essays in qualitative research

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

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

What Is Qualitative Research? | Methods & Examples

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

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

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

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

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

Table of contents

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

• Flexibility

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

• Natural settings

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

• Meaningful insights

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

• Generation of new ideas

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

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

• Unreliability

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

• Subjectivity

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

• Limited generalisability

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

• Labour-intensive

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

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

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

There are five common approaches to qualitative research :

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

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

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

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

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

Cite this Scribbr article

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

Bhandari, P. (2023, January 30). What Is Qualitative Research? | Methods & Examples. Scribbr. Retrieved 3 June 2024, from https://www.scribbr.co.uk/research-methods/introduction-to-qualitative-research/

Is this article helpful?

Pritha Bhandari

• Search Menu

Sign in through your institution

• Browse content in Arts and Humanities
• Browse content in Archaeology
• Anglo-Saxon and Medieval Archaeology
• Archaeological Methodology and Techniques
• Archaeology by Region
• Archaeology of Religion
• Archaeology of Trade and Exchange
• Biblical Archaeology
• Contemporary and Public Archaeology
• Environmental Archaeology
• Historical Archaeology
• History and Theory of Archaeology
• Industrial Archaeology
• Landscape Archaeology
• Mortuary Archaeology
• Prehistoric Archaeology
• Underwater Archaeology
• Zooarchaeology
• Browse content in Architecture
• Architectural Structure and Design
• History of Architecture
• Residential and Domestic Buildings
• Theory of Architecture
• Browse content in Art
• Art Subjects and Themes
• History of Art
• Industrial and Commercial Art
• Theory of Art
• Biographical Studies
• Byzantine Studies
• Browse content in Classical Studies
• Classical History
• Classical Philosophy
• Classical Mythology
• Classical Literature
• Classical Reception
• Classical Art and Architecture
• Classical Oratory and Rhetoric
• Greek and Roman Papyrology
• Greek and Roman Epigraphy
• Greek and Roman Law
• Greek and Roman Archaeology
• Late Antiquity
• Religion in the Ancient World
• Digital Humanities
• Browse content in History
• Colonialism and Imperialism
• Diplomatic History
• Environmental History
• Genealogy, Heraldry, Names, and Honours
• Genocide and Ethnic Cleansing
• Historical Geography
• History by Period
• History of Emotions
• History of Agriculture
• History of Education
• History of Gender and Sexuality
• Industrial History
• Intellectual History
• International History
• Labour History
• Legal and Constitutional History
• Local and Family History
• Maritime History
• Military History
• National Liberation and Post-Colonialism
• Oral History
• Political History
• Public History
• Regional and National History
• Revolutions and Rebellions
• Slavery and Abolition of Slavery
• Social and Cultural History
• Theory, Methods, and Historiography
• Urban History
• World History
• Browse content in Language Teaching and Learning
• Language Learning (Specific Skills)
• Language Teaching Theory and Methods
• Browse content in Linguistics
• Applied Linguistics
• Cognitive Linguistics
• Computational Linguistics
• Forensic Linguistics
• Grammar, Syntax and Morphology
• Historical and Diachronic Linguistics
• History of English
• Language Evolution
• Language Reference
• Language Acquisition
• Language Variation
• Language Families
• Lexicography
• Linguistic Anthropology
• Linguistic Theories
• Linguistic Typology
• Phonetics and Phonology
• Psycholinguistics
• Sociolinguistics
• Translation and Interpretation
• Writing Systems
• Browse content in Literature
• Bibliography
• Children's Literature Studies
• Literary Studies (Romanticism)
• Literary Studies (American)
• Literary Studies (Asian)
• Literary Studies (European)
• Literary Studies (Eco-criticism)
• Literary Studies (Modernism)
• Literary Studies - World
• Literary Studies (1500 to 1800)
• Literary Studies (19th Century)
• Literary Studies (20th Century onwards)
• Literary Studies (African American Literature)
• Literary Studies (British and Irish)
• Literary Studies (Early and Medieval)
• Literary Studies (Fiction, Novelists, and Prose Writers)
• Literary Studies (Gender Studies)
• Literary Studies (Graphic Novels)
• Literary Studies (History of the Book)
• Literary Studies (Plays and Playwrights)
• Literary Studies (Poetry and Poets)
• Literary Studies (Postcolonial Literature)
• Literary Studies (Queer Studies)
• Literary Studies (Science Fiction)
• Literary Studies (Travel Literature)
• Literary Studies (War Literature)
• Literary Studies (Women's Writing)
• Literary Theory and Cultural Studies
• Mythology and Folklore
• Shakespeare Studies and Criticism
• Browse content in Media Studies
• Browse content in Music
• Applied Music
• Dance and Music
• Ethics in Music
• Ethnomusicology
• Gender and Sexuality in Music
• Medicine and Music
• Music Cultures
• Music and Media
• Music and Religion
• Music and Culture
• Music Education and Pedagogy
• Music Theory and Analysis
• Musical Scores, Lyrics, and Libretti
• Musical Structures, Styles, and Techniques
• Musicology and Music History
• Performance Practice and Studies
• Race and Ethnicity in Music
• Sound Studies
• Browse content in Performing Arts
• Browse content in Philosophy
• Aesthetics and Philosophy of Art
• Epistemology
• Feminist Philosophy
• History of Western Philosophy
• Metaphysics
• Moral Philosophy
• Non-Western Philosophy
• Philosophy of Language
• Philosophy of Mind
• Philosophy of Perception
• Philosophy of Science
• Philosophy of Action
• Philosophy of Law
• Philosophy of Religion
• Philosophy of Mathematics and Logic
• Practical Ethics
• Social and Political Philosophy
• Browse content in Religion
• Biblical Studies
• Christianity
• East Asian Religions
• History of Religion
• Judaism and Jewish Studies
• Qumran Studies
• Religion and Education
• Religion and Health
• Religion and Politics
• Religion and Science
• Religion and Law
• Religion and Art, Literature, and Music
• Religious Studies
• Browse content in Society and Culture
• Cookery, Food, and Drink
• Cultural Studies
• Customs and Traditions
• Ethical Issues and Debates
• Hobbies, Games, Arts and Crafts
• Natural world, Country Life, and Pets
• Popular Beliefs and Controversial Knowledge
• Sports and Outdoor Recreation
• Technology and Society
• Travel and Holiday
• Visual Culture
• Browse content in Law
• Arbitration
• Browse content in Company and Commercial Law
• Commercial Law
• Company Law
• Browse content in Comparative Law
• Systems of Law
• Competition Law
• Browse content in Constitutional and Administrative Law
• Government Powers
• Judicial Review
• Local Government Law
• Military and Defence Law
• Parliamentary and Legislative Practice
• Construction Law
• Contract Law
• Browse content in Criminal Law
• Criminal Procedure
• Criminal Evidence Law
• Sentencing and Punishment
• Employment and Labour Law
• Environment and Energy Law
• Browse content in Financial Law
• Banking Law
• Insolvency Law
• History of Law
• Human Rights and Immigration
• Intellectual Property Law
• Browse content in International Law
• Private International Law and Conflict of Laws
• Public International Law
• IT and Communications Law
• Jurisprudence and Philosophy of Law
• Law and Politics
• Law and Society
• Browse content in Legal System and Practice
• Courts and Procedure
• Legal Skills and Practice
• Primary Sources of Law
• Regulation of Legal Profession
• Medical and Healthcare Law
• Browse content in Policing
• Criminal Investigation and Detection
• Police and Security Services
• Police Procedure and Law
• Police Regional Planning
• Browse content in Property Law
• Personal Property Law
• Study and Revision
• Terrorism and National Security Law
• Browse content in Trusts Law
• Wills and Probate or Succession
• Browse content in Medicine and Health
• Browse content in Allied Health Professions
• Arts Therapies
• Clinical Science
• Dietetics and Nutrition
• Occupational Therapy
• Operating Department Practice
• Physiotherapy
• Radiography
• Speech and Language Therapy
• Browse content in Anaesthetics
• General Anaesthesia
• Neuroanaesthesia
• Clinical Neuroscience
• Browse content in Clinical Medicine
• Acute Medicine
• Cardiovascular Medicine
• Clinical Genetics
• Clinical Pharmacology and Therapeutics
• Dermatology
• Endocrinology and Diabetes
• Gastroenterology
• Genito-urinary Medicine
• Geriatric Medicine
• Infectious Diseases
• Medical Toxicology
• Medical Oncology
• Pain Medicine
• Palliative Medicine
• Rehabilitation Medicine
• Respiratory Medicine and Pulmonology
• Rheumatology
• Sleep Medicine
• Sports and Exercise Medicine
• Community Medical Services
• Critical Care
• Emergency Medicine
• Forensic Medicine
• Haematology
• History of Medicine
• Browse content in Medical Skills
• Clinical Skills
• Communication Skills
• Nursing Skills
• Surgical Skills
• Browse content in Medical Dentistry
• Oral and Maxillofacial Surgery
• Paediatric Dentistry
• Restorative Dentistry and Orthodontics
• Surgical Dentistry
• Medical Ethics
• Medical Statistics and Methodology
• Browse content in Neurology
• Clinical Neurophysiology
• Neuropathology
• Nursing Studies
• Browse content in Obstetrics and Gynaecology
• Gynaecology
• Occupational Medicine
• Ophthalmology
• Otolaryngology (ENT)
• Browse content in Paediatrics
• Neonatology
• Browse content in Pathology
• Chemical Pathology
• Clinical Cytogenetics and Molecular Genetics
• Histopathology
• Medical Microbiology and Virology
• Patient Education and Information
• Browse content in Pharmacology
• Psychopharmacology
• Browse content in Popular Health
• Caring for Others
• Complementary and Alternative Medicine
• Self-help and Personal Development
• Browse content in Preclinical Medicine
• Cell Biology
• Molecular Biology and Genetics
• Reproduction, Growth and Development
• Primary Care
• Professional Development in Medicine
• Browse content in Psychiatry
• Addiction Medicine
• Child and Adolescent Psychiatry
• Forensic Psychiatry
• Learning Disabilities
• Old Age Psychiatry
• Psychotherapy
• Browse content in Public Health and Epidemiology
• Epidemiology
• Public Health
• Browse content in Radiology
• Clinical Radiology
• Interventional Radiology
• Nuclear Medicine
• Radiation Oncology
• Reproductive Medicine
• Browse content in Surgery
• Cardiothoracic Surgery
• Gastro-intestinal and Colorectal Surgery
• General Surgery
• Neurosurgery
• Paediatric Surgery
• Peri-operative Care
• Plastic and Reconstructive Surgery
• Surgical Oncology
• Transplant Surgery
• Trauma and Orthopaedic Surgery
• Vascular Surgery
• Browse content in Science and Mathematics
• Browse content in Biological Sciences
• Aquatic Biology
• Biochemistry
• Bioinformatics and Computational Biology
• Developmental Biology
• Ecology and Conservation
• Evolutionary Biology
• Genetics and Genomics
• Microbiology
• Molecular and Cell Biology
• Natural History
• Plant Sciences and Forestry
• Research Methods in Life Sciences
• Structural Biology
• Systems Biology
• Zoology and Animal Sciences
• Browse content in Chemistry
• Analytical Chemistry
• Computational Chemistry
• Crystallography
• Environmental Chemistry
• Industrial Chemistry
• Inorganic Chemistry
• Materials Chemistry
• Medicinal Chemistry
• Mineralogy and Gems
• Organic Chemistry
• Physical Chemistry
• Polymer Chemistry
• Study and Communication Skills in Chemistry
• Theoretical Chemistry
• Browse content in Computer Science
• Artificial Intelligence
• Computer Architecture and Logic Design
• Game Studies
• Human-Computer Interaction
• Mathematical Theory of Computation
• Programming Languages
• Software Engineering
• Systems Analysis and Design
• Virtual Reality
• Browse content in Computing
• Business Applications
• Computer Security
• Computer Games
• Computer Networking and Communications
• Digital Lifestyle
• Graphical and Digital Media Applications
• Operating Systems
• Browse content in Earth Sciences and Geography
• Atmospheric Sciences
• Environmental Geography
• Geology and the Lithosphere
• Maps and Map-making
• Meteorology and Climatology
• Oceanography and Hydrology
• Palaeontology
• Physical Geography and Topography
• Regional Geography
• Soil Science
• Urban Geography
• Browse content in Engineering and Technology
• Agriculture and Farming
• Biological Engineering
• Civil Engineering, Surveying, and Building
• Electronics and Communications Engineering
• Energy Technology
• Engineering (General)
• Environmental Science, Engineering, and Technology
• History of Engineering and Technology
• Mechanical Engineering and Materials
• Technology of Industrial Chemistry
• Transport Technology and Trades
• Browse content in Environmental Science
• Applied Ecology (Environmental Science)
• Conservation of the Environment (Environmental Science)
• Environmental Sustainability
• Environmentalist Thought and Ideology (Environmental Science)
• Management of Land and Natural Resources (Environmental Science)
• Natural Disasters (Environmental Science)
• Nuclear Issues (Environmental Science)
• Pollution and Threats to the Environment (Environmental Science)
• Social Impact of Environmental Issues (Environmental Science)
• History of Science and Technology
• Browse content in Materials Science
• Ceramics and Glasses
• Composite Materials
• Metals, Alloying, and Corrosion
• Nanotechnology
• Browse content in Mathematics
• Applied Mathematics
• Biomathematics and Statistics
• History of Mathematics
• Mathematical Education
• Mathematical Finance
• Mathematical Analysis
• Numerical and Computational Mathematics
• Probability and Statistics
• Pure Mathematics
• Browse content in Neuroscience
• Cognition and Behavioural Neuroscience
• Development of the Nervous System
• Disorders of the Nervous System
• History of Neuroscience
• Invertebrate Neurobiology
• Molecular and Cellular Systems
• Neuroendocrinology and Autonomic Nervous System
• Neuroscientific Techniques
• Sensory and Motor Systems
• Browse content in Physics
• Astronomy and Astrophysics
• Atomic, Molecular, and Optical Physics
• Biological and Medical Physics
• Classical Mechanics
• Computational Physics
• Condensed Matter Physics
• Electromagnetism, Optics, and Acoustics
• History of Physics
• Mathematical and Statistical Physics
• Measurement Science
• Nuclear Physics
• Particles and Fields
• Plasma Physics
• Quantum Physics
• Relativity and Gravitation
• Semiconductor and Mesoscopic Physics
• Browse content in Psychology
• Affective Sciences
• Clinical Psychology
• Cognitive Psychology
• Cognitive Neuroscience
• Criminal and Forensic Psychology
• Developmental Psychology
• Educational Psychology
• Evolutionary Psychology
• Health Psychology
• History and Systems in Psychology
• Music Psychology
• Neuropsychology
• Organizational Psychology
• Psychological Assessment and Testing
• Psychology of Human-Technology Interaction
• Psychology Professional Development and Training
• Research Methods in Psychology
• Social Psychology
• Browse content in Social Sciences
• Browse content in Anthropology
• Anthropology of Religion
• Human Evolution
• Medical Anthropology
• Physical Anthropology
• Regional Anthropology
• Social and Cultural Anthropology
• Theory and Practice of Anthropology
• Browse content in Business and Management
• Business Ethics
• Business Strategy
• Business History
• Business and Technology
• Business and Government
• Business and the Environment
• Comparative Management
• Corporate Governance
• Corporate Social Responsibility
• Entrepreneurship
• Health Management
• Human Resource Management
• Industrial and Employment Relations
• Industry Studies
• Information and Communication Technologies
• International Business
• Knowledge Management
• Management and Management Techniques
• Operations Management
• Organizational Theory and Behaviour
• Pensions and Pension Management
• Public and Nonprofit Management
• Strategic Management
• Supply Chain Management
• Browse content in Criminology and Criminal Justice
• Criminal Justice
• Criminology
• Forms of Crime
• International and Comparative Criminology
• Youth Violence and Juvenile Justice
• Development Studies
• Browse content in Economics
• Agricultural, Environmental, and Natural Resource Economics
• Asian Economics
• Behavioural Finance
• Behavioural Economics and Neuroeconomics
• Econometrics and Mathematical Economics
• Economic History
• Economic Systems
• Economic Methodology
• Economic Development and Growth
• Financial Markets
• Financial Institutions and Services
• General Economics and Teaching
• Health, Education, and Welfare
• History of Economic Thought
• International Economics
• Labour and Demographic Economics
• Law and Economics
• Macroeconomics and Monetary Economics
• Microeconomics
• Public Economics
• Urban, Rural, and Regional Economics
• Welfare Economics
• Browse content in Education
• Adult Education and Continuous Learning
• Care and Counselling of Students
• Early Childhood and Elementary Education
• Educational Equipment and Technology
• Educational Strategies and Policy
• Higher and Further Education
• Organization and Management of Education
• Philosophy and Theory of Education
• Schools Studies
• Secondary Education
• Teaching of a Specific Subject
• Teaching of Specific Groups and Special Educational Needs
• Teaching Skills and Techniques
• Browse content in Environment
• Applied Ecology (Social Science)
• Climate Change
• Conservation of the Environment (Social Science)
• Environmentalist Thought and Ideology (Social Science)
• Natural Disasters (Environment)
• Social Impact of Environmental Issues (Social Science)
• Browse content in Human Geography
• Cultural Geography
• Economic Geography
• Political Geography
• Browse content in Interdisciplinary Studies
• Communication Studies
• Museums, Libraries, and Information Sciences
• Browse content in Politics
• African Politics
• Asian Politics
• Chinese Politics
• Comparative Politics
• Conflict Politics
• Elections and Electoral Studies
• Environmental Politics
• Ethnic Politics
• European Union
• Foreign Policy
• Gender and Politics
• Human Rights and Politics
• Indian Politics
• International Relations
• International Organization (Politics)
• International Political Economy
• Irish Politics
• Latin American Politics
• Middle Eastern Politics
• Political Behaviour
• Political Economy
• Political Institutions
• Political Methodology
• Political Communication
• Political Philosophy
• Political Sociology
• Political Theory
• Politics and Law
• Politics of Development
• Public Policy
• Public Administration
• Quantitative Political Methodology
• Regional Political Studies
• Russian Politics
• Security Studies
• State and Local Government
• UK Politics
• US Politics
• Browse content in Regional and Area Studies
• African Studies
• Asian Studies
• East Asian Studies
• Japanese Studies
• Latin American Studies
• Middle Eastern Studies
• Native American Studies
• Scottish Studies
• Browse content in Research and Information
• Research Methods
• Browse content in Social Work
• Addictions and Substance Misuse
• Adoption and Fostering
• Care of the Elderly
• Child and Adolescent Social Work
• Couple and Family Social Work
• Direct Practice and Clinical Social Work
• Emergency Services
• Human Behaviour and the Social Environment
• International and Global Issues in Social Work
• Mental and Behavioural Health
• Social Justice and Human Rights
• Social Policy and Advocacy
• Social Work and Crime and Justice
• Social Work Macro Practice
• Social Work Practice Settings
• Social Work Research and Evidence-based Practice
• Welfare and Benefit Systems
• Browse content in Sociology
• Childhood Studies
• Community Development
• Comparative and Historical Sociology
• Economic Sociology
• Gender and Sexuality
• Gerontology and Ageing
• Health, Illness, and Medicine
• Marriage and the Family
• Migration Studies
• Occupations, Professions, and Work
• Organizations
• Population and Demography
• Race and Ethnicity
• Social Theory
• Social Movements and Social Change
• Social Research and Statistics
• Social Stratification, Inequality, and Mobility
• Sociology of Religion
• Sociology of Education
• Sport and Leisure
• Urban and Rural Studies
• Browse content in Warfare and Defence
• Defence Strategy, Planning, and Research
• Land Forces and Warfare
• Military Administration
• Military Life and Institutions
• Naval Forces and Warfare
• Other Warfare and Defence Issues
• Peace Studies and Conflict Resolution
• Weapons and Equipment

The Oxford Handbook of Qualitative Research (2nd edn)

Patricia Leavy Independent Scholar Kennebunk, ME, USA

• Cite Icon Cite
• Permissions Icon Permissions

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

Signed in as

Institutional accounts.

• Google Scholar Indexing
• GoogleCrawler [DO NOT DELETE]

Personal account

• Sign in with email/username & password
• Get email alerts
• Save searches
• Purchase content
• Activate your purchase/trial code
• Add your ORCID iD

Institutional access

Sign in with a library card.

• Sign in with username/password
• Recommend to your librarian
• Institutional account management
• Get help with access

Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:

IP based access

Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account.

Choose this option to get remote access when outside your institution. Shibboleth/Open Athens technology is used to provide single sign-on between your institution’s website and Oxford Academic.

• Click Sign in through your institution.
• Select your institution from the list provided, which will take you to your institution's website to sign in.
• When on the institution site, please use the credentials provided by your institution. Do not use an Oxford Academic personal account.
• Following successful sign in, you will be returned to Oxford Academic.

If your institution is not listed or you cannot sign in to your institution’s website, please contact your librarian or administrator.

Enter your library card number to sign in. If you cannot sign in, please contact your librarian.

Society Members

Society member access to a journal is achieved in one of the following ways:

Sign in through society site

Many societies offer single sign-on between the society website and Oxford Academic. If you see ‘Sign in through society site’ in the sign in pane within a journal:

• Click Sign in through society site.
• When on the society site, please use the credentials provided by that society. Do not use an Oxford Academic personal account.

If you do not have a society account or have forgotten your username or password, please contact your society.

Sign in using a personal account

Some societies use Oxford Academic personal accounts to provide access to their members. See below.

A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions.

Some societies use Oxford Academic personal accounts to provide access to their members.

Viewing your signed in accounts

Click the account icon in the top right to:

• View your signed in personal account and access account management features.
• View the institutional accounts that are providing access.

Signed in but can't access content

Oxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian.

For librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more.

Our books are available by subscription or purchase to libraries and institutions.

• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Rights and permissions
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

• Technical Support
• Find My Rep

You are here

Qualitative Research Writing Credible and Trustworthy Writing from Beginning to End

• Michelle Salmona - Institute for Mixed Methods Research
• Dan Kaczynski - Central Michigan University
• Eli Lieber - University of California, Los Angeles, USA
• Description

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

This book provides a detailed account of how to think about enacting the process of qualitative research for students. Beginning with the brainstorming process of writing and moving through the critical components of qual research, the book helps students new to these concepts feel more familiar with qualitative research.

This book provides your students with a roadmap for writing up qualitative research projects. It's a good length and level of detail for undergraduate or early-stage graduate students.

Chapters 7 and 8 are CRUCIAL for my students. I have to do a lot of explaining around writing up findings, discussion, and conclusion. I offer lots of examples, but these chapters put it all into easily digestible bites, with really good examples. I would definitely use these chapters – they are excellent.

This book is a primer on how academic research writers can effectively begin, think about, and accomplish qualitative research.

There are some helpful tips for students. For example, the tips to self-evaluate and acknowledge one's role in the research process and to start writing even if the ideas are not clear yet are things I cover with every cohort of students I teach and are useful to include in the text.

This book will really help our graduate students think about writing as a process and not as a product — something they really need to understand.

The accessibility of the language and how the text focuses on leading the student through the writing process to support them in making connections between their research questions, research purpose, and data makes this book distinct from others.

This is a great book with detailed steps of considerations and tasks needed to complete each step of the research process.

Challenging topics are addressed in a clear and easy-to-comprehend format. The tools and strategies shared are very useful and show the reader that there is no one right way of doing things in qualitative research. There are multiple options to choose from based on personal preferences and ways of doing things. The chapters provide a good framework to guide students and novice researchers through the process.

Useful guide for students and others writing up research

• Integrates qualitative research and writing  for a seamless knowledge generation process
• Digital tools  feature prominently throughout the book to take advantage of the latest technology to help organize and analyze your writing and research
• Concrete, practical steps  offer researchers a roadmap for writing
• Unique chapters on  Visualizing Your Writing  and  Writing About Data  tackle uniquely difficult aspects of qualitative research
• Tables and figures throughout summarize information and offer examples of organization
• Questions throughout ask the reader to reflect back on their study and offer strategies for getting started writing
• Chapters follow the research process so readers can start thinking about writing as they work on their projects.

Sample Materials & Chapters

Ch01_Thinking Before Writing

Ch02_Beginning the Story

For instructors

Please select a format:

Select a Purchasing Option

Related products.

• Open access
• Published: 16 November 2020

Navigating the qualitative manuscript writing process: some tips for authors and reviewers

• Chris Roberts   ORCID: orcid.org/0000-0001-8613-682X 1 ,
• Koshila Kumar   ORCID: orcid.org/0000-0001-8504-1052 2 &
• Gabrielle Finn   ORCID: orcid.org/0000-0002-0419-694X 3  

BMC Medical Education volume  20 , Article number:  439 ( 2020 ) Cite this article

10k Accesses

10 Citations

27 Altmetric

Metrics details

An Editorial to this article was published on 04 August 2022

Qualitative research explores the ‘black box’ of how phenomena are constituted. Such research can provide rich and diverse insights about social practices and individual experiences across the continuum of undergraduate, postgraduate and continuing education, sectors and contexts. Qualitative research can yield unique data that can complement the numbers generated in quantitative research, [ 1 ] by answering “how” and “why” research questions. As you will notice in this paper, qualitative research is underpinned by specific philosophical assumptions, quality criteria and has a lexicon or a language specific to it.

A simple search of BMC Medical Education suggests that there are over 800 papers that employ qualitative methods either on their own or as part of a mixed methods study to evaluate various phenomena. This represents a considerable investment in time and effort for both researchers and reviewers. This paper is aimed at maximising this investment by helping early career researchers (ECRs) and reviewers new to the qualitative research field become familiar with quality criteria in qualitative research and how these can be applied in the qualitative manuscript writing process. Fortunately, there are numerous guidelines for both authors and for reviewers of qualitative research, including practical “how to” checklists [ 2 , 3 ]. These checklists can be valuable tools to confirm the essential elements of a qualitative study for early career researchers (ECRs). Our advice in this article is not intended to replace such “how to” guidance. Rather, the suggestions we make are intended to help ECRs increase their likelihood of getting published and reviewers to make informed decisions about the quality of qualitative research being submitted for publication in BMC Medical Education. Our advice is themed around long-established criteria for the quality of qualitative research developed by Lincoln and Guba [ 4 ]. (see Table  1 ) Each quality criterion outlined in Table 1 is further expanded in Table  2 in the form of several practical steps pertinent to the process of writing up qualitative research.

As a general starting point, the early career writer is advised to consult previously published qualitative papers in the journal to identify the genre (style) and relative emphasis of different components of the research paper. Patton [ 5 ] advises researchers to “FOCUS! FOCUS! FOCUS!” in deciding which components to include in the paper, highlighting the need to exclude side topics that add little to the narrative and reduce the cognitive load for readers and reviewers alike. Authors are also advised to do significant re-writing, rephrasing, re-ordering of initial drafts, to remove faulty grammar, and addresses stylistic and structural problems [ 6 ]. They should be mindful of “the golden thread,” that is their central argument that holds together the literature review, the theoretical and conceptual framework, the research questions, methodology, the analysis and organisation of the data and the conclusions. Getting a draft reviewed by someone outside of the research/writing team is one practical strategy to ensure the manuscript is well presented and relates to the plausibility element.

The introduction of a qualitative paper can be seen as beginning a conversation. Lingard advises that in this conversation, authors need to persuade the reader and reviewer of the strength, originality and contributions of their work [ 7 ]. In constructing a persuasive rationale, ECRs need to clearly distinguish between the qualitative research phenomenon (i.e. the broad research issue or concept under investigation) and the research context (i.e. the local setting or situation) [ 5 ]. The introduction section needs to culminate in a qualitative research question/s. It is important that ECRs are aware that qualitative research questions need to be fine-tuned from their original state to reflect gaps in the literature review, the researcher/s’ philosophical stance, the theory used, or unexpected findings [ 8 ]. This links to the elements of plausibility and consistency outlined in Table 1 .

Also, in the introduction of a qualitative paper, ECRs need to explain the multiple “lenses” through which they have considered complex social phenomena; including the underpinning research paradigm and theory. A research paradigm reveals the researcher/s’ values and assumptions about research and relates to axiology (what do you value?), ontology (what is out there to know?) epistemology (what and how can you know it?), and methodology (how do you go about acquiring that knowledge?) [ 9 ] ECRs are advised to explicitly state their research paradigm and its underpinning assumptions. For example, Ommering et al., state “We established our research within an interpretivist paradigm, emphasizing the subjective nature in understanding human experiences and creation of reality.” [ 10 ] Theory refers to a set of concepts or a conceptual framework that helps the writer to move beyond description to ‘explaining, predicting, or prescribing responses, events, situations, conditions, or relationships.’ [ 11 ] Theory can provide comprehensive understandings at multiple levels, including: the macro or grand level of how societies work, the mid-range level of how organisations operate; and the micro level of how people interact [ 12 ]. Qualitative studies can involve theory application or theory development [ 5 ]. ECRs are advised to briefly summarise their theoretical lens and identify what it means to consider the research phenomenon, process, or concept being studied with that specific lens. For example, Kumar and Greenhill explain how the lens of workplace affordances enabled their paper to draw “attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role.” [ 13 ] Ensuring that the elements of theory and research paradigm are explicit and aligned, enhances plausibility, consistency and transparency of qualitative research. The use of theory can also add to the currency of research by enabling a new lens to be cast on a research phenomenon, process, or concept and reveal something previously unknown or surprising.

Moving to the methods, methodology is a general approach to studying a research topic and establishes how one will go about studying any phenomenon. In contrast, methods are specific research techniques and in qualitative research, data collection methods might include observation or interviewing, or photo elicitation methods, while data analysis methods may include content analysis, narrative analysis, or discourse analysis to mention a few [ 8 ]. ECRs will need to ensure the philosophical assumptions, methodology and methods follow from the introduction of a manuscript and the research question/s, [ 3 ] and this enhances the consistency and transparency elements. Moreover, triangulation or the combining of multiple observers, theories, methods, and data sources, is vital to overcome the limitation of singular methods, lone analysts, and single-perspective theories or models [ 8 ]. ECRs should report on not only what was triangulated but also how it was performed, thereby enhancing the elements of plausibility and consistency. For example, Touchie et al., describe using three researchers, three different focus groups, and representation of three different participant cohorts to ensure triangulation [ 14 ]. When it comes to the analysis of qualitative data, ECRs may claim they have used a specific methodological approach (e.g. interpretative phenomenological approach or a grounded theory approach) whereas the analytical steps are more congruent with a more generalist approach, such as thematic analysis [ 15 ]. ECRs are advised that such methodological approaches are founded on a number of philosophical considerations which need to inform the framing and conduct of a study, not just the analysis process. Alignment between the methodology and the methods informs the consistency, transparency and plausibility elements.

Comprehensively describing the research context in a way that is understandable to an international audience helps to illuminate the specific ‘laboratory’ for the research, and how the processes applied or insights generated in this ‘laboratory’ can be adapted or translated to other contexts. This addresses the relevancy element. To further enhance plausibility and relevance, ECRs should situate their work clearly on the evaluation–research continuum. Although not a strictly qualitative research consideration, evaluation focuses mostly on understanding how specific local practices may have resulted in specific outcomes for learners. While evaluation is vital for quality assurance and improvement, research has a broader and strategic focus and rates more highly against the currency and relevancy criteria. ECRs are more likely to undertake evaluation studies aimed at demonstrating the impact and outcomes of an educational intervention in their local setting, consistent with level one of Kirkpatrick’s criteria [ 16 ]. For example, Palmer and colleagues explain that they aimed to “develop and evaluate a continuing medical education (CME) course aimed at improving healthcare provider knowledge” [ 17 ]. To be competitive for publication, evaluation studies need to (measure and) report on at least level two and above of Kirkpatrick’s criteria. Learning how to problematise and frame the investigation of a problem arising from practice as research, provides ECRs with an opportunity to adopt a more critical and scholarly stance.

Also, in the methods, ECRs may provide detail about the study context and participants but little in the way of personal reflexive statements. Unlike quantitative research which claims that knowledge is objective and seeks to remove subjective influences, qualitative research recognises that subjectivity is inherent and that the researcher is directly involved in interpreting and constructing meanings [ 8 ]. For example, Bindels and colleagues provide a clear and concise description about their own backgrounds making their ‘lens’ explicit and enabling the reader to understand the multiple perspectives that have informed their research process [ 18 ]. Therefore, a clear description of the researcher/s position and relationship to the research phenomenon, context and participants, is vital for transparency, relevance and plausibility. We three are all experienced qualitative researchers, writers, reviewers and are associate editors for BMC Medical Education. We are situated in this research landscape as consumers, architects, and arbiters and we engage in these roles in collaboration with others. This provides a useful vantage point from which to provide commentary on key elements which can cause frustration for would-be authors and reviewers of qualitative research papers [ 19 ].

In the discussion of a qualitative paper, ECRs are encouraged to make detailed comments about the contributions of their research and whether these reinforce, extend, or challenge existing understandings based on an analysis that is theoretically or socially significant [ 20 ]. As an example, Barratt et al., found important data to inform the training of medical interns in the use of personal protective equipment during the COVID 19 pandemic [ 21 ]. ECRs are also expected to address the “so what” question which relates to the the consequence of findings for policy, practice and theory. Authors will need to explicitly outline the practical, theoretical or methodological implications of the study findings in a way that is actionable, thereby enhancing relevance and plausibility. For example, Burgess et al., presented their discussion according to four themes and outlined associated implications for individuals and institutions [ 22 ]. A balanced view of the research can be presented by ensuring there is congruence between the data and the claims made and searching the data and/or literature for evidence that disconfirms the findings. ECRs will also need to put forward the sources of uncertainty (rather than limitations) in their research and argue what these may mean for the interpretations made and how the contributions to knowledge could be adopted by others in different contexts [ 23 ]. This links to the plausibility and transparency elements.

In conclusion

Qualitative research is underpinned by specific philosophical assumptions, quality criteria and a lexicon, which ECRs and reviewers need to be mindful of as they navigate the qualitative manuscript writing and reviewing processes. We hope that the guidance provided here is helpful for ECRs in preparing submissions and for reviewers in making informed decisions and providing quality feedback.

Silverman D. Introducing Qualitative Research in Silverman D (Ed) Qualitative Research, 4th Edn. London: Sage; 1984. p. 3–14.

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(6):349–57.

Article   Google Scholar  

Tai J, Ajjawi R. Undertaking and reporting qualitative research. Clin Teach. 2016;13(3):175–82.

Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: Sage Publications; 1985. p. 1995.

Google Scholar  

Patton MQ. Qualitative research & evaluation methods: integrating theory and practice. 4th Edn. Thousan Oaks: Sage publications; 2014.

Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. London: Sage; 2013.

Lingard L. Joining a conversation: the problem/gap/hook heuristic. Perspect Med Educ. 2015;4(5):252–3.

Cohen L, Manion L, Morrison K. Research Methods in Education. 8th Edn. Abingdon: Routledge; 2019.

Brown MEL, Dueñas AN. A medical science Educator’s guide to selecting a research paradigm: building a basis for better research. Med Sci Educ. 2020;30(1):545–53. https://doi.org/10.1007/s40670-019-00898-9 .

Ommering BWC, Wijnen-Meijer M, Dolmans DHJM, Dekker FW, van Blankenstein FM. Promoting positive perceptions of and motivation for research among undergraduate medical students to stimulate future research involvement: a grounded theory study. BMC Med Educ. 2020;20(1):204. https://doi.org/10.1186/s12909-020-02112-6 .

Bradbury-Jones C, Taylor J, Herber O. How theory is used and articulated in qualitative research: development of a new typology. Soc Sci Med. 2014;120:135–41.

Reeves S, Albert M, Kuper A, Hodges BD. Why use theories in qualitative research? BMJ. 2008;7;337:a949. https://doi.org/10.1136/bmj.a949 .

Kumar K, Greenhill J. Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study. BMC Med Educ. 2016;16(1):68. https://doi.org/10.1186/s12909-016-0590-8 .

Touchie C, Humphrey-Murto S, Varpio L. Teaching and assessing procedural skills: a qualitative study. BMC Med Educ. 2013;13(1):69. https://doi.org/10.1186/1472-6920-13-69 .

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

Yardley S, Dornan T. Kirkpatrick’s levels and education ‘evidence’. Med Educ. 2012;46(1):97–106.

Palmer RC, Samson R, Triantis M, Mullan ID. Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers. BMC Med Educ. 2011;11(1):59.

Bindels E, Verberg C, Scherpbier A, Heeneman S, Lombarts K. Reflection revisited: how physicians conceptualize and experience reflection in professional practice – a qualitative study. BMC Med Educ. 2018;18(1):105. https://doi.org/10.1186/s12909-018-1218-y .

Finlay L. “Outing” the researcher: the provenance, process, and practice of reflexivity. Qual Health Res. 2002;12:531–45. https://doi.org/10.1177/104973202129120052 .

Watling CJ, Lingard L. Grounded theory in medical education research: AMEE guide no. 70. Med Teach. 2012;34(10):850–61. https://doi.org/10.3109/0142159X.2012.704439 .

Barratt R, Wyer M, Hor S-y, Gilbert GL. Medical interns’ reflections on their training in use of personal protective equipment. BMC Med Educ. 2020;20(1):328. https://doi.org/10.1186/s12909-020-02238-7 .

Burgess A, Roberts C, Clark T, Mossman K. The social validity of a national assessment Centre for selection into general practice training. BMC Med Educ. 2014;14(1):261.

Lingard L. The art of limitations. Perspect Med Educ. 2015;4(3):136–7. https://doi.org/10.1007/s40037-015-0181-0 .

Download references

Author information

Authors and affiliations.

Education Office, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

Chris Roberts

Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

Koshila Kumar

Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9NT, Manchester, UK

Gabrielle Finn

You can also search for this author in PubMed   Google Scholar

Contributions

CR and KK wrote the first draft. All three authors contributed to severally revising the manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Chris Roberts .

Ethics declarations

Competing interests.

The authors declare they have no competing interests.

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 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.

Roberts, C., Kumar, K. & Finn, G. Navigating the qualitative manuscript writing process: some tips for authors and reviewers. BMC Med Educ 20 , 439 (2020). https://doi.org/10.1186/s12909-020-02370-4

Download citation

Published : 16 November 2020

DOI : https://doi.org/10.1186/s12909-020-02370-4

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

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

• UNC Libraries
• HSL Subject Research
• Qualitative Research Resources
• Writing Up Your Research

Qualitative Research Resources: Writing Up Your Research

Created by health science librarians.

• What is Qualitative Research?
• Qualitative Research Basics
• Special Topics
• Training Opportunities: UNC & Beyond
• Help at UNC
• Qualitative Software for Coding/Analysis
• Software for Audio, Video, Online Surveys
• Finding Qualitative Studies
• Assessing Qualitative Research

About this Page

Writing conventions for qualitative research, sample size/sampling:.

• Integrating Qualitative Research into Systematic Reviews
• Publishing Qualitative Research
• Presenting Qualitative Research
• Qualitative & Libraries: a few gems
• Data Repositories

Why is this information important?

• The conventions of good writing and research reporting are different for qualitative and quantitative research.
• Your article will be more likely to be published if you make sure you follow appropriate conventions in your writing.

On this page you will find the following helpful resources:

• Articles with information on what journal editors look for in qualitative research articles.
• Articles and books on the craft of collating qualitative data into a research article.

These articles provide tips on what journal editors look for when they read qualitative research papers for potential publication.  Also see Assessing Qualitative Research tab in this guide for additional information that may be helpful to authors.

Belgrave, L., D. Zablotsky and M.A. Guadagno.(2002). How do we talk to each other? Writing qualitative research for quantitative readers . Qualitative Health Research , 12(10),1427-1439.

Hunt, Brandon. (2011) Publishing Qualitative Research in Counseling Journals . Journal of Counseling and Development 89(3):296-300.

Fetters, Michael and Dawn Freshwater. (2015). Publishing a Methodological Mixed Methods Research Article. Journal of Mixed Methods Research 9(3): 203-213.

Koch, Lynn C., Tricia Niesz, and Henry McCarthy. (2014). Understanding and Reporting Qualitative Research: An Analytic Review and Recommendations for Submitting Authors. Rehabilitation Counseling Bulletin 57(3):131-143.

Morrow, Susan L. (2005) Quality and Trustworthiness in Qualitative Research in Counseling Psychology ; Journal of Counseling Psychology 52(2):250-260.

Oliver, Deborah P. (2011) "Rigor in Qualitative Research." Research on Aging 33(4): 359-360.

Sandelowski, M., & Leeman, J. (2012). Writing usable qualitative health research findings . Qual Health Res, 22(10), 1404-1413.

Schoenberg, Nancy E., Miller, Edward A., and Pruchno, Rachel. (2011) The qualitative portfolio at The Gerontologist : strong and getting stronger. Gerontologist 51(3): 281-284.

Weaver-Hightower, M. B. (2019). How to write qualitative research . [e-book]

Sidhu, Kalwant, Roger Jones, and Fiona Stevenson (2017). Publishing qualitative research in medical journals. Br J Gen Pract ; 67 (658): 229-230. DOI: 10.3399/bjgp17X690821 PMID: 28450340

• This article is based on a workshop on publishing qualitative studies held at the Society for Academic Primary Care Annual Conference, Dublin, July 2016.

Smith, Mary Lee.(1987) Publishing Qualitative Research. American Educational Research Journal 24(2): 173-183.

Tong, Allison, Sainsbury, Peter, Craig, Jonathan ; Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups , International Journal for Quality in Health Care , Volume 19, Issue 6, 1 December 2007, Pages 349–357, https://doi.org/10.1093/intqhc/mzm042 .

Tracy, Sarah. (2010) Qualitative Quality: Eight 'Big-Tent' Criteria for Excellent Qualitative Research. Qualitative Inquiry 16(10):837-51.

Because reviewers are not always familiar with qualitative methods, they may ask for explanation or justification of your methods when you submit an article. Because different disciplines,different qualitative methods, and different contexts may dictate different approaches to this issue, you may want to consult articles in your field and in target journals for publication.  Additionally, here are some articles that may be helpful in thinking about this issue. 

Bonde, Donna. (2013). Qualitative Interviews: When Enough is Enough . Research by Design.

Guest, Greg, Arwen Bunce, and Laura Johnson. (2006) How Many Interviews are Enough?: An Experiment with Data Saturation and Variability. Field Methods 18(1): 59-82.

Morse, Janice M. (2015) "Data Were Saturated..." Qualitative Health Research 25(5): 587-88 . doi:10.1177/1049732315576699.

Nelson, J. (2016) "Using Conceptual Depth Criteria: Addressing the Challenge of Reaching Saturation in Qualitative Research." Qualitative Research, December. doi:10.1177/1468794116679873.

Patton, Michael Quinn. (2015) "Chapter 5: Designing Qualitative Studies, Module 30 Purposeful Sampling and Case Selection. In Qualitative Research & Evaluation Methods: Integrating Theory and Practice, Fourth edition, pp. 264-72. Thousand Oaks, California: SAGE Publications, Inc. ISBN: 978-1-4129-7212-3

Small, Mario Luis. (2009) 'How Many Cases Do I Need?': On Science and the Logic of Case-Based Selection in Field-Based Research. Ethnography 10(1): 538.

Search the UNC-CH catalog for books about qualitative writing . Selected general books from the catalog are listed below. If you are a researcher at another institution, ask your librarian for assistance locating similar books in your institution's catalog or ordering them via InterLibrary Loan.  

Oft quoted and food for thought

• Morse, J. M. (1997). " Perfectly healthy, but dead": the myth of inter-rater reliability. DOI:10.1177/104973239700700401 Editorial
• Silberzahn, R., Uhlmann, E. L., Martin, D. P., Anselmi, P., Aust, F., Awtrey, E., ... & Carlsson, R. (2018). Many analysts, one data set: Making transparent how variations in analytic choices affect results. Advances in Methods and Practices in Psychologi
• << Previous: Assessing Qualitative Research
• Next: Integrating Qualitative Research into Systematic Reviews >>
• Last Updated: May 14, 2024 12:50 PM
• URL: https://guides.lib.unc.edu/qual

• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

• Qualitative Methods
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

The word qualitative implies an emphasis on the qualities of entities and on processes and meanings that are not experimentally examined or measured [if measured at all] in terms of quantity, amount, intensity, or frequency. Qualitative researchers stress the socially constructed nature of reality, the intimate relationship between the researcher and what is studied, and the situational constraints that shape inquiry. Such researchers emphasize the value-laden nature of inquiry. They seek answers to questions that stress how social experience is created and given meaning. In contrast, quantitative studies emphasize the measurement and analysis of causal relationships between variables, not processes. Qualitative forms of inquiry are considered by many social and behavioral scientists to be as much a perspective on how to approach investigating a research problem as it is a method.

Denzin, Norman. K. and Yvonna S. Lincoln. “Introduction: The Discipline and Practice of Qualitative Research.” In The Sage Handbook of Qualitative Research . Norman. K. Denzin and Yvonna S. Lincoln, eds. 3 rd edition. (Thousand Oaks, CA: Sage, 2005), p. 10.

Characteristics of Qualitative Research

Below are the three key elements that define a qualitative research study and the applied forms each take in the investigation of a research problem.

• Naturalistic -- refers to studying real-world situations as they unfold naturally; non-manipulative and non-controlling; the researcher is open to whatever emerges [i.e., there is a lack of predetermined constraints on findings].
• Emergent -- acceptance of adapting inquiry as understanding deepens and/or situations change; the researcher avoids rigid designs that eliminate responding to opportunities to pursue new paths of discovery as they emerge.
• Purposeful -- cases for study [e.g., people, organizations, communities, cultures, events, critical incidences] are selected because they are “information rich” and illuminative. That is, they offer useful manifestations of the phenomenon of interest; sampling is aimed at insight about the phenomenon, not empirical generalization derived from a sample and applied to a population.

The Collection of Data

• Data -- observations yield a detailed, "thick description" [in-depth understanding]; interviews capture direct quotations about people’s personal perspectives and lived experiences; often derived from carefully conducted case studies and review of material culture.
• Personal experience and engagement -- researcher has direct contact with and gets close to the people, situation, and phenomenon under investigation; the researcher’s personal experiences and insights are an important part of the inquiry and critical to understanding the phenomenon.
• Empathic neutrality -- an empathic stance in working with study respondents seeks vicarious understanding without judgment [neutrality] by showing openness, sensitivity, respect, awareness, and responsiveness; in observation, it means being fully present [mindfulness].
• Dynamic systems -- there is attention to process; assumes change is ongoing, whether the focus is on an individual, an organization, a community, or an entire culture, therefore, the researcher is mindful of and attentive to system and situational dynamics.

The Analysis

• Unique case orientation -- assumes that each case is special and unique; the first level of analysis is being true to, respecting, and capturing the details of the individual cases being studied; cross-case analysis follows from and depends upon the quality of individual case studies.
• Inductive analysis -- immersion in the details and specifics of the data to discover important patterns, themes, and inter-relationships; begins by exploring, then confirming findings, guided by analytical principles rather than rules.
• Holistic perspective -- the whole phenomenon under study is understood as a complex system that is more than the sum of its parts; the focus is on complex interdependencies and system dynamics that cannot be reduced in any meaningful way to linear, cause and effect relationships and/or a few discrete variables.
• Context sensitive -- places findings in a social, historical, and temporal context; researcher is careful about [even dubious of] the possibility or meaningfulness of generalizations across time and space; emphasizes careful comparative case study analysis and extrapolating patterns for possible transferability and adaptation in new settings.
• Voice, perspective, and reflexivity -- the qualitative methodologist owns and is reflective about her or his own voice and perspective; a credible voice conveys authenticity and trustworthiness; complete objectivity being impossible and pure subjectivity undermining credibility, the researcher's focus reflects a balance between understanding and depicting the world authentically in all its complexity and of being self-analytical, politically aware, and reflexive in consciousness.

Berg, Bruce Lawrence. Qualitative Research Methods for the Social Sciences . 8th edition. Boston, MA: Allyn and Bacon, 2012; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 2nd ed. Thousand Oaks, CA: Sage Publications, 1995; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Basic Research Design for Qualitative Studies

Unlike positivist or experimental research that utilizes a linear and one-directional sequence of design steps, there is considerable variation in how a qualitative research study is organized. In general, qualitative researchers attempt to describe and interpret human behavior based primarily on the words of selected individuals [a.k.a., “informants” or “respondents”] and/or through the interpretation of their material culture or occupied space. There is a reflexive process underpinning every stage of a qualitative study to ensure that researcher biases, presuppositions, and interpretations are clearly evident, thus ensuring that the reader is better able to interpret the overall validity of the research. According to Maxwell (2009), there are five, not necessarily ordered or sequential, components in qualitative research designs. How they are presented depends upon the research philosophy and theoretical framework of the study, the methods chosen, and the general assumptions underpinning the study. Goals Describe the central research problem being addressed but avoid describing any anticipated outcomes. Questions to ask yourself are: Why is your study worth doing? What issues do you want to clarify, and what practices and policies do you want it to influence? Why do you want to conduct this study, and why should the reader care about the results? Conceptual Framework Questions to ask yourself are: What do you think is going on with the issues, settings, or people you plan to study? What theories, beliefs, and prior research findings will guide or inform your research, and what literature, preliminary studies, and personal experiences will you draw upon for understanding the people or issues you are studying? Note to not only report the results of other studies in your review of the literature, but note the methods used as well. If appropriate, describe why earlier studies using quantitative methods were inadequate in addressing the research problem. Research Questions Usually there is a research problem that frames your qualitative study and that influences your decision about what methods to use, but qualitative designs generally lack an accompanying hypothesis or set of assumptions because the findings are emergent and unpredictable. In this context, more specific research questions are generally the result of an interactive design process rather than the starting point for that process. Questions to ask yourself are: What do you specifically want to learn or understand by conducting this study? What do you not know about the things you are studying that you want to learn? What questions will your research attempt to answer, and how are these questions related to one another? Methods Structured approaches to applying a method or methods to your study help to ensure that there is comparability of data across sources and researchers and, thus, they can be useful in answering questions that deal with differences between phenomena and the explanation for these differences [variance questions]. An unstructured approach allows the researcher to focus on the particular phenomena studied. This facilitates an understanding of the processes that led to specific outcomes, trading generalizability and comparability for internal validity and contextual and evaluative understanding. Questions to ask yourself are: What will you actually do in conducting this study? What approaches and techniques will you use to collect and analyze your data, and how do these constitute an integrated strategy? Validity In contrast to quantitative studies where the goal is to design, in advance, “controls” such as formal comparisons, sampling strategies, or statistical manipulations to address anticipated and unanticipated threats to validity, qualitative researchers must attempt to rule out most threats to validity after the research has begun by relying on evidence collected during the research process itself in order to effectively argue that any alternative explanations for a phenomenon are implausible. Questions to ask yourself are: How might your results and conclusions be wrong? What are the plausible alternative interpretations and validity threats to these, and how will you deal with these? How can the data that you have, or that you could potentially collect, support or challenge your ideas about what’s going on? Why should we believe your results? Conclusion Although Maxwell does not mention a conclusion as one of the components of a qualitative research design, you should formally conclude your study. Briefly reiterate the goals of your study and the ways in which your research addressed them. Discuss the benefits of your study and how stakeholders can use your results. Also, note the limitations of your study and, if appropriate, place them in the context of areas in need of further research.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Heath, A. W. The Proposal in Qualitative Research. The Qualitative Report 3 (March 1997); Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 3rd edition. Thousand Oaks, CA: Sage, 1999; Maxwell, Joseph A. "Designing a Qualitative Study." In The SAGE Handbook of Applied Social Research Methods . Leonard Bickman and Debra J. Rog, eds. 2nd ed. (Thousand Oaks, CA: Sage, 2009), p. 214-253; Qualitative Research Methods. Writing@CSU. Colorado State University; Yin, Robert K. Qualitative Research from Start to Finish . 2nd edition. New York: Guilford, 2015.

Strengths of Using Qualitative Methods

The advantage of using qualitative methods is that they generate rich, detailed data that leave the participants' perspectives intact and provide multiple contexts for understanding the phenomenon under study. In this way, qualitative research can be used to vividly demonstrate phenomena or to conduct cross-case comparisons and analysis of individuals or groups.

Among the specific strengths of using qualitative methods to study social science research problems is the ability to:

• Obtain a more realistic view of the lived world that cannot be understood or experienced in numerical data and statistical analysis;
• Provide the researcher with the perspective of the participants of the study through immersion in a culture or situation and as a result of direct interaction with them;
• Allow the researcher to describe existing phenomena and current situations;
• Develop flexible ways to perform data collection, subsequent analysis, and interpretation of collected information;
• Yield results that can be helpful in pioneering new ways of understanding;
• Respond to changes that occur while conducting the study ]e.g., extended fieldwork or observation] and offer the flexibility to shift the focus of the research as a result;
• Provide a holistic view of the phenomena under investigation;
• Respond to local situations, conditions, and needs of participants;
• Interact with the research subjects in their own language and on their own terms; and,
• Create a descriptive capability based on primary and unstructured data.

Anderson, Claire. “Presenting and Evaluating Qualitative Research.” American Journal of Pharmaceutical Education 74 (2010): 1-7; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Limitations of Using Qualitative Methods

It is very much true that most of the limitations you find in using qualitative research techniques also reflect their inherent strengths . For example, small sample sizes help you investigate research problems in a comprehensive and in-depth manner. However, small sample sizes undermine opportunities to draw useful generalizations from, or to make broad policy recommendations based upon, the findings. Additionally, as the primary instrument of investigation, qualitative researchers are often embedded in the cultures and experiences of others. However, cultural embeddedness increases the opportunity for bias generated from conscious or unconscious assumptions about the study setting to enter into how data is gathered, interpreted, and reported.

Some specific limitations associated with using qualitative methods to study research problems in the social sciences include the following:

• Drifting away from the original objectives of the study in response to the changing nature of the context under which the research is conducted;
• Arriving at different conclusions based on the same information depending on the personal characteristics of the researcher;
• Replication of a study is very difficult;
• Research using human subjects increases the chance of ethical dilemmas that undermine the overall validity of the study;
• An inability to investigate causality between different research phenomena;
• Difficulty in explaining differences in the quality and quantity of information obtained from different respondents and arriving at different, non-consistent conclusions;
• Data gathering and analysis is often time consuming and/or expensive;
• Requires a high level of experience from the researcher to obtain the targeted information from the respondent;
• May lack consistency and reliability because the researcher can employ different probing techniques and the respondent can choose to tell some particular stories and ignore others; and,
• Generation of a significant amount of data that cannot be randomized into manageable parts for analysis.

Research Tip

Human Subject Research and Institutional Review Board Approval

Almost every socio-behavioral study requires you to submit your proposed research plan to an Institutional Review Board. The role of the Board is to evaluate your research proposal and determine whether it will be conducted ethically and under the regulations, institutional polices, and Code of Ethics set forth by the university. The purpose of the review is to protect the rights and welfare of individuals participating in your study. The review is intended to ensure equitable selection of respondents, that you have met the requirements for obtaining informed consent , that there is clear assessment and minimization of risks to participants and to the university [read: no lawsuits!], and that privacy and confidentiality are maintained throughout the research process and beyond. Go to the USC IRB website for detailed information and templates of forms you need to submit before you can proceed. If you are  unsure whether your study is subject to IRB review, consult with your professor or academic advisor.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Labaree, Robert V. "Working Successfully with Your Institutional Review Board: Practical Advice for Academic Librarians." College and Research Libraries News 71 (April 2010): 190-193.

Another Research Tip

Finding Examples of How to Apply Different Types of Research Methods

SAGE publications is a major publisher of studies about how to design and conduct research in the social and behavioral sciences. Their SAGE Research Methods Online and Cases database includes contents from books, articles, encyclopedias, handbooks, and videos covering social science research design and methods including the complete Little Green Book Series of Quantitative Applications in the Social Sciences and the Little Blue Book Series of Qualitative Research techniques. The database also includes case studies outlining the research methods used in real research projects. This is an excellent source for finding definitions of key terms and descriptions of research design and practice, techniques of data gathering, analysis, and reporting, and information about theories of research [e.g., grounded theory]. The database covers both qualitative and quantitative research methods as well as mixed methods approaches to conducting research.

SAGE Research Methods Online and Cases

NOTE :  For a list of online communities, research centers, indispensable learning resources, and personal websites of leading qualitative researchers, GO HERE .

For a list of scholarly journals devoted to the study and application of qualitative research methods, GO HERE .

• << Previous: 6. The Methodology
• Next: Quantitative Methods >>
• Last Updated: May 30, 2024 9:38 AM
• URL: https://libguides.usc.edu/writingguide

Qualitative Research Essay Examples

A qualitative research essay describes non-numerical findings of an idea, opinion, or process. These data are usually obtained through in-depth interviews, observation, or focus group discussions. Besides, you should indicate the selected research method. It is a short paper format, so don’t be tempted to go into unnecessary details.

For example, if your topic is Apple performance management, you should focus on the long-term efficiency of the company rather than its annual indexes. Leave the figures for a quantitative research project.

Check our qualitative research essay examples to get an idea of what the task requires from you. Here the topics range from psychology and linguistics to sociology and economics.

168 Best Qualitative Research Essay Examples

Evolution of amazon business model.

• Subjects: Business Company Analysis
• Words: 2080

Physical Education Curriculum

• Subjects: Curriculum Development Education
• Words: 5011

Cause and Effect of Cell Phone Usage Among High School Students from U.S. and Middle East

• Subjects: Education Writing & Assignments
• Words: 1218

Impact of Employee Motivation in Organizational Performance

• Subjects: Business Management
• Words: 1490

Epidemiological Studies of Tuberculosis

• Subjects: Epidemiology Health & Medicine
• Words: 1357

Jewel Production and Its Purpose

• Words: 2435

Training programs for semiliterate and illiterate populations in Swaziland

• Subjects: Health & Medicine Healthcare Institution
• Words: 4727

Air Care Gap Analysis

• Subjects: Consumer Science Economics
• Words: 1691

The Removal of the Compulsory Retirement Age to Employ People Between the Ages of 65 and 80

• Subjects: Labor Law Law
• Words: 1257

Relationship Between Sleep and Depression in Adolescence

• Subjects: Psychological Issues Psychology
• Words: 2186

Improving Customer Service in a Nigerian Musical Instrument Company

• Subjects: Business E-Commerce
• Words: 6393

Child Behavior Today and Ten Years Ago

• Subjects: Sociological Theories Sociology
• Words: 1391

Research Methods in Linguistics

• Subjects: Language Use Linguistics

Washback Effect of School-Based Assessment on Teaching and Learning in Hong Kong

• Subjects: Education Education Theories
• Words: 2258

The Real World of Management

• Words: 3925

Effects of Transnational Organized Crime on Foreign Politics

• Subjects: Literature World Literature
• Words: 1934

The Concept of Product Development

• Words: 1428

Risk Analysis Process

• Words: 2108

Anger Management Educational Model

• Words: 1244

Qualitative Research Method Analysis

• Subjects: Math Sciences
• Words: 1766

Mobile Marketing: The Hotelier’s Point of View

• Subjects: Business Marketing
• Words: 6940

Enterprise Resource Planning System’s Role in an Organization

• Subjects: Business Logistics
• Words: 3598

Virgin Australia Airline Quality Management System

• Subjects: Business Strategy
• Words: 4273

Critical Success Factors for the Implementation of System in the State of Qatar

• Words: 2159

Multicultural Training of Counselors Increases Competency

• Words: 3396

Relationship between Mood and Opinion

• Words: 1439

Development of Training and Mentoring Program

• Words: 1068

Gender and Education: Australian Single-Sex Schools

• Subjects: Education Education Perception
• Words: 3022

Managing Challenges in Schools

• Words: 1658

Law Enforcement Race and Domestic Calls

• Subjects: Law Enforcement Politics & Government
• Words: 4150

Phenomenology and Hermeneutics Research Methodologies

• Words: 2980

Operational Management Effectiveness

• Words: 3220

Free News and Readers Preferences Correlation

• Subjects: Entertainment & Media World News
• Words: 4752

The High Infant and Perinatal Mortality Rates in Chicago

• Subjects: Health & Medicine Healthcare Research

Spirituality in the Workplace

• Subjects: Business Business Ethics
• Words: 2495

L1 and L2 Glosses in Vocabulary Retention and Memorisation

• Subjects: Linguistics Teaching

Social Media and Older Australians

• Subjects: Entertainment & Media Social Media Advertising
• Words: 1397

Conflict in Syria: Opportunity for Future Democratisation?

• Subjects: Political Culture Politics & Government
• Words: 4486

Retention of Talented Employees in the UAE Competitive Market

Green energy brand strategy.

• Words: 4223

Homeland Security Department

• Subjects: Homeland Security Law

Cultural and Diversity Management Interview

• Subjects: Business Corporate Culture
• Words: 1384

Conflicts in Syria Present No Opportunity for Future Democratization

Mobile systems uses and impact on business.

• Words: 4162

Stop-and-Frisk Policy in New York

• Words: 2246

Recovering Energy from Waste

• Subjects: Environment Recycling
• Words: 1711

Cross Cultural Management and International Business

• Words: 2773

Peer Assessment as a Teaching Strategy

• Subjects: Education Pedagogical Approaches
• Words: 5585

How We Can Attract Higher Quality Volunteers

• Subjects: Sociological Issues Sociology
• Words: 1156

The Importance of Education During Early Childhood

• Subjects: Education Learning Challenges
• Words: 1806

Trends in Branding: Context and Application

• Words: 3118

Grounded Theory

• Subjects: Philosophy Philosophy of Science

Spatial Data Division of Abu Dhabi Municipality

• Subjects: Data Tech & Engineering
• Words: 3603

Branding Concept Development

• Subjects: Brand Management Business
• Words: 3042

Anti-Inflammatory Diet and IBD Management in Adults

• Subjects: Gastroenterology Health & Medicine
• Words: 3404

Reliability of Incremental Shuttle Walk Test

• Subjects: Health & Medicine Rehabilitation
• Words: 2291

Nypro Inc’s Innovation Model

• Words: 1296

Consolidated Model for Teaching Adults

• Subjects: Adult Education Education
• Words: 2587

How Can an Organization Implement an Enterprise Resource Planning System?

• Words: 8238

Leadership at KTG: Challenges and an Action Plan

• Words: 3312

Special Interest Disability and Personal Interview

• Words: 2317

Qatar’s Economic Diversification

• Subjects: Economics Political Economy Processes
• Words: 3569

The Impact of Social Media on Political Leaders

• Subjects: Political Communication Politics & Government
• Words: 3351

Secure Online Shopping System Model on Customer Behavior

• Words: 4384

Criteria Used in Assessing the Relative Success of a Family Business

• Subjects: Economics Microeconomics
• Words: 2564

Green Computing in Botswana

• Subjects: Other Technology Tech & Engineering

Security Laws in Stock Markets

• Subjects: Business & Corporate Law Law

Public’s Opinion on Alternative Sentencing

• Subjects: Criminal Law Law
• Words: 5092

Strategic HRM in a Multinational Firm

• Words: 3734

The International Monetary Fund and the World Bank

• Subjects: Economics Finance
• Words: 4996

The Strategic Management of IKEA for Furniture Company in UAE or Gulf Corporate Countries

• Subjects: Business
• Words: 3444

Response to Intervention and Assistive Technology

• Subjects: Education Special Education
• Words: 1199

History of Vietnamese Diaspora

• Words: 1393

Carbon Management Accounting

• Subjects: Environment Planet Protection
• Words: 2218

Alcohol Abuse by Quentin McCarthy

• Subjects: Psychology Psychology of Abuse
• Words: 2759

Fifth Grade Students’ Learning Level

• Words: 1400

Planning Psycho-educational Preliminary Tasks

• Subjects: Psychological Principles Psychology
• Words: 1484

LVMH in China’s Domestic Market

• Subjects: Business Case Study
• Words: 4859

Data Warehouse and Data Mining in Business

• Words: 4190

Sustaining a Culture in Multinational Corporations

• Words: 2264

Microfinance in developing economies

• Words: 2209

Air Pollution: Public Health Impact

• Subjects: Climate Change Environment
• Words: 1200

Knowledge Strategy Report from the Ting Shao Kuang Art Gallery: In Search for a Proper Management Strategy

• Words: 1639

Isolated Families – Australia

Corporate social responsibilities in russia.

• Words: 1113

Information Freedom in Government

• Subjects: Government Politics & Government
• Words: 2870

Recruiting in Al-Andalus School

• Words: 3549

Migration and National Security

• Subjects: Immigration Sociology
• Words: 2262

Simple Stimulus Learning: Habituation and Perceptuality

• Subjects: Education Learning Specifics
• Words: 1195

Human Resource Management and Organizational Culture

• Words: 3566

Strategic Management in Current and Future Businesses

• Words: 2203

Cross-Cultural Management in Multinational Corporations

• Subjects: Business Employees Management
• Words: 2475

Current Issues in International Management

• Subjects: Business Impact of Business Issues
• Words: 7003

Cultural, Gender and Racial Differences in Sports

• Subjects: Sports Sports Science
• Words: 3702

Performance Evaluation Procedures and Tools

• Subjects: Development Psychology
• Words: 1955

The Novelty of Teams

• Words: 1958

Youth Arts and the Regulation of Subjectivity

• Words: 1975

Evidenced-Based Practice: Autism Management in Children

• Words: 1388

Education and Career Opportunities System Evaluation

• Words: 1506

Role of Planning Professionals

• Subjects: Geography Sciences
• Words: 3996

Strategic Objectives: Able Corporation

• Words: 1362

Kudler Fine Foods: Issues and Challenges Accompanying Its Growth

Efficient change in organizations.

• Words: 2267

Materials for Artificial Hip Joints’

• Subjects: Health & Medicine Surgery
• Words: 1117

Analysis of QDR and QDR Independent Panel

• Subjects: Military Politics & Government
• Words: 1648

Coca-Cola’s Acquisition of Chinese Juice Company: Understanding Business Environment

• Words: 1491

Literacy Linguistic Usage

• Subjects: American Literature Literature
• Words: 1038

Peculiarities of Using Drama, Improvisation, and Creative Approach

• Subjects: Approach to Learning Education
• Words: 3037

Ethics Awareness Inventory and Ethical Choices in the Workplace

• Words: 1119

Organizational Change Models and Approaches

• Subjects: Economic Systems & Principles Economics
• Words: 2212

The Concept of Organization Structure and Teamwork

• Words: 1381

Australian System of Employment Relations

• Subjects: Business Employee Relationships
• Words: 2023

The Concept of Politeness in the Cross-Cultural Communication

• Subjects: Communications Sociology

The Mining Sector of Australia: New Taxation Arrangements

• Subjects: Economics Taxation
• Words: 4412

Chocolate Business Plan

• Words: 10111

Importance of Public Relations and Relationship Marketing

• Words: 2848

Management in Organisation

• Subjects: Big Economic Issues Economics
• Words: 3041

Modern State as an Impediment to Environmental Issues

• Words: 3768

Youth Antisocial Behaviour: Britain

• Words: 2001

Corporatism in Global Operations

• Subjects: Economic Concepts Economics
• Words: 1817

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

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
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

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

StatPearls [Internet].

Qualitative study.

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

Affiliations

Last Update: September 18, 2022 .

• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

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

Grounded theory

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

Phenomenology

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

Narrative research

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

Research Paradigm

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

Positivist versus postpositivist

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

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

Constructivist

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

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

Data Sampling 

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

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

Data Collection and Analysis

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

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

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

Dissemination

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

Applications

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

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

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

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

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

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

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

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

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

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

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

• Issues of Concern

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

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

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

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

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

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

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

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

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

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

• Enhancing Healthcare Team Outcomes

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

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

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

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

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

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

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

In this Page

Bulk download.

• Bulk download StatPearls data from FTP

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Suicidal Ideation. [StatPearls. 2024] Suicidal Ideation. Harmer B, Lee S, Rizvi A, Saadabadi A. StatPearls. 2024 Jan
• Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. [Cochrane Database Syst Rev. 2022] 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, et al. Cochrane Database Syst Rev. 2022 Feb 1; 2(2022). Epub 2022 Feb 1.
• Macromolecular crowding: chemistry and physics meet biology (Ascona, Switzerland, 10-14 June 2012). [Phys Biol. 2013] Macromolecular crowding: chemistry and physics meet biology (Ascona, Switzerland, 10-14 June 2012). Foffi G, Pastore A, Piazza F, Temussi PA. Phys Biol. 2013 Aug; 10(4):040301. Epub 2013 Aug 2.
• Review Evidence Brief: The Effectiveness Of Mandatory Computer-Based Trainings On Government Ethics, Workplace Harassment, Or Privacy And Information Security-Related Topics [ 2014] Review Evidence Brief: The Effectiveness Of Mandatory Computer-Based Trainings On Government Ethics, Workplace Harassment, Or Privacy And Information Security-Related Topics Peterson K, McCleery E. 2014 May
• Review Public sector reforms and their impact on the level of corruption: A systematic review. [Campbell Syst Rev. 2021] Review Public sector reforms and their impact on the level of corruption: A systematic review. Mugellini G, Della Bella S, Colagrossi M, Isenring GL, Killias M. Campbell Syst Rev. 2021 Jun; 17(2):e1173. Epub 2021 May 24.

Recent Activity

• Qualitative Study - StatPearls Qualitative Study - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

A Qualitative Research Essay

Related Papers

JEELS (Journal of English Education and Linguistics Studies)

The primary objective of this paper is to assert the contribution of qualitative research in ELT. This paper has presented qualitative theories and features advantages and limitations, the criteria of good qualitative research, and analysis of two articles based on Tracy " s model. The analysis result showed that both articles have some limitations such as the uncovering of potential resources and perspectives on how effective extensive reading programs should be implemented in tertiary education in Indonesia. However, most of the criteria that Tracy established were found in these articles, such as relevance of the area of study, timeliness and significance; sufficient, abundant, appropriate and complex use of theoretical constructs, as well as data collection and analysis processes.

The Modern Language …

Xuesong Gao

Anang Mardani

IJORER : International Journal of Recent Educational Research

Bahawal Soomro (Lecturer-English)

This review makes a point in favor of the assertion made for the book that it is a practical introduction to the qualitative research in applied linguistics. The book consists of four parts: an overview of qualitative research, qualitative research methods, qualitative data collection methods, ethical practice issues and the writing of research reports. After proving a rich introduction to the qualitative research, the book discusses qualitative research approaches using a reader-friendly and interactive structure: pre-reading and post-reading questions along with the list of further readings. Then the data collection tools have been thoroughly discussed. What makes this book more useful is the use of illustrative examples for each qualitative research approach and data collection tool. The last part discusses core issues of ethics and drafting a research report. From the perspective of a novice researcher, it has achieved the goal of educating readers about qualitative research met...

Seda Khadimally

Crafting a research design is a daunting task no matter what research method the researcher chooses to work with. Qualitative research study stands as one of the most rigorous and demanding—yet rewarding—research paradigms when the researchers have a narrative, a story to portray in the literature-specific both for their readers and the scientific community. With the intent to describe not only their own personal journey, but also that of those who help unravel previously unexplained phenomena, qualitative researchers undertake a central theme and refer to the lived experiences of their study participants, starting from the data collection stage to analysis and interpretation of their findings. They ask the very fundamental question words (i.e., how, why, and what) with which the study builds up to a rather more profound level. With certain philosophical underpinnings, dimensions, and approaches, qualitative researchers find themselves engaged in a plethora of words, texts, and images (Creswell, 2007). Researchers’ ontological and epistemological positioning additionally informs their choices of methods and methodology, the latter which is a theoretical perspective acting as a bridge between the two (Creswell, 2007). Regarding this and other characteristics, it is also important to note that an impeccable qualitative study design cannot be achieved without researchers’ investing a long time and finances, the resources without which a seamless research study would not be produced. With the purpose of discussing such and several more distinctive characteristics, metaphors, various research paradigms, and considerations throughout, the purpose of this paper is to shed light to what a qualitative research study essentially is, how researchers deal with it throughout the research process, when it is appropriate to conduct one and when not, its advantages, disadvantages, and others. Each component that goes into the design of qualitative research study will be handled under close lens.

DR FREDRICK ONASANYA

The paper covers the following areas: definitions, characteristics, methods of data collection methods of qualitative research, sustaining the validity of qualitative research, judgments of truthfulness, or dependable qualitative research, analyzes of qualitative data, advantages and disadvantages of qualitative research. Qualitative research is about digging into matters, understanding, and developments, responding to questions, by examining and determining and making sense of unstructured data Qualitative research is mainly exploratory utilize to earn understanding of fundamental reasons, impressions, and motivations. It furnishes perceptivenesses into the problems or assists to originate thoughts or hypotheses for possible qualitative research. Qualitative research has the power to investigate or examine into reactions and answers from the participants.. The researcher can obtain information not expected by the researcher

Methodological Issues in Management Research: Advances, Challenges, and the Way Ahead

Richa Awasthy

Current paper is an overview of qualitative research. It starts with discussing meaning of research and links it with a framework of experiential learning. Complexity of socio-political environment can be captured with methodologies appropriate to capture dynamism and intricacy of human life. Qualitative research is a process of capturing lived-in experiences of individuals, groups, and society. It is an umbrella concept which involves variety of methods of data collection such as interviews, observations, focused group discussions, projective tools, drawings, narratives, biographies, videos, and anything which helps to understand world of participants. Researcher is an instrument of data collection and plays a crucial role in collecting data. Main steps and key characteristics of qualitative research are covered in this paper. Reader would develop appreciation for methodiness in qualitative research. Quality of qualitative research is explained referring to aspects related to rigor...

Khalid Arar

Springer eBooks

Seyyed-Abdolhamid Mirhosseini

Sandra Mathison

RELATED PAPERS

Marta Filipová

Elisabetta Moro

Tectonophysics

David Durney

Endocrinology & Metabolic Syndrome

Guadalupe Ruiz Vivanco

Revista CUIDARTE

Matiana Morales del Pilar

Rita Patriasih

Hebrew Higher Education

David Marcus

Chemical Communications

Biophysical Journal

Qui Pham van

Colloids and Surfaces B: Biointerfaces

Ester Pastor

VISA: Journal of Vision and Ideas

Melani Putri

Food Bioscience

Manuela Pintado

在线制作乔治华盛顿大学毕业证 gwu毕业证文凭证书实拍图学历学位认证原版一模一样

Journal of Biological Chemistry

Luiz E.a.m. Mello

Otolaryngology-Head and Neck Surgery

Microscopy and Microanalysis

Journal of Environment and Management

tresia kristiana

frederico margem

Journal of Colloid and Interface Science

Jeena Varghese

Samira Jafari

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Background of the Study in Qualitative Research

Ai generator.

Introduction The transition to inclusive education in mainstream schools has raised important questions about the experiences of students with disabilities. This qualitative study explores the experiences and challenges faced by these students in inclusive educational settings.

Contextual Framework Inclusive education aims to integrate all students, regardless of their abilities, into mainstream classrooms. Historically, students with disabilities were often placed in separate schools or classes. Theories of inclusive education, social integration, and equity in education provide a basis for understanding the current shift towards inclusivity.

Literature Review Previous research highlights both the benefits and challenges of inclusive education. Studies show that inclusive settings can promote social interaction and reduce stigmatization. However, they also reveal significant challenges, such as inadequate teacher training, lack of resources, and peer bullying. Despite these findings, there is limited qualitative research that captures the personal experiences and perspectives of students with disabilities in inclusive settings.

Rationale Understanding the lived experiences of students with disabilities in inclusive settings is crucial for developing effective educational practices and policies. This study aims to fill the gap by providing in-depth insights into their daily experiences, challenges, and coping strategies.

Objectives and Research Questions

• To explore the personal experiences of students with disabilities in inclusive classrooms.
• What are the main challenges faced by these students in inclusive educational settings?
• How do students with disabilities perceive their interactions with peers and teachers?
• What strategies do students with disabilities use to navigate inclusive classrooms?

Conclusion The background of the study highlights the importance of examining the experiences of students with disabilities in inclusive educational settings. By providing rich, qualitative data, this research aims to inform better practices and policies to support the successful inclusion of all students in mainstream schools.

Text prompt

• Instructive
• Professional

10 Examples of Public speaking

20 Examples of Gas lighting

• Systematic Review
• Open access
• Published: 30 May 2024

Patient experiences: a qualitative systematic review of chemotherapy adherence

• Amineh Rashidi 1 ,
• Susma Thapa 1 ,
• Wasana Sandamali Kahawaththa Palliya Guruge 1 &
• Shubhpreet Kaur 1  

BMC Cancer volume  24 , Article number:  658 ( 2024 ) Cite this article

122 Accesses

Metrics details

Adherence to chemotherapy treatment is recognized as a crucial health concern, especially in managing cancer patients. Chemotherapy presents challenges for patients, as it can lead to potential side effects that may adversely affect their mobility and overall function. Patients may sometimes neglect to communicate these side effects to health professionals, which can impact treatment management and leave their unresolved needs unaddressed. However, there is limited understanding of how patients’ experiences contribute to improving adherence to chemotherapy treatment and the provision of appropriate support. Therefore, gaining insights into patients’ experiences is crucial for enhancing the accompaniment and support provided during chemotherapy.

This review synthesizes qualitative literature on chemotherapy adherence within the context of patients’ experiences. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase, Scopus, and the Cochrane Library, systematically searched from 2006 to 2023. Keywords and MeSH terms were utilized to identify relevant research published in English. Thirteen articles were included in this review. Five key themes were synthesized from the findings, including positive outlook, receiving support, side effects, concerns about efficacy, and unmet information needs. The review underscores the importance for healthcare providers, particularly nurses, to focus on providing comprehensive information about chemotherapy treatment to patients. Adopting recommended strategies may assist patients in clinical practice settings in enhancing adherence to chemotherapy treatment and improving health outcomes for individuals living with cancer.

Peer Review reports

Introduction

Cancer can affect anyone and is recognized as a chronic disease characterized by abnormal cell multiplication in the body [ 1 ]. While cancer is prevalent worldwide, approximately 70% of cancer-related deaths occur in low- to middle-income nations [ 1 ]. Disparities in cancer outcomes are primarily attributed to variations in the accessibility of comprehensive diagnosis and treatment among countries [ 1 , 2 ]. Cancer treatment comes in various forms; however, chemotherapy is the most widely used approach [ 3 ]. Patients undergoing chemotherapy experience both disease-related and treatment-related adverse effects, significantly impacting their quality of life [ 4 ]. Despite these challenges, many cancer patients adhere to treatment in the hope of survival [ 5 ]. However, some studies have shown that concerns about treatment efficacy may hinder treatment adherence [ 6 ]. Adherence is defined as “the extent to which a person’s behaviour aligns with the recommendations of healthcare providers“ [ 7 ]. Additionally, treatment adherence is influenced by the information provided by healthcare professionals following a cancer diagnosis [ 8 ]. Patient experiences suggest that the decision to adhere to treatment is often influenced by personal factors, with family support playing a crucial role [ 8 ]. Furthermore, providing adequate information about chemotherapy, including its benefits and consequences, can help individuals living with cancer gain a better understanding of the advantages associated with adhering to chemotherapy treatment [ 9 ].

Recognizing the importance of adhering to chemotherapy treatment and understanding the impact of individual experiences of chemotherapy adherence would aid in identifying determinants of adherence and non-adherence that are modifiable through effective interventions [ 10 ]. Recently, systematic reviews have focused on experiences and adherence in breast cancer [ 11 ], self-management of chemotherapy in cancer patients [ 12 ], and the influence of medication side effects on adherence [ 13 ]. However, these reviews were narrow in scope, and to date, no review has integrated the findings of qualitative studies designed to explore both positive and negative experiences regarding chemotherapy treatment adherence. This review aims to synthesize the qualitative literature on chemotherapy adherence within the context of patients’ experiences.

This review was conducted in accordance with the Joanna Briggs Institute [ 14 ] guidelines for systemic review involving meta-aggregation. This review was registered in PROSPERO (CRD42021270459).

Search methods

The searches for peer reviewed publications in English from January 2006-September 2023 were conducted by using keywords, medical subject headings (MeSH) terms and Boolean operators ‘AND’ and ‘OR’, which are presented in the table in Appendix 1 . The searches were performed in a systematic manner in core databases such including Embase, Medline, PsycINFO, CINAHL, Web of Science, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). The search strategy was developed from keywords and medical subject headings (MeSH) terms. Librarian’s support and advice were sought in forming of the search strategies.

Study selection and inclusion criteria

The systematic search was conducted on each database and all articles were exported to Endnote and duplicates records were removed. Then, title and abstract of the full text was screened by two independent reviewers against the inclusion criteria. For this review, populations were patients aged 18 and over with cancer, the phenomenon of interest was experiences on chemotherapy adherence and context was considered as hospitals, communities, rehabilitation centres, outpatient clinics, and residential aged care. All peer-reviewed qualitative study design were also considered for inclusion. Studies included in this review were classified as primary research, published in English since 2006, some intervention implemented to improve adherence to treatment. This review excluded any studies that related to with cancer and mental health condition, animal studies and grey literature.

Quality appraisal and data extraction

The JBI Qualitative Assessment and Review Instrument for qualitative studies was used to assess the methodological quality of the included studies, which was conducted by the primary and second reviewers independently. There was no disagreement between the reviews. The qualitative data on objectives, study population, context, study methods, and the phenomena of interest and findings form the included studies were extracted.

Data synthesis

The meta-aggregation approach was used to combine the results with similar meaning. The primary and secondary reviewers created categories based on the meanings and concept. These categories were supported by direct quotations from participants. The findings were assess based on three levels of evidence, including unequivocal, credible, and unsupported [ 15 , 16 ]. Findings with no quotation were not considered for synthesis in this review. The categories and findings were also discussed by the third and fourth reviewers until a consensus was reached. The review was approved by the Edith Cowan University Human Research Ethics Committee (2021–02896).

Study inclusion

A total of 4145 records were identified through a systematic search. Duplicates ( n  = 647) were excluded. Two independent reviewers conducted screening process. The remaining articles ( n  = 3498) were examined for title and abstract screening. Then, the full text screening conducted, yielded 13 articles to be included in the final synthesis see Appendix 2 .

Methodological quality of included studies

All included qualitative studies scored between 7 and 9, which is displayed in Appendix 3 . The congruity between the research methodology and the research question or objectives, followed by applying appropriate data collection and data analysis were observed in all included studies. Only one study [ 17 ] indicated the researcher’s statement regarding cultural or theoretical perspectives. Three studies [ 18 , 19 , 20 ] identified the influence of the researcher on the research and vice-versa.

Characteristics of included studies

Most of studies conducted semi-structured and in-depth interviews, one study used narrative stories [ 19 ], one study used focus group discussion [ 21 ], and one study combined focus group and interview [ 22 ] to collect data. All studies conducted outpatient’s clinic, community, or hospital settings [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The study characteristics presented in Appendix 4 .

Review findings

Eighteen findings were extracted and synthesised into five categories: positive outlook, support, side effects, concern about efficacy and unmet information needs.

Positive outlook

Five studies discussed the link between positivity and hope and chemotherapy adherence [ 19 , 20 , 23 , 27 , 28 ]. Five studies commented that feeling positive and avoid the negativity and worry could encourage people to adhere in their mindset chemotherapy: “ I think the main thing for me was just keeping a positive attitude and not worrying, not letting myself worry about it ” [ 20 ]. Participants also considered the positive thoughts as a coping mechanism, that would help them to adhere and complete chemotherapy: “ I’m just real positive on how everything is going. I’m confident in the chemo, and I’m hoping to get out of her soon ” [ 23 ]. Viewing chemotherapy as part of their treatment regimen and having awareness of negative consequences of non-adherence to chemotherapy encouraged them to adhere chemotherapy: “ If I do not take medicine, I do not think I will be able to live ” [ 28 ]. Adhering chemotherapy was described as a survivor tool which helped people to control cancer-related symptoms: “ it is what is going to restore me. If it wasn’t this treatment, maybe I wasn’t here talking to you. So, I have to focus in what he is going to give me, life !” [ 27 ]. Similarly, people accepted the medical facts and prevent their life from worsening; “ without the treatment, it goes the wrong way. It is hard, but I have accepted it from the beginning, yes. This is how it is. I cannot do anything about it. Just have to accept it ” [ 19 ].

Finding from six studies contributed to this category [ 20 , 21 , 23 , 24 , 25 , 29 ]. Providing support from families and friends most important to the people. Receiving support from family members enhanced a sense responsibility towards their families, as they believed to survive for their family even if suffered: “ yes, I just thought that if something comes back again and I say no, then I have to look my family and friends in the eye and say I could have prevented it, perhaps. Now, if something comes back again, I can say I did everything I could. Cancer is bad enough without someone saying: It’s your own fault!!” [ 29 ]. Also, emotional support from family was described as important in helping and meeting their needs, and through facilitation helped people to adhere chemotherapy: “ people who genuinely mean the support that they’re giving […] just the pure joy on my daughter’s face for helping me. she was there day and night for me if I needed it, and that I think is the main thing not to have someone begrudgingly looking after you ” [ 20 ]. Another study discussed the role family, friends and social media as the best source of support during their treatment to adhere and continue “ I have tons of friends on Facebook, believe it or not, and it’s amazing how many people are supportive in that way, you know, just sending get-well wishes. I can’t imagine going through this like 10 years ago whenever stuff like that wasn’t around ” [ 23 ]. Receiving support from social workers was particularly helpful during chemotherapy in encouraging adherence to the chemotherapy: “ the social worker told me that love is courage. That was a huge encouragement, and I began to encourage myself ” [ 25 ].

Side effects

Findings from five studies informed this category [ 17 , 21 , 22 , 25 , 26 ]. Physical side effects were described by some as the most unpleasure experience: “ the side effects were very uncomfortable. I felt pain, fatigue, nausea, and dizziness that limited my daily activities. Sometimes, I was thinking about not keeping to my chemotherapy schedule due to those side effect ” [ 17 ]. The impact of side effects affected peoples’ ability to maintain their independence and self-care: “ I couldn’t walk because I didn’t have the energy, but I wouldn’t have dared to go out because the diarrhoea was so bad. Sometimes I couldn’t even get to the toilet; that’s very embarrassing because you feel like you’re a baby ” [ 26 ]. Some perceived that this resulted in being unable to perform independently: “ I was incredibly weak and then you still have to do things and you can’t manage it ” [ 22 ]. These side effect also decreased their quality of life “ I felt nauseated whenever I smelled food. I simply had no appetite when food was placed in front of me. I lost my sense of taste. Food had no taste anymore ” [ 25 ]. Although, the side effects impacted on patients´ leisure and free-time activities, they continued to undertake treatment: “ I had to give up doing the things I liked the most, such as going for walks or going to the beach. Routines, daily life in general were affected ” [ 21 ].

Concern about efficacy

Findings form four studies informed this category [ 17 , 18 , 24 , 28 ]. Although being concerned about the efficacy of the chemotherapy and whether or not chemotherapy treatment would be successful, one participant who undertook treatment described: “the efficacy is not so great. It is said to expect about 10% improvement, but I assume that it declines over time ” [ 28 ]. People were worried that such treatment could not cure their cancer and that their body suffered more due to the disease: “ I was really worried about my treatment effectiveness, and I will die shortly ” [ 17 ]. There were doubts expressed about remaining the cancer in the body after chemotherapy: “ there’s always sort of hidden worries in there that whilst they’re not actually taking the tumour away, then you’re wondering whether it’s getting bigger or what’s happening to it, whether it’s spreading or whatever, you know ” [ 24 ]. Uncertainty around the outcome of such treatment, or whether recovering from cancer or not was described as: “it makes you feel confused. You don’t know whether you are going to get better or else whether the illness is going to drag along further” [ 18 ].

Unmet information needs

Five studies contributed to this category [ 17 , 21 , 22 , 23 , 26 ]. The need for adequate information to assimilate information and provide more clarity when discussing complex information were described. Providing information from clinicians was described as minimal: “they explain everything to you and show you the statistics, then you’re supposed to take it all on-board. You could probably go a little bit slower with the different kinds of chemo and grappling with these statistics” [ 26 ]. People also used the internet search to gain information about their cancer or treatments, “I’ve done it (consult google), but I stopped right away because there’s so much information and you don’t know whether it’s true or not ” [ 21 ]. The need to receive from their clinicians to obtain clearer information was described as” I look a lot of stuff up online because it is not explained to me by the team here at the hospital ” [ 23 ]. Feeling overwhelmed with the volume of information could inhibit people to gain a better understanding of chemotherapy treatment and its relevant information: “ you don’t absorb everything that’s being said and an awful lot of information is given to you ” [ 22 ]. People stated that the need to know more information about their cancer, as they were never dared to ask from their clinicians: “ I am a low educated person and come from a rural area; I just follow the doctor’s advice for my health, and I do not dare to ask anything” [ 17 ].

The purpose of this review was to explore patient’s experiences about the chemotherapy adherence. After finalizing the searches, thirteen papers were included in this review that met the inclusion criteria.

The findings of the present review suggest that social support is a crucial element in people’s positive experiences of adhering to chemotherapy. Such support can lead to positive outcomes by providing consistent and timely assistance from family members or healthcare professionals, who play vital roles in maintaining chemotherapy adherence [ 30 ]. Consistent with our study, previous research has highlighted the significant role of family members in offering emotional and physical support, which helps individuals cope better with chemotherapy treatment [ 31 , 32 ]. However, while receiving support from family members reinforces individuals’ sense of responsibility in managing their treatment and their family, it also instils a desire to survive cancer and undergo chemotherapy. One study found that assuming self-responsibility empowers patients undergoing chemotherapy, as they feel a sense of control over their therapy and are less dependent on family members or healthcare professionals [ 33 ]. A qualitative systematic review reported that support from family members enables patients to become more proactive and effective in adhering to their treatment plan [ 34 ]. This review highlights the importance of maintaining a positive outlook and rational beliefs as essential components of chemotherapy adherence. Positive thinking helps individuals recognize their role in chemotherapy treatment and cope more effectively with their illness by accepting it as part of their treatment regimen and viewing it as a tool for survival. This finding is supported by previous studies indicating that positivity and positive affirmations play critical roles in helping individuals adapt to their reality and construct attitudes conducive to chemotherapy adherence [ 35 , 36 ]. Similarly, maintaining a positive mindset can foster more favourable thoughts regarding chemotherapy adherence, ultimately enhancing adherence and overall well-being [ 37 ].

This review identified side effects as a significant negative aspect of the chemotherapy experience, with individuals expressing concerns about how these side effects affected their ability to perform personal self-care tasks and maintain independent living in their daily lives. Previous studies have shown that participants with a history of chemotherapy drug side effects were less likely to adhere to their treatment regimen due to worsening symptoms, which increased the burden of medication side effects [ 38 , 39 ]. For instance, cancer patients who experienced minimal side effects from chemotherapy were at least 3.5 times more likely to adhere to their treatment plan compared to those who experienced side effects [ 40 ]. Despite experiencing side effects, patients were generally willing to accept and adhere to their treatment program, although one study in this review indicated that side effects made some patients unable to maintain treatment adherence. Side effects also decreased quality of life and imposed restrictions on lifestyle, as seen in another study where adverse effects limited individuals in fulfilling daily commitments and returning to normal levels of functioning [ 41 ]. Additionally, unmet needs regarding information on patients’ needs and expectations were common. Healthcare professionals were considered the most important source of information, followed by consultation with the internet. Providing information from healthcare professionals, particularly nurses, can support patients effectively and reinforce treatment adherence [ 42 , 43 ]. Chemotherapy patients often preferred to base their decisions on the recommendations of their care providers and required adequate information retention. Related studies have highlighted that unmet needs among cancer patients are known factors associated with chemotherapy adherence, emphasizing the importance of providing precise information and delivering it by healthcare professionals to improve adherence [ 44 , 45 ]. Doubts about the efficacy of chemotherapy treatment, as the disease may remain latent, were considered negative experiences. Despite these doubts, patients continued their treatment, echoing findings from a study where doubts regarding efficacy were identified as a main concern for chemotherapy adherence. Further research is needed to understand how doubts about treatment efficacy can still encourage patients to adhere to chemotherapy treatment.

Strengths and limitation

The strength of this review lies in its comprehensive search strategy across databases to select appropriate articles. Additionally, the use of JBI guidelines provided a comprehensive and rigorous methodological approach in conducting this review. However, the exclusion of non-English studies, quantitative studies, and studies involving adolescents and children may limit the generalizability of the findings. Furthermore, this review focuses solely on chemotherapy treatment and does not encompass other types of cancer treatment.

Conclusion and practical implications

Based on the discussion of the findings, it is evident that maintaining a positive mentality and receiving social support can enhance chemotherapy adherence. Conversely, experiencing treatment side effects, concerns about efficacy, and unmet information needs may lead to lower adherence. These findings present an opportunity for healthcare professionals, particularly nurses, to develop standardized approaches aimed at facilitating chemotherapy treatment adherence, with a focus on providing comprehensive information. By assessing patients’ needs, healthcare professionals can tailor approaches to promote chemotherapy adherence and improve the survival rates of people living with cancer. Raising awareness and providing education about cancer and chemotherapy treatment can enhance patients’ understanding of the disease and its treatment options. Utilizing videos and reading materials in outpatient clinics and pharmacy settings can broaden the reach of educational efforts. Policy makers and healthcare providers can collaborate to develop sustainable patient education models to optimize patient outcomes in the context of cancer care. A deeper understanding of individual processes related to chemotherapy adherence is necessary to plan the implementation of interventions effectively. Further research examining the experiences of both adherent and non-adherent patients is essential to gain a comprehensive understanding of this topic.

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. on our submission system as well.

World Health Organization. Cancer 2021 [ https://www.who.int/news-room/fact-sheets/detail/cancer .

Klapheke A, Yap SA, Pan K, Cress RDDHSDCA. Sociodemographic disparities in chemotherapy treatment and impact on survival among patients with metastatic bladder cancer. Urologic Oncology: Seminars Original Investigations. 2018;36(6):19–308.

Article   Google Scholar  

Moth EB, Kiely BE, Naganathan V, Martin A, Blinman P. How do oncologists make decisions about chemotherapy for their older patients with cancer? A survey of Australian oncologists. Support Care Cancer. 2018;26(2):451–60.

Article   CAS   PubMed   Google Scholar  

Khamboon T, Pakanta I. Intervention for symptom cluster management of fatigue, loss of appetite, and anxiety among patients with lung cancer undergoing chemotherapy. Asia-Pacific J Oncol Nurs. 2021;8(3):267–75.

Garcia ACM, Camargos Junior JB, Sarto KK, Silva Marcelo CAd, Paiva EMC, Nogueira DA, Mills J. Quality of life, self-compassion and mindfulness in cancer patients undergoing chemotherapy: a cross-sectional study. Eur J Oncol Nurs. 2021;51:N.PAG-N.PAG.

Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about Medicines prescribed for long-term conditions: a Meta-Analytic Review of the necessity-concerns Framework. PLoS ONE. 2013;8(12):e80633.

Article   PubMed   PubMed Central   Google Scholar  

WHO. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organisation; 2003.

Google Scholar  

Warby A, Dhillon HM, Kao S, Vardy JL. A survey of patient and caregiver experience with malignant pleural mesothelioma. Support Care Cancer. 2019;27(12):4675–86.

Article   PubMed   Google Scholar  

Arunachalam SS, Shetty AP, Panniyadi N, Meena C, Kumari J, Rani B, et al. Study on knowledge of chemotherapy’s adverse effects and their self-care ability to manage - the cancer survivors impact. Clin Epidemiol Global Health. 2021;11:100765.

Article   CAS   Google Scholar  

Nizet P, Touchefeu Y, Pecout S, Cauchin E, Beaudouin E, Mayol S, et al. Exploring the factors influencing adherence to oral anticancer drugs in patients with digestive cancer: a qualitative study. Support Care Cancer. 2022;30(3):2591–604.

Clancy C, Lynch J, Oconnor P, Dowling M. Breast cancer patients’ experiences of adherence and persistence to oral endocrine therapy: a qualitative evidence synthesis. Eur J Oncol Nurs. 2020;44.

Magalhães B, Fernandes C, Lima L, Martinez-Galiano JM, Santos C. Cancer patients’ experiences on self-management of chemotherapy treatment-related symptoms: A systematic review and thematic synthesis. Eur J Oncol Nurs. 2020;49.

Peddie N, Agnew S, Crawford M, Dixon D, MacPherson I, Fleming L. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: a qualitative systematic review and thematic synthesis. Breast. 2021;58:147–59.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ: Br Med J. 2009;339(7716):332–6.

Joanna Briggs Institute. The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews. Checklist for qualitative research. 2017.

Zachary M, Kylie P, Craig L, Edoardo A, Alan P. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol [Internet]. 2014;14(1):108.

Iskandarsyah A, de Klerk C, Suardi DR, Soemitro MP, Sadarjoen SS, Passchier J. Psychosocial and cultural reasons for Delay in seeking help and Nonadherence to treatment in Indonesian women with breast Cancer: a qualitative study. Health Psychol. 2014;33(3):214–21.

Chircop D, Scerri J. The lived experience of patients with Non-hodgkin’s lymphoma undergoing chemotherapy. Eur J Oncol Nurs. 2018;35:117–21.

Kvåle K, Synnes O. Living with life-prolonging chemotherapy—control and meaning‐making in the tension between life and death. Eur J Cancer Care. 2018;27(1):1.

Staneva AA, Beesley VL, Niranjan N, Gibson AF, Rowlands I, Webb PM. I wasn’t gonna let it stop me: exploring women’s experiences of getting through chemotherapy for ovarian cancer. Cancer Nurs. 2019;42(2):E31–8.

Talens A, Guilabert M, Lumbreras B, Aznar MT, López-Pintor E. Medication Experience and Adherence to Oral Chemotherapy: A Qualitative Study of Patients’ and Health Professionals’ Perspectives. Int J Environ Res Public Health. 2021;18(8).

Dumas L, Lidington E, Appadu L, Jupp P, Husson O, Banerjee S, et al. Exploring older women’s attitudes to and experience of treatment for advanced ovarian cancer: a qualitative phenomenological study. Cancers. 2021;13(6):1207.

Albrecht TA, Keim-Malpass J, Boyiadzis M, Rosenzweig M. Psychosocial experiences of young adults diagnosed with acute leukemia during hospitalization for induction chemotherapy treatment. J Hospice Palliat Nurs. 2019;21(2):167–73.

Beaver K, Williamson S, Briggs J. Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer. Eur J Oncol Nurs. 2016;20:77–86.

Chou J-F, Lu YY. Intraperitoneal chemotherapy: the lived experiences of Taiwanese patients with ovarian cancer. Clin J Oncol Nurs. 2019;23(6):E100–6.

Farrell C, Heaven C. Understanding the impact of chemotherapy on dignity for older people and their partners. Eur J Oncol Nurs. 2018;36:82–8.

Wakiuchi J, Silva Marcon S, de Oliveira DC, Aparecida Sales C. Rebuilding subjectivity from the experience of cancer and its treatment. Revista Brasileira De Enfermagem. 2019;72(1):125–33.

Yagasaki K, Komatsu H, Takahashi T. Inner conflict in patients receiving oral anticancer agents: a qualitative study. BMJ Open [Internet]. 2015; 5(4).

Gassmann C, Kolbe N, Brenner A. Experiences and coping strategies of oncology patients undergoing oral chemotherapy: first steps of a grounded theory study. Eur J Oncol Nurs. 2016;23:106–14.

Tang GX, Yan PP, Yan CL, Fu B, Zhu SJ, Zhou LQ, et al. Determinants of suicidal ideation in gynecological cancer patients. Psycho-oncology. 2016;25(1):97–103.

Oven Ustaalioglu B, Acar E, Caliskan M. The predictive factors for perceived social support among cancer patients and caregiver burden of their family caregivers in Turkish population. Int J Psychiatry Clin Pract. 2018;22(1):63–9.

Levkovich I, Cohen M, Karkabi K. The experience of fatigue in breast Cancer patients 1–12 Month Post-chemotherapy: a qualitative study. Behav Med. 2019;45(1):7–18.

Simchowitz B, Shiman L, Spencer J, Brouillard D, Gross A, Connor M, Weingart SN. Perceptions and experiences of patients receiving oral chemotherapy. Clin J Oncol Nurs. 2010;14(4):447–53.

Rashidi A, Kaistha P, Whitehead L, Robinson S. Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: a review of published qualitative research studies. Int J Nurs Stud 2020;110(103727).

Aydogan U, Doganer YC, Komurcu S, Ozturk B, Ozet A, Saglam K. Coping attitudes of cancer patients and their caregivers and quality of life of caregivers. Indian J Palliat Care. 2016;22(2):150–6.

Langford DJ, Morgan S, Cooper B, Paul S, Kober K, Wright F, et al. Association of personality profiles with coping and adjustment to cancer among patients undergoing chemotherapy. Psycho-oncology. 2020;29(6):1060–7.

Jamie MJ, Pensak NA, Sporn NJ, MacDonald JJ, Lennes IT, Safren SA et al. Treatment satisfaction and adherence to oral chemotherapy in patients with Cancer. J Oncol Pract. 2017;13(2).

Tsai Y-F, Huang W-C, Cho S-F, Hsiao H-H, Liu Y-C, Lin S-F, et al. Side effects and medication adherence of tyrosine kinase inhibitors for patients with chronic myeloid leukemia in Taiwan. Medicine. 2018;97(26):415.

D S, M P, G R, S H. Importance of medication adherence and factors affecting it. IP Int J Compr Adv Pharmacolog. 2020;3(2):69–77.

Bekalu YE, Wudu MA, Gashu AW. Adherence to Chemotherapy and Associated factors among patients with Cancer in Amhara Region, Northeastern Ethiopia, 2022. A cross-sectional study. Cancer Control. 2023;30.

Hsu H-C, Liou W-S, Chiang A-J, Tsai S-Y, Jeang S-R, Wu S-L, et al. Longitudinal perceptions of the side effects of chemotherapy in patients with gynecological cancer. Support Care Cancer. 2017;25(11):3457–64.

Gow K, Rashidi A, Whithead L. Factors influencing medication adherence among adults living with diabetes and comorbidities: a qualitative systematic review. Curr Diab Rep. 2023:1–7.

Rashidi A, Whitehead L, Kaistha P. Nurses’ perceptions of factors influencing treatment engagement among patients with cardiovascular diseases: a systematic review. BMC Nurs. 2021;20(1):251.

Zebrack BJ, Block R, Hayes-Lattin B, Embry L, Aguilar C, Meeske KA, et al. Psychosocial service use and unmet need among recently diagnosed adolescent and young adult cancer patients. Cancer. 2013;119(1):201–14.

Timmers L, Boons CCLM, van den Verbrugghe M, Van Hecke A, Hugtenburg JG. Supporting adherence to oral anticancer agents: clinical practice and clues to improve care provided by physicians, nurse practitioners, nurses and pharmacists. BMC Cancer. 2017;17(1).

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia

Amineh Rashidi, Susma Thapa, Wasana Sandamali Kahawaththa Palliya Guruge & Shubhpreet Kaur

You can also search for this author in PubMed   Google Scholar

Contributions

First author (AR) and second author (ST) conceived the review and the second author oversight for all stages of the review provided by the second author. All authors (AR), (ST), (WG) and (SK) undertook the literature search. Data extraction, screening the included papers and quality appraisal were undertaken by all authors (AR), (ST), (WG) and (SK). First and second authors (AR) and (ST) analysed the data and wrote the first draft of the manuscript and revised the manuscript and all authors (AR), (ST), (WG) and (SK) approved the final version of the manuscript.

Corresponding author

Correspondence to Amineh Rashidi .

Ethics declarations

Ethics approval and consent to participate.

The review was approved by the Edith Cowan University Human Research Ethics Committee (2021–02896). A proposal for the systematic review was assessed by the Edith Cowan University Human Research Ethics Committee and deemed not appropriate for full ethical review. However, a Data Management Plan (2021-02896-RASHIDI) was approved and monitored as part of this procedure. Raw data was extracted from the published manuscripts and authors could not identify individual participants during or after this process.

Consent for publication

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

Supplementary material 2, supplementary material 3, supplementary material 4, supplementary material 5, 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.

Rashidi, A., Thapa, S., Kahawaththa Palliya Guruge, W. et al. Patient experiences: a qualitative systematic review of chemotherapy adherence. BMC Cancer 24 , 658 (2024). https://doi.org/10.1186/s12885-024-12353-z

Download citation

Received : 17 November 2023

Accepted : 07 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s12885-024-12353-z

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

• Chemotherapy treatment
• Medication adherence
• Qualitative research
• Patients experiences

ISSN: 1471-2407

• Submission enquiries: [email protected]
• General enquiries: [email protected]

• Open access
• Published: 03 June 2024

Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study

• Michael Van der Voorden 1 ,
• Arie Franx 1 &
• Kees Ahaus 2  

BMC Health Services Research volume  24 , Article number:  700 ( 2024 ) Cite this article

Metrics details

Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.

This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals ( N  = 8) and patients ( N  = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach.

Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: ‘structure’, ‘culture’, ‘education’, ‘emotional’, and ‘physical and technology’. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients.

Conclusions

Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, ‘politics’. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations’ structure, culture and practices.

Peer Review reports

Every day, 830 women worldwide die as a result of complications during and following pregnancy and childbirth [ 1 ]. Most of these complications are considered preventable and often occur during hospitalization [ 1 , 2 , 3 , 4 ]. In Obstetrics, this mainly involves severe bleeding and infection after childbirth [ 1 ]. Preventable complications occur not only within Obstetrics but also within all specialties and therefore are a reason why patient safety has become an international priority [ 5 , 6 , 7 ]. In this regard, patient participation is increasingly used as a strategy to improve patient safety [ 8 , 9 , 10 ].

Recent research within the context of Obstetrics indeed shows the added value of patient participation in in-hospital patient safety [ 11 ] and more broadly [ 10 , 12 , 13 ]. A common example of patient participation, including Obstetrics patients, is shared decision-making, where the patient is expected to receive sufficient information from the professional and be supported in making medical choices [ 14 , 15 ]. This can help detect inconsistencies in care [ 16 ]. Another example is the use of a surgical safety checklist in cesarean deliveries [ 17 , 18 ], which can contribute to a reduction in errors and complications [ 17 , 19 ]. A third illustration is where patients are enabled to monitor their medication and thereby contribute to medication management [ 20 , 21 , 22 ], a reduction in medication errors, and improved outcomes [ 14 , 23 ].

Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged [ 24 ]. First, involving patients in safety initiatives can lead to anxiety in patients [ 25 ]. This includes situations where patients gain a better understanding of medication errors, which increases anxiety [ 24 ]. Second, the relationship between the patient and a professional can be negatively affected [ 26 ]. Sometimes this occurs because, when the patient and professional do negotiate, there are differences in opinions as to whether the patient’s wishes and needs are medically justified [ 24 ]. Third, more responsibility may be placed on the patient than the patient wants [ 24 , 27 ]. For example, patients may feel they have too much responsibility or that professionals have shifted too much responsibility onto them [ 24 ]. Fourth, patient participation in safety initiatives can take up more of the professional’s time [ 24 , 26 ] since a ‘participating’ patient may pose more questions to healthcare professionals.

To ultimately promote patient safety within an Obstetrics department, it is important to mitigate these negative effects of patient participation in patient safety. To this end, we firstly conducted a general review of the literature on actions that could be taken and classified these according to the model by Bate et al. [ 28 ]. This model has six categories of actions: ‘structure’, ‘political’, ‘cultural’, ‘educational’, ’emotional’, and ’physical and technology’ to promote healthcare improvements [ 28 ]. The reviewed literature looked at how to deal in general with common problems such as anxious patients [ 29 ] or an unsatisfactory patient-doctor relationship [ 30 ]. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.

Study design

The aim of this study was to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.

To achieve the goal of this research, qualitative research was employed. As a form of qualitative research, an exploratory interview study was conducted to uncover the actions of both patients and professionals within an Obstetrics department. The Standards for Reporting Qualitative Research checklist [ 31 ] was used to provide transparency (see Additional file 1 ).

Inclusion criteria and participants

This study was conducted within the Obstetrics Department of Erasmus Medical University Center in Rotterdam, the Netherlands. Interviews were held with both patients and birth care professionals to capture their thoughts on appropriate actions to mitigate the negative effects of patient participation on patient safety. Initially, 32 patients and 21 professionals were approached by email, phone, or face-to-face. The inclusion criteria for the patients were that the patient had been admitted to the Obstetrics department, were potentially willing to participate in an interview at least three weeks and no more than six weeks after childbirth, and had mastered the Dutch language sufficiently to fully participate. Inclusion criteria for the professionals were a position as a physician or clinical midwife, at least six months of employment in the Obstetrics department, and sufficient mastery of the Dutch language. A lack of time was the major reason given for nonparticipation by professionals. Patients mostly declined because of insufficient energy after childbirth. We continued to enroll participants until data saturation was achieved. This was achieved once eight patients and eight professionals had been interviewed (see Table  1 ). Data saturation is reached when the researcher begins to hear the same comments repeatedly within interviews [ 32 ]. Within this group of respondents, data saturation was reached because the same actions emerged in the last interviews. This occurred even after the clinical midwife was added alongside the gynecologists.

Data collection

Interviews were conducted between March 2020 and January 2021 by one researcher (MV). Due to COVID-19 concerns, safety measures were observed and the interviews took place on the basis of the patients’ and professionals’ preferences. Nine interviews were conducted face-to-face and seven were conducted by phone. The interviews lasted an average of 59 minutes (range: 43 to 101 minutes) with a focus on forms of individual patient participation. The four negative effects of patient participation on patient safety identified in an earlier study [ 24 ] were used as a starting point. The interview topic guide developed for this purpose [ 24 ] was also used for this study. In addition, in this study both patients and professionals were specifically asked about actions that could be taken to mitigate these negative effects. The in-depth interviews provided a sense of the local culture in this department. Following the interviews, a member check was carried out by asking the respondents to check for factual inaccuracies in the transcripts. Twelve of the sixteen participants took part in this check. None reported any factual inaccuracies, and no changes were made.

Data analysis

The texts of the interviews were transcribed, analyzed, and coded by one of the authors using ATLAS.ti V.8 for Windows. ATLAS.ti is a widely used tool to structure qualitative analysis [ 33 ] and we opted for deductive analysis because this was an appropriate approach to classify the proposed actions [ 28 ]) and generate an accessible overview of the actions identified. The model by Bate et al. [ 28 ] was used for this purpose, aiming to systematically identify the actions within the six different categories for healthcare improvement. Because the actions can influence each other and are interdependent, it is suitable to do this according to the classified themes that are interconnected. Firstly, it concerns structural, which involves organizing, planning, and coordinating quality efforts. Secondly, political addresses and deals with the politics of change surrounding any quality improvement effort. Thirdly, cultural entails giving quality a shared, collective meaning, value, and significance within the organization. Fourthly, educational is characterized by creating a learning process that supports improvement. Fifthly, emotional involves engaging and motivating people by linking quality improvement efforts to inner sentiments and deeper commitments and beliefs. Sixthly, it pertains to physical and technological, which involves designing physical infrastructure and technological systems that support and sustain quality efforts [ 28 ]. For the coding process, codes were initially assigned to the various actions mentioned by both patients and professionals, enabling us to provide an overview of the actions suggested. Furthermore, this approach provided insight into the level of consensus and the differences and similarities in the actions suggested by patients and by professionals. These actions were then classified according to the six categories proposed by Bate et al. [ 28 ]. All the actions suggested by our participants could be fitted within these categories.

The interviews yielded 18 actions, 13 of which were identified by both patients and professionals. These 18 actions could all be placed in one of five of the six categories proposed by Bate et al. Table  2 below provides a summary of the categories, suggested actions , and whether they were offered by patients, professionals, or both. For an overview of illustrative quotes that most effectively illustrate the story of the results, see Table  3 .

The first category ‘structure’ is about establishing working arrangements to prevent negative effects and to ensure patient participation in patient safety should negative effects arise.

Appoint a case manager

The respondents mentioned the importance of having a case manager in the primary process as a priority. As soon as patients experience a decrease in trust or the relationship between patient and professional is negatively affected, patients would like to know to whom they can go to discuss the situation. The case manager would then have the task of reassuring patients and ensuring transparency.

Make time for adequate attention

Both patients and professionals believed that when a patient’s confidence decreases or the relationship between patient and professional has been affected negatively, it is important that they can engage in a conversation about their anxiety. This requires the professionals to be able to free up time to accomplish this.

Provide information concerning responsibilities

To ensure that patients do not feel too much responsibility and that professionals hand over sufficient responsibility, professionals mentioned that it is important to adequately inform patients about the responsibilities of both patients and professionals. When patients know what they are responsible for, they feel more involved in their own care pathway. If errors or deviations in the care pathway are identified by patients, they generally become more anxious and trust may decrease. When this happens, it is important to keep the patient well-informed and provide clarity about the course of action.

Prepare well for childbirth

Patients considered this action important so that they can experience as little unnecessary anxiety as possible just before and during childbirth. In doing so, it should be made clear to patients exactly what to expect during childbirth. The interviews highlighted that good preparation for delivery can lead to a better patient experience.

Clarify role of partner or family

To maintain a sense of safety for patients in all situations, the professionals said that it is important that they establish protocols and standard information packages to ensure they discuss issues with the partner or contact person of the mother-to-be. Here, it is important that the professional takes responsibility for discussing this, so that the patient does not feel that the onus is on herself to pass on information.

The actions within ‘the culture’ category concern ensuring a patient-centered cultural shift, where it is important that professionals work together with the same values.

Patient-centered culture change

The suggested cultural changes related to patient-centeredness touch not only on actions within the culture theme, but also within other themes. From the interviews, it was clear that the respondents could conceive actions related to the mindset and motivation of the professionals. Further, what patients find important seems to be receiving minimal attention at present. In addition, patients were given minimal voice in the care process. To mitigate the negative effects, a cultural change is needed through which a patient’s values become the focus of their care.

Encourage patient participation

Professionals admitted that they do not always encourage patient participation because they frequently consider patients’ wants and needs as medically irresponsible and of little relevance to the outcome. As a result, professionals may shy away from patient participation. To mitigate the negative effects, it is important that patients are encouraged to participate in a desirable way. The professionals indicated that patients who want to proactively participate can be labeled as difficult.

Actively listen to the patient

Here, the professionals indicated that they are not used to actively listening to the patient. Both patients and professionals indicated that active listening is important to hear clearly why patients have anxieties.

Be transparent

Patients said that they are very dependent on the information they receive from professionals. Anxiety can be alleviated by openness and transparency. Moreover, patients indicated that it is important to provide full information when there are more questions. Provided this happens, patients indicate that there is less interference from them because they then know enough.

Work unambiguously

Unambiguous working was mentioned by both patients and professionals although both have different interpretations of this. From the patients’ point of view, it is mainly about unambiguous policies and not doing things that have not been agreed upon. For professionals, it is more about working with consistent values. That is, as soon as a negative effect arises, it is important that professionals have a consistent way of approaching patients.

Educational

Actions within the ‘educational’ category are about establishing an educational system that seeks to learn from negative effects in order to make improvements and avoid future negative effects.

Improve negotiation skills

The professionals reported that, at the point when patients and professionals start to create a birth plan and the patients and professionals negotiate the patient’s wants and needs and maybe fail to come to an agreement, they require conversational techniques that they do not always possess and therefore need to learn these skills.

Train on shared decision-making

Both patients and professionals indicated the need for training to enable them to take a more active role and participate more effectively in patient safety. This training should focus on shared decision-making, aiming to inform both patients and professionals on what responsibility they should take on and what is expected of them.

Ensure systematic feedback

Patients and professionals both indicated that healthcare organizations should use a standard questionnaire to continuously examine any negative outcomes and identify improvements that could be made to avoid these. Furthermore, this systematic feedback should be structurally fed back to the professionals in order that they can learn from it.

The ‘emotional’ theme is about sharing experiences and engaging patients by managing their expectations and showing leadership.

Share stories

The respondents mentioned that structurally listening to experiences and perceptions is an action that can prevent future negative effects. To establish this process, it is necessary to hold focus groups or open conversations with patients. This should lead to professionals being encouraged to work on making improvements.

Demonstrate leadership

Professionals reported that when the relationship between a patient and a professional has been negatively affected, it is important that the professional demonstrates leadership. This requires professionals to continuously explain why something is done, how it is done, and why it makes sense from the professional’s perspective to do it this way. Furthermore, professionals indicated that this requires listening to patients’ objections and that it is the role of professionals to actively address these objections.

Manage expectations

Respondents indicated that in situations where confidence decreases, it is important that patients know where they stand and that their confidence is restored. The professionals indicated that they often feel they have to live up to unrealistic expectations, such as in terms of facilities in the birthing room. As a result, patients and professionals may cease to get along. Patients reported here that it is important that boundaries and limitations are indicated in advance.

Physical and technology

The ‘physical and technology’ category is about ensuring that the negative effects of patient participation in patient safety are actually mitigated.

Create app for patients’ questions

Patient participation initiatives related to patient safety result in more questions arising from patients, requiring professionals to spend more time answering them. To make this more efficient, patients suggested developing an app so they could send questions to the professionals in advance. This was with the goal of reducing the time input by professionals. In addition, some professionals indicated that there should be an app that contains all the information that is important for the patient.

Clarify the patient journey

Both patients and professionals mentioned that it is important to reduce patients’ sense of bearing considerable responsibility, as this would contribute to managing their expectations during the patient journey. The professional will need to collaborate with an advisor to develop a patient journey that could provide an overview of when and where the patient should obtain appropriate information and therefore know what is expected.

In a previous study, we identified four different negative effects of patient participation in patient safety [ 24 ]. To ultimately promote patient safety in an Obstetrics department, this study aims to identify actions to mitigate the negative effects of patient participation in patient safety. These findings are relevant because the approach to addressing these negative effects of patient participation in patient safety within an Obstetrics department is currently lacking. Based on this, Obstetrics departments within hospitals can implement these actions in practice. Within this study, eighteen actions have been identified and four particularly relevant findings are discussed below.

Firstly, the results indicate that the common thread among the eighteen actions is a focus on ‘patient-centered culture change’. Currently, however, this department primarily view it from the perspective of the professionals, rather than adequately considering the viewpoint of the patients. Within this category ‘culture’, various actions emerged: patient-centered culture change, encourage patient participation, actively listen to the patient, be transparent, and work unambiguously. Within this paragraph, further exploration is conducted through comparisons to illustrate the importance of achieving a cultural shift towards the patient’s perspective within this context. An interesting angle here could come from the service dominant logic: that it is not only service providers that create value, but rather that service receivers do so for themselves in use or in collaboration with service providers [ 34 , 35 , 36 ]. This involves an evolution where service-dominant logic shifts the focus from goods to services [ 37 ]. This consideration, and what can be learned from service dominant logic, has resulted in an application called ‘value-in-use’. Hereby, value is created by the user during the usage of resources, processes (and/or their outcomes) [ 38 ]. Translating this to the Obstetrics department of this study, the conclusion could be that participation through patients in safety initiatives within birth care remains at a low level. The respondents indicated that the general line of thought and much of the reasoning is done from the perspective of professionals and does not adequately include the patients’ expertise, knowledge, and thinking. That the patient is not always perceived as a partner is not a surprising outcome, as this has been highlighted in several studies [ 39 , 40 ]. This is, for example, because patient-centered care in maternity care is perceived differently in practice [ 41 ]. Additionally, it is important to acknowledge that effecting such changes within organizations is challenging and requires significant engagement from patients [ 42 ] and professionals [ 43 ]. Continuing to invest in this area remains valuable, as the literature describes the positive contribution in terms of better outcomes, experiences, and reduced costs [ 44 , 45 ]. This reflection demonstrates that the underlying theme of this study, aiming for a cultural shift towards patient-centeredness, is valuable.

Secondly, recognizing the importance of achieving a cultural shift towards the patient’s perspective, this section delves deeper into how it is possible to accomplish this within an Obstetrics context.

This involves examining the link with the results of this study, falling under the categories of ‘educational’ and ‘emotional’. Several recent studies have examined how health care organizations can develop patient-centered care and how to implement this in practice [ 46 , 47 , 48 , 49 ]. A previous study [ 50 ] investigated the link between patient safety and patient-centered care within an Obstetrics department, concluding that professionals play an important role in achieving a culture of patient-centered care. In particular, professionals’ knowledge on doing so, demonstration of leadership, academic supervision, mentorship, and financial resources were cited as key components [ 50 ]. Looking at this study, demonstrate leadership was indicated by professionals and categorized under ‘emotional’. In practice, professionals often face various challenges in demonstrating leadership [ 51 , 52 ] Also within the organization where this study took place, efforts are being made to further formalize and strengthen the leadership role, where professionals perform both clinical and management tasks. Various studies indicate that doing so without proper training or preparation is difficult [ 53 , 54 ], and a structured approach is needed for it to succeed [ 52 ]. Additionally, share stories and manage expectations were mentioned in this study. The action of sharing stories could closely relate to systematically gathering feedback and actually taking action based on it in practice. Listening to the stories of obstetric patients aligns well with the idea of driving a culture change towards patient-centered care, by better understanding what they actually want rather than imposing guidelines [ 55 ]. At the same time, effectively listening to patients in general is complex and involves various challenges, such as professionals’ time constraints [ 56 ]. Moreover, it is noted that receiving feedback and actually acting upon it is also complex [ 57 ], thus intersecting with the educational category of actions. Thereby, managing patient expectations is crucial to prepare them for the choices that need to be made [ 58 ]. There often appears to be a difference between the expectations of an obstetric patient has for or during childbirth, particularly stemming from the established birth plan, and what actually occurs in practice. This while various professionals observe that unrealistic expectations are included in the birth plan [ 59 ]. In this regard, the expectations that patients have can influence patient satisfaction, underscoring the importance of professionals managing patient expectations [ 60 ]. This leads to the conclusion that actions in the ‘emotional’ category are complex and require more attention to implement in practice.

Having the right negotiation skills was categorized as an ‘educational’ action in this current study and again was only suggested by the professionals. The desired negotiation skills among professionals are essential for proper interaction with the patient, improving quality, as well as handling tensions or conflicts [ 61 ]. Since this is still insufficiently integrated into practice, there needs to be sufficient time and financial investment to make this possible through training(s) [ 62 ]. Other actions mentioned within the specific context of Obstetrics in other studies did not emerge as important actions in our study. In this study, two other ‘educational’ actions have been identified: training on shared decision-making and ensuring systematic feedback. Shared decision-making is already being experimented with and integrated within this Obstetrics department. However, both patients and professionals have indicated the need for training to better implement this in practice. The literature also suggests that Obstetric patients do not yet perceive shared decision making as adequately integrated [ 63 ]. One reason for this shortfall is the additional time commitment required from professionals on a daily basis [ 64 ]. Within this Obstetrics department, a significant amount of patient feedback is already being collected. However, there is currently no effective cycle in place to learn from and improve based on this feedback. Therefore, it can be argued that the feedback is not yet being adequately utilized.

Third, it is notable that within the categories ‘structure’ and ‘physical and technology’, actions emerge that intuitively seem embedded in practice. Under the category ‘structure’, the actions include appoint a case manager, make time for adequate attention, provide information concerning responsibilities, prepare well for childbirth, and clarify the role of partner or family. When it comes to appointing a case manager, this is something that is receiving increasing attention in the practice of the department and the hospital, particularly for patients who, in addition to being pregnant, also have (other) medical diseases. The case manager can be deployed as a point of contact at the individual level to align the care plan with the patient, as well as in collaboration with various other professionals [ 65 ]. It can be said that this is still perceived as relatively new within Dutch maternity care [ 66 ]. When it comes to making time for adequate attention, providing information concerning responsibilities, preparing well for childbirth, and clarifying the role of partner or family it may seem as if these actions are self-evident and therefore can be applied easily in the practice of an Obstetrics department. Given the often urgent nature of an Obstetrics department, time pressure in such situations can increase. A previous study [ 67 ] indicates that when time pressure is higher within an Obstetrics department, professionals feel a stronger need to make decisions themselves. This could explain why both patients and professionals have mentioned all three actions.

Under the category ‘physical and technology’, the actions include creating an app for patients’ questions and clarifying the patient journey. The suggestion of creating an app within this Obstetrics department is somewhat surprising, as such an app for patient questions may already be implemented within the hospital. However, it is possible that its usage is still minimal or that patients and professionals are not sufficiently familiar with it. In a study on the use of eHealth and mobile health within an Obstetric context, it is suggested that it is the role of professionals to involve pregnant women in order to lead to successful integration [ 68 ]. Additionally, the results suggest that for managing responsibilities and the expectations associated with them, it is essential to provide better insight into the patient journey. It could be valuable to make the patient journey transparent, with it being the responsibility of professionals to capture the perceptions, preferences, and expectations of the patient upfront [ 69 ].

Fourth, our study yielded 18 actions to mitigate the negative effects of patient participation in patient safety within an Obstetrics department in five of these six categories. That is, no one mentioned an action falling within the ‘politics’ category that Bate et al. define as: ‘dealing with conflicts and tensions between different interests and power relations’ . We offer two possible explanations for why politics was not mentioned in our study. First, many respondents within an Obstetrics department were unfamiliar with the topic being addressed in this study and, consequently, may not have been able to put it into a broader perspective and suggest actions in the political sphere. Second, the actions were primarily envisaged from the practical perspectives of the patients and professionals. As such, one could argue that politics as previously defined are largely absent. This can be seen as an interesting result because the literature often discusses tensions that can arise between patients and professionals when there are conflicting interests [ 70 , 71 , 72 ]. An example from the obstetric literature suggests that with patient participation in the form of promoting shared decision-making, tension can arise when the patient is challenged to make a choice. However, this may conflict with the clinician’s clinical experience or care standards [ 73 ]. Ultimately, this could affect patient safety if the patient prioritizes their own interests over the clinical ones. Another specific example from the obstetric literature shows that among Black American women, a study revealed a sense of powerlessness where doctors played a dominant role in the process [ 74 ]. Based on this, it could be argued that there is potentially a ‘politics’ element based on power relations and the interaction between patients and professionals. And it is plausible that in the future, consideration should be given to actions in the ‘politics’ domain, as such tensions may arise in practice.

Strengths and limitations

First, this study is an inventory off the actions to be taken from the input of both patients and professionals. Because the strength of this is that it allows the conclusion that most of the actions (13/18) were mentioned by both groups. Second, to our knowledge, this is the first study to examine, from the perspective of patient participation in patient safety, the mitigation of negative effects within an Obstetrics department. Thus, it contributes to closing a gap in the scientific literature. Despite these strengths, there are three limitations. Our sample size was limited both in terms of patients and professionals. Additionally, most of the patients were highly educated, and there was no equal distribution among professionals, thus potentially not reflecting the broader population. This might have introduced selection bias [ 75 ]. However, additional respondents were recruited until data saturation was achieved. Second, the generalizability of this research is limited, although this is not necessarily a goal in qualitative research [ 76 ]. That is, the actions identified come from a specific context and generate an overview of this. Third, by choosing to analyze the data deductively based on Bate et al.’s model [ 28 ], the results were shaped by the categories therein. Other models for deductive analysis might have revealed broader or different actions. Nevertheless, the model used does provide specific categories that can then be further elaborated by practitioners.

Eighteen different actions emerged within five categories from this study in a specific context of an Obstetrics department. No actions fit within the model’s sixth category of ‘politics’. The main finding from this study is that most of the actions highlight the need for a patient-centered culture change. Currently, this still relies heavily on the perspective of professionals and too little consideration is given to that of patients. Future studies could repeat our approach but in a different specific context to see whether other practical actions would be identified for further development. This could include looking at other respondents within the study population, such as other job groups of professionals or less educated patients.

Practical implications

A specialty or department must recognize that these negative effects occur in patient participation within the realm of patient safety. By doing so, space, money and time have to be created to elaborate on these actions by patients and professionals and integrate them into the organizations’ structure, culture and practices.

Data availability

All data generated or analyzed during this study are included in this published article.

Reference list

WHO. Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality . Accessed 3 Feb 2023.

Hempel S, Newberry S, Wang Z, Shekelle PG, Shanman R, Johnsen B, Ganz DA. Review of the evidence on falls prevention in hospitals. Task 4 Final Report, Working Paper prepared for the Agency for health care Research and Quality. 2012. Contract No. HHSA2902010000171, PRISM No. HHSA29032001T, Task Order , 1 .

Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG. Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5Part2):390–6.

Article   PubMed   Google Scholar  

Tzeng HM, Yin CY. Patient engagement in hospital fall prevention. Nurs Econ. 2015;33(6):326.

PubMed   Google Scholar  

Azyabi A, Karwowski W, Davahli MR. Assessing patient safety culture in hospital settings. Int J Environ Res Public Health. 2021;18(5):2466.

Article   PubMed   PubMed Central   Google Scholar  

Guinea S, Andersen P, Reid-Searl K, Levett-Jones T, Dwyer T, Heaton L, Bickell P. Simulation-based learning for patient safety: the development of the Tag Team Patient Safety Simulation methodology for nursing education. Collegian. 2019;26(3):392–8.

Article   Google Scholar  

Battles JB, Lilford RJ. Organizing patient safety research to identify risks and hazards. BMJ Qual Saf. 2003;12(suppl 2):ii2–7.

Google Scholar  

Radecki B, Keen A, Miller J, McClure JK, Kara A. Innovating fall safety: engaging patients as experts. J Nurs Care Qual. 2020;35(3):220–6.

Khan A, Coffey M, Litterer KP, Baird JD, Furtak SL, Garcia BM, Clifton EY. Families as partners in hospital error and adverse event surveillance. JAMA Pediatr. 2017;171(4):372–81.

Sarkhosh S, Abdi Z, Ravaghi H. Engaging patients in patient safety: a qualitative study examining healthcare managers and providers’ perspectives. BMC Nurs. 2022;21(1):374.

Park M, Giap TTT. Patient and family engagement as a potential approach for improving patient safety: a systematic review. J Adv Nurs. 2020;76(1):62–80.

Armstrong N, Herbert G, Aveling EL, Dixon-Woods M, Martin G. Optimizing patient involvement in quality improvement. Health Expect. 2013;16(3):e36–47.

Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010, January;85(1);53–62. Elsevier.

Poprzeczny AJ, Stocking K, Showell M, Duffy JM. Patient decision aids to facilitate shared decision making in obstetrics and gynecology: a systematic review and meta-analysis. Obstet Gynecol. 2020;135(2):444–51.

Edmonds BT. Shared decision-making and decision support: their role in obstetrics and gynecology. Curr Opin Obstet Gynecol. 2014;26(6):523–30.

Vincent C. Patient safety. Wiley; 2011.

Singh SS, Mehra N, Hopkins L. Surgical safety checklist in Obstetrics and gynaecology. Safety. 2012. 2, 1A.

Harris K, Russ S. (2021). Patient-completed safety checklists as an empowerment tool for patient involvement in patient safety: concepts, considerations and recommendations. Future Healthc J, 8(3), e567.

Harris K, Søfteland E, Moi AL, Harthug S, Storesund A, Jesuthasan S, Haugen AS, et al. Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist–a qualitative study. BMC Health Serv Res. 2020;20:1–10.

Hall J, Peat M, Birks Y, Golder S, Entwistle V, Gilbody S, Wright J, et al. Effectiveness of interventions designed to promote patient involvement to enhance safety: a systematic review. Qual Saf Health Care. 2010;19(5):e10–e10.

Mohsin-Shaikh S, Garfield S, Franklin BD. Patient involvement in medication safety in hospital: an exploratory study. Int J Clin Pharm. 2014;36:657–66.

Sharma AE, Rivadeneira NA, Barr-Walker J, Stern RJ, Johnson AK, Sarkar U. Patient engagement in health care safety: an overview of mixed-quality evidence. Health Aff. 2018;37(11):1813–20.

Roughead L, Semple S, Rosenfeld E. Literature review: medication safety in Australia. Syd Aust Comm Saf Qual Health Care. 2013.

Van der Voorden M, Ahaus K, Franx A. (2023). Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands. BMJ open, 13(1), e063175.

Entwistle V. Nursing shortages and patient safety problems in hospital care: is clinical monitoring by families part of the solution? Health Expectations: Int J Public Participation Health care Health Policy. 2004;7(1):1.

Entwistle VA, Mello MM, Brennan TA. Advising patients about patient safety: current initiatives risk shifting responsibility. Joint Comm J Qual Patient Saf. 2005;31(9):483–94.

Davis RE, Sevdalis N, Vincent CA. Patient involvement in patient safety. J Patient Saf. 2012;8(4):182–8.

Bate P, Mendel P, Robert G. Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States. CRC; 2007.

Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Simas TAM, Lemieux LA, et al. Consensus bundle on maternal mental health: perinatal depression and anxiety. J Obstet Gynecol Neonatal Nursing. 2017;46(2):272–81.

Chipidza FE, Wallwork RS, Stern TA. Impact of the doctor-patient relationship. Prim care Companion CNS Disorders. 2015;17(5):27354.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51.

Grady MP. Qualitative and action research: a practitioner handbook. Phi Delta Kappa International; 1998.

Smit B, Scherman V. Computer-assisted qualitative data analysis software for scoping reviews: a case of ATLAS. Ti. Int J Qualitative Methods. 2021;20:16094069211019140.

Vargo SL, Lusch RF. Service-dominant logic: continuing the evolution. J Acad Mark Sci. 2008;36:1–10.

Vargo SL, Maglio PP, Akaka MA. On value and value co-creation: a service systems and service logic perspective. Eur Manag J. 2008;26(3):145–52.

Vargo SL, Lusch RF. Relationship in transition: an introduction to the special issue on relationship and service-dominant logic. J Bus Market Manage. 2010;4:167–8.

Peng Y, Wu T, Chen Z, Deng Z. (2022). Value cocreation in health care: systematic review. J Med Internet Res, 24(3), e33061.

Grönroos C, Voima P. Critical service logic: making sense of value creation and co-creation. J Acad Mark Sci. 2013;41:133–50.

Gee RE, Corry MP. Patient engagement and shared decision making in maternity care. Obstet Gynecol. 2012;120(5):995–7.

Sahlström M, Partanen P, Rathert C, Turunen H. Patient participation in patient safety still missing: patient safety experts’ views. Int J Nurs Pract. 2016;22(5):461–9.

Adams T, Sarnak D, Lewis J, Convissar J, Young SS. (2018). What do clinicians who deliver maternity services think patient-centered care is and how is that different for vulnerable women? A qualitative study. Journal of pregnancy, 2018, 1–7.

Orebaugh M. Instigating and influencing patient engagement: a hospital library’s contributions to patient health and organizational success. J Hosp Librariansh. 2014;14(2):109–19.

Patel N, Rajasingam D. User engagement in the delivery and design of maternity services. Best Pract Res Clin Obstet Gynecol. 2013;27(4):597–608.

Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 2013;32(2):207–14.

James J. Patient engagement. Health Affairs Health Policy Brief. 2013;14:101377.

Bokhour BG, Fix GM, Mueller NM, Barker AM, Lavela SL, Hill JN, Lukas CV, et al. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Serv Res. 2018;18(1):1–11.

Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: a conceptual framework. Health Expect. 2018;21(2):429–40.

Alharbi TSJ, Ekman I, Olsson LE, Dudas K, Carlström E. Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care. Health Policy. 2012;108(2–3):294–301.

Carlström ED, Ekman I. Organisational culture and change: implementing person-centred care. J Health Organ Manag. 2012;26(2):175–91.

Severinsson IE, Haruna M, Rönnerhag M, Holm AL, Hansen BS, Berggren I. (2017). Evidence of linkages between patient safety and person-centred care in the maternity and obstetric context-An integrative review.

Denis JL, van Gestel N. Medical doctors in healthcare leadership: theoretical and practical challenges. BMC Health Serv Res. 2016;16:45–56.

Imran D, Rog K, Gallichio J, Alston L. The challenges of becoming and being a clinician manager: a qualitative exploration of the perception of medical doctors in senior leadership roles at a large Australian health service. BMC Health Serv Res. 2021;21:1–9.

Spehar I, Frich JC, Kjekshus LE. Clinicians in management: a qualitative study of managers’ use of influence strategies in hospitals. BMC Health Serv Res. 2014;14:1–10.

Spehar I, Frich JC, Kjekshus LE. Clinicians’ experiences of becoming a clinical manager: a qualitative study. BMC Health Serv Res. 2012;12:1–11.

Flanagan B, Lord B, Reed R, Crimmins G. Listening to women’s voices: the experience of giving birth with paramedic care in Queensland, Australia. BMC Pregnancy Childbirth. 2019;19:1–9.

McKenna L, Brown T, Oliaro L, Williams B, Williams A. (2020). Listening in health care. The handbook of listening, 373–383.

Kogan JR, Conforti LN, Bernabeo EC, Durning SJ, Hauer KE, Holmboe ES. Faculty staff perceptions of feedback to residents after direct observation of clinical skills. Med Educ. 2012;46(2):201–15.

Archer W, Latif A, Faull C. (2017). Communicating with palliative care patients nearing the end of life, their families and carers. Pharm J, 298(10.1211).

Farahat AH, Mohamed HES, Elkader SA, El-Nemer A. Effect of implementing a Birth Plan on womens’ childbirth experiences and maternal & neonatal outcomes. J Educ Pract. 2015;6(6):24–31.

Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186(5):S160–72.

Pan AJ, Pan AJ, Leary KR. Professional interactions: negotiation and expression for Future Physicians and Healthcare Providers. Univers J Educational Res. 2017;5(11):2101–6.

Eisemann BS, Wagner RD, Reece EM. Practical negotiation for medical professionals. Seminars in plastic surgery. Volume 32. Thieme Medical; 2018, November. pp. 166–71. 04.

Durand MA, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, Elwyn G. (2014). Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS ONE, 9(4), e94670.

Joseph-Williams, N., Lloyd, A., Edwards, A., Stobbart, L., Tomson, D., Macphail, S., ... & Thomson, R. (2017). Implementing shared decision making in the NHS: lessons from the MAGIC programme. Bmj, 357.

Minkman MM, Ligthart SA, Huijsman R. Integrated dementia care in the Netherlands: a multiple case study of case management programmes. Health Soc Care Commun. 2009;17(5):485–94.

Groenen CJ, van Duijnhoven NT, Faber MJ, Koetsenruijter J, Kremer JA, Vandenbussche FP. Use of social network analysis in maternity care to identify the profession most suited for case manager role. Midwifery. 2017;45:50–5.

Raoust GM, Bergström J, Bolin M, Hansson SR. (2022). Decision-making during obstetric emergencies: a narrative approach. PLoS ONE, 17(1), e0260277.

Goetz, M., Müller, M., Matthies, L. M., Hansen, J., Doster, A., Szabo, A., ... & Wallwiener, S. (2017). Perceptions of patient engagement applications during pregnancy: a qualitative assessment of the patient’s perspective. JMIR mHealth and uHealth, 5(5), e7040.

Sassen B. Nursing and the Patient Journey. Improving person-centered Innovation of nursing care: Leadership for Change. Cham: Springer Nature Switzerland; 2023. pp. 165–8.

Chapter   Google Scholar  

Busch IM, Saxena A, Wu AW. Putting the patient in patient safety investigations: barriers and strategies for involvement. J Patient Saf. 2021;17(5):358–62.

Saino C, Lauri SE, Eriksson. « Cancer Patient’s Views Experiences Participation Care Decis Making» Nurs Ethics. 2001;8(2):97–113.

Little P, Dorward M, Warner G, Moore M, Stephens K, Senior J, Kendrick T. Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care. BMJ. 2004;328(7437):441.

Diamond-Brown L. It can be challenging, it can be scary, it can be gratifying: obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making. Soc Sci Med. 2018;205:48–54.

Rosenthal L, Lobel M. Explaining racial disparities in adverse birth outcomes: unique sources of stress for black American women. Soc Sci Med. 2011;72(6):977–83.

Tripepi G, Jager KJ, Dekker FW, Zoccali C. Selection bias and information bias in clinical research. Nephron Clin Pract. 2010;115(2):c94–9.

Polit DF, Beck CT. Generalization in quantitative and qualitative research: myths and strategies. Int J Nurs Stud. 2010;47(11):1451–8.

Download references

Acknowledgements

The authors would like to thank the Obstetrics Department of Erasmus University Medical Center and the individual patients and professionals involved for participating in this study and thereby providing relevant data.

The authors have not received a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and affiliations.

Department of Obstetrics and Gynaecology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands

Michael Van der Voorden & Arie Franx

Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, Netherlands

You can also search for this author in PubMed   Google Scholar

Contributions

M.V.: Conceptualization, methodology, formal analysis, investigation, data curation, writing, original draft, review & editing A.F.: conceptualization, resources, review & editing, supervision K.A.: conceptualization, resources, review & editing, supervision.

Corresponding author

Correspondence to Michael Van der Voorden .

Ethics declarations

Ethics approval and consent to participate.

The study protocol (MEC-2020-0246) was approved by the institutional review board of Erasmus University Medical Center. Written informed consent was obtained from all participants. All methods were applied in accordance with the relevant guidelines and regulations.

Consent for publication

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.

Van der Voorden, M., Franx, A. & Ahaus, K. Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study. BMC Health Serv Res 24 , 700 (2024). https://doi.org/10.1186/s12913-024-11154-1

Download citation

Received : 22 November 2023

Accepted : 29 May 2024

Published : 03 June 2024

DOI : https://doi.org/10.1186/s12913-024-11154-1

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

• Patient participation
• Involvement
• Patient-centered care
• Patient safety
• Culture change
• Gynaecology
• Negative effects

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis

• Substantive Review
• Published: 22 May 2024

Cite this article

• Sarah E. Janek   ORCID: orcid.org/0009-0002-1213-2791 1 ,
• Sandy Hatoum   ORCID: orcid.org/0009-0002-3618-9733 2 ,
• Leila Ledbetter   ORCID: orcid.org/0000-0002-5206-8002 3 &
• Michael V. Relf   ORCID: orcid.org/0000-0002-4951-8869 1 , 2  

51 Accesses

Explore all metrics

Men living with HIV (MLWH) in sub-Saharan Africa experience poor health outcomes and increased AIDS-related deaths due to stigma influencing testing and treatment uptake and adherence. PRISMA 2020 was used to report a meta-synthesis of the stigma experiences of MLWH in SSA. With the help of an expert librarian, a search of six databases was formulated and performed to examine the available qualitative and mixed method studies with qualitative results relevant to the research question. Studies focused on adult men living with HIV, with five studies specifically examining the HIV experience of men who have sex with men. Study themes were synthesized to describe MLWH’s perceived, internalized, anticipated, enacted, and intersectional stigma experiences. Most studies included masculinity as a key theme that affected both testing and treatment adherence upon diagnosis. Future research is needed to better understand subpopulations, such as men who have sex with men living with HIV, and what interventions may be beneficial to mitigate the disparities among MLWH in SSA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

“It is not an acceptable disease”: A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia

Overcoming hiv stigma a qualitative analysis of hiv cure research and stigma among men who have sex with men living with hiv, understanding hiv-related stigma among women in the southern united states: a literature review.

Kaiser Family Foundation. The global HIV/AIDS epidemic. KFF. 2022. https://www.kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/ . Accessed 13 Nov 2022.

UNAIDS. Fact sheet—latest global and regional statistics on the status of the AIDS epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2022. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf . Accessed 23 Oct 2022.

West CA, Chang GC, Currie DW, Bray R, Kinchen S, Behel S, McCullough-Sanden R, Low A, Bissek A, Shang JD, Ndongmo CB, Dokubo EK, Balachandra S, Lobognon LR, Dube L, Nuwagaba-Biribonwoha H, Li M, Pasipamire M, Getaneh Y, Lulseged S, Eshetu F, Kingwara L, Zielinski-Gutierrez E, Tlhomola M, Ramphalla P, Kalua T, Auld AF, Williams DB, Remera E, Rwibasira GN, Mugisha V, Malamba SS, Mushi J, Jalloh MF, Mgomella GS, Kirungi WL, Biraro S, Awor AC, Barradas DT, Mugurungi O, Rogers JH, Bronson M, Bodika SM, Ajiboye A, Gaffga N, Moore C, Patel HK, Voetsch AC. Unawareness of HIV infection among men aged 15–59 years in 13 sub-Saharan African countries: findings from the population-based HIV impact assessments, 2015–2019. JAIDS. 2021;87:S97.

PubMed   Google Scholar  

UNAIDS. Executive summary—in danger: UNAIDS global AIDS update 2022 [Internet]. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2022. https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-update-summary_en.pdf . Accessed 23 Oct 2022.

UNAIDS. Addressing a blind spot in the response to HIV—reaching out to men and boys. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2017. https://www.unaids.org/sites/default/files/media_asset/blind_spot_en.pdf . Accessed 23 Oct 2022.

Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103:813–21. https://doi.org/10.2105/AJPH.2012.301069 .

Article   PubMed   PubMed Central   Google Scholar  

Relf MV, Holzemer WL, Holt L, Nyblade L, Caiola CE. A review of the state of the science of HIV and stigma: context, conceptualization, measurement, interventions, gaps, and future priorities. J Assoc Nurses AIDS Care. 2021;32:392–407. https://doi.org/10.1097/JNC.0000000000000237 .

Herek GM. AIDS and stigma. Am Behav Sci. 1999;42:1106–16. https://doi.org/10.1177/00027649921954787 .

Article   Google Scholar  

Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17:1785–95. https://doi.org/10.1007/s10461-013-0437-9 .

Derlega VJ, Winstead BA, Greene K, Serovich J, Elwood WN. Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis. J Health Psychol. 2002;7:415–32. https://doi.org/10.1177/1359105302007004330 .

Article   PubMed   Google Scholar  

Arinaitwe I, Amutuhaire H, Atwongyeire D, Tusingwire E, Kawungezi PC, Rukundo GZ, Ashaba S. Social support, food insecurity, and HIV stigma among men living with HIV in rural southwestern Uganda: a cross-sectional analysis. HIV AIDS (Auckl). 2021;13:657–66. https://doi.org/10.2147/HIV.S316174 .

Mburu G, Ram M, Siu G, Bitira D, Skovdal M, Holland P. Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes. BMC Public Health. 2014;14:1061. https://doi.org/10.1186/1471-2458-14-1061 .

Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. A scoping review on the role of masculine norms in men’s engagement in the HIV care continuum in sub-Saharan Africa. AIDS Care. 2019;31:1435–46. https://doi.org/10.1080/09540121.2019.1595509 .

Abara WE, Garba I. HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: implications for HIV prevention, care, and surveillance. Glob Public Health. 2017;12:469–82. https://doi.org/10.1080/17441692.2015.1094107 .

Joshi K, Lessler J, Olawore O, Loevinsohn G, Bushey S, Tobian AAR, Grabowski MK. Declining HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis of empiric data. J Int AIDS Soc. 2021. https://doi.org/10.1002/jia2.25818 .

Nyato D, Kuringe E, Drake M, Casalini C, Nnko S, Shao A, Komba A, Baral SD, Wambura M, Changalucha J. Participants’ accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review. BMC Public Health. 2018. https://doi.org/10.1186/s12889-018-5303-2 .

Hamilton A, Thompson N, Choko AT, Hlongwa M, Jolly P, Korte JE, Conserve DF. HIV self-testing uptake and intervention strategies among men in sub-Saharan Africa: a systematic review. Front Public Health. 2021. https://doi.org/10.3389/fpubh.2021.594298 .

Hlongwa M, Hlongwana K, Makhunga S, Choko AT, Dzinamarira T, Conserve D, Tsai AC. Linkage to HIV care following HIV self-testing among men: systematic review of quantitative and qualitative studies from six countries in sub-Saharan Africa. AIDS Behav. 2022. https://doi.org/10.1007/s10461-022-03800-8 .

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021. https://doi.org/10.1136/bmj.n71 .

Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107:863–9. https://doi.org/10.2105/AJPH.2017.303744 .

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6. https://doi.org/10.1016/j.jclinepi.2016.01.021 .

UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2014. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf . Accessed 10 June 2023.

UNAIDS. AIDS by the numbers: AIDS is not over, but it can be. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2016. https://www.unaids.org/sites/default/files/media_asset/AIDS-by-the-numbers-2016_en.pdf . Accessed 10 June 2023.

Covidence systematic review software. Veritas Health Innovation. 2022. https://www.covidence.org/ . Accessed 8 Mar 2022.

Kmet LM, Lee RC, Cook LS. HTA initiative #13: standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research. 2004. https://www.ihe.ca/download/standard_quality_assessment_criteria_for_evaluating_primary_research_papers_from_a_variety_of_fields.pdf . Accessed 24 Oct 2022.

Sandelowski M, Barroso J. Handbook for synthesizing qualitative research. New York: Springer Publishing Company; 2007.

Google Scholar  

Belay YA, Yitayal M, Atnafu A, Taye FA. Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia. AIDS Res Ther. 2022;19:1–16. https://doi.org/10.1186/s12981-022-00452-5 .

Hlongwa M, Jama NA, Mehlomakulu V, Pass D, Basera W, Nicol E. Barriers and facilitating factors to HIV treatment among men in a high-HIV-burdened district in KwaZulu-Natal, South Africa: a qualitative study. Am J Mens Health. 2022. https://doi.org/10.1177/15579883221120987 .

Lofgren SM, Tsui S, Atuyambe L, Ankunda L, Komuhendo R, Wamala N, Sadiq A, Kirumira P, Srishyla D, Flynn A, Pastick KA, Meya DB, Nakasujja N, Porta C. Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study. AIDS Care. 2022;34:597–605. https://doi.org/10.1080/09540121.2021.1946000 .

Mandawa MB, Mahiti GR. Factors contributing to loss to follow-up from HIV care among men living with HIV/AIDS in Kibaha District, Tanzania. HIV AIDS (Auckl). 2022;14:503–16. https://doi.org/10.2147/hiv.S381204 .

Mange T, Henderson N, Lukelelo N. ‘After 25 years of democracy we are still stigmatised and discriminated against’ healthcare experiences of HIV-positive older black gay men in a township in South Africa. J Pract Teach Learn. 2022;9:87–100. https://doi.org/10.1921/jpts.v19i1-2.1674 .

Mathenjwa M, Khidir H, Milford C, Mosery N, Rambally Greener L, Pratt MC, O’Neil K, Harrison A, Bangsberg DR, Safren SA, Smit JA, Psaros C, Matthews LT. Acceptability of an intervention to promote viral suppression and serostatus disclosure for men living with HIV in South Africa: qualitative findings. AIDS Behav. 2022;26:1–12. https://doi.org/10.1007/s10461-021-03278-w .

Muwanguzi PA, Nelson LE, Ngabirano TD, Kiwanuka N, Osingada CP, Sewankambo NK. Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: a qualitative study. Front Public Health. 2022. https://doi.org/10.3389/fpubh.2022.650719 .

Nabikande S, Namutundu J, Nangendo J, Okello T, Agwang W, Tusabe J, Kabwama SN, Katahoire AR. Men’s late presentation for HIV care in Eastern Uganda: the role of masculinity norms. PLoS ONE. 2022. https://doi.org/10.1371/journal.pone.0277534 .

Ndione AG, Procureur F, Senne JN, Cornaglia F, Gueye K, Ndour CT, Lépine A. Sexuality-based stigma and access to care: intersecting perspectives between health care providers and men who have sex with men in HIV care centres in Senegal. Health Policy Plan. 2022;37:587–96. https://doi.org/10.1093/heapol/czac010 .

Rich C, Mavhu W, France NF, Munatsi V, Byrne E, Willis N, Nolan A. Exploring the beliefs, experiences and impacts of HIV-related self-stigma amongst adolescents and young adults living with HIV in Harare, Zimbabwe: a qualitative study. PLoS ONE. 2022. https://doi.org/10.1371/journal.pone.0268498 .

Hendrickson ZM, Naugle DA, Tibbels N, Dosso A, Van Lith LM, Mallalieu EC, Kamara D, Dailly-Ajavon P, Cisse A, Ahanda KS, Thaddeus S, Babalola S, Hoffman CJ. “You take medications, you live normally”: the role of antiretroviral therapy in mitigating men’s perceived threats of HIV in Côte d’Ivoire. AIDS Behav. 2019;23:2600–9. https://doi.org/10.1007/s10461-019-02614-5 .

Naugle DA, Tibbels NJ, Hendrickson ZM, Dosso A, Van Lith LM, Mallalieu EC, Kouadio AM, Kra W, Kamara D, Dailly-Ajavon P, Cissé A, Seifert-Ahanda K, Thaddeus S, Babalola S, Hoffman CJ. Bringing fear into focus: the intersections of HIV and masculine gender norms in Côte d’Ivoire. PLoS ONE. 2019. https://doi.org/10.1371/journal.pone.0223414 .

Tibbels NJ, Hendrickson ZM, Naugle DA, Dosso A, Van Lith LM, Mallalieu EC, Kouadio AM, Kra W, Kamara D, Dailly-Ajavon P, Cisse A, Seifert-Ahanda K, Thaddeus S, Babalola S, Hoffmann CJ. Men’s perceptions of HIV care engagement at the facility- and provider-levels: experiences in Cote d’Ivoire. PLoS ONE. 2019. https://doi.org/10.1371/journal.pone.0211385 .

Balogun A, Bissell P, Saddiq M. Negotiating access to the Nigerian healthcare system: the experiences of HIV-positive men who have sex with men. Cult Health Sex. 2020;22:233–46. https://doi.org/10.1080/13691058.2019.1582802 .

Mukumbang FC. Leaving no man behind: how differentiated service delivery models increase men’s engagement in HIV care. Int J Health Policy Manag. 2021;10:129–40. https://doi.org/10.34172/ijhpm.2020.32 .

Ogunbajo A, Kershaw T, Kushwaha S, Boakye F, Wallace-Atiapah N-D, Nelson LE. Barriers, motivators, and facilitators to engagement in HIV care among HIV-infected Ghanaian men who have sex with men (MSM). AIDS Behav. 2018;22:829–39. https://doi.org/10.1007/s10461-017-1806-6 .

Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, Avina S. “It is always better for a man to know his HIV status”—a qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLoS ONE. 2020. https://doi.org/10.1371/journal.pone.0231645 .

Okoror TA, Falade CO, Walker EM, Olorunlana A, Anaele A. Social context surrounding HIV diagnosis and construction of masculinity: a qualitative study of stigma experiences of heterosexual HIV positive men in southwest Nigeria. BMC Public Health. 2016;16:507. https://doi.org/10.1186/s12889-016-3165-z .

Sileo KM, Reed E, Kizito W, Wagman JA, Stockman JK, Wanyenze RK, Chemusto H, Musoke W, Mukasa B, Kiene SM. Masculinity and engagement in HIV care among male fisherfolk on HIV treatment in Uganda. Cult Health Sex. 2019;21:774–88. https://doi.org/10.1080/13691058.2018.1516299 .

Zissette S, Watt MH, Prose NS, Mntambo N, Moshabela M. “If you don’t take a stand for your life, who will help you?”: men’s engagement in HIV care in KwaZulu-Natal, South Africa. Psychol Men Masc. 2016;17:265–73. https://doi.org/10.1037/men0000025 .

Berner-Rodoreda A, Ngwira E, Alhassan Y, Chione B, Dambe R, Bärnighausen T, Phiri S, Taegtmeyer M, Neuhann F. “Deadly”, “fierce”, “shameful”: notions of antiretroviral therapy, stigma and masculinities intersecting men’s life-course in Blantyre, Malawi. BMC Public Health. 2021. https://doi.org/10.1186/s12889-021-12314-2 .

Mantell JE, Masvawure TB, Mapingure M, Apollo T, Gwanzura C, Block L, Bennett E, Preko P, Musuka G, Rabkin M. Engaging men in HIV programmes: a qualitative study of male engagement in community-based antiretroviral refill groups in Zimbabwe. J Int AIDS Soc. 2019. https://doi.org/10.1002/jia2.25403 .

Misra S, Mehta HT, Eschliman EL, Rampa S, Poku OB, Wang W-Q, Ho-Foster AR, Mosepele M, Becker TD, Entaile P, Arscott-Mills T, Opondo PR, Blank MB, Yang LH. Identifying “what matters most” to men in Botswana to promote resistance to HIV-related stigma. Qual Health Res. 2021;31:1680–96. https://doi.org/10.1177/10497323211001361 .

Mooney AC, Gottert A, Khoza N, Rebombo D, Hove J, Suárez AJ, Twine R, MacPhail C, Treves-Kagan S, Kahn K, Pettifor A, Lippman SA. Men’s perceptions of treatment as prevention in South Africa: implications for engagement in HIV care and treatment. AIDS Educ Prev. 2017;29:274–87. https://doi.org/10.1521/aeap.2017.29.3.274 .

Moyo I, Macherera M, Mavhandu-Mudzusi AH. The lived experiences of men who have sex with men when accessing HIV care services in Zimbabwe. Health SA. 2021. https://doi.org/10.4102/hsag.v26i0.1462 .

Meskele M, Khuzwayo N, Taylor M. Mapping the evidence of intimate partner violence among women living with HIV/AIDS in sub-Saharan Africa: a scoping review. BMJ Open. 2021. https://doi.org/10.1136/bmjopen-2020-041326 .

Tenkorang EY, Asamoah-Boaheng M, Owusu AY. Intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa: a mixed-method systematic review and meta-analysis. Trauma Violence Abuse. 2021;22:1104–28. https://doi.org/10.1177/1524838020906560 .

Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. What role do masculine norms play in men’s HIV testing in sub-Saharan Africa?: a scoping review. AIDS Behav. 2018;22:2468–79. https://doi.org/10.1007/s10461-018-2160-z .

Naanyu V, Ruff J, Goodrich S, Spira T, Bateganya M, Toroitich-Ruto C, Otieno-Nyunya B, Siika AM, Wools-Kaloustian K. Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya. BMC Health Serv Res. 2020. https://doi.org/10.1186/s12913-020-05236-z .

Makoae LN, Seboni NM, Molosiwa K, Moleko M, Human S, Sukati NA, Holzemer WL. The symptom experience of people living with HIV/AIDS in southern Africa. J Assoc Nurses AIDS Care. 2005;16:22–32. https://doi.org/10.1016/j.jana.2005.03.005 .

McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2020. https://doi.org/10.1002/jrsm.1411 .

Download references

Acknowledgements

The manuscript was supported by the Fogarty International Center/National Institutes of Health through Award Number R21TW011247 (M. Relf, Contact MPI/L. Nyblade, MPI) and the Duke University Center for AIDS Research (CFAR), an NIH funded program (5P30AI064518). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Research reported in this publication was supported by the Fogarty International Center of the National Institutes for Health under award R21TW012007 and by the Duke Center for AIDS Research, a National Institutes of Health funded program under award number 5P30AI064518. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Author information

Authors and affiliations.

School of Nursing, Duke University, 307 Trent Drive, Box 3322, Durham, NC, 27710, USA

Sarah E. Janek & Michael V. Relf

Duke Global Health Institute, Durham, NC, USA

Sandy Hatoum & Michael V. Relf

Medical Center Library, Duke University, Durham, NC, USA

Leila Ledbetter

You can also search for this author in PubMed   Google Scholar

Contributions

All authors on this paper meet the four criteria for authorship as identified by the International Committee of Medical Journal Editors; all authors have contributed to the drafting or been involved in revising it, reviewed the final version of this manuscript before submission, and agree to be accountable for all aspects of the work. Specifically, using the CRediT taxonomy, the specific contribution of each author is as follows: Conceptualization & Methodology: S. Janek, L. Ledbetter, M. Relf. Formal Analysis: S. Hatoum, S. Janek, M. Relf. Funding Acquisition: M. Relf. Investigation: S. Hatoum, S. Janek, L. Ledbetter, M. Relf. Methodology: S. Janek, L. Ledbetter, M. Relf. Project administration: M. Relf. Supervision: M. Relf. Verification: S. Hatoum, S. Janek, M. Relf. Writing—manuscript draft: S. Janek. Writing—review & editing: S. Hatoum, S. Janek, L. Ledbetter, M. Relf.

Corresponding authors

Correspondence to Sarah E. Janek or Michael V. Relf .

Ethics declarations

Conflict of interest.

The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

Additional information

Publisher's note.

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

Registration The protocol that guided this meta-synthesis was prospectively registered with Prospero (registration ID: CRD42022315871).

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 35 KB)

Rights and permissions.

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Janek, S.E., Hatoum, S., Ledbetter, L. et al. Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04329-8

Download citation

Accepted : 20 March 2024

Published : 22 May 2024

DOI : https://doi.org/10.1007/s10461-024-04329-8

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

• Meta-synthesis
• People with HIV
• Sub-Saharan Africa
• Qualitative methodology
• Find a journal
• Publish with us
• Track your research

• Open access
• Published: 03 June 2024

Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis

• Ruixuan Zhao 1 ,
• Shijie Fang 1 ,
• Dongwen Li 2 &
• Cheng Zhang 3  

BMC Nursing volume  23 , Article number:  370 ( 2024 ) Cite this article

Metrics details

Nurses play an important role in the treatment of war wounds on the plateau, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the altitude emergency rescue experience and training needs of nurses in military hospitals and provide them with targeted assistance.

We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM) were searched for relevant studies published from the establishment of the database to May 2023. Additionally, we conducted a manual search of the references of the identified studies. Registered on the PROSPERO database (CRD42024537104).

A total of 17 studies, including 428 participants, were included, and 139 research results were extracted, summarized into 10 new categories, and formed 3 meta-themes. Meta-theme 1: mental state of military nurses during deployment. Meta-theme 2: the experience of military nurses during deployment. Meta-theme 3: training needs for emergency care.

Conclusions

Emergency rescue of high-altitude war injuries is a challenging process. Leaders should pay full attention to the feelings and needs of military nurses during the first aid process and provide them with appropriate support.

Peer Review reports

Introduction

The plateau area has the characteristics of high altitude, cold all the year round, many ice peaks and snow mountains, and hypoxia [ 1 ]. These characteristics pose major obstacles to both military operations and non-military operations and at the same time, due to the complex terrain and inconvenient transportation, the detection, handling, treatment, and evacuation of the wounded become very difficult. These special natural environments put forward higher requirements for medical rescue [ 2 , 3 ]. As an important part of military or non-military missions, military nurses play an important role in emergency rescue [ 4 ]. There has been a long history of military nurses engaging in war, military operations and humanitarian missions, they are required to provide not only routine health care during peacetime, but also medical services during conflict or humanitarian assistance in response to disasters, public emergencies and epidemics [ 5 , 6 ]. The rescue process is arduous, and nurses may face great challenges. When they are at high altitude environment, they are prone to hypoxia, frostbite, sunburn, fall, blindness, etc., and may be accompanied by high altitude pulmonary edema and high-altitude coma. In war and non-war military operations, military nurses are required to care for a variety of trauma patients, including burns, traumatic amputations, shock, bleeding, penetrating injuries, spinal cord injuries, head injuries, crush injuries, radiation injuries, chemical injuries, infectious diseases, and more. This has higher requirements for the physical, psychological and professional knowledge of military nurses [ 4 , 7 , 8 ].

To provide better care for the wounded and respond to various emergency situations, military nurses must continuously improve their competence. In addition, according to the literature [ 4 , 6 , 9 ], the demand of military nurses for emergency rescue training is gradually increasing, with nurses with deployment experience reporting limited first aid proficiency and a lack of practical training, and related qualitative studies are also increasing, but a single qualitative research result is difficult to fully and accurately reflect the needs of military nurses. Therefore, this study uses a meta-synthesis approach to analyze and summarize such studies the to understand experience and training needs of nurses in military hospitals with altitude war injury emergency rescue, to provide reference for formulating altitude emergency rescue training strategies, and better meet their needs and provide them with appropriate support.

Study design

The Joanna Briggs Institute(JBI)methodology for systematic reviews of qualitative evidence [ 10 ] guided this systematic review and qualitative meta-synthesis. We used the PROSPERO to identify published or ongoing research relevant to the topic and registered for this review(CRD42024537104). In addition, we report our findings by the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement [ 11 ].

Search strategy

We performed systematic searches in Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM). The retrieval time limit was from the establishment of the database to May 2023. The following search terms were used in different combinations: plateau, qualitative study, Emergency rescue, train, Military nurses, education, disaster, public health emergency, rescue, army, War readiness, war. Additionally, we conducted a manual search of the references to the identified studies to find additional eligible articles.

Inclusion and exclusion criteria

Articles that satisfied the following criteria were included in the qualitative synthesis: 1)study population(P): military nurses; 2)phenomenon of interest(I): highland or mountain emergency rescue or emergency rescue experiences, experiences and training needs; 3)context(Co): military nurse emergency rescue process or training process; 4)type of study: qualitative research, including phenomenological, descriptive qualitative research, rooted theory, ethnography, etc.

The exclusion criteria were as follows: 1)duplicate literature, literature with unavailable full text or incomplete data, literature with substandard quality (The JBI qualitative research critical assessment is graded C); 2)literature not in English; 3) secondary research.

Article filtering and quality assessment

Literature screening was done independently by 2 researchers following strict inclusion and exclusion criteria, and they independently assessed the quality of the included literature using the JBI Manual for Systematic reviews of qualitative evidence [ 10 ]. The guideline has 10 evaluation items, each items uses “yes”, “no”, and “not provided” as evaluation indicators. In this study, literature quality is divided into A, B and C. A represents that the literature meets all the above evaluation indicators, B represents that the literature partially meets, and C represents that it does not meet all the above evaluation indicators. During the article selection and quality evaluation process, disagreements were settled with discussion or with a third author’s assistance.

Data extraction

Data management was enabled by the reference management program Endnote 20. Data extraction consists of two researchers reading the content contained in the study independently to extract relevant and useful information, cross-reviewed, and when any disagreement was discussion to resolve it with a third experienced researcher. The relevant content of each study was extracted using a standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review (JBI-QARI), the JBI-QARI qualitative criteria are: (1) unequivocal (U)—refers to findings that are a matter of fact, beyond a reasonable doubt; (2) credible (C)—refers to findings that are plausible interpretations of the primary data within the theoretical framework; (3) unsupported (Un)—relates to findings that are unsupported by the data [ 12 ]. The researchers extracted data according to the above criteria. Data extraction included author, country, objective, study population, research Methodology, and main results.

Data synthesis

This data extraction was carried out and checked independently by 2 researchers, and when disagreements were encountered, a third researcher was asked and consensus was reached on the results. We used Thomas and Hardens’ three stage thematic synthesis approach [ 13 ]: (1) coding the text; (2) developing descriptive themes; (3) generating analytical themes. First, two researchers independently coded the results based on text content and meaning; then, researchers looked for similarities and differences between the textual data, and classify the meaning of the original dataset; finally, the categories were evaluated repeatedly to identify similarities and obtain synthesized results.

Study characteristics

A total of 1070 articles were searched, we found two additional articles by checking the references of articles, and the exclusion of duplicate publications yielded 783 articles. After reading the titles and abstracts, 708 articles were excluded. After reading the remaining 75 articles 58 articles were excluded, including 52 articles with content mismatches, 3 articles studied population errors and full text information could not be obtained for 3 articles, Finally, 17 studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] were identified for inclusion in this analysis. The results of the search are shown in the PRISMA flowchart in Fig.  1 . The 17 included studies were published between 2005 and 2023, of which 16 were qualitative studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 28 ] and one were mixed-methods studies [ 27 ]. A total of 428 participants, involved 6 countries, including China (2 study [ 7 , 27 ]), USA (6 studies [ 9 , 15 , 17 , 20 , 21 , 22 ]), Sweden (2 studies [ 14 ]), Iran (3studies [ 19 , 24 , 25 ]), Israel (1 study [ 28 ]), Korean (2 studies [ 23 , 26 ]), and British (1 study [ 18 ]). The characteristics of the included literature are shown in Table  1 .

Quality assessment of studies

The included studies were evaluated separately by two trained researchers using the JBI Qualitative Research quality Evaluation criteria, who then participated in the discussion together. When disagreements arose, the help of a third researcher was sought and the final results were unanimously approved by the researchers. All literature included in this study was either A or B grade, which three studies were quality rating of A and 13 studies with a B. Table  2 presents the results of the critical appraisal of the 17 studies.

PRISMA flowchart and literature selection results

Results of synthesis

This study uses the method of aggregative integration [ 12 ] to integrate the results, that is, to further organize and summarize the meaning of the collected results, so as to make the results more convincing, targeted and general. Researchers in understanding the various qualitative research philosophy and methodology of the premise, through repeated reading, analysis and interpretation of each research results, are summarized, integration, form a new category and form integrated results. Finally extracted the results of 17 studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], which were summarized into 10 new categories and formed 3 meta-themes. The categories are presented below with supporting subcategories and illustrative quotes from the original studies.

Theme 1: Mental state of military nurses during deployment

Feeling down.

Military nurses are often frustrated by complex battlefield environments or natural disasters. For example, some nurses may be frustrated by the lack of equipment or supplies, or despair that they cannot save the lives of the wounded; They were frustrated that they could not do more for the wounded. Other nurses were depressed about life after witnessing the brutality of war.

“I am afraid of the battlefield situation on the plateau, and do not understand the local dialect, I do not know how to carry out the rescue work, and I am worried that I have not done anything, dragging everyone down.” [ 7 ]. “You are going to be frustrated at the lack of resources”; “you are going to see young people slaughtered more or less and feel hopelessness at not being able to save their lives.’’ [ 14 ]. “Nurses reported frustration at the time it took for patients to arrive, the extent of injuries, and that they could not do more to save some patients.” [ 9 ].

Emotion management

During deployment, nurses use a variety of methods to vent their emotions and keep them positive. Such as, taking a shower, keeping a journal, talking to others, Mutual acceptance and respect. By adopting positive coping measures, they enable themselves to be competent in their caring role and increase their belief in caring.

“After each surgery I went to take a shower, pouring out my heart in tears, washing myself changing to a clean uniform, then going back like a new person” [ 28 ]. “I’ve had some depression on and off since I came back from Vietnam. If I kept a journal maybe I could get a better handle on some of the things that happened to me over there” [ 15 ]. “Confide in you colleagues and don’t hold things in…I think that’s what kept us going real well” [ 15 ].

Sense of responsibility

It is crucially important for a nurse to understand the mission, policies, and procedures of the armed forces and the part one is asked to play as a military nurse. They need to understand that the purpose of the military is to support, protect, and defend a country’s national security interests. Performing military missions will enable them to serve a greater purpose in life. As both soldiers as well as nurses, based on the sense of responsibility to make them in a state of crisis to protect and serve the people, which make them proud. Military nurses also have an inspiring role to play by example.

“We worked together in the implementation of emergency rescue support tasks, filled with positive energy and a sense of honor, and strengthened our sense of mission” [ 7 ]. “To be something of a father-figure, to give the soldiers a feeling of safety. Keep your eye on your men so that they know they will be looked after if anything happens” [ 14 ].

Theme 2: the experience of military nurses during deployment

There are three main types of “chaos” here: Natural disasters and wars make the environment chaotic; the environment of disaster or war often makes the rescue work of nurses full of uncertainty, which leads to confusion in the team; chaos in the role of nurses during deployment.

“You get over there, [combat] it [the chaos] becomes real, bullets are flying, we’re being mortared … all these injuries, people with broken bones, blown off arms, burns … [In disasters, initially] “It was pure chaos, triage was going on, treatment was going on, people [were] everywhere, lying on the conveyor belt, in wheelchairs, tons of elderly, some had no clothing, it was just a sea of people that you could not see through” [ 22 ]. “One of our biggest challenges in critical situations is ambiguity or confusion in roles. These programs help us to clarify different roles in critical situations” [ 24 ].

Unique environment

This is different from the usual environment, its “Unique” is manifested as: the uncertainty of the war zone; patients with complex injuries, such as explosion injuries, penetrating injuries; lack of resources and poor health care; and the special natural environment at high-altitudes.

“We did not know what to expect in a war zone” [ 28 ]. “I usually have the habit of taking a bath every day, the most difficult to adapt to the field toilet and bathing, bathing like a market, the toilet is very simple, what flying animals can appear, often the toilet has not yet waited, it is necessary to gather training” [ 7 ]. “The biggest headache for me was the sweltering heat of the tent during the day and the shivering cold at night” [ 7 ].

Team support

Team support is important. Maintaining a cohesive team relationship can not only improve the efficiency of casualty rescue, but also provide psychological support to each other. During deployment, the team helps and supports each other, and they are like a family. In addition, successful teams need strong leadership to ensure that the task is completed smoothly.

“We were working in harmony, with collaboration between us. In this way, we could overcome this difficult and stressful time” [ 28 ]. “The chief nurse knew her people. She knew the nurses. She had a feel for what was going on in the unit and she knew who and when she could pull them, and where the staff needed to be to get the job done to cut down on the confusion ” [ 9 ].

The need for specialized skills

Due to the special nature of war trauma, medical personnel lack knowledge and experience in its cause mechanism and operation principle. Other nurses noted their lack of experience in military nursing because they had not been deployed before. Therefore, according to the study, military nurses need to improve their professional skills before deployment.

“I have not systematically received the training of the professional theoretical knowledge of war injury rescue, and I have a sense of panic about the lack of professional knowledge when facing the practical rescue” [ 7 ].

Training needs for emergency care

Psychological training needs.

Military nursing is different from traditional nursing in terms of military obligations and requirements. Firstly, nurses need to cultivate military values, responsibility, patriotism, and a sense of sacrifice. Second, in a battlefield or disaster environment, military nurses face a variety of scenarios, so it requires them to develop a positive mindset. Finally, they need to keep their confidence and overcome their fear.

“I think professional education should begin with enforcement in mind, and it is necessary for nurses to cultivate a spirit of sacrifice and patriotism.” [ 27 ]. “Be secure in yourself and in your professional abilities and limitations. Be realistic in your expectations. You have to cope with the reality and deal with it, even though it is very, very hard” [ 15 ].

Military training content needs

Nurses play an increasingly important role in military missions and are often deployed to different missions, such as humanitarian operations, natural disasters and public health emergencies. Therefore, it is necessary that they have the relevant knowledge, skills and abilities. And they suggest that it is best to train them in local customs and languages before deployment. The special nature of military medicine, they have a lot to learn in the military, including combat and trauma care areas; Chemical, biological, radiological or nuclear (CBRN) preparation/reaction, such as Combat Casualty Care Course, Emergency War Surgery Course, or Trauma Nursing Core Course, etc. In addition, in the plateau region, they also learn medical care under extreme conditions.

“I think the emergency response capacity should be enforced, such as when we run into public health emergencies and natural disasters; s” [ 27 ]. “Now, I think we are dealing with these cultural aspects in all our operational readiness courses” [ 15 ]. “Fluid resuscitation on plains and plateaus is different; thus, we also need to learn medical care and nursing skills for extreme environments” [ 27 ].

Training methods needs

Mixed training methods should be adopted in teaching. Among them, practice, scenario simulation and distance learning are effective training methods, for example, they participated in training exercises in a field training environment or simulation laboratory. At the same time, they should not forget that teamwork training is also important in training.

“I think scenario simulation is a good way, because theory lectures are too boring and we need to put theory into practice” [ 27 ]. “When participating in professional education, trainees should take part in exercise to avoid only talking on paper” [ 27 ]. “We had teamwork training during that education program, and I was impressed with this activity, which provided training on team cohesion” [ 27 ]. “Tabletop exercises were unrealistic and less helpful. We did not practice for a mass casualty.” [ 9 ].

This systematic review and comprehensive study discussed the experience and training needs of nurses in military hospital in altitude first aid. The findings of the review have shown that military nurses faced a lot of physical and emotional stress during deployment. These stressors came from lack of professional ability, inadequate professional preparation, chaotic battlefield environment and extreme natural environment and similar. Military nurses found reasonable ways to cope with stress in a variety of military Settings. They receive training to improve professional competence and self-efficacy, while external support from care managers and colleagues also plays a vital role. However, more strategies are needed to enhance this effect.

The comprehensive quality of the individual (including physical and psychological quality) has a crucial impact on the rescue mission of military nurses [ 8 ]. For rescue in various environments(aircraft carriers, hospital ships, evacuation aircraft, plateaus, hypoxia, cold, desert, Gobi, high humidity, low pressure, jungle, and other area), rescuers need to have good physical fitness, positive and optimistic psychological quality and self-adjustment ability, in order to maximize their own knowledge and skills of high quality play out [ 29 ]. However, the findings of this review [ 7 , 9 , 16 , 17 ] indicate that military nurses may experience altitude sickness, fatigue, nausea, and even acute pulmonary edema when faced with a cold, oxygen-deprived altitude environment; faced with many casualties, they feel depressed, helpless, sad and even depressed. Therefore, military nurses should pay attention to physical training, enhance physical quality, to resist and adapt to extreme environment; nursing managers accurately their psychological state, timely guidance, tracking comfort. The findings of this review also suggest strengthening teamwork and support, which can help nurses support each other during periods of loneliness and provide quality care to wounded patients [ 6 , 7 , 22 , 24 ]. Bonnie et al [ 30 ]. also suggests trying to change thinking and manage emotions by changing feelings and reframing experiences.

Knowledge and technology are the fundamental prerequisites for military nurses to accomplish rescue operations [ 31 ]. This review found that knowledge and skills were mentioned more frequently, indicating that knowledge and skills were the most concerned skills of nurses participating in deployment, and rich knowledge storage and skilled nursing skills are crucial to the first aid of the wounded. Other studies have also drawn a similar conclusion. For example, Harris [ 32 ] found that one unique aspect of clinical expertise in the context of military nursing is clinical diversity, and military nurses should not specialize in just one specialty, but should have multidisciplinary nursing knowledge and skills. Formulating a scientific and effective training program is helpful to improve the ability of military nurses. Caporiccio et al [ 33 ]. found continuing professional education (CPE) is widely recognized by nurses who learn the latest knowledge and skills through CPE, which has become the primary source for maintaining their competencies and ensuring better outcomes worldwide. The training including trauma care, combat knowledge, field nursing, the cultural customs and languages of the deployment place, chemical, biological, radiological or nuclear (CBRN) preparation/reaction(such as Combat Casualty Care Course, Emergency War Surgery Course, or Trauma Nursing Core Course, etc.) [ 8 , 9 , 14 , 15 , 27 ]. Learning barriers have family and work factors, trainees often did not want to attend training because they are worried about their children or heavy work, the learning environment is also an important factor, and the positive learning atmosphere organized by the staff can make the trainees full of passion for learning [ 34 ]. In addition, appropriate training methods have a positive effect on improving nurses’ professional skills. The main methods include practice, scene simulation and distance learning. And leaders should pay attention to teamwork training among medical staff [ 9 , 27 , 35 ]. Overall, making scientific training programs and creating a good learning atmosphere are helpful to improve the knowledge and technology of military nurses.

Competency is the key to affect the rescue mission of military nurses [ 31 ]. Competency is an important invisible feature for military nurses to complete rescue tasks, and is the driving force for other skills to play. Military nurses need to have the ability of organization and management, nursing risk prediction, nursing decision making, emergency handling and so on when performing rescue tasks [ 29 , 36 ]. These are essential conditions for successful treatment. Some studies have shown that team members from different majors simulate operation and rescue tasks in non-task environments, which can effectively prevent the repetition of wrong behaviors by improving leadership, communication skills, teamwork, etc [ 24 , 37 ]. Good communication and teamwork can also reduce the occurrence of adverse events during rescue [ 24 ]. Decisive decision-making ability becomes the key to winning survival time, and good emergency response ability can often avoid further damage [ 4 , 29 , 38 ]. Therefore, military nurses with good comprehensive ability can achieve the rescue effect of both efficiency and quality. Through simulation-based training, military nurses can improve their personal knowledge, skills, abilities, thinking and team ability [ 4 ]. Such as high-fidelity simulation could improve emergency management capabilities, team leadership, and basic nursing skills [ 39 ]; human patient simulators could improve their cognitive thinking and critical thinking skills [ 40 ]; hyper-realistic immersive training could improve the performance of multidisciplinary medical team members and facilitate effective collaboration between members and teams [ 41 ]. We found that military nurses are more willing to improve their ability through practice [ 27 ]. Consequently, it is suggested that the management should expand the practical training mode and combine various simulated training with simulated extreme environment to enhance the comprehensive ability and adaptability of military nurses to special environment.

Strengths and limitations

The advantage of this study is that we not only searched medical databases but supplemented this with manual searches to ensure that studies were fully retrieved. Secondly, we conducted quality control, data extraction, and study quality assessment. Finally, the study is largely reflective of the dilemmas and needs of military nurse and is of great significance to military emergency care. However, there are some limitations to this study. Although the search strategy was thorough, some articles may have been missed, such as the gray literature. And the lack of detailed discussion on the potential influence of the researchers on some of the research studies suggests a possible bias of the findings of original studies.

This qualitative systematic review reviews the experience of military nurses during deployment and analyzes the feelings, experiences, and needs of military nurses during military duty. In contrast, there is less research on emergency rescue operations in extreme environments such as high altitudes, which should be the focus of future exploratory research. Qualitative research in this area should address the lack of mental, physical, and professional preparedness of deployers by understanding the experiences of those with deployment experience in extreme environments. In the future, managers should design diversified, personalized training programs and training methods that are suitable for the deployment of military nurses in a variety of environments.

Data availability

Data used to support the findings of this study are available from the corresponding author upon request.

Nicholson B, Neskey J, Stanfield R, Fetterolf B, Ersando J, Cohen J, Kue R. Integrating prolonged Field Care into Rough Terrain and Mountain Warfare Training: the Mountain critical care course. J Spec Oper Med. 2019;19(1):66–9.

Article   PubMed   Google Scholar  

Xu T, Wang Z, Li T, Pei V, Wen L, Wan L, Wang Y, Yu X. Tibetan plateau earthquake: Altitude challenges to medical rescue work. Emerg Med J. 2013;30(3):232–5.

Larsen J, Blagnys H, Cooper B, Press C, Sambridge N, Livesey M, Watt C, Allewell C, Chapman N. Mountain Rescue Casualty Care and the Undergraduate Medical Elective. Wild Environ med. 2019;30(2):210–6.

Article   Google Scholar  

Niu A, Ma H, Zhang S, Zhu X, Deng J, Luo Y. The effectiveness of simulation-based training on the competency of military nurses: a systematic review. Nurse Educ Today. 2022;119:105536.

Lu Y, Rong G, Yu SP, Sun Z, Duan X, Dong Z, Xia H, Zhan N, Jin C, Ji J, et al. Chinese military medical teams in the Ebola outbreak of Sierra Leone. J R Army Med Corps. 2016;162(3):198–202.

Article   PubMed   PubMed Central   Google Scholar  

Ma H, Huang J, Deng Y, Zhang Y, Lu F, Yang Y, Luo Y. Deployment experiences of military nurses: a systematic review and qualitative meta-synthesis. J Nurs Manag. 2021;29(5):869–77.

X L, X F. A qualitative study of army civilian nurses’ experience on battlefield rescue in the northwest plateau theater. J Nurs Adm. 2020;20(03):184–8.

Google Scholar  

Ma H, Chihava TN, Fu J, Zhang S, Lei L, Tan J, Lin L, Luo Y. Competencies of military nurse managers: a scoping review and unifying framework. J Nurs Manag. 2020;28(6):1166–76.

PubMed   PubMed Central   Google Scholar  

De Jong MJ, Benner R, Benner P, Richard ML, Kenny DJ, Kelley P, Bingham M, Debisette AT. Mass casualty care in an expeditionary environment: developing local knowledge and expertise in context. J Trauma Nurs. 2010;17(1):45–58.

Aromataris E, MZ: JBI Manual for Evidence Synthesis. 2020, JBI( https://synthesismanual.jbi.global/https://jbi-global-wiki.refined.site/space/MANUAL) .

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181.

Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015;13(3):179–87.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.

Lindblad C, Sjöström B. Battlefield emergency care: a study of nurses’ perspectives. Accid Emerg Nurs. 2005;13(1):29–35.

Scannell-Desch EA. Lessons learned and advice from Vietnam war nurses: a qualitative study. J Adv Nurs. 2005;49(6):600–7.

Ekfeldt B, Österberg R, Nyström M. Preparing for care in a combat environment. Int J Caring Sci. 2015;8(1):1–8.

Elliott B. Military nurses’ experiences returning from war. J Adv Nurs. 2015;71(5):1066–75.

Finnegan A, Finnegan S, Bates D, Ritsperis D, McCourt K, Thomas M. Preparing British military nurses to deliver nursing care on deployment. An Afghanistan study. Nurse Educ Today. 2015;35(1):104–12.

Rahimaghaee F, Hatamopour K, Seylani K, Delfan V. Nurses’ perceptions of care during wartime: a qualitative study. Int Nurs Rev. 2016;63(2):218–25.

Rivers FM. US Military nurses: serving within the Chaos of Disaster. Nurs Clin North Am. 2016;51(4):613–23.

Tow JC, Hudson DB. Lived experience of the Warrior nurse as an Advisor. Mil Med. 2016;181(4):328–33.

Rivers F, Gordon S. Military nurse deployments: similarities, differences, and resulting issues. Nurs Outlook. 2017;65(5s):S100–8.

Han JJ. The lived experience of Korean female military nursing officers during the Vietnam War. J Transcult Nurs. 2019;30(5):471–7.

Vafadar Z, Aghaei MH, Ebadi A. Military nurses’ experiences of interprofessional education in Crisis Management: a qualitative content analysis. J Adv Med Educ Prof. 2021;9(2):85–93.

Varpio L, Bader-Larsen K, Hamwey M, Durning S, Meyer H, Cruthirds D, Artino A. Delivering patient care during large-scale emergency situations: lessons from military care providers. PLoS ONE. 2021;16(3):e0248286.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kwon YH, Han HJ, Park E. Nursing experience of New nurses Caring for COVID-19 patients in military hospitals: a qualitative study. Healthc (Basel) 2022, 10(4).

Ma H, Zhang S, Zhu X, Huang J, Cheng Z, Luo Y. Continuing professional education experiences and expectations of nurses in Chinese military hospitals: a quantitative and qualitative study. Nurse Educ Today. 2023;120:105645.

Segev R. Learning from critical care nurses’ wartime experiences and their long-term impacts. Nurs Crit Care. 2023;28(2):253–60.

Ross MC. Military nursing competencies. Nurs Clin North Am. 2010;45(2):169–77.

Hagerty BM, Williams RA, Bingham M, Richard M. Military nurses and combat-wounded patients: a qualitative analysis of psychosocial care. Perspect Psychiatr Care. 2011;47(2):84–92.

Zhu XL, Ni W, Linlin L, Yanfei S, Anting L, Jianmei W. The Core Competence Construction of Helicopter Rescue Nurses in Plateau and Alpine areas:a qualitative research. Military Nurs. 2023;40(01):102–5.

Harris RA. A qualitative descriptive study that identifies essential competencies and leadership characteristics of army adult medical-surgical critical care head nurses. George Mason University; 2008.

Caporiccio J, Louis KR, Lewis-O’Connor A, Son KQ, Raymond N, Garcia-Rodriguez IA, Dollar E, Gonzalez L. Continuing Education for Haitian nurses: evidence from qualitative and quantitative Inquiry. Ann Glob Health 2019, 85(1).

Ma H, Niu A, Sun L, Luo Y. Development and evaluation of competency-based curriculum for continuing professional development among military nurses: a mixed methods study. BMC Med Educ. 2022;22(1):793.

Kellicut DC, Kuncir EJ, Williamson HM, Masella PC, Nielsen PE. Surgical Team Assessment Training: improving surgical teams during deployment. Am J Surg. 2014;208(2):275–83.

Suresh MR, Valdez-Delgado KK, Staudt AM, Trevino JD, Mann-Salinas EA, VanFosson CA. An Assessment of Pre-deployment Training for Army nurses and medics. Mil Med. 2021;186(1–2):203–11.

Webster CS. Crisis Management in Acute Care settings: human factors and team psychology in a high-stakes environment. Anesth Analgesia. 2017;125(3):1069.

Savage E, Forestier C, Withers N, Tien H, Pannell D. Tactical combat casualty care in the Canadian forces: lessons learned from the Afghan war. Can J Surg. 2011;54(6):S118–123.

Hughes RV, Smith SJ, Sheffield CM, Wier G. Assessing performance outcomes of new graduates utilizing simulation in a military transition program. J Nurses Prof Dev. 2013;29(3):143–8.

Johnson D, Johnson S. The effects of using a human patient simulator compared to a CD-ROM in teaching critical thinking and performance. US Army Med Dep J 2014:59–64.

Hoang TN, LaPorta AJ, Malone JD, Champagne R, Lavell K, De La Rosa GM, Gaul L, Dukovich M. Hyper-realistic and immersive surgical simulation training environment will improve team performance. Trauma Surg Acute Care Open. 2020;5(1):e000393.

Download references

This systematic review is supported by the military medical research project of General Hospital of Western Theater Command (2019ZY08).

Author information

Authors and affiliations.

North Sichuan Medical University, Nanchong, Sichuan, 637000, China

Ruixuan Zhao & Shijie Fang

General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China

Chengdu Medical College, Chengdu, Sichuan, 610500, China

Cheng Zhang

You can also search for this author in PubMed   Google Scholar

Contributions

Ruixuan Zhao wrote the main manuscript text; Ruixuan Zhao, Shijie Fang and Dongwen Li Collectioned and analysis the data.; Ruixuan Zhao, Shijie Fang and Cheng Zhang were involved in data synthesis; Dongwen Li had a writing review; Ruixuan Zhao and Dongwen Li prepared Fig. 1 and Table 1, and 2; Ruixuan Zhao, Shijie Fang, Cheng Zhang, and Dongwen Li prepared additional file 1 – 4 ; All authors reviewed the manuscript.

Corresponding author

Correspondence to Dongwen Li .

Ethics declarations

Ethics approval and consent to participate.

Not Applicable.

Consent for publication

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

Supplementary material 2, supplementary material 3, supplementary material 4, 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.

Zhao, R., Fang, S., Li, D. et al. Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis. BMC Nurs 23 , 370 (2024). https://doi.org/10.1186/s12912-024-02029-1

Download citation

Received : 18 September 2023

Accepted : 20 May 2024

Published : 03 June 2024

DOI : https://doi.org/10.1186/s12912-024-02029-1

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

• Military nurse
• High altitude
• Training needs
• Meta-synthesis

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]