qualitative research weaknesses and strengths

23 Advantages and Disadvantages of Qualitative Research

Investigating methodologies. Taking a closer look at ethnographic, anthropological, or naturalistic techniques. Data mining through observer recordings. This is what the world of qualitative research is all about. It is the comprehensive and complete data that is collected by having the courage to ask an open-ended question.

Print media has used the principles of qualitative research for generations. Now more industries are seeing the advantages that come from the extra data that is received by asking more than a “yes” or “no” question.

The advantages and disadvantages of qualitative research are quite unique. On one hand, you have the perspective of the data that is being collected. On the other hand, you have the techniques of the data collector and their own unique observations that can alter the information in subtle ways.

That’s why these key points are so important to consider.

What Are the Advantages of Qualitative Research?

1. Subject materials can be evaluated with greater detail. There are many time restrictions that are placed on research methods. The goal of a time restriction is to create a measurable outcome so that metrics can be in place. Qualitative research focuses less on the metrics of the data that is being collected and more on the subtleties of what can be found in that information. This allows for the data to have an enhanced level of detail to it, which can provide more opportunities to glean insights from it during examination.

2. Research frameworks can be fluid and based on incoming or available data. Many research opportunities must follow a specific pattern of questioning, data collection, and information reporting. Qualitative research offers a different approach. It can adapt to the quality of information that is being gathered. If the available data does not seem to be providing any results, the research can immediately shift gears and seek to gather data in a new direction. This offers more opportunities to gather important clues about any subject instead of being confined to a limited and often self-fulfilling perspective.

3. Qualitative research data is based on human experiences and observations. Humans have two very different operating systems. One is a subconscious method of operation, which is the fast and instinctual observations that are made when data is present. The other operating system is slower and more methodical, wanting to evaluate all sources of data before deciding. Many forms of research rely on the second operating system while ignoring the instinctual nature of the human mind. Qualitative research doesn’t ignore the gut instinct. It embraces it and the data that can be collected is often better for it.

4. Gathered data has a predictive quality to it. One of the common mistakes that occurs with qualitative research is an assumption that a personal perspective can be extrapolated into a group perspective. This is only possible when individuals grow up in similar circumstances, have similar perspectives about the world, and operate with similar goals. When these groups can be identified, however, the gathered individualistic data can have a predictive quality for those who are in a like-minded group. At the very least, the data has a predictive quality for the individual from whom it was gathered.

5. Qualitative research operates within structures that are fluid. Because the data being gathered through this type of research is based on observations and experiences, an experienced researcher can follow-up interesting answers with additional questions. Unlike other forms of research that require a specific framework with zero deviation, researchers can follow any data tangent which makes itself known and enhance the overall database of information that is being collected.

6. Data complexities can be incorporated into generated conclusions. Although our modern world tends to prefer statistics and verifiable facts, we cannot simply remove the human experience from the equation. Different people will have remarkably different perceptions about any statistic, fact, or event. This is because our unique experiences generate a different perspective of the data that we see. These complexities, when gathered into a singular database, can generate conclusions with more depth and accuracy, which benefits everyone.

7. Qualitative research is an open-ended process. When a researcher is properly prepared, the open-ended structures of qualitative research make it possible to get underneath superficial responses and rational thoughts to gather information from an individual’s emotional response. This is critically important to this form of researcher because it is an emotional response which often drives a person’s decisions or influences their behavior.

8. Creativity becomes a desirable quality within qualitative research. It can be difficult to analyze data that is obtained from individual sources because many people subconsciously answer in a way that they think someone wants. This desire to “please” another reduces the accuracy of the data and suppresses individual creativity. By embracing the qualitative research method, it becomes possible to encourage respondent creativity, allowing people to express themselves with authenticity. In return, the data collected becomes more accurate and can lead to predictable outcomes.

9. Qualitative research can create industry-specific insights. Brands and businesses today need to build relationships with their core demographics to survive. The terminology, vocabulary, and jargon that consumers use when looking at products or services is just as important as the reputation of the brand that is offering them. If consumers are receiving one context, but the intention of the brand is a different context, then the miscommunication can artificially restrict sales opportunities. Qualitative research gives brands access to these insights so they can accurately communicate their value propositions.

10. Smaller sample sizes are used in qualitative research, which can save on costs. Many qualitative research projects can be completed quickly and on a limited budget because they typically use smaller sample sizes that other research methods. This allows for faster results to be obtained so that projects can move forward with confidence that only good data is able to provide.

11. Qualitative research provides more content for creatives and marketing teams. When your job involves marketing, or creating new campaigns that target a specific demographic, then knowing what makes those people can be quite challenging. By going through the qualitative research approach, it becomes possible to congregate authentic ideas that can be used for marketing and other creative purposes. This makes communication between the two parties to be handled with more accuracy, leading to greater level of happiness for all parties involved.

12. Attitude explanations become possible with qualitative research. Consumer patterns can change on a dime sometimes, leaving a brand out in the cold as to what just happened. Qualitative research allows for a greater understanding of consumer attitudes, providing an explanation for events that occur outside of the predictive matrix that was developed through previous research. This allows the optimal brand/consumer relationship to be maintained.

What Are the Disadvantages of Qualitative Research?

1. The quality of the data gathered in qualitative research is highly subjective. This is where the personal nature of data gathering in qualitative research can also be a negative component of the process. What one researcher might feel is important and necessary to gather can be data that another researcher feels is pointless and won’t spend time pursuing it. Having individual perspectives and including instinctual decisions can lead to incredibly detailed data. It can also lead to data that is generalized or even inaccurate because of its reliance on researcher subjectivisms.

2. Data rigidity is more difficult to assess and demonstrate. Because individual perspectives are often the foundation of the data that is gathered in qualitative research, it is more difficult to prove that there is rigidity in the information that is collective. The human mind tends to remember things in the way it wants to remember them. That is why memories are often looked at fondly, even if the actual events that occurred may have been somewhat disturbing at the time. This innate desire to look at the good in things makes it difficult for researchers to demonstrate data validity.

3. Mining data gathered by qualitative research can be time consuming. The number of details that are often collected while performing qualitative research are often overwhelming. Sorting through that data to pull out the key points can be a time-consuming effort. It is also a subjective effort because what one researcher feels is important may not be pulled out by another researcher. Unless there are some standards in place that cannot be overridden, data mining through a massive number of details can almost be more trouble than it is worth in some instances.

4. Qualitative research creates findings that are valuable, but difficult to present. Presenting the findings which come out of qualitative research is a bit like listening to an interview on CNN. The interviewer will ask a question to the interviewee, but the goal is to receive an answer that will help present a database which presents a specific outcome to the viewer. The goal might be to have a viewer watch an interview and think, “That’s terrible. We need to pass a law to change that.” The subjective nature of the information, however, can cause the viewer to think, “That’s wonderful. Let’s keep things the way they are right now.” That is why findings from qualitative research are difficult to present. What a research gleans from the data can be very different from what an outside observer gleans from the data.

5. Data created through qualitative research is not always accepted. Because of the subjective nature of the data that is collected in qualitative research, findings are not always accepted by the scientific community. A second independent qualitative research effort which can produce similar findings is often necessary to begin the process of community acceptance.

6. Researcher influence can have a negative effect on the collected data. The quality of the data that is collected through qualitative research is highly dependent on the skills and observation of the researcher. If a researcher has a biased point of view, then their perspective will be included with the data collected and influence the outcome. There must be controls in place to help remove the potential for bias so the data collected can be reviewed with integrity. Otherwise, it would be possible for a researcher to make any claim and then use their bias through qualitative research to prove their point.

7. Replicating results can be very difficult with qualitative research. The scientific community wants to see results that can be verified and duplicated to accept research as factual. In the world of qualitative research, this can be very difficult to accomplish. Not only do you have the variability of researcher bias for which to account within the data, but there is also the informational bias that is built into the data itself from the provider. This means the scope of data gathering can be extremely limited, even if the structure of gathering information is fluid, because of each unique perspective.

8. Difficult decisions may require repetitive qualitative research periods. The smaller sample sizes of qualitative research may be an advantage, but they can also be a disadvantage for brands and businesses which are facing a difficult or potentially controversial decision. A small sample is not always representative of a larger population demographic, even if there are deep similarities with the individuals involve. This means a follow-up with a larger quantitative sample may be necessary so that data points can be tracked with more accuracy, allowing for a better overall decision to be made.

9. Unseen data can disappear during the qualitative research process. The amount of trust that is placed on the researcher to gather, and then draw together, the unseen data that is offered by a provider is enormous. The research is dependent upon the skill of the researcher being able to connect all the dots. If the researcher can do this, then the data can be meaningful and help brands and progress forward with their mission. If not, there is no way to alter course until after the first results are received. Then a new qualitative process must begin.

10. Researchers must have industry-related expertise. You can have an excellent researcher on-board for a project, but if they are not familiar with the subject matter, they will have a difficult time gathering accurate data. For qualitative research to be accurate, the interviewer involved must have specific skills, experiences, and expertise in the subject matter being studied. They must also be familiar with the material being evaluated and have the knowledge to interpret responses that are received. If any piece of this skill set is missing, the quality of the data being gathered can be open to interpretation.

11. Qualitative research is not statistically representative. The one disadvantage of qualitative research which is always present is its lack of statistical representation. It is a perspective-based method of research only, which means the responses given are not measured. Comparisons can be made and this can lead toward the duplication which may be required, but for the most part, quantitative data is required for circumstances which need statistical representation and that is not part of the qualitative research process.

The advantages and disadvantages of qualitative research make it possible to gather and analyze individualistic data on deeper levels. This makes it possible to gain new insights into consumer thoughts, demographic behavioral patterns, and emotional reasoning processes. When a research can connect the dots of each information point that is gathered, the information can lead to personalized experiences, better value in products and services, and ongoing brand development.

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Chapter 10: Qualitative Data Collection & Analysis Methods

10.7 Strengths and Weaknesses of Qualitative Interviews

As the preceding sections have suggested, qualitative interviews are an excellent way to gather detailed information. Whatever topic is of interest to the researcher can be explored in much more depth by employing this method than with almost any other method. Not only are participants given the opportunity to elaborate in a way that is not possible with other methods, such as survey research, but, in addition, they are able share information with researchers in their own words and from their own perspectives, rather than attempting to fit those perspectives into the perhaps limited response options provided by the researcher. Because qualitative interviews are designed to elicit detailed information, they are especially useful when a researcher’s aim is to study social processes, or the “how” of various phenomena. Yet another, and sometimes overlooked, benefit of qualitative interviews that occurs in person is that researchers can make observations beyond those that a respondent is orally reporting. A respondent’s body language, and even her or his choice of time and location for the interview, might provide a researcher with useful data.

As with quantitative survey research, qualitative interviews rely on respondents’ ability to accurately and honestly recall whatever details about their lives, circumstances, thoughts, opinions, or behaviors are being examined. Qualitative interviewing is also time-intensive and can be quite expensive. Creating an interview guide, identifying a sample, and conducting interviews are just the beginning of the process. Transcribing interviews is labor-intensive, even before coding begins. It is also not uncommon to offer respondents some monetary incentive or thank-you for participating, because you are asking for more of the participants’ time than if you had mailed them a questionnaire containing closed-ended questions. Conducting qualitative interviews is not only labor intensive but also emotionally taxing. Researchers embarking on a qualitative interview project with a subject that is sensitive in nature should keep in mind their own abilities to listen to stories that may be difficult to hear.

Research Methods for the Social Sciences: An Introduction Copyright © 2020 by Valerie Sheppard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Strengths and weaknesses

Strengths of qualitative research.

• Qualitative methods tend to collect very rich data in an efficient manner: rather than being limited to the responders to a set of pre-defined questions, it is possible to explore interesting concepts that can lead to novel theory by analysing the entirety of a participant’s interview/story/interaction.
• Qualitative methods can lead to the generation of new theory from unexpected findings that go against “conventional” public health understanding
• When combined with quantitative methods, qualitative research can provide a much more complete picture. For example, a well-designed process evaluation of a trial may provide important insights into participant attitudes, beliefs, and thoughts about the intervention and its acceptability, which may not be evident from the quantitative outcome evaluation.

Weaknesses of qualitative research

• It is important that qualitative researchers adhere to robust methodology in order to ensure high quality research. Poor quality qualitative work can lead to misleading findings.
• Qualitative research alone is often insufficient to make population-level summaries. The research is not designed for this purpose, as the aim is not to generate summaries generalisable to the wider population.
• Policy makers may not understand or value the interpretive position and therefore may not recognize the importance of qualitative research.
• Qualitative research can be time and labour-intensive. Conducting multiple interviews and focus groups can be logistically difficult to arrange and time consuming. Furthermore, tranalysanscription and analysis of the data (comparing, coding, and inducting) requires intense concentration and full immersion in the data – a process that can be far more time-consuming than a descriptive statistical analysis.

© I Crinson & M Leontowitsch 2006, G Morgan 2016

ReviseSociology

A level sociology revision – education, families, research methods, crime and deviance and more!

Qualitative Data – Strengths and Limitations

Table of Contents

Last Updated on September 1, 2021 by Karl Thompson

A summary of the theoretical, practical and ethical strengths and weaknesses of qualitative data sources such as unstructured interviews, participant observation and documents.

Examples of Qualitative Data

• Open question questionnaires
• Unstructured interviews
• Participant observation
• Public and private documents such as newspapers and letters.

Theoretical strengths

• Better validity than for quantitative data
• More insight (Verstehen)
• More in-depth data
• More respondent-led, avoids the imposition problem.
• Good for exploring issues the researcher knows little about.
• Preferred by Interpretivists

Practical strengths

• A useful way of accessing groups who don’t like formal methods/ authority

Ethical strengths

• Useful for sensitive topics
• Allows respondents to ‘speak for themselves’
• Treats respondents as equals

Theoretical limitations

• Difficult to make comparisons
• No useful for finding trends, finding correlations.
• Typically small samples, low representativeness
• Low reliability as difficult to repeat the exact context of research.
• Subjective bias of researcher may influence data (interviewer bias)
• Disliked by Positivists

Practical limitations

• Time consuming
• Expensive per person researched compared to qualitative data
• Difficult to gain access (PO)
• Analyzing data can be difficult

Ethical limitations

• Close contact means more potential for harm
• Close contact means more difficult to guarantee anonymity and confidentiality
• Informed consent can be an issue with PO.

Nature of Topic – When would you use it, when would you avoid using it?

• Useful for complex topics you know little about
• Not necessary for simple topics.

Signposting

This post has been written as a revision summary for students revising the research methods aspect of A-level sociology.

More in-depth versions of qualitative data topics can be found below…

Covert and Covert  Participant Observation   

The strengths and limitations of covert participant observation  

Interviews in Social Research  

Secondary Qualitative Data Analysis in Sociology  

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Qualitative vs Quantitative Research Methods & Data Analysis

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

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

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

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

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

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What is the difference between quantitative and qualitative?

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

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

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

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

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

What Is Qualitative Research?

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

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

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

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

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

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

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

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

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

Qualitative Methods

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

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

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

Here are some examples of qualitative data:

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

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

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

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

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

Qualitative Data Analysis

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

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

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

Key Features

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

Limitations of Qualitative Research

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

Advantages of Qualitative Research

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

What Is Quantitative Research?

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

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

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

Quantitative Methods

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

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

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

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

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

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

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

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

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

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

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

Quantitative Data Analysis

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

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

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

Limitations of Quantitative Research

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

Advantages of Quantitative Research

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

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

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

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

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

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

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

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

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

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

Further Information

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

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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 .

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The strengths and weaknesses of quantitative and qualitative research: what method for nursing?

Affiliation.

• 1 Department of Professional Development, Wealden College of Health and Social Studies, East Surrey Hospital, Redhill, Surrey, England.
• PMID: 7822608
• DOI: 10.1046/j.1365-2648.1994.20040716.x

The overall purpose of research for any profession is to discover the truth of the discipline. This paper examines the controversy over the methods by which truth is obtained, by examining the differences and similarities between quantitative and qualitative research. The historically negative bias against qualitative research is discussed, as well as the strengths and weaknesses of both approaches, with issues highlighted by reference to nursing research. Consideration is given to issues of sampling; the relationship between the researcher and subject; methodologies and collated data; validity; reliability, and ethical dilemmas. The author identifies that neither approach is superior to the other; qualitative research appears invaluable for the exploration of subjective experiences of patients and nurses, and quantitative methods facilitate the discovery of quantifiable information. Combining the strengths of both approaches in triangulation, if time and money permit, is also proposed as a valuable means of discovering the truth about nursing. It is argued that if nursing scholars limit themselves to one method of enquiry, restrictions will be placed on the development of nursing knowledge.

Publication types

• Comparative Study
• Data Collection / methods
• Ethics, Nursing
• Nurse-Patient Relations
• Nursing Research / methods*
• Nursing Research / standards
• Reproducibility of Results
• Research Design / standards*
• Research Personnel / psychology

• Open access
• Published: 13 May 2024

What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

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There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

Peer Review reports

Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

Author information

Olivia R. Phillips and Cerian Harries share joint first authorship.

Authors and Affiliations

Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

Joanne R. Morling

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Contributions

Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

Corresponding author

Correspondence to Olivia R. Phillips .

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Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

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More From Forbes

19 ways to communicate ‘weaknesses’ in job interviews.

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Job interviewers commonly ask candidates questions about their professional weaknesses. When asked this type of question, a job seeker will want to frame any shortcomings they share within a context that demonstrates self-awareness and a commitment to professional growth.

Below, Forbes Coaches Council members share effective ways to disclose weaknesses without falling into the traps of humble bragging or excessive self-critique. With these tips in mind, you can turn your potential vulnerabilities into narratives of resilience and adaptability.

1. Emphasize Your Ability To Move Forward

A weakness question is never about the weakness. It’s about overcoming, perseverance, positive change and learning. Say little about the weakness and emphasize your ability to move forward. Show how your process of improvement can be applied to all you do in your work. - David J. Smith , David J. Smith Consulting, LLC

2. Demonstrate Self-Reflection And Honesty

It’s important to show self-reflection and honesty in answering this question. You can say, “Something I’ve learned about myself is...” and add what you have done to rectify the tendency. You might add, “That’s one of the reasons I want to work with you and the team at this firm. I want to develop that skill with guidance and share my complementary strengths with the team.” - Cathy Bonczek , CCB Communications LLC.

3. Own Up To Your Flaws With Good Humor

Everyone has flaws. People who own their weaknesses and compensate for them are better able to focus on their strengths. Own up to what you’re not so great at, and point out gently that you are applying to a job where your strengths will shine. Lighten it up with a little humor as to why you are not applying for a job that requires your strengths to show your resilience and personality. - Lisa D. Foster , Lisa D. Foster, Coach

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Biden-trump debates: what to know as trump pushes for 2 more faceoffs, a storm of 3 000 ukrainian bomblets blew up four russian jets at their base in crimea, 4. be honest and straightforward.

Say, “Yes, I do have some weaknesses,” and “No, unfortunately, I am not perfect. But I know one thing about me, I will always do, and be, whatever it takes to learn, improve and thrive in life. And that’s why I am here today.” - David Kubes , Access Consciousness Leadership

Forbes Coaches Council is an invitation-only community for leading business and career coaches. Do I qualify?

5. Focus On How You Utilize ‘Lesser Strengths’

As a Gallup-Certified Strengths Coach, I’m always encouraging clients to focus on what they do best. If they have a weakness, it is typically because they don’t use it enough and are out of their comfort zone. I recommend honesty as the best policy. Talk about how the more you utilize those “lesser strengths” (we don’t like to call them weaknesses), the stronger you will be in that area. - Liz Trocchio Smith , The Trocchio Advantage

6. Talk About A Skill You Are Working To Develop

Hiring managers are most interested in gauging self-awareness, so use this question as an opportunity to demonstrate that. Focus on a skill you are actively working on versus a character trait, and don’t discount the power of language in your response. While subtle, refer to the weakness instead as an “area of opportunity” or “challenge” to reframe it for yourself and the interviewer. - Nathalie Weister , EPM Studio

7. Present Weaknesses As Strengths Taken To Extremes

In interviews, present weaknesses as strengths taken to extremes, per Daniel Ofman’s Core Quality Quadrant . For instance, while attention to detail is beneficial, it can lead to perfectionism. Identify such a strength, discuss its potential pitfalls, and outline steps you’re taking to maintain balance. This approach demonstrates self-awareness and a proactive stance toward continuous professional development. - Giorgios Bouronikos , International institute for Research & Human Development

8. Show How You Use Strengths To Support Weaker Areas

To effectively answer questions about your strengths and weaknesses, show your awareness of both traits and how you use your strengths to support your weaker areas. For example: “I am strong in (name your strength), but I’m not as confident in (name your weakness). This is a challenge because (explain how this weakness impedes your progress). To mitigate this, I use (highlight strengths you are applying to overcome it).” - Daria Rudnik , Daria Rudnik Coaching & Consulting

9. Define Weaknesses In Terms Of Strengths To Show Scale

It’s important to answer questions directly and briefly—don’t hide! Without humble-bragging, define your weaknesses in terms of your strengths so that the scale becomes visible: “My biggest weakness is going for too much detail, but I’m comfortable with that, as it further enhances my strength of being the go-to person when the executives want to know what’s really going on.” - Gideon Malherbe , Virtual Consulting

10. Focus On A Weakness That Is Not Essential To The Job

It’s best to be prepared and speak to a weakness that is an overused strength rather than one that is considered an essential skill for performing well on the job. For example, “I am a perfectionist, and I am really working hard on allowing myself the grace to deliver what’s ‘good enough’ for a particular body of work,” and, “I am passionate about my work and need to brace myself at times to get enough rest.” - Martina Kuhlmeyer , Martina Kuhlmeyer Coaching and Consulting

11. Select A Weakness That Shows Growth Potential

Select a genuine, manageable weakness that doesn’t hinder your job performance but shows potential for personal growth. Discuss specific areas where you’ve faced challenges and are actively improving. Provide detailed examples from projects or tasks, demonstrating clear progress and enhancement of your skills. This approach underscores your commitment to continuous development and self-awareness. - Gina Martin , Gina Martin Coaching

12. Provide An Action-Oriented Answer

Focus on a weakness you’re already actively working to improve. Be positive and hopeful, and explain the specific steps you’re taking. This kind of action-oriented answer helps demonstrate your self-awareness and commitment to growth. When you frame a weakness in the context of an active learning process, you’re being authentic and truthful and demonstrating your emotional intelligence. - Laura Plato , New Frequency - Coaching and Consulting

13. Describe Failure As A Teacher

Share how you’ve turned weaknesses into strengths: “I fail fast, cheap and forward because failure is a schoolmaster for me.” Detail how setbacks have helped you refine policies and improve outcomes, providing examples. Align this focus on your growth mindset with the job’s requirements, emphasizing your resilience and dedication to continual improvement. - Severin Sorensen , ePraxis

14. Discuss What You Are Doing To Improve

First, recognize that this is a trick question. You are supposed to have weaknesses, as we all do. However, talk about them from the standpoint of what you are doing about them. For example, if you struggle with time management, talk about how you are actively working to get better at it. Self-awareness in a new employee is a highly desirable trait, especially for those applying for leadership roles. - Curtis Odom , Prescient Strategists

15. Be Comfortable With Vulnerability

Resist providing answers such as, “I am a perfectionist,” or “I am a workaholic.” Instead, be comfortable with vulnerability. Consider instead something like: “Well, if I could improve on one thing over the next year, it would be distributing leadership a little more among the teams I lead.” Self-awareness is of great value. Show them you have it. - Patrick Jinks, PhD , The Leader’s Perspective

16. Illustrate How You Addressed A Past Weakness

The first thing to do is acknowledge that everyone has weaknesses; the key is what you do to compensate for them. Follow up with a story that illustrates how you identified and successfully addressed a weakness that you had in the past. - John Lowe , Ty Boyd, Inc.

17. Frame Your Weakness As A Learning Opportunity

Approach the question with honesty and self-awareness, framing your weakness as a learning opportunity. Discuss specific actions you’ve taken to improve, demonstrating self-reliance and a desire to evolve. Connect this process to how it makes you a better fit for the role, showing self-confidence and a commitment to personal growth. Avoid disclosing too much and insincere responses. - Gamini Hewawasam, PhD , ManoLead NFP

18. Highlight Your Successes In Weaker Areas

Be honest, and make sure you let the interviewer know what you do to overcome that weakness (with examples), as well as the success you’ve experienced in that area, so that they know it won’t negatively affect you on the job. This is especially important if your weakness is related to the job function and could impede your ability to do the job well. - Sharissa Sebastian , Leadership Mastery Alliance

19. Be Humble

We all have weaknesses. We all fail. It’s how we learn. Share a story of a time you failed that highlights a skill or element of mindset that you became aware of as a result of the failure, and discuss how you worked on developing and improving it. Don’t tell stories of how strengths are really weaknesses; it will make you seem disingenuous and inauthentic. - Julian Lighton , Moo Pie Advisors Inc

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• v.8(4); 2019 Aug

Limited by our limitations

Paula t. ross.

Medical School, University of Michigan, Ann Arbor, MI USA

Nikki L. Bibler Zaidi

Study limitations represent weaknesses within a research design that may influence outcomes and conclusions of the research. Researchers have an obligation to the academic community to present complete and honest limitations of a presented study. Too often, authors use generic descriptions to describe study limitations. Including redundant or irrelevant limitations is an ineffective use of the already limited word count. A meaningful presentation of study limitations should describe the potential limitation, explain the implication of the limitation, provide possible alternative approaches, and describe steps taken to mitigate the limitation. This includes placing research findings within their proper context to ensure readers do not overemphasize or minimize findings. A more complete presentation will enrich the readers’ understanding of the study’s limitations and support future investigation.

Introduction

Regardless of the format scholarship assumes, from qualitative research to clinical trials, all studies have limitations. Limitations represent weaknesses within the study that may influence outcomes and conclusions of the research. The goal of presenting limitations is to provide meaningful information to the reader; however, too often, limitations in medical education articles are overlooked or reduced to simplistic and minimally relevant themes (e.g., single institution study, use of self-reported data, or small sample size) [ 1 ]. This issue is prominent in other fields of inquiry in medicine as well. For example, despite the clinical implications, medical studies often fail to discuss how limitations could have affected the study findings and interpretations [ 2 ]. Further, observational research often fails to remind readers of the fundamental limitation inherent in the study design, which is the inability to attribute causation [ 3 ]. By reporting generic limitations or omitting them altogether, researchers miss opportunities to fully communicate the relevance of their work, illustrate how their work advances a larger field under study, and suggest potential areas for further investigation.

Goals of presenting limitations

Medical education scholarship should provide empirical evidence that deepens our knowledge and understanding of education [ 4 , 5 ], informs educational practice and process, [ 6 , 7 ] and serves as a forum for educating other researchers [ 8 ]. Providing study limitations is indeed an important part of this scholarly process. Without them, research consumers are pressed to fully grasp the potential exclusion areas or other biases that may affect the results and conclusions provided [ 9 ]. Study limitations should leave the reader thinking about opportunities to engage in prospective improvements [ 9 – 11 ] by presenting gaps in the current research and extant literature, thereby cultivating other researchers’ curiosity and interest in expanding the line of scholarly inquiry [ 9 ].

Presenting study limitations is also an ethical element of scientific inquiry [ 12 ]. It ensures transparency of both the research and the researchers [ 10 , 13 , 14 ], as well as provides transferability [ 15 ] and reproducibility of methods. Presenting limitations also supports proper interpretation and validity of the findings [ 16 ]. A study’s limitations should place research findings within their proper context to ensure readers are fully able to discern the credibility of a study’s conclusion, and can generalize findings appropriately [ 16 ].

Why some authors may fail to present limitations

As Price and Murnan [ 8 ] note, there may be overriding reasons why researchers do not sufficiently report the limitations of their study. For example, authors may not fully understand the importance and implications of their study’s limitations or assume that not discussing them may increase the likelihood of publication. Word limits imposed by journals may also prevent authors from providing thorough descriptions of their study’s limitations [ 17 ]. Still another possible reason for excluding limitations is a diffusion of responsibility in which some authors may incorrectly assume that the journal editor is responsible for identifying limitations. Regardless of reason or intent, researchers have an obligation to the academic community to present complete and honest study limitations.

A guide to presenting limitations

The presentation of limitations should describe the potential limitations, explain the implication of the limitations, provide possible alternative approaches, and describe steps taken to mitigate the limitations. Too often, authors only list the potential limitations, without including these other important elements.

Describe the limitations

When describing limitations authors should identify the limitation type to clearly introduce the limitation and specify the origin of the limitation. This helps to ensure readers are able to interpret and generalize findings appropriately. Here we outline various limitation types that can occur at different stages of the research process.

Study design

Some study limitations originate from conscious choices made by the researcher (also known as delimitations) to narrow the scope of the study [ 1 , 8 , 18 ]. For example, the researcher may have designed the study for a particular age group, sex, race, ethnicity, geographically defined region, or some other attribute that would limit to whom the findings can be generalized. Such delimitations involve conscious exclusionary and inclusionary decisions made during the development of the study plan, which may represent a systematic bias intentionally introduced into the study design or instrument by the researcher [ 8 ]. The clear description and delineation of delimitations and limitations will assist editors and reviewers in understanding any methodological issues.

Data collection

Study limitations can also be introduced during data collection. An unintentional consequence of human subjects research is the potential of the researcher to influence how participants respond to their questions. Even when appropriate methods for sampling have been employed, some studies remain limited by the use of data collected only from participants who decided to enrol in the study (self-selection bias) [ 11 , 19 ]. In some cases, participants may provide biased input by responding to questions they believe are favourable to the researcher rather than their authentic response (social desirability bias) [ 20 – 22 ]. Participants may influence the data collected by changing their behaviour when they are knowingly being observed (Hawthorne effect) [ 23 ]. Researchers—in their role as an observer—may also bias the data they collect by allowing a first impression of the participant to be influenced by a single characteristic or impression of another characteristic either unfavourably (horns effect) or favourably (halo effort) [ 24 ].

Data analysis

Study limitations may arise as a consequence of the type of statistical analysis performed. Some studies may not follow the basic tenets of inferential statistical analyses when they use convenience sampling (i.e. non-probability sampling) rather than employing probability sampling from a target population [ 19 ]. Another limitation that can arise during statistical analyses occurs when studies employ unplanned post-hoc data analyses that were not specified before the initial analysis [ 25 ]. Unplanned post-hoc analysis may lead to statistical relationships that suggest associations but are no more than coincidental findings [ 23 ]. Therefore, when unplanned post-hoc analyses are conducted, this should be clearly stated to allow the reader to make proper interpretation and conclusions—especially when only a subset of the original sample is investigated [ 23 ].

Study results

The limitations of any research study will be rooted in the validity of its results—specifically threats to internal or external validity [ 8 ]. Internal validity refers to reliability or accuracy of the study results [ 26 ], while external validity pertains to the generalizability of results from the study’s sample to the larger, target population [ 8 ].

Examples of threats to internal validity include: effects of events external to the study (history), changes in participants due to time instead of the studied effect (maturation), systematic reduction in participants related to a feature of the study (attrition), changes in participant responses due to repeatedly measuring participants (testing effect), modifications to the instrument (instrumentality) and selecting participants based on extreme scores that will regress towards the mean in repeat tests (regression to the mean) [ 27 ].

Threats to external validity include factors that might inhibit generalizability of results from the study’s sample to the larger, target population [ 8 , 27 ]. External validity is challenged when results from a study cannot be generalized to its larger population or to similar populations in terms of the context, setting, participants and time [ 18 ]. Therefore, limitations should be made transparent in the results to inform research consumers of any known or potentially hidden biases that may have affected the study and prevent generalization beyond the study parameters.

Explain the implication(s) of each limitation

Authors should include the potential impact of the limitations (e.g., likelihood, magnitude) [ 13 ] as well as address specific validity implications of the results and subsequent conclusions [ 16 , 28 ]. For example, self-reported data may lead to inaccuracies (e.g. due to social desirability bias) which threatens internal validity [ 19 ]. Even a researcher’s inappropriate attribution to a characteristic or outcome (e.g., stereotyping) can overemphasize (either positively or negatively) unrelated characteristics or outcomes (halo or horns effect) and impact the internal validity [ 24 ]. Participants’ awareness that they are part of a research study can also influence outcomes (Hawthorne effect) and limit external validity of findings [ 23 ]. External validity may also be threatened should the respondents’ propensity for participation be correlated with the substantive topic of study, as data will be biased and not represent the population of interest (self-selection bias) [ 29 ]. Having this explanation helps readers interpret the results and generalize the applicability of the results for their own setting.

Provide potential alternative approaches and explanations

Often, researchers use other studies’ limitations as the first step in formulating new research questions and shaping the next phase of research. Therefore, it is important for readers to understand why potential alternative approaches (e.g. approaches taken by others exploring similar topics) were not taken. In addition to alternative approaches, authors can also present alternative explanations for their own study’s findings [ 13 ]. This information is valuable coming from the researcher because of the direct, relevant experience and insight gained as they conducted the study. The presentation of alternative approaches represents a major contribution to the scholarly community.

Describe steps taken to minimize each limitation

No research design is perfect and free from explicit and implicit biases; however various methods can be employed to minimize the impact of study limitations. Some suggested steps to mitigate or minimize the limitations mentioned above include using neutral questions, randomized response technique, force choice items, or self-administered questionnaires to reduce respondents’ discomfort when answering sensitive questions (social desirability bias) [ 21 ]; using unobtrusive data collection measures (e.g., use of secondary data) that do not require the researcher to be present (Hawthorne effect) [ 11 , 30 ]; using standardized rubrics and objective assessment forms with clearly defined scoring instructions to minimize researcher bias, or making rater adjustments to assessment scores to account for rater tendencies (halo or horns effect) [ 24 ]; or using existing data or control groups (self-selection bias) [ 11 , 30 ]. When appropriate, researchers should provide sufficient evidence that demonstrates the steps taken to mitigate limitations as part of their study design [ 13 ].

In conclusion, authors may be limiting the impact of their research by neglecting or providing abbreviated and generic limitations. We present several examples of limitations to consider; however, this should not be considered an exhaustive list nor should these examples be added to the growing list of generic and overused limitations. Instead, careful thought should go into presenting limitations after research has concluded and the major findings have been described. Limitations help focus the reader on key findings, therefore it is important to only address the most salient limitations of the study [ 17 , 28 ] related to the specific research problem, not general limitations of most studies [ 1 ]. It is important not to minimize the limitations of study design or results. Rather, results, including their limitations, must help readers draw connections between current research and the extant literature.

The quality and rigor of our research is largely defined by our limitations [ 31 ]. In fact, one of the top reasons reviewers report recommending acceptance of medical education research manuscripts involves limitations—specifically how the study’s interpretation accounts for its limitations [ 32 ]. Therefore, it is not only best for authors to acknowledge their study’s limitations rather than to have them identified by an editor or reviewer, but proper framing and presentation of limitations can actually increase the likelihood of acceptance. Perhaps, these issues could be ameliorated if academic and research organizations adopted policies and/or expectations to guide authors in proper description of limitations.

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