Units of meaning.
In general, qualitative analysis begins with organizing data. Large amounts of data need to be stored in smaller and manageable units, which can be retrieved and reviewed easily. To obtain a sense of the whole, analysis starts with reading and rereading the data, looking at themes, emotions and the unexpected, taking into account the overall picture. You immerse yourself in the data. The most widely used procedure is to develop an inductive coding scheme based on actual data [ 11 ]. This is a process of open coding, creating categories and abstraction. In most cases, you do not start with a predefined coding scheme. You describe what is going on in the data. You ask yourself, what is this? What does it stand for? What else is like this? What is this distinct from? Based on this close examination of what emerges from the data you make as many labels as needed. Then, you make a coding sheet, in which you collect the labels and, based on your interpretation, cluster them in preliminary categories. The next step is to order similar or dissimilar categories into broader higher order categories. Each category is named using content-characteristic words. Then, you use abstraction by formulating a general description of the phenomenon under study: subcategories with similar events and information are grouped together as categories and categories are grouped as main categories. During the analysis process, you identify ‘missing analytical information’ and you continue data collection. You reread, recode, re-analyse and re-collect data until your findings provide breadth and depth.
Throughout the qualitative study, you reflect on what you see or do not see in the data. It is common to write ‘analytic memos’ [ 3 ], write-ups or mini-analyses about what you think you are learning during the course of your study, from designing to publishing. They can be a few sentences or pages, whatever is needed to reflect upon: open codes, categories, concepts, and patterns that might be emerging in the data. Memos can contain summaries of major findings and comments and reflections on particular aspects.
In ethnography, analysis begins from the moment that the researcher sets foot in the field. The analysis involves continually looking for patterns in the behaviours and thoughts of the participants in everyday life, in order to obtain an understanding of the culture under study. When comparing one pattern with another and analysing many patterns simultaneously, you may use maps, flow charts, organizational charts and matrices to illustrate the comparisons graphically. The outcome of an ethnographic study is a narrative description of a culture.
In phenomenology, analysis aims to describe and interpret the meaning of an experience, often by identifying essential subordinate and major themes. You search for common themes featuring within an interview and across interviews, sometimes involving the study participants or other experts in the analysis process. The outcome of a phenomenological study is a detailed description of themes that capture the essential meaning of a ‘lived’ experience.
Grounded theory generates a theory that explains how a basic social problem that emerged from the data is processed in a social setting. Grounded theory uses the ‘constant comparison’ method, which involves comparing elements that are present in one data source (e.g., an interview) with elements in another source, to identify commonalities. The steps in the analysis are known as open, axial and selective coding. Throughout the analysis, you document your ideas about the data in methodological and theoretical memos. The outcome of a grounded theory study is a theory.
Descriptive generic qualitative research is defined as research designed to produce a low inference description of a phenomenon [ 12 ]. Although Sandelowski maintains that all research involves interpretation, she has also suggested that qualitative description attempts to minimize inferences made in order to remain ‘closer’ to the original data [ 12 ]. Descriptive generic qualitative research often applies content analysis. Descriptive content analysis studies are not based on a specific qualitative tradition and are varied in their methods of analysis. The analysis of the content aims to identify themes, and patterns within and among these themes. An inductive content analysis [ 11 ] involves breaking down the data into smaller units, coding and naming the units according to the content they present, and grouping the coded material based on shared concepts. They can be represented by clustering in treelike diagrams. A deductive content analysis [ 11 ] uses a theory, theoretical framework or conceptual model to analyse the data by operationalizing them in a coding matrix. An inductive content analysis might use several techniques from grounded theory, such as open and axial coding and constant comparison. However, note that your findings are merely a summary of categories, not a grounded theory.
Analysis software can support you to manage your data, for example by helping to store, annotate and retrieve texts, to locate words, phrases and segments of data, to name and label, to sort and organize, to identify data units, to prepare diagrams and to extract quotes. Still, as a researcher you would do the analytical work by looking at what is in the data, and making decisions about assigning codes, and identifying categories, concepts and patterns. The computer assisted qualitative data analysis (CAQDAS) website provides support to make informed choices between analytical software and courses: http://www.surrey.ac.uk/sociology/research/researchcentres/caqdas/support/choosing . See Box 5 for further reading on qualitative analysis.
Ethnography | • Atkinson P, Coffey A, Delamount S, Lofland J, Lofmand L. Handbook of ethnography. Sage: Thousand Oaks (CA); 2001. • Spradley J. The ethnographic interview. Holt Rinehart & Winston: New York (NY); 1979. • Spradley J. Participant observation. Holt Rinehart & Winston: New York (NY); 1980. |
Phenomenology | • Colaizzi PF. Psychological research as the phenomenologist views it. In: Valle R, King M, editors. Essential phenomenological alternative for psychology. New York (NY): Oxford University Press; 1978. p. 41-78. • Smith J.A, Flowers P, Larkin M. Interpretative phenomenological analysis. Theory, method and research. Sage: London; 2010. |
Grounded theory | • Charmaz K. Constructing grounded theory. 2nd ed. Sage: Thousand Oaks (CA); 2014. • Corbin J, Strauss A. Basics of qualitative research. Techniques and procedures for developing grounded theory. Sage: Los Angeles (CA); 2008. |
Content analysis | • Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative Content Analysis: a focus on trustworthiness. Sage Open 2014: 1–10. DOI: 10.1177/2158244014522633. • Elo S. Kyngäs A. The qualitative content analysis process. J Adv Nurs. 2008; 62: 107–115. • Hsieh HF. Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15: 1277–1288. |
The next and final article in this series, Part 4, will focus on trustworthiness and publishing qualitative research [ 13 ].
The authors thank the following junior researchers who have been participating for the last few years in the so-called ‘Think tank on qualitative research’ project, a collaborative project between Zuyd University of Applied Sciences and Maastricht University, for their pertinent questions: Erica Baarends, Jerome van Dongen, Jolanda Friesen-Storms, Steffy Lenzen, Ankie Hoefnagels, Barbara Piskur, Claudia van Putten-Gamel, Wilma Savelberg, Steffy Stans, and Anita Stevens. The authors are grateful to Isabel van Helmond, Joyce Molenaar and Darcy Ummels for proofreading our manuscripts and providing valuable feedback from the ‘novice perspective’.
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Questions? Call us:
Email:
Essay Writing
Term Paper Writing
Research Paper Writing
Dissertation Writing
Other Services
Top 70 qualitative research topics to ace 2022.
November 16, 2020
There is no denying it; qualitative research topics are not as easy as ABC. To some, statistics is an enthralling subject while others may opt to clean the sea rather than sit in a statistics class. Millions of students around the globe face this crossroad. The task is further complicated by the fact that qualitative assignments deal with a cognitive analysis of data.
If this is you, calm down. Our expert writers have already analyzed your problem and collated a list of 70 qualitative research paper topics for your inspiration. Keep your eyes peeled.
However, before we venture into our topic list, here is something you need to have at your fingertips;
It is the creative and investigative analysis of intangible and inexact data. The method is inductive in that the researcher codes the data during or after the collection. It is, therefore, necessary to have top-notch qualitative research topics for a first-class paper.
You can never miss a qualitative research assignment. Therefore, use any of the examples of qualitative research topics above for your motivation. The issues should propel you to composing a top-rated qualitative research paper.
In case you are stuck, seek our quality and cheap writing help services 24/7. Order now!
Take a break from writing.
Top academic experts are here for you.
Free Website Traffic Checker
Discover your competitors' strengths and leverage them to achieve your own success
Qualitative research questions help you understand consumer sentiment. They’re strategically designed to show organizations how and why people feel the way they do about a brand, product, or service. It looks beyond the numbers and is one of the most telling types of market research a company can do.
The UK Data Service describes this perfectly, saying, “The value of qualitative research is that it gives a voice to the lived experience .”
Read on to see seven use cases and 83 qualitative research questions, with the added bonus of examples that show how to get similar insights faster with Similarweb Research Intelligence.
A qualitative research question explores a topic in-depth, aiming to better understand the subject through interviews, observations, and other non-numerical data. Qualitative research questions are open-ended, helping to uncover a target audience’s opinions, beliefs, and motivations.
Choosing the right qualitative research questions can be incremental to the success of your research and the findings you uncover. Here’s my six-step process for choosing the best qualitative research questions.
For a question to be considered qualitative, it usually needs to be open-ended. However, as I’ll explain, there can sometimes be a slight cross-over between quantitative and qualitative research questions.
These allow for a wide range of responses and can be formatted with multiple-choice answers or a free-text box to collect additional details. The next two types of qualitative questions are considered open questions, but each has its own style and purpose.
These ask respondents to choose from a predetermined set of responses, such as “On a scale of 1-5, how satisfied are you with the new product?” While they’re traditionally quantitative, adding a free text box that asks for extra comments into why a specific rating was chosen will provide qualitative insights alongside their respective quantitative research question responses.
There are many applications of qualitative research and lots of ways you can put your findings to work for the success of your business. Here’s a summary of the most common use cases for qualitative questions and examples to ask.
These types of questions help you find out why customers choose products or services and what they are looking for when making a purchase.
Use these questions to reveal insights into how customers interact with a company’s products or services and how those experiences can be improved.
First, I’m going to do a website market analysis of the banking credit and lending market in the finance sector to get a clearer picture of industry benchmarks.
Here, I can view device preferences across any industry or market instantly. It shows me the device distribution for any country across any period. This clearly answers the question of how mobile dominate my target audience is , with 59.79% opting to access site via a desktop vs. 40.21% via mobile
I then use the trends section to show me the exact split between mobile and web traffic for each key player in my space. Let’s say I’m about to embark on a competitive campaign that targets customers of Chase and Bank of America ; I can see both their audiences are highly desktop dominant compared with others in their space .
Research questions like this can help you understand customer pain points and give you insights to develop products that meet those needs.
Using the market analysis element of Similarweb Digital Intelligence, I select my industry or market, which I’ve kept as banking and credit. A quick click into marketing channels shows me which channels drive the highest traffic in my market. Taking direct traffic out of the equation, for now, I can see that referrals and organic traffic are the two highest-performing channels in this market.
Similarweb allows me to view the specific referral partners and pages across these channels.
Looking closely at referrals in this market, I’ve chosen chase.com and its five closest rivals . I select referrals in the channel traffic element of marketing channels. I see that Capital One is a clear winner, gaining almost 25 million visits due to referral partnerships.
Next, I get to see exactly who is referring traffic to Capital One and the total traffic share for each referrer. I can see the growth as a percentage and how that has changed, along with an engagement score that rates the average engagement level of that audience segment. This is particularly useful when deciding on which new referral partnerships to pursue.
Once I’ve identified the channels and campaigns that yield the best results, I can then use Similarweb to dive into the various ad creatives and content that have the greatest impact.
These ads are just a few of those listed in the creatives section from my competitive website analysis of Capital One. You can filter this list by the specific campaign, publishers, and ad networks to view those that matter to you most. You can also discover video ad creatives in the same place too.
In just five minutes ⏰
Companies need to make sure pricing stays relevant and competitive. Use these questions to determine customer perceptions on pricing and develop pricing strategies to maximize profits and reduce churn.
Get Faster Answers to Qualitative Research Questions with Similarweb Today
Here, I’m using Capital One as an example site. I can see trending pages on their site showing the largest increase in page views. Other filters include campaign, best-performing, and new–each of which shows you page URLs, share of traffic, and growth as a percentage. This page is particularly useful for staying on top of trending topics , campaigns, and new content being pushed out in a market by key competitors.
It’s vital to stay in touch with changing consumer needs. These questions can also be used for new product or service development, but this time, it’s from the perspective of a product manager or development team.
Market segmentation seeks to create groups of consumers with shared characteristics. Use these questions to learn more about different customer segments and how to target them with tailored messaging.
This example shows me Bank of America’s social media distribution, with YouTube , Linkedin , and Facebook taking the top three spots, and accounting for almost 80% of traffic being driven from social media.
When doing any type of market research, it’s important to benchmark performance against industry averages and perform a social media competitive analysis to verify rival performance across the same channels.
Organizations must assess market sentiment toward other players to compete and beat rival firms. Whether you want to increase market share , challenge industry leaders , or reduce churn, understanding how people view you vs. the competition is key.
Using the audience interests element of Similarweb website analysis, you can view the cross-browsing behaviors of a website’s audience instantly. You can see a matrix that shows the percentage of visitors on a target site and any rival site they may have visited.
With the Similarweb audience overlap feature, view the cross-visitation habits of an audience across specific websites. In this example, I chose chase.com and its four closest competitors to review. For each intersection, you see the number of unique visitors and the overall proportion of each site’s audience it represents. It also shows the volume of unreached potential visitors.
Here, you can see a direct comparison of the audience loyalty represented in a bar graph. It shows a breakdown of each site’s audience based on how many other sites they have visited. Those sites with the highest loyalty show fewer additional sites visited.
From the perspective of chase.com, I can see 47% of their visitors do not visit rival sites. 33% of their audience visited 1 or more sites in this group, 14% visited 2 or more sites, 4% visited 3 or more sites, and just 0.8% viewed all sites in this comparison.
Similarweb Research Intelligence drastically improves market research efficiency and time to insight. Both of these can impact the bottom line and the pace at which organizations can adapt and flex when markets shift, and rivals change tactics.
Outdated practices, while still useful, take time . And with a quicker, more efficient way to garner similar insights, opting for the fast lane puts you at a competitive advantage.
With a birds-eye view of the actions and behaviors of companies and consumers across a market , you can answer certain research questions without the need to plan, do, and review extensive qualitative market research .
Wrapping up
Qualitative research methods have been around for centuries. From designing the questions to finding the best distribution channels, collecting and analyzing findings takes time to get the insights you need. Similarweb Digital Research Intelligence drastically improves efficiency and time to insight. Both of which impact the bottom line and the pace at which organizations can adapt and flex when markets shift.
Similarweb’s suite of digital intelligence solutions offers unbiased, accurate, honest insights you can trust for analyzing any industry, market, or audience.
Are quantitative or qualitative research questions best?
Both have their place and purpose in market research. Qualitative research questions seek to provide details, whereas quantitative market research gives you numerical statistics that are easier and quicker to analyze. You get more flexibility with qualitative questions, and they’re non-directional.
What are the advantages of qualitative research?
Qualitative research is advantageous because it allows researchers to better understand their subject matter by exploring people’s attitudes, behaviors, and motivations in a particular context. It also allows researchers to uncover new insights that may not have been discovered with quantitative research methods.
What are some of the challenges of qualitative research?
Qualitative research can be time-consuming and costly, typically involving in-depth interviews and focus groups. Additionally, there are challenges associated with the reliability and validity of the collected data, as there is no universal standard for interpreting the results.
by Liz March
Digital Research Specialist
Liz March has 15 years of experience in content creation. She enjoys the outdoors, F1, and reading, and is pursuing a BSc in Environmental Science.
Related Posts
Wondering what similarweb can do for your business.
Give it a try or talk to our insights team — don’t worry, it’s free!
Run remote usability tests on any digital product to deep dive into your key user flows
Learn how users are behaving on your website in real time and uncover points of frustration
A tool for collaborative analysis of qualitative data and for building your research repository and database.
How-to articles, expert tips, and the latest news in user testing & user experience
Detailed explainers of Trymata’s features & plans, and UX research terms & topics
Conduct user testing, desktop usability video.
You’re on a business trip in Oakland, CA. You've been working late in downtown and now you're looking for a place nearby to grab a late dinner. You decided to check Zomato to try and find somewhere to eat. (Don't begin searching yet).
It was hard to find the bart station. The collections not being able to be sorted was a bit of a bummer
Feedback from the owners would be nice
The flow was good, lots of bright photos
I like that you can sort by what you are looking for and i like the idea of collections
You're going on a vacation to Italy next month, and you want to learn some basic Italian for getting around while there. You decided to try Duolingo.
I felt like there could have been a little more of an instructional component to the lesson.
It would be cool if there were some feature that could allow two learners studying the same language to take lessons together. I imagine that their screens would be synced and they could go through lessons together and chat along the way.
Overall, the app was very intuitive to use and visually appealing. I also liked the option to connect with others.
Overall, the app seemed very helpful and easy to use. I feel like it makes learning a new language fun and almost like a game. It would be nice, however, if it contained more of an instructional portion.
All accounts, tests, and data have been migrated to our new & improved system!
Use the same email and password to log in:
Legacy login: Our legacy system is still available in view-only mode, login here >
What’s the new system about? Read more about our transition & what it-->
Conduct End-to-End User Testing & Research
Question: How do individuals with chronic illnesses perceive and manage their overall well-being?
Context: This question aims to explore the subjective experiences of individuals living with chronic illnesses, focusing on their perceptions of well-being and the strategies they employ to manage their health.
Question: What are the experiences of teachers implementing project-based learning in high school science classrooms?
Context: This question delves into the qualitative aspects of teaching practices, seeking to understand the lived experiences of teachers as they implement a specific instructional approach (project-based learning) in a particular academic context (high school science classrooms).
Question: How do marginalized communities perceive and navigate social inclusion in urban environments?
Context: This question addresses the sociological dimensions of social inclusion within urban settings, focusing on the perspectives and strategies of marginalized communities as they navigate societal structures.
Question: What are the coping mechanisms employed by individuals facing post-traumatic stress disorder?
Context: This question explores the psychological experiences of individuals dealing with post-traumatic stress disorder, aiming to uncover the qualitative aspects of coping strategies and mechanisms.
Question: How does a specific cultural group express identity through traditional rituals and ceremonies?
Context: This anthropological question focuses on cultural practices and rituals as expressions of identity within a specific cultural group, aiming to uncover the meanings and functions of these traditions.
Question: What are the lived experiences of transgender individuals in the workplace, particularly regarding inclusion and discrimination?
Context: This question within gender studies explores the qualitative dimensions of transgender individuals’ workplace experiences, emphasizing the nuanced aspects of inclusion and discrimination they may encounter.
Question: How do local communities perceive and respond to environmental conservation efforts in their region?
Context: This question addresses the intersection of environmental studies and sociology, aiming to understand the qualitative perspectives of local communities toward conservation initiatives, exploring their perceptions and responses.
Question: How do employees perceive leadership styles and their impact on workplace culture?
Context: Within the realm of business and management, this question explores the qualitative aspects of organizational culture, focusing on employees’ perceptions of leadership styles and their influence on the workplace environment.
Question: What are the social implications and user experiences of emerging technologies in the context of augmented reality applications?
Context: This question within the field of technology and society investigates the qualitative dimensions of user experiences and social implications related to the adoption of augmented reality applications.
Question: How do individuals from diverse cultural backgrounds interpret and respond to media representations of body image?
Context: This question explores the intersection of communication studies and cultural studies, aiming to understand the qualitative variations in how individuals from diverse cultural backgrounds interpret and respond to media depictions of body image.
Question: What are the public perceptions and attitudes toward government policies on climate change?
Context: Within political science, this question delves into the qualitative aspects of public opinion, seeking to understand how individuals perceive and respond to government policies related to climate change.
Question: How do international students experience acculturation and adaptation in a foreign academic environment?
Context: This question within cultural studies explores the qualitative dimensions of acculturation and adaptation, focusing on the experiences of international students within the context of a foreign academic environment.
Question: How do families navigate and negotiate roles and responsibilities in the context of remote work?
Context: In the domain of family studies, this question addresses the qualitative aspects of family dynamics, examining how families navigate and negotiate roles and responsibilities in the context of remote work.
Question: How do community members perceive and engage with public health campaigns aimed at promoting vaccination in underserved urban areas?
Context: This public health question investigates the qualitative aspects of community perceptions and engagement with vaccination campaigns, particularly in urban areas with limited access to healthcare resources.
Question: What are the experiences of residents in gentrifying neighborhoods regarding changes in their community dynamics, affordability, and social cohesion?
Context: Within urban planning, this question explores the qualitative dimensions of gentrification, focusing on residents’ lived experiences and perceptions of neighborhood transformations.
Question: How do contemporary authors use literature to critique and challenge societal norms around gender roles and identity?
Context: In the realm of literature and cultural criticism, this question examines the qualitative dimensions of literary works, exploring how authors use their craft to challenge and critique societal norms related to gender.
Question: What are the perceptions of social workers regarding the challenges and opportunities in providing mental health support to homeless populations?
Context: This social work question addresses the qualitative aspects of mental health support within homeless populations, exploring social workers’ perspectives on challenges and opportunities in their roles.
Question: How do tourists from different cultural backgrounds experience and interpret authenticity in local culinary traditions?
Context: Within tourism and hospitality, this question explores the qualitative aspects of cultural experiences, focusing on tourists’ perceptions and interpretations of authenticity in local culinary traditions.
Question: How do audiences engage with and interpret representations of diverse identities in streaming platforms’ original content?
Context: In the realm of media and entertainment, this question investigates the qualitative dimensions of audience engagement and interpretation of diverse identities in content produced by streaming platforms.
Question: What are the narratives and memories of individuals who lived through a significant historical event, and how have these narratives evolved over time?
Context: Within historical studies, this question explores the qualitative aspects of personal narratives and memory, investigating how individuals recall and frame their experiences of a significant historical event.
Question: How do multilingual individuals navigate language use and identity in diverse linguistic environments?
Context: In the field of linguistics, this question delves into the qualitative dimensions of language use and identity, focusing on how multilingual individuals navigate linguistic diversity in their environments.
Question: What are the perceptions and behaviors of employees in organizations regarding cybersecurity practices, and how do these perceptions influence organizational security?
Context: Within cybersecurity, this question explores the qualitative aspects of employees’ perceptions and behaviors related to cybersecurity practices, examining their impact on organizational security.
Question: How do users experience and adapt to voice-controlled virtual assistants in their daily lives, considering factors such as privacy concerns and usability?
Context: In human-computer interaction, this question investigates the qualitative aspects of user experiences with voice-controlled virtual assistants, considering factors such as privacy concerns and usability challenges.
Question: How do local communities perceive and negotiate the impacts of international development projects on their cultural and economic landscapes?
Context: This international development question explores the qualitative dimensions of community perceptions and negotiations regarding the impacts of international development projects, considering cultural and economic factors.
Question: What are the psychological experiences and coping mechanisms of athletes during periods of extended competition hiatus, such as the postponement of major sporting events?
Context: In sport psychology, this question delves into the qualitative aspects of athletes’ psychological experiences and coping mechanisms during extended competition hiatus, such as the postponement of major sporting events.
These additional detailed examples provide a broader perspective on qualitative research questions, covering diverse fields of study and highlighting the nuanced inquiries within each domain.
Interested in learning more about the fields of product, research, and design? Search our articles here for helpful information spanning a wide range of topics!
Feedback analysis steps for better usability testing, the importance of user feedback survey in usability testing, 15 best user feedback tools for actionable insights.
What is sociology, what issues does sociological research explore, what qualitative research methods are used for sociology topics, how to choose sociology research topic ideas, ideas for interesting sociology research paper topics.
Sociology is the study of human societies, social behaviors, and the complex relationships that shape our world. Through its focus on social structures, institutions, and interactions, sociology provides deep insights into the ways in which individuals and groups influence and are influenced by society. Qualitative research methods , such as interviews , ethnography , and case studies , are central to sociological inquiry, allowing researchers to explore the nuances of social life and the underlying factors that drive social change. Whether you're interested in social movements, cultural identity, or the impact of mass media, choosing a strong research topic in sociology is key to contributing meaningful insights to the field. This article offers inspiration and guidance for selecting compelling sociology research topics, as well as practical advice on designing and executing your research project.
Sociology is the scientific study of society, focusing on the patterns of social relationships, social interaction, and cultural diversity that shape human behavior. It seeks to understand how individuals and groups interact within the larger social structures of communities, institutions, and societies. Sociologists examine a wide range of social phenomena, from the dynamics of small groups to the functioning of entire societies, exploring how social order is maintained, how power and inequality are distributed, and how social change occurs over time.
One of the key aspects of sociology is its emphasis on the social context in which human behavior occurs. Sociologists are interested in how societal norms, values, and institutions influence individual actions and how, in turn, these actions can shape society. This perspective allows sociology to address a wide array of issues, from the micro-level of individual interactions to the macro-level of global social processes.
Sociology is inherently interdisciplinary, drawing on insights from history, economics, psychology, anthropology, and political science to build a comprehensive understanding of social life. The field employs both qualitative and quantitative research methods to explore social phenomena. While quantitative methods provide statistical insights into social patterns, qualitative methods offer a deeper understanding of the meanings and motivations behind these patterns. Through qualitative research, sociologists can uncover the lived experiences of individuals, explore the complexities of social identities, and examine the intricate dynamics of social institutions.
In essence, sociology provides the means to critically analyze the social world, offering explanations for social phenomena and contributing to our understanding of the forces that shape human behavior. By studying sociology, we gain a better understanding of the complexities of social life and the ways in which we can address social issues to create more just and equitable societies.
Sociological research papers explore a wide range of issues that are central to understanding human society. By examining social structures, behaviors, and relationships, sociologists seek to uncover the underlying mechanisms that drive social processes and contribute to social change. Here are some of the key issues that sociological research addresses:
One of the most prominent areas of sociological research is social inequality. Sociologists investigate how resources, power, and opportunities are distributed unevenly across different social groups based on factors such as class, race, gender, and ethnicity. This research explores the causes and consequences of inequality, including its impact on individuals' life chances, access to education, physical health, employment, and overall social cohesion. For example, sociologists might study how income inequality affects social mobility or how racial and gender discrimination manifests in different social institutions.
Sociological research also focuses on the role and function of social institutions, such as family, education, religion, and the state. These institutions play a critical role in shaping individuals' lives and maintaining social order. Sociologists examine how these institutions operate, how they contribute to social stability or change, and how they interact with one another. For instance, research might explore how educational institutions reproduce social inequalities or how religious institutions influence political behavior.
Culture is another central concern of sociological research. Sociologists study how cultural norms, values, and beliefs are created, maintained, and transformed over time. This research often involves exploring how cultural practices influence social behavior and how cultural change occurs. For example, sociologists might investigate how globalization affects local cultural identities or how media representations shape public perceptions of social issues. Understanding culture is key to understanding how societies function and how individuals navigate their social worlds.
Social change is a fundamental aspect of sociological inquiry. Sociologists are interested in how societies evolve over time and how social movements contribute to these changes. Research in this area might focus on the origins and development of social movements, the strategies they use to effect change, and their impact on society. For example, sociologists might study the civil rights movement, feminist movements, or environmental activism, analyzing how these movements challenge existing social structures and contribute to the creation of new social norms and policies.
Another important area of sociological research is the study of identity and socialization. Sociologists explore how individuals develop their sense of self and identity through interactions with others and within the context of larger social structures. This research examines the processes of socialization that occur in families, schools, and identity groups like college students and political activists, and how these processes shape individuals' beliefs, behaviors, and social roles. For example, sociologists might study how gender identity is constructed and reinforced through socialization or how cultural identity is maintained and expressed in multicultural societies.
Unlock your data with our AI-driven tools by downloading a free trial of ATLAS.ti.
Qualitative research methods are central to sociology, offering deep insights into the social processes, meanings, and experiences that shape human behavior. These methods are particularly effective for exploring complex social phenomena in detail and understanding the perspectives of individuals within their social contexts. Here are some of the key qualitative research methods employed in sociology.
Ethnography is a method that involves immersive fieldwork , where sociologists observe and participate in the daily lives of the people they study. This approach allows researchers to gain a deep understanding of a particular culture, community, or social group by becoming part of the social setting. Ethnographers often spend extended periods of time within the community they are studying, engaging in activities and observing interactions to document social practices, rituals, and everyday behaviors. This method is particularly valuable for exploring how social norms are maintained, how power dynamics operate in everyday life, and how people construct and negotiate their identities.
Interviews are another fundamental qualitative method in sociology, providing a way to gather detailed information about individuals' experiences, perspectives, and interpretations of social phenomena. Interviews can be structured , semi-structured , or unstructured , depending on the research objectives . Structured interviews follow a predetermined set of questions, while unstructured interviews are more open-ended, allowing respondents to guide the conversation. Semi-structured interviews strike a balance between these two, offering both flexibility and focus. Interviews are especially useful for exploring sensitive or complex issues, such as how people understand their social roles, how they cope with social challenges, or how they perceive social change.
Focus groups involve guided discussions with small groups of participants on specific topics. This method allows sociologists to explore how people collectively discuss and negotiate meanings, norms, and values. Focus groups are effective for understanding group dynamics and the influence of social interactions on individual opinions. For example, a focus group might be used to explore public attitudes toward social policies, how cultural beliefs shape health behaviors, or how different groups experience social inequalities. By facilitating discussion among participants, researchers can gain insights into how social norms are reinforced or challenged within a group context.
Content analysis is a qualitative method used to analyze textual, visual, or audio data, with the goal of understanding how information is communicated and how social meanings are constructed. This method is often used to study media representations, social media content, or historical documents. Sociologists might analyze news articles, advertisements, or television shows to examine how they reflect and shape societal values, stereotypes, and ideologies. Content analysis can reveal underlying patterns in how different groups are portrayed, how social issues are framed, and how cultural narratives evolve over time.
While qualitative methods are essential for exploring the depth and complexity of social life, quantitative methods play a crucial role in sociology as well. Quantitative research involves the collection and analysis of numerical data to identify patterns, correlations, and causal relationships within social phenomena. Common quantitative methods include surveys , experiments, and statistical analysis. Surveys are widely used to gather data on social attitudes, behaviors, and demographics, allowing researchers to generalize findings across larger populations. Experiments, though less common in sociology, are used to test hypotheses under controlled conditions. Statistical analysis helps sociologists process large datasets to uncover trends and relationships between variables.
Choosing good or manageable sociology research topics is a crucial step in conducting meaningful and impactful studies. A well-chosen topic should not only align with your interests but also address significant social issues, contribute new insights to the field, and be feasible in terms of research scope and available resources. Here are some key factors to consider when selecting a research topic in sociology.
The first step in choosing a research topic is to identify your area of interest within sociology. Sociology is a broad field that covers various aspects of social life, including culture, institutions, interactions, and inequalities. Reflect on the topics or issues that resonate with you the most. Are you particularly interested in exploring social inequalities, cultural dynamics, social movements, or the effects of technology on society? By focusing on an area that you are passionate about, you are more likely to stay motivated and engaged throughout the research process.
Once you have identified your area of interest, narrow it down to a specific research question or problem. For example, if you are interested in social inequalities, you might focus on how educational attainment varies by socio-economic status or how gender roles are negotiated in different cultural contexts. A specific, well-defined research question will guide your study and help you maintain a clear focus.
When choosing a research topic, it is important to consider its significance within the broader field of sociology. A good research topic should address a social issue that is relevant and timely. Consider whether your topic has the potential to contribute new insights to ongoing debates or to address gaps in the existing literature . For instance, you might choose to study how the COVID-19 pandemic has affected mental health in different demographic groups, a topic that is both current and socially significant.
Additionally, think about the practical implications of your research. Sociological research can influence public policy, inform social programs, and contribute to social change. Choose a topic that has the potential to make a real-world impact, whether by shedding light on an underexplored issue, challenging existing assumptions, or offering solutions to social problems.
Feasibility is another critical factor to consider when choosing a research topic. Your topic should be manageable within the constraints of your time, resources, and access to data. Consider the scope of your research—are you planning to conduct a case study, survey a large population, or engage in ethnographic fieldwork? Ensure that you have the necessary resources, such as access to participants, relevant data, and the appropriate research tools.
It’s also important to consider the ethical implications of your research. Sociological research often involves working with human subjects, so you need to ensure that your study design respects participants’ rights and adheres to ethical standards. This includes obtaining informed consent , ensuring confidentiality , and minimizing any potential harm to participants.
If you are conducting qualitative research , such as interviews or focus groups , think about how you will gain access to your target population and whether you can realistically collect the data you need. For quantitative research , consider the availability of existing datasets or the feasibility of collecting new data.
Finally, consider how your research topic aligns with relevant sociological theories. Theoretical frameworks provide a lens through which you can analyze your research findings and situate your study within the broader sociological discourse. For example, if you are studying social inequalities, you might draw on conflict theory to explore how power and resources are distributed in society, or use symbolic interactionism to examine how individuals navigate social roles and identities.
Choosing a topic that engages with established theories can enhance the academic rigor of your research and provide a strong foundation for your analysis. Additionally, consider how your research might contribute to the development or refinement of these theories. By aligning your topic with relevant theoretical perspectives, you can ensure that your research is not only empirically robust but also theoretically informed.
Sociology offers a rich array of topics that explore the complexities of social life, from the dynamics of social movements to the influence of mass media. Below are several research topics for a compelling sociology paper, organized by key areas within sociology, each offering a unique perspective on contemporary social issues.
Social movements are a vital area of sociological research, as they are powerful forces for social change. Studying social movements allows sociologists to explore how collective action is organized, how movements mobilize resources, and how they challenge existing power structures. Potential research topics in this area include:
Cultural identity is a key concept in sociology, encompassing the ways in which individuals and groups define themselves and are perceived by others. Research in this area often focuses on the intersection of culture, ethnicity, and identity. Some possible research topics include:
Socioeconomic status (SES) is a fundamental concept in sociology, influencing nearly every aspect of an individual's life, including education, health, and social mobility. Research topics in this area can include:
The influence of mass media and technology on society is a rapidly evolving area of sociological research. This area explores how media and technology shape social behavior, cultural norms, and public opinion. Research topics might include:
Gender inequality remains a persistent issue in societies around the world. Sociological research on gender examines how social structures, cultural norms, and individual behaviors contribute to the maintenance of gender disparities. Research topics in this area could include:
Mental health has many useful medical sociology research topics, as it intersects with various social, cultural, and economic factors. Sociologists study how mental health is understood, treated, and experienced across different social groups. Good sociology research topics in this area might include:
Sociological research often focuses on how social attitudes are formed, maintained, and changed over time. This area of study can include topics related to public opinion, social norms, and the factors that influence belief systems. Possible research topics include:
Community development is a field of sociology that focuses on the processes and strategies used to improve the quality of life in communities. Research in this area can examine how communities organize to address social, economic, and environmental challenges. Potential research topics include:
Organize, code, and analyze your data all in one intuitive platform. Download a free trial today.
Background Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) was a large trial comparing the clinical and cost-effectiveness of two rehabilitation interventions in adults with a first-time traumatic shoulder dislocation. Participants were allocated to receive either a single session of advice (ARTISAN) or a single session of advice and a programme of physiotherapy (ARTISAN plus). Trial results illustrated that additional physiotherapy after an initial session was not superior in improving functional outcomes for participants.
Objectives In this study, we aim to explore the experiences of a purposive sample of participants from both the ARTISAN and ARTISAN plus groups regarding their rehabilitation journey.
Design This is a semistructured interview-based study.
Setting The study was conducted in the United Kingdom.
Participants Thirty-one participants of ARTISAN trial: 16 participants from ARTISAN group and 15 from ARTISAN plus group.
Outcome measures and analysis The study follows the consolidated criteria for reporting qualitative research. The framework analysis was used to synthesise the participants’ experiences. The interviews were coded through NVivo 12.6.1.
Results Three dominant and interrelated topics emerged from the interview data: (1) feelings about their shoulder rehabilitation outcome, (2) judgement of ARTISAN rehabilitation materials, (3) assessment of shoulder rehabilitation service provision.
Conclusion Both forms of intervention have some merit for some individuals. Thus, it may be appropriate to look at the patients’ preference for offering treatment to them. Recognising and facilitating this will be of benefit to both the patients and healthcare as a whole.
Data are available upon reasonable request. All codes and quotations can be found in the supplementary file.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .
https://doi.org/10.1136/bmjopen-2024-083975
Request permissions.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
The study used semistructured interviews, allowing in-depth exploration of participants’ experiences.
Interviewers used prompts and rephrased questions to mitigate recall issues among older participants.
Due to the COVID-19 pandemic, the methodology was adapted from face-to-face interviews to telephone interviews and the planned return of transcripts to participants for checking was not done (due to remote working).
The shift to telephone interviews could have affected the depth of understanding of participants’ feelings and reactions.
The sample size and specific context may limit the transferability of the findings.
The UK, National Institute for Health and Care Research, Health Technology Assessment-funded Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN) trial took place between November 2018 and March 2022. The trial aimed to compare the clinical and cost-effectiveness of two rehabilitation interventions in adults with a first-time traumatic shoulder dislocation. 1 Participants, presenting with first-time traumatic shoulder dislocation, meeting the inclusion criteria, were randomly allocated to receive either a single session of advice or a single session of advice and a programme of physiotherapy, delivered by trained physiotherapists; 482 participants were randomised and screened from 41 NHS Trusts. 2
The trial reports that there was no evidence of a difference in the primary outcome (Oxford Shoulder Instability Score) at the primary endpoint (6 months) between the two groups. 2 Additionally, there were no statistically significant differences observed in the QuickDASH (a self-completed shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) scores, nor were there consistent differences in the EQ-5D-5L secondary outcomes. 2 Noting that the offer of additional physiotherapy after an initial session was not superior in improving functional outcomes for participants. 2
Embedded within the ARTISAN trial were a cost-effectiveness study and a qualitative interview study. 1 Understanding patient perspectives is essential for achieving successful treatment of anterior shoulder instability. 3 Patient adherence to rehabilitation protocols, their personal experiences and perceived barriers and facilitators play a significant role in influencing treatment outcomes. 4 Here, in this paper, we present the results of the ARTISAN interviews exploring their findings alongside the findings from the clinical effectiveness trial. 2 The results from the interview study, which were analysed before the effectiveness results were revealed, are presented here and provide insight into possible reasons for the outcome.
This is a qualitative study, exploring the experiences and reality of participants, via individual semistructured interviews. This study is in accordance with the consolidated criteria for reporting qualitative research 5 (see online supplemental appendix 1, table 1 ).
Participants.
All participants, on consenting to participate in the trial, were informed about the interview substudy, and asked if they would be willing to be potentially contacted. A purposive sample was used, to ensure a diverse range of characteristics including location, treatment allocation, gender, age, of those who expressed an interest in participating. 6 7 Up to 50 interviews were planned to capture a comprehensive range of experiences related to shoulder dislocation rehabilitation. The decision to set the sample at around 50 was based on researchers’ experience and represented over 10% of the randomised population. Potential participants were contacted by the researcher (ZL), who confirmed their interest, provided information and arranged interviews at the 12-month postrandomisation timepoint. This was for two reasons, first it allowed participants sufficient time to undergo their rehabilitation journey and reflect on their experiences comprehensively, but second, and more importantly for the trial, we set it at this point in time, so that interviews were carried out outside of trial data collection and thus did not bias the main results. The interviewer was not known to the participants prior to the study and was centrally based.
Semistructured interviews of participants from both arms were undertaken by a researcher (ZL) experienced in qualitative research methods. The interview schedule is presented in online supplemental appendix 2 . The interview topics were generated through a combination of literature review, expert input and patient feedback with pilot testing conducted to ensure reliability and validity. 8 Interviews were planned to be face-to-face, but the COVID-19 pandemic required the team to conduct most of these interviews by telephone. This shift to remote working away from the office meant that we had to adapt and while our protocol stated we would return transcripts to participants for checking this was not done. Three interviews were conducted in the participants’ homes, one at the participant’s workplace and the rest through telephone. All interviews were done between 11 February 2020 and 1 February 2021. The approximate time for each interview was 45 min. Field notes were written up as soon as possible after the interviews to record the interviewers’ immediate impressions. Interviews were digitally recorded, subjected to permission of each participant, and they transcribed verbatim by an independent university-approved transcription company and anonymised. All transcription interviews from audios were checked by another researcher (SN).
Data were analysed thematically using the Framework method, as follows: data familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation. 6 7 The analysis was conducted by researchers with extensive expertise in qualitative research methods. SN, who joined the trial team after the interviews were recorded, listened to the audio recordings to check the accuracy. She became familiar with the data. The transcripts were imported to the NVivo release V.12.6.1 9 to facilitate coding data and mapping them. SN generated initial relevant codes/topic; these were generally based around the specific questions asked of participants. The next analysis stage involved DRE collating the codes to note meaningful patterns in the data that were relevant to the research question. DRE and SN created themes and subthemes that captured the essence of the participants’ voices. Themes and subthemes are presented using quotes to illustrate the participant view.
Rigour was enhanced during the process by coding the first five transcriptions by two independent, experienced researchers (ZHL and SN). Discrepancies were addressed by DRE, who has extensive experience in process evaluation and played a key role as a coapplicant for the ARTISAN trial, contributing to its design. SN independently coded all transcripts and discussed them in detail with DRE. The results were presented before releasing a statistical and health economics result. Reflexivity was maintained throughout the analysis process, with researchers reflecting on their own biases and preconceptions, thereby enhancing the credibility, transferability and dependability of the findings. 10
The qualitative analyses and results were prepared and presented to the Chief Investigator, RK, who is a leading expert in the physiotherapy with extensive experience in randomised controlled trials, before the main trial results were known.
Patient representatives provided input on study design, intervention development and dissemination plans, ensuring a comprehensive approach. Detailed patient and public involvement activities are outlined in the ARTISAN trial report. 11
A total of 102 participants, who had expressed an interest in involvement in the qualitative study at the time of consenting to be in the ARTISAN trial, were contacted. Seventeen declined to participate, and 54 did not respond. A total of 31 participants consented and were interviewed from both arms of the trial, ARTISAN and ARTISAN plus (see table 1 ). The participants were from 17 different trial sites in the UK. Of them, 16 participants were allocated to the ARTISAN’s arm, and 15 participants were allocated to the ARTISAN plus arm.
Demographic characteristics of ARTISAN interview study participants
The majority of the participants in the ARTISAN plus arm were men (11 out of 15), while there was a balance between participants (eight men and eight women) in the ARTISAN’s arm. The participants’ means (SD) of age were 49 (21) and 59 (17) for the ARTISAN and ARTISAN plus arms, respectively. Five participants in the ARTISAN’s arm and four in the ARTISAN plus arm stated they were involved in sporting activities that needed high levels of physical activity. Most of them described no difficulties with their shoulder before the injury. Only two and three participants in the ARTISAN and ARTISAN plus had a previous problem that goes back many years ago. There was a wide variety of the injury caused; however, seven participants (four in the ARTISAN plus arm and three in the ARTISAN’s arm) got an injury while doing sports activities such as football, rugby, weightlifting and riding a bike. The injury in the three participants in the ARTISAN group resulted in a fractured shoulder in addition to dislocation. The practitioner team decided to perform shoulder surgery for one participant in the ARTISAN plus arm due to pre-existing arthritis. Most participants in both groups believed they were provided the Ambulance and Emergency (A&E) services straightforwardly and quickly, while one participant in the ARTISAN’s arm faced a delay because he needed to be transferred from a small unit to another hospital with an A&E department. A shoulder dislocation for all participants was diagnosed by X-rays. After putting the shoulder back, they received painkillers to relieve the pain and were recommended to wear a sling for at least a week.
Our findings (detailed below) illustrate participants’ experiences of receiving and interacting with rehabilitation services.
Three dominant and interrelated topics emerged from the interview data questions: (1) feelings about their shoulder rehabilitation outcome, (2) judgement of ARTISAN rehabilitation materials, (3) assessment of shoulder rehabilitation services provision
Themes and their subthemes, within each of these topics, are reported below comparing and contrasting responses from both arms of the trial ((ARTISAN) advise only and those from (ARTISAN plus) advise plus a programme of physiotherapy). Quotations are used as exemplars of themes with each quote linked to a particular participant denoted by the arm of the trial, they were involved in AP=ARTISAN plus arm or A=ARTISAN followed by their id number (see table 1 ), their gender (m or f) and age (eg, A11, m, 31). See Appendix 3 for additional quotations.
This topic breaks down into several themes/subthemes, providing an insight into the assessment of their feelings about their recovery including movement and use of their shoulder and being able to get back to their previous activities or not. Noting that within the ARTISAN arm, fewer participants expressed satisfaction with their shoulder movement levels.
Shoulder status (How they feel their shoulder is now postrehabilitation)
Participants who received ARTISAN plus report improvement in returning to their normal life and working activities. Almost all of them expressed the status of their shoulder as ‘better’.
I feel good now, and then I can…I’m back to doing all the jobs I could do before (AP13, m 59), I think I'm back at 100 now (AP25, m,72), Probably getting up to 100% I guess. (AP27, m,72).
A few did still feel that they still a little way to go.
I would say yeah, probably 70% now. Yeah, around about that. Yes, yeah (AP3, m, 65), Like maybe more 60 than 50 in terms of movements (AP28, m, 36).
Compared with the ARTISAN arm where there were fewer participants who believed their shoulder was at a good level of movement.
…had almost complete range of movement (A21, f, 65). It’s absolutely fine… (A26, f, 68).
Interestingly, most participants who had received ARTISAN plus apparently liked to recommend it to the others with the same problem because they were very satisfied with the result from having multiphysiotherapy sessions.
Yeah, I would recommend, I would definitely recommend anybody to go do that what I did, yeah, definitely. Definitely, yeah (AP12, f, 62).
The other source of satisfaction from the result for most of them was receiving positive reinforcement from the physiotherapist about outcomes and being told that they were doing the exercise correctly.
Only the reassurance that everything was going fine (AP22, m, 67), So, I suppose I needed those sorts of reassurances before I got into heavier physiotherapy (AP12, f, 62).
On the other hand, most people in the ARTISAN arm have found the exercises as the most helpful part of rehabilitation to get back their abilities.
Yeah. I would…I would tell them, you need that physio exercise, yeah (A19, m, 48).
Setting short-term goals and identifying milestones were noted as helpful by some participants in both groups. Helping them have a realistic view of their shoulder progression.
the goals were…because I think it kind of helps you set a realistic view of you know, going on to next session that if you could do this” (A19, m, 48).“Yeah, the goals were…because I think it kind of helps you set a realistic view of, you know, going on to the next session that if you could do this, it was literally things like being able to reach something from one of the cupboards in the kitchen, kind of thing. So, I think it’s really good to just help set umm and be able to achieve, also to help set expectations (A19, m, 48). The main point was the face-to-face setting of goals between sessions (AP27, m, 72). I do find useful writing down, there was a sheet in one of the books where you wrote down what you achieve every day. And that really worked for me as well because you weren’t in this wilderness you were actually working step by step towards something… you know you can get a lot of resources but actually the biggest resource is your own determination (AP5, f, 71)
All of the trial participants had the opportunity to use the provided rehabilitation training materials in addition to the support given by the physiotherapist in the sessions they all had with them. These materials seem to be more important for the ARTISAN participants as they generally only had the one in-person session with the physiotherapist. However, it is also important to know to what extent the participants have used the materials and what their experience is in using them.
Almost all participants in the ARTISAN arm report using the booklets while only half of the ARTISAN plus arm reported used them. In addition, none of the ARTISAN plus participants report having used the videos and website compared with around half of those in the ARTISAN arm. The ARTISAN plus participants who have not used the materials believed that they had gained enough from their in-person visits with the physiotherapist; therefore, they did not feel the need to refer to the training materials.
just after the first (physio) session, I had the chance to have a very quick look at the booklets, so, it was enough exercise and guidance from physiotherapist over the sessions, …, didn’t feel need them! (AP7, m, 37). I had time, was off from work, almost at home, and was keen on going through the booklets, but only booklets, no website, and videos, so I think it was quite helpful (AP15, m, 33). I got those stuff (training materials), …, but yea! I don’t remember using them! yea, didn’t look at them at all (A18, f, 72) (I) got the booklet and everything, I went on the website, saw the videos and, yeah (A32, F, 59).
The main reported source of difficulty in using the materials provided was in the ARTISAN arm where there were problems reported accessing the video and internet-based materials. A few of the participants from ARTISAN have reported some problems with the booklets provided. These problems are very low in the ARTISAN plus arm.
There was but I don't have the internet at my house… (A21, f, 65), I couldn't quite find…I couldn't follow the instructions on those. And I couldn't log into the website. So, I couldn't get any additional information”. I had a booklet. I didn't find them all easy to follow. There was a couple…I mean they did run through it with me, the fracture clinic, but they more demonstrated it I would say. But I didn't find everything in the booklet that easy to follow. I did with the hospital physiotherapist, I actually had to do it because my arm was in better shape (A32, f, 59). I think there was one [picture] that wasn't quite clear, but I checked it out with her the next time I went (AP22, m, 67). I suppose the booklet umm is in some ways misinterpreted because it is not in 3D you know so surely for a picture… a picture does not always give you the right angle or the right umm motion to use (AP5, f, 71).
The content of the materials was consistent with what had been provided in face-to-face rehabilitation sessions in view of almost participants. The materials were also reported to be comprehensive and to meet the needs of the participants in both arms.
From the ARTISAN participants:
It was very good because you get…further on, you’ve sort of got more exercises to do. So, you really need that leaflet to show you the different exercises you need to do (A26, f, 68). Yeah well, the exercises we did were the exercises in the pamphlet that I was given which I said to you, and hmmm the physio she did them all with me… 2 or three times (A2, m, 56).
From the ARTISAN plus participants
It was just giving me alternatives to do. It’s the same kind of stress on the shoulder, but it was a different exercise. But more or less, there were those like, you know (AP28, m, 36). She (the physiotherapist) did. She did go through the booklet with it and marked certain things, you know like she wrote in the book the few exercises that I should be doing (AP1, m, 27).
This theme reflects participants feelings about the provision of physiotherapy/rehabilitation in terms of the accessibility to the providing rehabilitation centres, physiotherapist performance and then the form of sessions provided. This part of the participants’ experiences reflects insights about the barriers that can influence the participants getting to the centres, and to what extent participant believe the physiotherapists have been engaged in their rehabilitation/treatment process.
Several of the participants in ARTISAN plus have experienced some physical difficulties in attending the rehabilitation sessions, such as problems with driving, finding a car park and a considerable distance to the physiotherapy clinic or hospital from their home.
Taking into account quite a long distance to travel and the roads aren’t that great, I have to be taken in by my wife obviously I was not driving (AP3, m, 62). Sort of 2 hours right around the hospital so if I wasn’t close it would be more difficult (AP1, m, 27).
Most of the people in this group stated that there are no difficulties to attend the physiotherapy sessions. They also mentioned that the health centres were flexible in providing suitable slots for appointments. In addition, there were positive comments about public transport and employers who were supportive.
Nothing whatsoever because I was able to get a time slot that suited me, which was earlyish morning. And there was no delay, you know. There was…it was all perfectly right for me (AP27, m, 72). No, no. Well, they were quite supportive at work (AP28, m, 36), No, you can get a bus to the hospital (AP15, m, 33).
Most of the participants in the ARTISAN group report not having experienced any obstacles or barriers to accessing rehabilitation services.
I didn't (have trouble to attend), but I walked attending…walked attending the physio (A23, f, 53), that’s fine (A26, f, 68).
However, some barriers remained for a small number of ARTISAN participants.
I couldn't drive. I got some free transport from the transport people. And then…and that stopped when I was told that…they had to tell me I must get on a bus because they have to keep it for people that are more seriously ill than me. And I was, therefore, trying to sort that out, and eventually, I got a friend to take me, across the road…. (After requiring additional physiotherapy sessions for frozen shoulder). (A21, f, 65) Parking. It’s terrible up there (A29, m, 26).
The physiotherapist was considered a valuable source of motivation in improving the injured shoulder by participants in both arms of the trial. All participants expressed that their physiotherapists went through the exercises and correct movement in detail as much as they could. Giving feedback and setting short and long-time goals by physiotherapists had a positive impact on the participants’ feelings, especially for ARTISAN plus.
It gave us confidence (AP10, f, 25). I don’t know who he (the physiotherapist) was, but it was a good job (AP13, m, 59). She (the physiotherapist) pretty much answered the questions anyway as we went along you know (AP20, m, 81).
The participants in the ARTISAN’s arm also found an excellent experience with their physiotherapists.
he (the physiotherapist) was a really, really, really good physio. Very straightforward, practical, on to work which I really like (A19, m, 48). He’s…he (the physiotherapist) was very, very positive attitude so that’s about all really. No, they're all very positive about what to do next (A21, f, 65). (Participant who was given additional physiotherapy session by the clinician).
Almost all participants in the ARTISAN group found the physiotherapy session helpful and informative; a few expressed they may have preferred having multiple physiotherapy sessions. A number noted that they felt that they benefited from a single session.
Yes, was helpful. He (the physiotherapist) gave me a booklet, he gave me lots of things and did say that if I had problems, then I was to go back (A14, f, 74). It was informative. They gave me a few exercises to do, and they scanned through all different movements to see where I was sort of suffering with it (A29, m, 26).
One ARTISAN participant noted that she experienced group-based physiotherapy sessions (outside of that provided by the trial). She was keen on attending these sessions because she thought it was an excellent opportunity to get peer support, to understand the limitations and develop coping strategies for dealing with issues that may arise.
Although everybody is different it was nice to talk to other people and other people have different things, but it was still nice to speak to someone in the same situation as you (A2, f, 56).
Two participants in the ARTISAN arm have sought out additional treatments or programmes apart from the training materials to increase their chance of returning to their previous sports activities.
I’m lucky enough that the club that I play rugby for has a physio that they employ as well, he recommended that the Derby shoulder stability programme, so I went along, did some of those exercises on that, and that was good, got to all progressions that I was trying to get back to, and the exercise that was provided from like the ARTISAN from the hospital was kind of due to get me back to general life, it probably would’ve been perfectly fine, but yeah, I want to go back to rugby so I know I needed to get my shoulder back to like full strength (A9, m, 24). Almost to the year, it was almost to the year and my shoulder was absolutely killing. I couldn't drive. It almost felt like well, I didn't know what was wrong with it. It felt like a frozen shoulder, and I ended up in the…I ended up going to a chiropractor (A23, f, 53).
Most participants with ARTISAN plus multiphysiotherapy sessions pointed out that they had enough chances to visit their physiotherapist to assess their shoulder movement, achieve their goals and receive instructions on doing the exercises correctly.
If I was doing something wrong, they could correct me (AP15, m, 33).
The most emphasised point in this group was getting reassurance and feedback from the physiotherapist.
Well, I suppose it’s…the fact that you can do a certain exercise over a period of time, then you get some feedback with a consultant to tell you how you’re doing (AP13, m, 59).
Several of them expressed that communication with a professional member such as a physiotherapist psychologically impacts the rehabilitation journey.
It certainly helped mentally. It gave you support. You felt that somebody was interested in trying to help, which was as much benefit as the physical side of it (AP20, m, 81).
A participant from the ARTISAN arm who received additional physiotherapy sessions highlights again the reassurance of having the contact with a therapist.
The other benefit really was the reassurance because I think one of the things that you did…that you worry about is you know it’s going to dislocate again (A19, m, 48).
The interview substudy, seamlessly integrated within the broader framework of the ARTISAN trial, served as a crucial avenue to explore the nuanced experiences of participants undergoing the trial treatments. By adopting a qualitative approach, we aimed to unravel the intricacies of their rehabilitation journeys and illuminate the factors influencing their adherence to the prescribed interventions. Our endeavour was not merely to supplement the quantitative findings of the main trial but to enrich the understanding of the outcomes by capturing the subjective narratives of the participants. Through the lens of 31 in-depth interviews, we explored the multifaceted dimensions of their experiences, ranging from their feelings about shoulder rehabilitation outcomes to their assessments of the provided rehabilitation services.
While the outcome of the trial found no difference between the two groups, the participant experiences give an insight that is a little different. 2 Similar findings were observed in the REPOSE trial, where qualitative data provided valuable context and a deeper understanding of patient experiences that were not captured by the quantitative results. 12 More ARTISAN plus participants reported that their expectations about their rehabilitation were met than those in the ARTISAN group. There were those, however, in both groups, who felt that they did not return to the level of physical activities that they would have liked (eg, Sports). Indeed, even participants in the ARTISAN plus group who had a programme of physiotherapy felt they were not reaching their preinjury levels of activity. A recent paper highlights that fear of recurrent dislocation may be a contributing factor to participants feeling they are not returning to their normal levels of physical activity. 3
Participants who only received the advice session (the ARTISAN group) do seem to want more engagement and more actual physiotherapy sessions. Several of the younger participants in the ARTISAN group have sought out additional treatment options (eg, exercise programmes, chiropractic sessions) in addition to what was provided to increase their chance of returning preinjury levels of activities. While ARTISAN plus participants, it seems were less likely to go for additional treatments outside of that provided.
The interviews give us an insight into the participants’ experiences in their rehabilitation journey. Involving them in the improvement journey seems to have a positive influence on their sense of improvement. Regardless of the participant’s allocated group, sex, age and history of doing exercise, the physiotherapist’s advice and efforts to give reassurance appear to play a crucial role in the participants’ mindset and confidence. Following operative and non-operative treatment of shoulder instability, physiotherapists plays a key role in the recovery process, supporting the patient and building strength and trust. 3 This highlights the importance of clearly communicating with participants, providing them with clear information and reassurance about their rehabilitation journey. This approach ensures effective treatment and contributes to a better overall experience and outcome for participants. Cridland et al , in a recent article, looking at patient experiences and perceptions of rotator cuff related shoulder pain rehabilitation, highlight the importance of participants’ trust in the health professional providing the rehabilitation. They note that this facilitates adherence and increases the belief that the condition is being effectively treated. 13 Main et al also emphasise the critical role of the therapeutic relationship in rehabilitation success. 14
Those participants who have engaged with the materials provided have found them helpful regardless of their background factors (sex, age and history of doing sport) and allocated arms. Both groups of participants have used the booklets and expressed good experiences with it.
The participants have raised some minor points regarding the difficulty with the booklets and the online materials were sometimes difficult to access. However, the participants in the ARTISAN plus group seem to have had a better chance of resolving this kind of problem because of having more contact with their therapist. Participants in both groups report using the videos and website less than the booklets. This is more obvious among the senior groups and women. Lack of internet access was an issue for several older participants, who struggled with digital materials. This underscores the need for alternative formats and enhanced support for digital resources to ensure all participants, regardless of their digital literacy or access to technology, can effectively engage with the provided materials. Addressing these aspects is crucial for improving the inclusivity and effectiveness of the future interventions. However, for those who viewed the video, it has given them a better idea of how to do the exercises correctly. The latter is more apparent among those participants at younger ages and with less severe injuries.
It was found that some participants, especially elderly participants, faced challenges in recalling their rehabilitation journey experiences, potentially affecting the accuracy of their recall. To mitigate this issue, the interviewer used prompts as necessary and adjusted questions to improve understanding. The study also observed variations in recall accuracy among different demographic groups, indicating that the passage of time since their rehabilitation may impact memory differently. These findings underscore the importance of demographic considerations in qualitative research, ensuring a comprehensive understanding of participants’ experiences. In addition, because of the COVID-19 pandemic and lockdown, only the first four interviews were held face-to-face, and the rest were by telephone. This potentially could have some effects on understanding the participants’ feelings and reactions, as non-verbal cues and personal rapport are more challenging to capture over the phone. Despite these limitations, efforts were made to ensure comprehensive data collection by employing consistent interview techniques and maintaining a flexible approach to question phrasing.
While our study comprehensively explored the patient experience in the ARTISAN trial, we did not evaluate the perspectives of the healthcare practitioners delivering the intervention. Understanding the experiences and insights of physiotherapists could provide valuable context to our findings. Future research should consider their views on treatment implementation. This approach aligns with the current emphasis on shared decision-making models in healthcare, where the collaboration between patients and practitioners is crucial for optimal treatment outcomes. 15
While previous qualitative studies have explored the experiences of people with shoulder instability, this study provides an in-depth reflection on participants’ voices specifically with shoulder dislocation during their physiotherapy journey within the UK-based randomised trial. However, the transferability of findings may be limited.
The overall clinical trial outcome was very conclusive, in which extraphysiotherapy was not superior and thus may not be the best form of rehabilitation for those who experience a first-time traumatic shoulder dislocation. This interview study supports this finding in that it shows us that both forms of intervention have merit for some individuals. Thus, it may be that tailoring the treatment offered to the needs of the patient is appropriate here. Not all patients want regular clinic visits or indeed support from a health professional. Recognising and facilitating this will be of benefit to both the patients and healthcare as a whole.
Patient consent for publication.
Not applicable.
Ethical approval for the interview study was included in the ethical approval of the main trial (Wales REC 3, REC reference: 18/WA/0236, 2018). All participants gave written informed consent prior to taking part. Participants gave informed consent to participate in the study before taking part.
We would like to thank Ziheng Liew for conducting the interviews. We also would like to thank all the participants who attended the interview sessions. In addition, we acknowledge this paper is written on behalf of the ARTISAN Team, and we would like to acknowledge the expert support of the ARTISAN Team which comprised: Helen Parsons, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0000-0002-2765-3728 ); Aminul Haque, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0000-0003-3589-6751 ); James Mason, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0000-0001-9210-4082 ); Henry Nwankwo, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0000-0001-7401-1923 ), Helen Bradley, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0009-0003-1663-4462 ); Stephen Drew, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, ( https://orcid.org/0000-0002-9523-682X ); Chetan Modi, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, ( https://orcid.org/0009-0008-3337-4419 ); Howard Bush, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, ( https://orcid.org/0000-0001-9360-0504 ); David Torgerson, York Clinical Trials Unit, University of York, York, UK, ( https://orcid.org/0000-0002-1667-4275 ); Martin Underwood, Warwick Clinical Trials Unit, University of Warwick, Warwick, UK, ( https://orcid.org/0000-0002-0309-1708 ).
Contributors DRE and RK have designed the study. DRE and SN have analysed the data. All authors have contribution to drafting the manuscript and reviewed. SN is the corresponding author, and all authors are guarantors for the overall content of the manuscript.
Funding ARTISAN trial founded by NIHR, Health Technology Assessment (HTA) Programme, (16/167/56) 01/06/18. The University of Warwick and University Hospitals Coventry and Warwickshire NHS Trust are co-sponsorship for this trial.
Competing interests RK is co-chair of the NIHR Programme Grants for Applied Research (PGfAR) committee, a paid position in NIHR but unrelated to the trial. She is also a previous chair of the NIHR West Midlands Research for Patient Benefit (RfPB) committee and member of the NIHR Health Technology Assessment (HTA) Clinical Evaluation and Trials Committee and NIHR Integrated Clinical Academic (ICA) doctoral committee. RK, DRE, HP, AH, JM, HN, SD, CM, HB, DT, MU have all been awarded current and previous NIHR research grants. HP, MU and RK are co-investigators on grants funded by the Australian NHMRC and NIHR funded studies receiving additional support from Stryker Ltd.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer-reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Author affiliations
Brianna Chang 3
Vivian Zagarese 4
Jamie K Turner 5 6
Ally Southworth 5
YingXing Wu 7
Paul Yeaton 8
Jeffrey S Stein 10
Sarah H Parker 4
John W Epling 1 2
Objective ‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated patients’ perceptions of sludge in the colorectal cancer (CRC) screening process and some impacts of this sludge.
Design We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey. The interviews informed final survey revisions and captured contextual data about patients’ experiences with sludge. Interview transcripts were inductively and deductively analysed to identify overarching themes. The survey quantified sludge, delayed or forgone screenings, screening experience (Net Promoter Score) and health system distrust (Health System Distrust Scale). We used χ 2 or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings, screening experience and health system distrust. Results were integrated for interpretation.
Setting Southeastern United States.
Participants Patients who were 45–75 years of age, at average risk for CRC and had either completed or been referred for CRC screening (colonoscopy or stool-based test) within the previous 12 months.
Results 22 interview participants and 255 survey participants completed the study. 38 (15%) survey participants rated their screening experience as poor (Net Promoter Score=0–7 out of 10). The mean (SD) Health System Distrust Scale score was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Perceptions of sludge in the CRC screening process varied, with long waiting times and burdensome communication being the most common sources (58% and 35% of participants, respectively). Sludge was positively associated with delayed or forgone screenings (OR=1.42, 95% CI 1.28, 1.57, p<0.001), poor screening experience (OR=1.15, 95% CI 1.04, 1.28, p=0.009) and health system distrust (β=0.47, p<0.001). Qualitative findings add descriptive detail about sludge encountered, context to impacts experienced, and illustrate the heavy emotional impact of sludge: ‘ it just isn’t worth it’ .
Conclusion Efforts to reduce sludge in the CRC screening process may improve timely completion of CRC screening, enhance patient experience and restore trust in the health system.
Administrative burden is ubiquitous in healthcare. The administrative burden that precludes or delays healthcare delivery can be described as ‘sludge’. Although there are numerous calls to reduce the sludge that clinicians and patients experience in healthcare processes, patients’ experiences with healthcare sludge have not been well described.
This study illuminates patients’ self-reported experience with sludge encountered in the colorectal cancer (CRC) screening process in the Southeastern United States. Sludge was associated with delayed or forgone screenings, poor experience and health system distrust. Participants with socioeconomic disadvantage experienced disproportionate sludge.
Study findings highlight numerous opportunities to improve CRC screening rates and enhance patient experience through clinical, operational and policy-level efforts to reduce sludge and streamline the care transitions associated with CRC screening.
With more than 2 million new cases diagnosed annually, colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. 1 Screening can play an important role in the prevention and early detection of CRC, but a significant number of individuals fail to receive timely screening. For example, in the USA, over 55 million individuals are eligible for CRC screening but have not received it. 2 Further efforts are needed to identify approaches for improving access to and completion of CRC screening.
Previous research suggests that ‘sludge’ is an underexplored barrier to the completion of CRC screening. 3 4 A behavioural economics term popularised by Harvard Law professor and author, Cass Sunstein, sludge describes administrative burdens or frictions that prevent people from achieving their goals. 5 Examples of sludge include redundant paperwork, complicated or inconsistent instructions, cumbersome communication and long waiting times. 6 As a complex, multistep pathway involving several screening test options (eg, colonoscopy, stool-based tests, flexible sigmoidoscopy), variable testing intervals and multiple care transitions (eg, primary care to gastroenterology to screening facility), the CRC screening process may be particularly prone to sludge. Although the impact of sludge on patients is not well recognised in the literature, there is evidence that patients may delay or forgo recommended care as a result of sludge, especially when they are in poor health. 4 7 8 In addition, sludge can contribute to psychological distress, confusion and anger and there is some evidence that sludge decreases trust. 9 10 Importantly, sludge may disproportionately impact disadvantaged patients, which can widen health and healthcare disparities. 10–12
There are multiple calls to reduce sludge in healthcare, 13–19 including the National Health Service Bureaucracy Busting Concordat 20 and the American Medical Association’s campaign for Getting Rid of Stupid Stuff . 21 Improved understanding of patients’ experiences with sludge is needed to respond to such calls through clinical, operational and policy-level efforts to improve the CRC screening process and enhance screening rates. Thus, the purpose of this mixed methods study was to evaluate patients’ experiences with sludge in the CRC screening process and to explore some impacts of this sludge. We hypothesised that sludge in the CRC screening process is: (a) common; (b) related to delayed or forgone screenings, poor screening experience and health system distrust; and (c) differentially experienced by patients living in rural areas and with socioeconomic disadvantage.
Using an exploratory sequential mixed methods study design, 22 we conducted a qualitative interview of patients who had recently engaged in the CRC screening process, followed by a quantitative survey of a second group of patients who had recently engaged in the CRC process. The semistructured interviews informed refinements to the patient survey and offered contextual insight into patients’ experiences with sludge in the CRC screening process. The survey quantified patient-reported sludge in the CRC screening process and evaluated the relationship between this sludge and delayed or forgone screenings, screening experience and health system distrust.
Informed consent was provided by participants before beginning the study. The Strengthening the Reporting of Observational Studies in Epidemiology for cross-sectional studies, 23 the Consolidated Criteria for Reporting Qualitative Research 24 and Advancing the Reporting of Mixed Methods Studies 22 checklists guided our research and the development of this report. The following abbreviations are used in the results: primary care provider (PCP), faecal immunochemical test (FIT), FIT-DNA test (Cologuard).
This study was conducted in southwest and south-central Virginia where the CRC screening rate is the lowest and CRC incidence is the highest in the state. 25 26 Interview and survey participants were mutually exclusive groups of patients who were 45–75 years of age, had either completed or been referred for CRC screening (colonoscopy or stool-based test) at a health system, centre or practice in southwest or south-central Virginia within the previous 12 months, and had no history of gastrointestinal cancer or inflammatory bowel disease (at any point) or gastrointestinal pain or rectal bleeding within the past 12 months. Participants were compensated via gift cards.
Study procedures are shown in figure 1 .
Overview of exploratory sequential mixed methods study design.
Prospective participants, identified via health system records or recruited via targeted regional social media posts, were invited to screen for eligibility to participate in a semistructured interview focused on their experience with CRC screening by completing a brief online screening instrument administered via REDCap. 27 Eligible participants were enrolled, consented and engaged in one approximately 60 min interview session with a researcher (BC) via video chat or in person in a private office space. The interview guide is included in online supplemental file 1 . Additional information for the qualitative procedures is included in online supplemental file 2 .
During Part 1 of the interview, participants completed a pilot version of the survey, pausing at designated points to provide feedback on the structure, format and clarity of survey questions and instructions. Participants then responded to the researcher’s open-ended questions during Part 2 of the interview, beginning with a request to share a detailed account of their recent experience with the CRC screening process and followed by prompts to elicit further details about sludge in the screening process, and if applicable, their response to any sludge experienced. The researcher kept field notes during both parts of the interviews and continued interviews until thematic saturation was achieved. Interviews were audio recorded and later transcribed for analysis. Transcript feedback was not elicited from participants.
Using the same eligibility criteria described in the previous section, patients were invited to participate in a survey about their experience with the CRC screening process ( online supplemental file 3 ). Developed by the research team and iteratively refined through collaborative work sessions, community engagement studios, 28 internal pilot testing and participant feedback during interview Part 1, the survey consisted of original and previously validated questions focused on sludge, screening experience and health system distrust. A summary of the survey development and evaluation process is included in online supplemental file 4 .
To evaluate sludge, participants were asked about their experience with administrative burdens that felt excessive or unnecessary during their CRC screening process (defined as beginning when a healthcare provider recommended screening and ending when the provider and the patient both receive results). Participants who had not completed the screening were asked to respond based on whatever portion of the process they had completed. Informed by previous work, 3 7 8 we specifically asked participants to quantify (on a 0–100 sliding scale) the amount of paperwork, communication, technology and waiting that felt excessive or unnecessary during the CRC screening process, with several examples provided for each ( online supplemental file 3 ). Two categories were assigned for waiting based on participant feedback offered throughout the survey refinement process (including interview Part 1). ‘Waiting–passive’ represented a delay or period of time during which the patient was waiting for a step in the CRC screening process to occur, but during which their time was not occupied (eg, waiting to be called to schedule a colonoscopy appointment, waiting for the appointment to occur, waiting to receive results), whereas ‘waiting–active’ represented the time, typically on-site in a healthcare facility, when patients were waiting for something to occur and during which they were not available to do something else (eg, in a waiting room). We calculated a cumulative sludge score by summing the sliding scale ratings for each sludge type for a potential score of 500. Participants were also asked in which phase(s) of the screening process (referral, scheduling, preparing, the test itself, acquiring results) they experienced each type of sludge.
To evaluate the impact of sludge on patients, we assessed three outcomes: delayed or forgone screenings, screening experience and health system distrust. Informed by the work of Kyle and Frakt, 8 we assessed delayed or forgone screenings via two questions: Was your colorectal cancer screening test delayed due to excessive or unnecessary administrative burden? and Did you skip your colorectal cancer screening test due to excessive or unnecessary administrative burden? We used the single-item Net Promoter Score (NPS) 29 ( How likely would you be to recommend this screening process to a close friend or family member? ), with 0 indicating not at all likely and 10 indicating extremely likely to assess ratings of screening experience and the Healthcare System Distrust Scale (HSDS) 30 to assess overall health system distrust.
General demographics and CRC screening characteristics (eg, type of screening test) were also collected. We used the US Department of Agriculture Rural-Urban Commuting Area codes to determine rurality. 31 Based on a priori power analysis showing that a sample size of 234 participants was needed to show a moderate effect size at the 0.05 level, we aimed to recruit 250 participants in anticipation of incomplete surveys.
Interview analysis.
For interview Part 1, one researcher (MR) listened to audio recordings of interviews, summarising potential survey modifications that emerged from participants’ feedback. This summary was combined with the interviewer’s field notes and reviewed with the senior author (JWE) to inform minor survey edits. For interview Part 2, interviews were auto transcribed using Microsoft Teams, with two researchers (JT and MR) manually verifying accuracy. Transcripts were uploaded to NVivo (QSR International, Melbourne, Australia) for analysis.
The qualitative analysis team used reflexive thematic analysis to identify and interpret themes that emerged from the data. 32 To obtain a codebook that included different perspectives, four researchers analysed transcripts, with VZ and AS using an inductive approach (emerging themes) and JT and EO using a deductive approach informed by themes identified in community engagement studios and our prior work. 3 Through an iterative, multiphase process, the codebooks were consolidated and refined to focus on participants’ experiences with sludge in the CRC screening process and their response to this sludge. We used Cohen’s kappa to assess coder agreement, with the average agreement among all four coders being 0.69 (moderate agreement). 33 The final output was a table of interview themes and exemplary quotations in online supplemental file 5 .
Continuous variables were summarised using either the mean with SD or the median with IQR, while categorical variables were presented as percentages. Strata for cumulative sludge scores (≤25 and >25) and NPS (0–7 and 8–10) were determined via visual inspection of data distributions. We conducted univariable comparisons using t-tests (or Wilcoxon two-sample tests) and analysis of variance (or Kruskal-Wallis tests) for continuous variables and χ 2 tests (or Fisher’s exact tests) for categorical variables. The association between the cumulative sludge score and primary outcome variables (delayed or forgone screenings, screening experience, distrust) was evaluated using linear and logistic regressions with the following candidate variables included in the regressions: cumulative sludge score, age group, gender, race, rurality, insurer, screening status and screening type. Ethnicity was not included in the analysis due to the limited number of Hispanic/Latino participants. To assess the contribution of each sludge type, we ran additional exploratory regressions with individual sludge-type subscores retained without variable selection. Statistical analyses were performed using R V.4.2 ( https://cran.r-project.org/ ).
To complement the research team’s interpretation of interview and survey results, we invited 16 professionals with expertise in CRC screening, behavioural economics, health equity, healthcare operations, health policy and/or patient advocacy to serve on an external expert panel. Panellists independently reviewed summaries of interview themes and survey results and responded to a structured online survey ( online supplemental file 6 ). Research team members were presented with interview and survey results and expert panel responses. The senior author (JWE) guided collaborative discussions to identify areas of convergence, complementarity or dissonance in the data and to come to consensus on key findings.
A total of 22 participants (mean (SD) age: 55.4 (9.2) years, 64% women) engaged in interviews, while 262 participants completed surveys (67% response rate) ( table 1 ). Seven survey responses were omitted since they were less than 80% complete, leaving a final sample of 255 (mean (SD) age: 58.2 (8.4) years, 65% women). 34 Demographic characteristics of the interview and survey cohorts are representative of the southwest and south-central Virginia regions. Below, we weave survey results with key themes and exemplary quotes from open-ended survey responses and the thematic analysis of interviews. 24
Most survey participants (n=178, 70%) experienced excessive or unnecessary administrative burdens or frictions during the CRC screening process (sludge score >25). Cumulative sludge scores ranged from 0 to 355 out of 500 possible points, with mean (SD) of 95.1 (89.2) and median (IQR) of 68 (16, 157). Waiting–passive was the most common type of sludge experienced, followed by waiting–active, communication, paperwork and technology ( table 2 ).
Cumulative sludge score varied by screening completion status (completed—median (IQR): 51 (12, 129) vs not completed—154 (70, 215), p<0.001); interview participants described feeling relieved or ‘ better about all the hassle ’ after the test was over. Sludge was reported in all phases of the CRC screening process but varied by screening phase and screening type ( figure 2 ). Survey participants who had completed screening reported sludge in 0 (43%), 1 (24%), 2 (18%), 3 (11%) or ≥4 (4%) phases, with scheduling the screening test as the most common (41%). Interview participants described missed calls, voicemails and ‘ a never-ending game of phone tag ’ during scheduling.
Types of sludge reported in each phase of the colorectal cancer screening process (colonoscopy and stool-based tests). The cumulative sludge score was higher for colonoscopy (median 76 (IQR 25,166)) than stool-based tests (median 48 (IQR 9, 150)) (p<0.05). IT, information technology.
Participants who had stool-based tests described confusion, ranging from ‘ not clear’ to ‘ utter chaos’ around multiple phases of the process. They found that instructions were inconsistent or incomplete, difficult to understand and that there were forms they needed but did not have. Some described challenges with scheduling a time to pick up their test kit. Others reported that they never received results and, in some cases, that their ordering clinician did not receive results either.
You have to go to some other place to pick up the special testing kit or else your insurance won’t cover it. I don’t have time to mess with going to yet another place. …I didn’t understand what to do so I just threw it in the trash. I did not understand the directions for Cologuard. It says it is easy but there were like 10 steps, and I had no clue what to do. They literally lost my poop card in the mail. WTF?
Cumulative sludge score was significantly higher for participants with Medicaid or dual Medicare-Medicaid (median (IQR): 79 (36, 169)) versus other payers (median (IQR): 60 (23, 126)) (p=0.048), but did not differ by other demographics ( online supplemental file 7 ). Reports of sludge related to financial processes were common.
…can’t figure out how to use my insurance website to know if this will be covered without my daughter’s help. I keep worrying about all those forms you have to turn in because if I do it wrong, they are going to mess up and charge me—that always happens—and I don’t have time to deal with it and I can’t pay for it. …getting all the billing stuff straightened out every single time…well, it just isn’t worth it.
Some participants perceived inequality in the waiting time for colonoscopy, stating that ‘ it’s all about who you know’ and ‘ whether or not your doctor is part of their system’ that determines waiting time. Others perceived profit-motivated drivers of sludge in the screening process.
They take anyone with the best insurance first, so they make more money. …no way that someone poor like me is going to make it to the top of the wait list no matter what my risk is because they say that Medicaid and Medicare don’t pay them good.
There were a few examples of participants misunderstanding the concept of administrative burden or sludge. Some misattributed the high cost of care, having to complete the colonoscopy prep, and concern about anaesthesia to sludge.
Delayed or forgone screenings, poor experience and health system distrust.
81 (37%) of survey participants indicated that their CRC screening test was delayed or forgone due to excessive or unnecessary paperwork, communication, technology or waiting. 38 (15%) survey participants rated their experience as poor (NPS of 0–7 out of 10). The mean (SD) for HSDS was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Variation in outcomes by demographic and screening characteristics is included in online supplemental file 7 .
Compared with survey participants who reported sludge in the CRC screening process, those who reported no sludge or very minimal sludge (cumulative sludge score ≤25) had a lower proportion of delayed or forgone screenings, fewer poor experience ratings and lower distrust scores ( figure 3 ). In our regression analysis using variable selection ( table 3 ), there was a positive relationship between cumulative sludge score and delayed or forgone screening, poor screening experience and health system distrust. In a separate regression run without variable selection to explore prediction of the outcomes with each type of sludge, there was a positive relationship between cumulative sludge score and delayed or forgone screening, poor screening experience and health system distrust ( table 4 ). Sludge in technology and both waiting variables was associated with delayed or forgone screenings, sludge in communication was associated with poor screening experience and sludge in communication and waiting–passive was associated with health system distrust.
Delayed or forgone screenings (A), poor screening experience (B) and health system distrust (C) in patients who experience no or very minimal sludge versus sludge. Cumulative sludge score ≤25 (n=77), cumulative sludge score >25 (n=178). Overall health system distrust: Healthcare System Distrust Scale (HSDS); the vertical axis shows the maximum possible score. *Mean.
…after a while, you just say forget it. It’s not worth it. I’m not really likely to recommend this process… it’s hard…especially when you work full time…
Participants expressed a general expectation that accessing healthcare is associated with ‘ jumping through multiple hoops’ , ‘ scheduling really far out’ , ‘ being your own advocate’ and resigning to ‘ the broken system’ .
Some participants described factors that mitigated the impact of sludge. For example, family history of CRC, social support and previous experience with CRC screening helped participants persist through sludge. Relationship with a PCP also facilitated the process: ‘ if Dr. [name omitted] wants me to do it, I’m going to do it no matter what’ . In contrast, perceptions of personal risk, mistrust in the health system, previous negative experiences with healthcare and unfamiliarity with the screening process exacerbated the impacts of sludge.
Sludge describes the administrative burdens or bureaucratic ‘red tape’ that patients may face in the process of acquiring healthcare. 6 Understanding patients’ experiences with sludge is crucial to responding to calls for reducing sludge and its harmful sequelae. In this mixed methods study, we found that most participants experienced some degree of sludge in the CRC screening process, with socioeconomically disadvantaged patients experiencing greater sludge. Those who experienced more sludge were more likely to delay or forgo screening, describe their screening experience as poor and report greater distrust in the health system. Given that delaying or forgoing screening increases CRC risk, efforts to reduce sludge may improve CRC screening rates and reduce the morbidity and mortality associated with CRC. Additionally, patient experience is an important component of healthcare quality, 35 and the eroding distrust in the health system is a widespread concern. 36 37 As such, reducing the sludge associated with the CRC screening process represents an opportunity to enhance healthcare quality and take important steps towards restoring trust in the health system.
Our findings align with others’ who have shown that individuals with socioeconomic disadvantage experience more administrative burden and greater negative impacts associated with this burden. 12 38–40 The concept of scarcity has been related to the experience of sludge. 41 Patients with limited resources (eg, finances, time, understanding) and overloaded with stressors may have less capacity to persist through sludge. Thus, reducing sludge may play an important role in reducing socioeconomic disparities in CRC screening and outcomes.
The scale-based outcomes in this study require some additional interpretation. The effect sizes observed for experience and distrust were generally small to moderate, but the qualitative data illustrate the depth of feeling associated with the outcomes. We chose a cut-off for the NPS (experience) that is felt to represent true dissatisfaction, rather than passivity, so even small magnitude findings of a poor experience in this study are meaningful. 29 We also consider any elevation in patients’ distrust of the health system to be important, even if incremental. In addition, we noted a relationship between completion of screening and improved experience and distrust scores, which may be attributable to a form of recall or recency bias affecting respondents’ answers. Since most CRC screening results are reassuring (negative findings), respondents who have completed screening will have had a ‘good’ final outcome and remember the experience as overall less traumatic. Further work in this area could ascertain screening results as additional information to aid analysis.
Subsequent efforts to uncover patients’ experiences with sludge encountered in cancer screening processes and to reduce this sludge may call on existing frameworks 11 42 and sludge reduction efforts in non-healthcare fields 5 43 44 to focus on the following:
Characterising additional impacts of sludge beyond delayed or forgone screenings, poor experience and distrust.
Evaluating the intersection between sludge and other well-recognised barriers to cancer screening (eg, low perception of risk, fear, embarrassment). 45–47
Exploring sludge tolerance (ie, what makes some people resilient throughout sludge-heavy processes while others are more vulnerable?). Our qualitative results suggest several factors that mitigated or intensified sludge.
Refocusing resources dedicated to improving the rate of delivery of preventive services to reducing health system and insurance-related sludge.
Streamlining the coordination of care between primary care and others involved in the cancer screening process.
Tailoring interventions to reduce sludge based on the associations identified in this study. For example, to enhance the patient experience, focusing on innovative communication efforts can keep patients engaged in the screening process as well as minimising perception of inequity or favouritism.
Evaluating messaging and communication methods preferred by patients when waiting times (passive or active) are inevitable.
Evaluating the impact and cost-effectiveness of patient navigator programmes to improve screening rates versus policy and process efforts to reduce sludge. 48 49
Incorporating quality metrics and incentives that promote administrative simplification and sludge reduction.
In the USA, most public and private insurers are required to cover the costs of clinical preventive services graded A or B by the US Preventive Services Task Force, with zero associated out-of-pocket cost to patients, as described in Section 2713 of the Affordable Care Act. 50 However, administration of this requirement is nuanced, can be sludge-laden, may require interaction with insurance companies and sometimes results in patient charges. Based on the burden of healthcare costs to many Americans and the concerns expressed by participants in the present study, assuring that patients are not responsible for out-of-pocket charges for cancer screenings, that there are no additional fees, that insurance-related paperwork and correspondence are minimised and simplified and that the number of uninsured patients is reduced is essential to improving CRC screening adherence, experience and outcomes.
Our study had some limitations. Although our participant cohorts were representative of the region and included participants affiliated with multiple health systems, centres and providers, the lack of diversity of our cohort (eg, racial, ethnic, language) and single region studied may limit the generalisability of results. Additionally, we report on the impact of sludge on only three outcome variables based on previous work by our team and others, 3 7 12 although we recognise that sludge likely impacts patients in numerous and potentially overlapping ways. Finally, the NPS, used to evaluate participants’ experience with the CRC screening process, is limited to a single question assessment that may not capture the complexity of decision-making around CRC screening.
There are numerous national calls to reduce the harmful administrative burden—sludge—encountered by patients as they seek recommended healthcare services. In this patient-focused, mixed methods study, sludge in the CRC screening process was positively associated with delayed or forgone screenings, poor screening experience and health system distrust. Participants with socioeconomic disadvantage experienced more sludge and greater impacts of sludge compared with those without socioeconomic disadvantage. Clinical, operational and policy-level efforts to reduce sludge may improve CRC screening rates, reduce disparities, enhance experience and reduce health system distrust.
IMAGES
VIDEO
COMMENTS
Qualitative Research Topics. Qualitative Research Topics are as follows: Understanding the lived experiences of first-generation college students. Exploring the impact of social media on self-esteem among adolescents. Investigating the effects of mindfulness meditation on stress reduction. Analyzing the perceptions of employees regarding ...
Anthropology. Political science. Psychology. Business management. History. Social science. The main goal of qualitative research is to help you understand the topic of your assignment by identifying the most important aspects of your topic and gathering enough information to provide an in-depth analysis of the topic at hand and provide the ...
Here are fantastic examples of qualitative research titles: Female harm: how it is influenced by culture. The socioeconomic impacts of free education. The link between food insecurity and poor performance in schools. Alcoholism among college students: a critical study. How to mitigate child labor in our society.
4. Feasibility: Assess whether the topic is feasible within the scope of your research project.Consider factors like available time, resources, and access to potential participants or data sources. 5. Clarity and Specificity: Your research topic should be clear, specific, and well-defined. Avoid overly broad topics that are difficult to explore in depth.
This article presents a list of 130-plus qualitative research topic ideas to help learners that struggle to get titles for their papers. It is helpful because many learners have difficulties picking titles that will make their essays impressive to educators. But before presenting the topics, this article defines qualitative research.
Qualitative research topics in education. The inner world of a modern schoolchild. Educational potential of epic texts in developing interest in the history of the motherland. Educational functions of the media. Educational potential of folk tales. Self-knowledge and self-education.
Examples of qualitative research topics can be found across different fields such as nursing and education, emphasizing the importance of selecting a well-researched topic to achieve academic success in a research paper. The core of qualitative research lies in its ability to explore complex phenomena from a subjective angle. Researchers gather ...
Revised on September 5, 2024. Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research. Qualitative research is the opposite of quantitative research, which ...
February 2015. by Erin E. Toolis and Phillip L. Hammack. Lifetime Activism, Marginality, and Psychology: Narratives of Lifelong Feminist Activists Committed to Social Change (PDF, 93KB) August 2014. by Anjali Dutt and Shelly Grabe. Qualitative Inquiry in the History of Psychology (PDF, 82KB) February 2014. by Frederick J. Wertz.
Revised on 30 January 2023. Qualitative research involves collecting and analysing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research. Qualitative research is the opposite of quantitative research, which ...
While many books and articles guide various qualitative research methods and analyses, there is currently no concise resource that explains and differentiates among the most common qualitative approaches. We believe novice qualitative researchers, students planning the design of a qualitative study or taking an introductory qualitative research course, and faculty teaching such courses can ...
5. Case study research. Case studies are a UX research method that provides comprehensive and contextual insights into a real-world case over a long period of time. They typically include a range of other qualitative research methods, like interviews, observations, and ethnographic research.
Qualitative research is a behavioral research method that seeks to understand the undertones, motivations, and subjective interpretations inherent in human behavior. It involves gathering nonnumerical data, such as text, audio, and video, allowing you to explore nuances and patterns that quantitative data can't capture.
Qualitative research: methods and examples. Qualitative research is an excellent way to gain insight into real-world problems. This research type can explain various aspects of individuals in a target group, such as their traits, behaviors, and motivations. Qualitative research involves gathering and evaluating non-numerical information to ...
Qualitative research is defined as an exploratory method that aims to understand complex phenomena, often within their natural settings, by examining subjective experiences, beliefs, attitudes, and behaviors. Unlike quantitative research, which focuses on numerical measurements and statistical analysis, qualitative research employs a range of ...
Qualitative Research Topics: Psych, Education, Health, Medicine & More. Wandering around the internet looking for qualitative research topics can be exhausting. We are writing this article to make it a one-stop solution for you. There is enough inspiration to come up with the most suitable topic for you, no matter your academic area.
Qualitative research questions are open-ended and seek to explore a given topic in-depth. According to the Australian & New Zealand Journal of Psychiatry , "Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans' lives and social worlds."
Abstract. This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions ...
Qualitative Research. Qualitative research is a type of research methodology that focuses on exploring and understanding people's beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.
In qualitative research, you sample deliberately, not at random. The most commonly used deliberate sampling strategies are purposive sampling, criterion sampling, theoretical sampling, convenience sampling and snowball sampling. ... To prepare an interview guide to enhance that a set of topics will be covered by every participant, ...
Top 70 Qualitative Research Topics To Ace 2022. November 16, 2020. There is no denying it; qualitative research topics are not as easy as ABC. To some, statistics is an enthralling subject while others may opt to clean the sea rather than sit in a statistics class. Millions of students around the globe face this crossroad.
83 Qualitative Research Questions & Examples. Start your free trial. by Liz March , Digital Research Specialist. 15 Min. December 31, 2022. Qualitative research questions help you understand consumer sentiment. They're strategically designed to show organizations how and why people feel the way they do about a brand, product, or service.
Context: Within tourism and hospitality, this question explores the qualitative aspects of cultural experiences, focusing on tourists' perceptions and interpretations of authenticity in local culinary traditions. Media and Entertainment: Question: How do audiences engage with and interpret representations of diverse identities in streaming ...
The following are examples of qualitative research topics. Qualitative Research Topics on Education. Discuss how remote learning has contributed to shaping communication in educational settings. Describe the educational function of the media, especially social media.
What qualitative research methods are used for sociology topics? Qualitative research methods are central to sociology, offering deep insights into the social processes, meanings, and experiences that shape human behavior. These methods are particularly effective for exploring complex social phenomena in detail and understanding the ...
Qualitative research is, oftentimes, an emotional, relational, political and intellectual rollercoaster ride. ... Under the findings and discussion, examples of how memos and poetry were used as reflexivity tools throughout the research process are shared. ... Who and where am I in this research topic? Oftentimes, in doctoral research, students ...
The study also observed variations in recall accuracy among different demographic groups, indicating that the passage of time since their rehabilitation may impact memory differently. These findings underscore the importance of demographic considerations in qualitative research, ensuring a comprehensive understanding of participants' experiences.
Methods. Using an exploratory sequential mixed methods study design,22 we conducted a qualitative interview of patients who had recently engaged in the CRC screening process, followed by a quantitative survey of a second group of patients who had recently engaged in the CRC process. The semistructured interviews informed refinements to the patient survey and offered contextual insight into ...