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

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

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

DATA SYNTHESIS

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

Planning and Writing the Report

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

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

CONCLUSIONS

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

Appendix 1. Excerpt from a sample transcript

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

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

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

Previous articles in this series:

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

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

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

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

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

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

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

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

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

Competing interests: None declared.

Further Reading

Examples of qualitative research in pharmacy practice.

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

Qualitative Research in General

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

Group Dynamics in Focus Groups

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

Social Constructivism

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

Mixed Methods

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

Collecting Qualitative Data

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

Constructivist Grounded Theory

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