how to discuss qualitative research findings

How To Write The Results/Findings Chapter

For qualitative studies (dissertations & theses).

By: Jenna Crossley (PhD). Expert Reviewed By: Dr. Eunice Rautenbach | August 2021

So, you’ve collected and analysed your qualitative data, and it’s time to write up your results chapter. But where do you start? In this post, we’ll guide you through the qualitative results chapter (also called the findings chapter), step by step. 

Overview: Qualitative Results Chapter

• What (exactly) the qualitative results chapter is
• What to include in your results chapter
• How to write up your results chapter
• A few tips and tricks to help you along the way
• Free results chapter template

What exactly is the results chapter?

The results chapter in a dissertation or thesis (or any formal academic research piece) is where you objectively and neutrally present the findings of your qualitative analysis (or analyses if you used multiple qualitative analysis methods ). This chapter can sometimes be combined with the discussion chapter (where you interpret the data and discuss its meaning), depending on your university’s preference.  We’ll treat the two chapters as separate, as that’s the most common approach.

In contrast to a quantitative results chapter that presents numbers and statistics, a qualitative results chapter presents data primarily in the form of words . But this doesn’t mean that a qualitative study can’t have quantitative elements – you could, for example, present the number of times a theme or topic pops up in your data, depending on the analysis method(s) you adopt.

Adding a quantitative element to your study can add some rigour, which strengthens your results by providing more evidence for your claims. This is particularly common when using qualitative content analysis. Keep in mind though that qualitative research aims to achieve depth, richness and identify nuances , so don’t get tunnel vision by focusing on the numbers. They’re just cream on top in a qualitative analysis.

So, to recap, the results chapter is where you objectively present the findings of your analysis, without interpreting them (you’ll save that for the discussion chapter). With that out the way, let’s take a look at what you should include in your results chapter.

What should you include in the results chapter?

As we’ve mentioned, your qualitative results chapter should purely present and describe your results , not interpret them in relation to the existing literature or your research questions . Any speculations or discussion about the implications of your findings should be reserved for your discussion chapter.

In your results chapter, you’ll want to talk about your analysis findings and whether or not they support your hypotheses (if you have any). Naturally, the exact contents of your results chapter will depend on which qualitative analysis method (or methods) you use. For example, if you were to use thematic analysis, you’d detail the themes identified in your analysis, using extracts from the transcripts or text to support your claims.

While you do need to present your analysis findings in some detail, you should avoid dumping large amounts of raw data in this chapter. Instead, focus on presenting the key findings and using a handful of select quotes or text extracts to support each finding . The reams of data and analysis can be relegated to your appendices.

While it’s tempting to include every last detail you found in your qualitative analysis, it is important to make sure that you report only that which is relevant to your research aims, objectives and research questions .  Always keep these three components, as well as your hypotheses (if you have any) front of mind when writing the chapter and use them as a filter to decide what’s relevant and what’s not.

Need a helping hand?

How do I write the results chapter?

Now that we’ve covered the basics, it’s time to look at how to structure your chapter. Broadly speaking, the results chapter needs to contain three core components – the introduction, the body and the concluding summary. Let’s take a look at each of these.

Section 1: Introduction

The first step is to craft a brief introduction to the chapter. This intro is vital as it provides some context for your findings. In your introduction, you should begin by reiterating your problem statement and research questions and highlight the purpose of your research . Make sure that you spell this out for the reader so that the rest of your chapter is well contextualised.

The next step is to briefly outline the structure of your results chapter. In other words, explain what’s included in the chapter and what the reader can expect. In the results chapter, you want to tell a story that is coherent, flows logically, and is easy to follow , so make sure that you plan your structure out well and convey that structure (at a high level), so that your reader is well oriented.

The introduction section shouldn’t be lengthy. Two or three short paragraphs should be more than adequate. It is merely an introduction and overview, not a summary of the chapter.

Pro Tip – To help you structure your chapter, it can be useful to set up an initial draft with (sub)section headings so that you’re able to easily (re)arrange parts of your chapter. This will also help your reader to follow your results and give your chapter some coherence.  Be sure to use level-based heading styles (e.g. Heading 1, 2, 3 styles) to help the reader differentiate between levels visually. You can find these options in Word (example below).

Section 2: Body

Before we get started on what to include in the body of your chapter, it’s vital to remember that a results section should be completely objective and descriptive, not interpretive . So, be careful not to use words such as, “suggests” or “implies”, as these usually accompany some form of interpretation – that’s reserved for your discussion chapter.

The structure of your body section is very important , so make sure that you plan it out well. When planning out your qualitative results chapter, create sections and subsections so that you can maintain the flow of the story you’re trying to tell. Be sure to systematically and consistently describe each portion of results. Try to adopt a standardised structure for each portion so that you achieve a high level of consistency throughout the chapter.

For qualitative studies, results chapters tend to be structured according to themes , which makes it easier for readers to follow. However, keep in mind that not all results chapters have to be structured in this manner. For example, if you’re conducting a longitudinal study, you may want to structure your chapter chronologically. Similarly, you might structure this chapter based on your theoretical framework . The exact structure of your chapter will depend on the nature of your study , especially your research questions.

As you work through the body of your chapter, make sure that you use quotes to substantiate every one of your claims . You can present these quotes in italics to differentiate them from your own words. A general rule of thumb is to use at least two pieces of evidence per claim, and these should be linked directly to your data. Also, remember that you need to include all relevant results , not just the ones that support your assumptions or initial leanings.

In addition to including quotes, you can also link your claims to the data by using appendices , which you should reference throughout your text. When you reference, make sure that you include both the name/number of the appendix , as well as the line(s) from which you drew your data.

As referencing styles can vary greatly, be sure to look up the appendix referencing conventions of your university’s prescribed style (e.g. APA , Harvard, etc) and keep this consistent throughout your chapter.

Section 3: Concluding summary

The concluding summary is very important because it summarises your key findings and lays the foundation for the discussion chapter . Keep in mind that some readers may skip directly to this section (from the introduction section), so make sure that it can be read and understood well in isolation.

In this section, you need to remind the reader of the key findings. That is, the results that directly relate to your research questions and that you will build upon in your discussion chapter. Remember, your reader has digested a lot of information in this chapter, so you need to use this section to remind them of the most important takeaways.

Importantly, the concluding summary should not present any new information and should only describe what you’ve already presented in your chapter. Keep it concise – you’re not summarising the whole chapter, just the essentials.

Tips for writing an A-grade results chapter

Now that you’ve got a clear picture of what the qualitative results chapter is all about, here are some quick tips and reminders to help you craft a high-quality chapter:

• Your results chapter should be written in the past tense . You’ve done the work already, so you want to tell the reader what you found , not what you are currently finding .
• Make sure that you review your work multiple times and check that every claim is adequately backed up by evidence . Aim for at least two examples per claim, and make use of an appendix to reference these.
• When writing up your results, make sure that you stick to only what is relevant . Don’t waste time on data that are not relevant to your research objectives and research questions.
• Use headings and subheadings to create an intuitive, easy to follow piece of writing. Make use of Microsoft Word’s “heading styles” and be sure to use them consistently.
• When referring to numerical data, tables and figures can provide a useful visual aid. When using these, make sure that they can be read and understood independent of your body text (i.e. that they can stand-alone). To this end, use clear, concise labels for each of your tables or figures and make use of colours to code indicate differences or hierarchy.
• Similarly, when you’re writing up your chapter, it can be useful to highlight topics and themes in different colours . This can help you to differentiate between your data if you get a bit overwhelmed and will also help you to ensure that your results flow logically and coherently.

If you have any questions, leave a comment below and we’ll do our best to help. If you’d like 1-on-1 help with your results chapter (or any chapter of your dissertation or thesis), check out our private dissertation coaching service here or book a free initial consultation to discuss how we can help you.

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20 Comments

This was extremely helpful. Thanks a lot guys

Hi, thanks for the great research support platform created by the gradcoach team!

I wanted to ask- While “suggests” or “implies” are interpretive terms, what terms could we use for the results chapter? Could you share some examples of descriptive terms?

I think that instead of saying, ‘The data suggested, or The data implied,’ you can say, ‘The Data showed or revealed, or illustrated or outlined’…If interview data, you may say Jane Doe illuminated or elaborated, or Jane Doe described… or Jane Doe expressed or stated.

I found this article very useful. Thank you very much for the outstanding work you are doing.

What if i have 3 different interviewees answering the same interview questions? Should i then present the results in form of the table with the division on the 3 perspectives or rather give a results in form of the text and highlight who said what?

I think this tabular representation of results is a great idea. I am doing it too along with the text. Thanks

That was helpful was struggling to separate the discussion from the findings

this was very useful, Thank you.

Very helpful, I am confident to write my results chapter now.

It is so helpful! It is a good job. Thank you very much!

Very useful, well explained. Many thanks.

Hello, I appreciate the way you provided a supportive comments about qualitative results presenting tips

I loved this! It explains everything needed, and it has helped me better organize my thoughts. What words should I not use while writing my results section, other than subjective ones.

Thanks a lot, it is really helpful

Thank you so much dear, i really appropriate your nice explanations about this.

Thank you so much for this! I was wondering if anyone could help with how to prproperly integrate quotations (Excerpts) from interviews in the finding chapter in a qualitative research. Please GradCoach, address this issue and provide examples.

what if I’m not doing any interviews myself and all the information is coming from case studies that have already done the research.

Very helpful thank you.

This was very helpful as I was wondering how to structure this part of my dissertation, to include the quotes… Thanks for this explanation

This is very helpful, thanks! I am required to write up my results chapters with the discussion in each of them – any tips and tricks for this strategy?

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Qualitative Data Analysis

23 Presenting the Results of Qualitative Analysis

Mikaila Mariel Lemonik Arthur

Qualitative research is not finished just because you have determined the main findings or conclusions of your study. Indeed, disseminating the results is an essential part of the research process. By sharing your results with others, whether in written form as scholarly paper or an applied report or in some alternative format like an oral presentation, an infographic, or a video, you ensure that your findings become part of the ongoing conversation of scholarship in your field, forming part of the foundation for future researchers. This chapter provides an introduction to writing about qualitative research findings. It will outline how writing continues to contribute to the analysis process, what concerns researchers should keep in mind as they draft their presentations of findings, and how best to organize qualitative research writing

As you move through the research process, it is essential to keep yourself organized. Organizing your data, memos, and notes aids both the analytical and the writing processes. Whether you use electronic or physical, real-world filing and organizational systems, these systems help make sense of the mountains of data you have and assure you focus your attention on the themes and ideas you have determined are important (Warren and Karner 2015). Be sure that you have kept detailed notes on all of the decisions you have made and procedures you have followed in carrying out research design, data collection, and analysis, as these will guide your ultimate write-up.

First and foremost, researchers should keep in mind that writing is in fact a form of thinking. Writing is an excellent way to discover ideas and arguments and to further develop an analysis. As you write, more ideas will occur to you, things that were previously confusing will start to make sense, and arguments will take a clear shape rather than being amorphous and poorly-organized. However, writing-as-thinking cannot be the final version that you share with others. Good-quality writing does not display the workings of your thought process. It is reorganized and revised (more on that later) to present the data and arguments important in a particular piece. And revision is totally normal! No one expects the first draft of a piece of writing to be ready for prime time. So write rough drafts and memos and notes to yourself and use them to think, and then revise them until the piece is the way you want it to be for sharing.

Bergin (2018) lays out a set of key concerns for appropriate writing about research. First, present your results accurately, without exaggerating or misrepresenting. It is very easy to overstate your findings by accident if you are enthusiastic about what you have found, so it is important to take care and use appropriate cautions about the limitations of the research. You also need to work to ensure that you communicate your findings in a way people can understand, using clear and appropriate language that is adjusted to the level of those you are communicating with. And you must be clear and transparent about the methodological strategies employed in the research. Remember, the goal is, as much as possible, to describe your research in a way that would permit others to replicate the study. There are a variety of other concerns and decision points that qualitative researchers must keep in mind, including the extent to which to include quantification in their presentation of results, ethics, considerations of audience and voice, and how to bring the richness of qualitative data to life.

Quantification, as you have learned, refers to the process of turning data into numbers. It can indeed be very useful to count and tabulate quantitative data drawn from qualitative research. For instance, if you were doing a study of dual-earner households and wanted to know how many had an equal division of household labor and how many did not, you might want to count those numbers up and include them as part of the final write-up. However, researchers need to take care when they are writing about quantified qualitative data. Qualitative data is not as generalizable as quantitative data, so quantification can be very misleading. Thus, qualitative researchers should strive to use raw numbers instead of the percentages that are more appropriate for quantitative research. Writing, for instance, “15 of the 20 people I interviewed prefer pancakes to waffles” is a simple description of the data; writing “75% of people prefer pancakes” suggests a generalizable claim that is not likely supported by the data. Note that mixing numbers with qualitative data is really a type of mixed-methods approach. Mixed-methods approaches are good, but sometimes they seduce researchers into focusing on the persuasive power of numbers and tables rather than capitalizing on the inherent richness of their qualitative data.

A variety of issues of scholarly ethics and research integrity are raised by the writing process. Some of these are unique to qualitative research, while others are more universal concerns for all academic and professional writing. For example, it is essential to avoid plagiarism and misuse of sources. All quotations that appear in a text must be properly cited, whether with in-text and bibliographic citations to the source or with an attribution to the research participant (or the participant’s pseudonym or description in order to protect confidentiality) who said those words. Where writers will paraphrase a text or a participant’s words, they need to make sure that the paraphrase they develop accurately reflects the meaning of the original words. Thus, some scholars suggest that participants should have the opportunity to read (or to have read to them, if they cannot read the text themselves) all sections of the text in which they, their words, or their ideas are presented to ensure accuracy and enable participants to maintain control over their lives.

Audience and Voice

When writing, researchers must consider their audience(s) and the effects they want their writing to have on these audiences. The designated audience will dictate the voice used in the writing, or the individual style and personality of a piece of text. Keep in mind that the potential audience for qualitative research is often much more diverse than that for quantitative research because of the accessibility of the data and the extent to which the writing can be accessible and interesting. Yet individual pieces of writing are typically pitched to a more specific subset of the audience.

Let us consider one potential research study, an ethnography involving participant-observation of the same children both when they are at daycare facility and when they are at home with their families to try to understand how daycare might impact behavior and social development. The findings of this study might be of interest to a wide variety of potential audiences: academic peers, whether at your own academic institution, in your broader discipline, or multidisciplinary; people responsible for creating laws and policies; practitioners who run or teach at day care centers; and the general public, including both people who are interested in child development more generally and those who are themselves parents making decisions about child care for their own children. And the way you write for each of these audiences will be somewhat different. Take a moment and think through what some of these differences might look like.

If you are writing to academic audiences, using specialized academic language and working within the typical constraints of scholarly genres, as will be discussed below, can be an important part of convincing others that your work is legitimate and should be taken seriously. Your writing will be formal. Even if you are writing for students and faculty you already know—your classmates, for instance—you are often asked to imitate the style of academic writing that is used in publications, as this is part of learning to become part of the scholarly conversation. When speaking to academic audiences outside your discipline, you may need to be more careful about jargon and specialized language, as disciplines do not always share the same key terms. For instance, in sociology, scholars use the term diffusion to refer to the way new ideas or practices spread from organization to organization. In the field of international relations, scholars often used the term cascade to refer to the way ideas or practices spread from nation to nation. These terms are describing what is fundamentally the same concept, but they are different terms—and a scholar from one field might have no idea what a scholar from a different field is talking about! Therefore, while the formality and academic structure of the text would stay the same, a writer with a multidisciplinary audience might need to pay more attention to defining their terms in the body of the text.

It is not only other academic scholars who expect to see formal writing. Policymakers tend to expect formality when ideas are presented to them, as well. However, the content and style of the writing will be different. Much less academic jargon should be used, and the most important findings and policy implications should be emphasized right from the start rather than initially focusing on prior literature and theoretical models as you might for an academic audience. Long discussions of research methods should also be minimized. Similarly, when you write for practitioners, the findings and implications for practice should be highlighted. The reading level of the text will vary depending on the typical background of the practitioners to whom you are writing—you can make very different assumptions about the general knowledge and reading abilities of a group of hospital medical directors with MDs than you can about a group of case workers who have a post-high-school certificate. Consider the primary language of your audience as well. The fact that someone can get by in spoken English does not mean they have the vocabulary or English reading skills to digest a complex report. But the fact that someone’s vocabulary is limited says little about their intellectual abilities, so try your best to convey the important complexity of the ideas and findings from your research without dumbing them down—even if you must limit your vocabulary usage.

When writing for the general public, you will want to move even further towards emphasizing key findings and policy implications, but you also want to draw on the most interesting aspects of your data. General readers will read sociological texts that are rich with ethnographic or other kinds of detail—it is almost like reality television on a page! And this is a contrast to busy policymakers and practitioners, who probably want to learn the main findings as quickly as possible so they can go about their busy lives. But also keep in mind that there is a wide variation in reading levels. Journalists at publications pegged to the general public are often advised to write at about a tenth-grade reading level, which would leave most of the specialized terminology we develop in our research fields out of reach. If you want to be accessible to even more people, your vocabulary must be even more limited. The excellent exercise of trying to write using the 1,000 most common English words, available at the Up-Goer Five website ( https://www.splasho.com/upgoer5/ ) does a good job of illustrating this challenge (Sanderson n.d.).

Another element of voice is whether to write in the first person. While many students are instructed to avoid the use of the first person in academic writing, this advice needs to be taken with a grain of salt. There are indeed many contexts in which the first person is best avoided, at least as long as writers can find ways to build strong, comprehensible sentences without its use, including most quantitative research writing. However, if the alternative to using the first person is crafting a sentence like “it is proposed that the researcher will conduct interviews,” it is preferable to write “I propose to conduct interviews.” In qualitative research, in fact, the use of the first person is far more common. This is because the researcher is central to the research project. Qualitative researchers can themselves be understood as research instruments, and thus eliminating the use of the first person in writing is in a sense eliminating information about the conduct of the researchers themselves.

But the question really extends beyond the issue of first-person or third-person. Qualitative researchers have choices about how and whether to foreground themselves in their writing, not just in terms of using the first person, but also in terms of whether to emphasize their own subjectivity and reflexivity, their impressions and ideas, and their role in the setting. In contrast, conventional quantitative research in the positivist tradition really tries to eliminate the author from the study—which indeed is exactly why typical quantitative research avoids the use of the first person. Keep in mind that emphasizing researchers’ roles and reflexivity and using the first person does not mean crafting articles that provide overwhelming detail about the author’s thoughts and practices. Readers do not need to hear, and should not be told, which database you used to search for journal articles, how many hours you spent transcribing, or whether the research process was stressful—save these things for the memos you write to yourself. Rather, readers need to hear how you interacted with research participants, how your standpoint may have shaped the findings, and what analytical procedures you carried out.

Making Data Come Alive

One of the most important parts of writing about qualitative research is presenting the data in a way that makes its richness and value accessible to readers. As the discussion of analysis in the prior chapter suggests, there are a variety of ways to do this. Researchers may select key quotes or images to illustrate points, write up specific case studies that exemplify their argument, or develop vignettes (little stories) that illustrate ideas and themes, all drawing directly on the research data. Researchers can also write more lengthy summaries, narratives, and thick descriptions.

Nearly all qualitative work includes quotes from research participants or documents to some extent, though ethnographic work may focus more on thick description than on relaying participants’ own words. When quotes are presented, they must be explained and interpreted—they cannot stand on their own. This is one of the ways in which qualitative research can be distinguished from journalism. Journalism presents what happened, but social science needs to present the “why,” and the why is best explained by the researcher.

So how do authors go about integrating quotes into their written work? Julie Posselt (2017), a sociologist who studies graduate education, provides a set of instructions. First of all, authors need to remain focused on the core questions of their research, and avoid getting distracted by quotes that are interesting or attention-grabbing but not so relevant to the research question. Selecting the right quotes, those that illustrate the ideas and arguments of the paper, is an important part of the writing process. Second, not all quotes should be the same length (just like not all sentences or paragraphs in a paper should be the same length). Include some quotes that are just phrases, others that are a sentence or so, and others that are longer. We call longer quotes, generally those more than about three lines long, block quotes , and they are typically indented on both sides to set them off from the surrounding text. For all quotes, be sure to summarize what the quote should be telling or showing the reader, connect this quote to other quotes that are similar or different, and provide transitions in the discussion to move from quote to quote and from topic to topic. Especially for longer quotes, it is helpful to do some of this writing before the quote to preview what is coming and other writing after the quote to make clear what readers should have come to understand. Remember, it is always the author’s job to interpret the data. Presenting excerpts of the data, like quotes, in a form the reader can access does not minimize the importance of this job. Be sure that you are explaining the meaning of the data you present.

A few more notes about writing with quotes: avoid patchwriting, whether in your literature review or the section of your paper in which quotes from respondents are presented. Patchwriting is a writing practice wherein the author lightly paraphrases original texts but stays so close to those texts that there is little the author has added. Sometimes, this even takes the form of presenting a series of quotes, properly documented, with nothing much in the way of text generated by the author. A patchwriting approach does not build the scholarly conversation forward, as it does not represent any kind of new contribution on the part of the author. It is of course fine to paraphrase quotes, as long as the meaning is not changed. But if you use direct quotes, do not edit the text of the quotes unless how you edit them does not change the meaning and you have made clear through the use of ellipses (…) and brackets ([])what kinds of edits have been made. For example, consider this exchange from Matthew Desmond’s (2012:1317) research on evictions:

The thing was, I wasn’t never gonna let Crystal come and stay with me from the get go. I just told her that to throw her off. And she wasn’t fittin’ to come stay with me with no money…No. Nope. You might as well stay in that shelter.

A paraphrase of this exchange might read “She said that she was going to let Crystal stay with her if Crystal did not have any money.” Paraphrases like that are fine. What is not fine is rewording the statement but treating it like a quote, for instance writing:

The thing was, I was not going to let Crystal come and stay with me from beginning. I just told her that to throw her off. And it was not proper for her to come stay with me without any money…No. Nope. You might as well stay in that shelter.

But as you can see, the change in language and style removes some of the distinct meaning of the original quote. Instead, writers should leave as much of the original language as possible. If some text in the middle of the quote needs to be removed, as in this example, ellipses are used to show that this has occurred. And if a word needs to be added to clarify, it is placed in square brackets to show that it was not part of the original quote.

Data can also be presented through the use of data displays like tables, charts, graphs, diagrams, and infographics created for publication or presentation, as well as through the use of visual material collected during the research process. Note that if visuals are used, the author must have the legal right to use them. Photographs or diagrams created by the author themselves—or by research participants who have signed consent forms for their work to be used, are fine. But photographs, and sometimes even excerpts from archival documents, may be owned by others from whom researchers must get permission in order to use them.

A large percentage of qualitative research does not include any data displays or visualizations. Therefore, researchers should carefully consider whether the use of data displays will help the reader understand the data. One of the most common types of data displays used by qualitative researchers are simple tables. These might include tables summarizing key data about cases included in the study; tables laying out the characteristics of different taxonomic elements or types developed as part of the analysis; tables counting the incidence of various elements; and 2×2 tables (two columns and two rows) illuminating a theory. Basic network or process diagrams are also commonly included. If data displays are used, it is essential that researchers include context and analysis alongside data displays rather than letting them stand by themselves, and it is preferable to continue to present excerpts and examples from the data rather than just relying on summaries in the tables.

If you will be using graphs, infographics, or other data visualizations, it is important that you attend to making them useful and accurate (Bergin 2018). Think about the viewer or user as your audience and ensure the data visualizations will be comprehensible. You may need to include more detail or labels than you might think. Ensure that data visualizations are laid out and labeled clearly and that you make visual choices that enhance viewers’ ability to understand the points you intend to communicate using the visual in question. Finally, given the ease with which it is possible to design visuals that are deceptive or misleading, it is essential to make ethical and responsible choices in the construction of visualization so that viewers will interpret them in accurate ways.

The Genre of Research Writing

As discussed above, the style and format in which results are presented depends on the audience they are intended for. These differences in styles and format are part of the genre of writing. Genre is a term referring to the rules of a specific form of creative or productive work. Thus, the academic journal article—and student papers based on this form—is one genre. A report or policy paper is another. The discussion below will focus on the academic journal article, but note that reports and policy papers follow somewhat different formats. They might begin with an executive summary of one or a few pages, include minimal background, focus on key findings, and conclude with policy implications, shifting methods and details about the data to an appendix. But both academic journal articles and policy papers share some things in common, for instance the necessity for clear writing, a well-organized structure, and the use of headings.

So what factors make up the genre of the academic journal article in sociology? While there is some flexibility, particularly for ethnographic work, academic journal articles tend to follow a fairly standard format. They begin with a “title page” that includes the article title (often witty and involving scholarly inside jokes, but more importantly clearly describing the content of the article); the authors’ names and institutional affiliations, an abstract , and sometimes keywords designed to help others find the article in databases. An abstract is a short summary of the article that appears both at the very beginning of the article and in search databases. Abstracts are designed to aid readers by giving them the opportunity to learn enough about an article that they can determine whether it is worth their time to read the complete text. They are written about the article, and thus not in the first person, and clearly summarize the research question, methodological approach, main findings, and often the implications of the research.

After the abstract comes an “introduction” of a page or two that details the research question, why it matters, and what approach the paper will take. This is followed by a literature review of about a quarter to a third the length of the entire paper. The literature review is often divided, with headings, into topical subsections, and is designed to provide a clear, thorough overview of the prior research literature on which a paper has built—including prior literature the new paper contradicts. At the end of the literature review it should be made clear what researchers know about the research topic and question, what they do not know, and what this new paper aims to do to address what is not known.

The next major section of the paper is the section that describes research design, data collection, and data analysis, often referred to as “research methods” or “methodology.” This section is an essential part of any written or oral presentation of your research. Here, you tell your readers or listeners “how you collected and interpreted your data” (Taylor, Bogdan, and DeVault 2016:215). Taylor, Bogdan, and DeVault suggest that the discussion of your research methods include the following:

• The particular approach to data collection used in the study;
• Any theoretical perspective(s) that shaped your data collection and analytical approach;
• When the study occurred, over how long, and where (concealing identifiable details as needed);
• A description of the setting and participants, including sampling and selection criteria (if an interview-based study, the number of participants should be clearly stated);
• The researcher’s perspective in carrying out the study, including relevant elements of their identity and standpoint, as well as their role (if any) in research settings; and
• The approach to analyzing the data.

After the methods section comes a section, variously titled but often called “data,” that takes readers through the analysis. This section is where the thick description narrative; the quotes, broken up by theme or topic, with their interpretation; the discussions of case studies; most data displays (other than perhaps those outlining a theoretical model or summarizing descriptive data about cases); and other similar material appears. The idea of the data section is to give readers the ability to see the data for themselves and to understand how this data supports the ultimate conclusions. Note that all tables and figures included in formal publications should be titled and numbered.

At the end of the paper come one or two summary sections, often called “discussion” and/or “conclusion.” If there is a separate discussion section, it will focus on exploring the overall themes and findings of the paper. The conclusion clearly and succinctly summarizes the findings and conclusions of the paper, the limitations of the research and analysis, any suggestions for future research building on the paper or addressing these limitations, and implications, be they for scholarship and theory or policy and practice.

After the end of the textual material in the paper comes the bibliography, typically called “works cited” or “references.” The references should appear in a consistent citation style—in sociology, we often use the American Sociological Association format (American Sociological Association 2019), but other formats may be used depending on where the piece will eventually be published. Care should be taken to ensure that in-text citations also reflect the chosen citation style. In some papers, there may be an appendix containing supplemental information such as a list of interview questions or an additional data visualization.

Note that when researchers give presentations to scholarly audiences, the presentations typically follow a format similar to that of scholarly papers, though given time limitations they are compressed. Abstracts and works cited are often not part of the presentation, though in-text citations are still used. The literature review presented will be shortened to only focus on the most important aspects of the prior literature, and only key examples from the discussion of data will be included. For long or complex papers, sometimes only one of several findings is the focus of the presentation. Of course, presentations for other audiences may be constructed differently, with greater attention to interesting elements of the data and findings as well as implications and less to the literature review and methods.

Concluding Your Work

After you have written a complete draft of the paper, be sure you take the time to revise and edit your work. There are several important strategies for revision. First, put your work away for a little while. Even waiting a day to revise is better than nothing, but it is best, if possible, to take much more time away from the text. This helps you forget what your writing looks like and makes it easier to find errors, mistakes, and omissions. Second, show your work to others. Ask them to read your work and critique it, pointing out places where the argument is weak, where you may have overlooked alternative explanations, where the writing could be improved, and what else you need to work on. Finally, read your work out loud to yourself (or, if you really need an audience, try reading to some stuffed animals). Reading out loud helps you catch wrong words, tricky sentences, and many other issues. But as important as revision is, try to avoid perfectionism in writing (Warren and Karner 2015). Writing can always be improved, no matter how much time you spend on it. Those improvements, however, have diminishing returns, and at some point the writing process needs to conclude so the writing can be shared with the world.

Of course, the main goal of writing up the results of a research project is to share with others. Thus, researchers should be considering how they intend to disseminate their results. What conferences might be appropriate? Where can the paper be submitted? Note that if you are an undergraduate student, there are a wide variety of journals that accept and publish research conducted by undergraduates. Some publish across disciplines, while others are specific to disciplines. Other work, such as reports, may be best disseminated by publication online on relevant organizational websites.

After a project is completed, be sure to take some time to organize your research materials and archive them for longer-term storage. Some Institutional Review Board (IRB) protocols require that original data, such as interview recordings, transcripts, and field notes, be preserved for a specific number of years in a protected (locked for paper or password-protected for digital) form and then destroyed, so be sure that your plans adhere to the IRB requirements. Be sure you keep any materials that might be relevant for future related research or for answering questions people may ask later about your project.

And then what? Well, then it is time to move on to your next research project. Research is a long-term endeavor, not a one-time-only activity. We build our skills and our expertise as we continue to pursue research. So keep at it.

• Find a short article that uses qualitative methods. The sociological magazine Contexts is a good place to find such pieces. Write an abstract of the article.
• Choose a sociological journal article on a topic you are interested in that uses some form of qualitative methods and is at least 20 pages long. Rewrite the article as a five-page research summary accessible to non-scholarly audiences.
• Choose a concept or idea you have learned in this course and write an explanation of it using the Up-Goer Five Text Editor ( https://www.splasho.com/upgoer5/ ), a website that restricts your writing to the 1,000 most common English words. What was this experience like? What did it teach you about communicating with people who have a more limited English-language vocabulary—and what did it teach you about the utility of having access to complex academic language?
• Select five or more sociological journal articles that all use the same basic type of qualitative methods (interviewing, ethnography, documents, or visual sociology). Using what you have learned about coding, code the methods sections of each article, and use your coding to figure out what is common in how such articles discuss their research design, data collection, and analysis methods.
• Return to an exercise you completed earlier in this course and revise your work. What did you change? How did revising impact the final product?
• Find a quote from the transcript of an interview, a social media post, or elsewhere that has not yet been interpreted or explained. Write a paragraph that includes the quote along with an explanation of its sociological meaning or significance.

The style or personality of a piece of writing, including such elements as tone, word choice, syntax, and rhythm.

A quotation, usually one of some length, which is set off from the main text by being indented on both sides rather than being placed in quotation marks.

A classification of written or artistic work based on form, content, and style.

A short summary of a text written from the perspective of a reader rather than from the perspective of an author.

Social Data Analysis Copyright © 2021 by Mikaila Mariel Lemonik Arthur is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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16 21. Qualitative research dissemination

Chapter outline.

• Ethical responsibility and cultural respectfulness (8 minute read time)
• Critical considerations (5 minute read time)
• Informing your dissemination plan (11 minute read time)
• Final product taking shape (10 minute read time)

Content warning: Examples in this chapter contain references to research as a potential tool to stigmatize or oppress vulnerable groups, mistreatment and inequalities experienced by Native American tribes, sibling relationships, caregiving, child welfare, criminal justice and recidivism, first generation college students, Covid-19, school culture and race, health (in)equity, physical and sensory abilities, and transgender youth.

Your sweat and hard work has paid off!  You’ve planned your study, collected your data, and completed your analysis. But alas, no rest for the weary student researcher.  Now you need to share your findings. As researchers, we generally have some ideas where and with whom we desire to share our findings, but these plans may evolve and change during our research process.  Communicating our findings with a broader audience is a critical step in the research process, so make sure not to treat this like an afterthought. Remember, research is about making a contribution to collective knowledge-building in the area of study that you are interested in.  Indeed, research is of no value if there is no audience to receive it. You worked hard…get those findings out there!

In planning for this phase of research, we can consider a variety of methods for sharing our study findings. Among other options, we may choose to write our findings up as an article in a professional journal, provide a report to an organization, give testimony to a legislative group, or create a presentation for a community event. We will explore these options in a bit more detail below in section 21.4 where we talk more about different types of qualitative research products. We also want to think about our intended audience.

For your research, answer these two key questions as you are planning for dissemination:

• Who are you targeting to communicate your findings to?  In other words, who needs to hear the results of your study?
• What do you hope your audience will take away after learning about your study?

21.1 Ethical responsibility and cultural respectfulness

Learning Objectives

Learners will be able to…

• Identify key ethical considerations in developing their qualitative research dissemination plan
• Conceptualize how research dissemination may impact diverse groups, both presently and into the future

Have you ever been misrepresented or portrayed in a negative light? It doesn’t feel good. It especially doesn’t feel good when the person portraying us has power, control and influence.  While you might not feel powerful, research can be a powerful tool, and can be used and abused for many ends. Once research is out in the world, it is largely out of our control, so we need to approach dissemination with care. Be thoughtful about how you represent your work and take time to think through the potential implications it may have, both intended and unintended, for the people it represents.

As alluded to in the paragraph above, research comes with hefty responsibilities. You aren’t off the hook if you are conducting quantitative research.  While quantitative research deals with numbers, these numbers still represent people and their relationships to social problems. However, with qualitative research, we are often dealing with a smaller sample and trying to learn more from them. As such, our job often carries additional weight as we think about how we will represent our findings and the people they reflect. Furthermore, we probably hope that our research has an impact; that in some way, it leads to change around some issue. This is especially true as social work researchers. Our research often deals with oppressed groups, social problems, and inequality. However, it’s hard to predict the implications that our research may have. This suggests that we need to be especially thoughtful about how we present our research to others.

Two of the core values of social work involve respecting the inherent dignity and worth of each person, practicing with integrity, and behaving in a trustworthy manner [1] .  As social work researchers, to uphold these values, we need to consider how we are representing the people we are researching. Our work needs to honestly and accurately reflect our findings, but it also needs to be sensitive and respectful to the people it represents. In Chapter 8 we discussed research ethics and introduced the concept of beneficence or the idea that research needs to support the welfare of participants. Beneficence is particularly important as we think about our findings becoming public and how the public will receive, interpret and use this information. Thus, both as social workers and researchers, we need to be conscientious of how dissemination of our findings takes place.

As you think about the people in your sample and the communities or groups to which they belong, consider some of these questions:

• How are participants being portrayed in my research?
• What characteristics or findings are being shared or highlighted in my research that may directly or indirectly be associated with participants?
• Have the groups that I am researching been stigmatized, stereotyped, and/or misrepresented in the past? If so, how does my research potentially reinforce or challenge these representations?
• How might my research be perceived or interpreted by members of the community or group it represents?
• In what ways does my research honor the dignity and worth of participants?

Qualitative research often has a voyeuristic quality to it, as we are seeking a window into participants’ lives by exploring their experiences, beliefs, and values. As qualitative researchers, we have a role as stewards or caretakers of data. We need to be mindful of how data are gathered, maintained, and most germane to our conversation here, how data are used. We need to craft research products that honor and respect individual participants (micro), our collective sample as a whole (meso), and the communities that our research may represent (macro).

As we prepare to disseminate our findings, our ethical responsibilities as researchers also involve honoring the commitments we have made during the research process. We need to think back to our early phases of the research process, including our initial conversations with research partners and other stakeholders who helped us to coordinate our research activities. If we made any promises along the way about how the findings would be presented or used, we need to uphold them here.  Additionally, we need to abide by what we committed to in our informed consent .  Part of our informed consent involves letting participants know how findings may be used.  We need to present our findings according to these commitments. We of course also have a commitment to represent our research honestly.

As an extension of our ethical responsibilities as researchers, we need to consider the impact that our findings may have, as well as our need to be socially conscientious researchers.  As scouts, we were taught to leave our campsite in a better state than when we arrived. I think it is helpful to think of research in these terms.  Think about the group(s) that may be represented by your research; what impact might your findings have for the lives of members of this group? Will it leave their lives in a better state than before you conducted your research? As a responsible researcher, you need to be thoughtful, aware and realistic about how your research findings might be interpreted and used by others. As social workers, while we hope that findings will be used to improve the lives of our clients, we can’t ignore that findings can also be used to further oppress or stigmatize vulnerable groups; research is not apolitical and we should not be naive about this. It is worth mentioning the concept of sustainable research here.  Sustainable research involves conducting research projects that have a long-term, sustainable impact for the social groups we work with. As researchers, this means that we need to actively plan for how our research will continue to benefit the communities we work with into the future. This can be supported by staying involved with these communities, routinely checking-in and seeking input from community members, and making sure to share our findings in ways that community members can access, understand, and utilize them. Nate Olson provides a very inspiring Ted Talk about the importance of building resilient communities. As you consider your research project, think about it in these terms.

Key Takeaways

• As you think about how best to share your qualitative findings, remember that these findings represent people. As such, we have a responsibility as social work researchers to ensure that our findings are presented in honest, respectful, and culturally sensitive ways.
• Since this phase of research deals with how we are going to share our findings with the public, we need to actively consider the potential implications of our research and how it may be interpreted and used.

Is your work, in some way, helping to contribute to a resilient and sustainable community? It may not be a big tangible project as described in Olson’s Ted Talk , but is it providing a resource for change and growth to a group of people, either directly or indirectly? Does it promote sustainability amongst the social networks that might be impacted by the research you are conducting?

21.2 Critical considerations

• Identify how issues of power and control are present in the dissemination of qualitative research findings
• Begin to examine and account for their own role in the qualitative research process, and address this in their findings

This is the part of our research that is shared with the public and because of this, issues like reciprocity, ownership, and transparency are relevant.  We need to think about who will have access to the tangible products of our research and how that research will get used. As researchers, we likely benefit directly from research products; perhaps it helps us to advance our career, obtain a good grade, or secure funding.  Our research participants often benefit indirectly by advancing knowledge about a topic that may be relevant or important to them, but often don’t experience the same direct tangible benefits that we do. However, a participatory perspective challenges us to involve community members from the outset in discussions about what changes would be most meaningful to their communities and what research products would be most helpful in accomplishing those changes. This is especially important as it relates to the role of research as a tool to support empowerment.

Ownership of research products is also important as an issue of power and control. We will discuss a range of venues for presenting your qualitative research, some of which are more amenable to shared ownership than others.  For instance, if you are publishing your findings in an academic journal, you will need to sign an agreement with that publisher about how the information in that article can be used and who has access to it.  Similarly, if you are presenting findings at a national conference, travel and other conference-related expenses and requirements may make access to these research products prohibitive. In these instances, the researcher and the organization(s) they negotiate with (e.g. the publishing company, the conference organizing body) share control.  However, disseminating qualitative findings in a public space, public record, or community-owned resource means that more equitable ownership might be negotiated. An equitable or reciprocal arrangement might not always be able to be reached, however. Transparency about who owns the products of research is important if you are working with community partners. To support this, establishing a Memorandum Of Understanding (MOU) or Memorandum of Agreement (MOA) e arly in the research process is important. This document should clearly articulate roles, responsibilities, and a number of other details, such as ownership of research products between the researcher and the partnering group(s).

Resources for learning more about MOUs and MOAs

Center for Community Health and Development, University of Kansas. (n.d.). Community toolbox: Section 9. Understanding and writing contracts and memoranda of agreement [Webpage]. https://ctb.ku.edu/en/table-of-contents/structure/organizational-structure/understanding-writing-contracts-memoranda-agreement/main

Collaborative Center for Health Equity, University of Wisconson Madison. (n.d.). Standard agreement for research with community organizations [Template] https://d1uqjtzsuwlnsf.cloudfront.net/wp-content/uploads/sites/163/2018/08/CCHE-UW-MOU-sample.pdf

Office of Research, UC Davis. (n.d.). Research MOUs [Webpage].  https://research.ucdavis.edu/proposals-grants-contracts/international-agreements/memorandum-understanding/

Office of Research, The University of Texas at Dallas. (n.d.). Types of agreements [Webpage]. https://research.utdallas.edu/researchers/contracts/types-of-agreements

In our discussion about qualitative research, we have also frequently identified the need for the qualitative researcher to account for their role throughout the research process.  Part of this accounting can specifically apply to qualitative research products. This is our opportunity to demonstrate to our audience that we have been reflective throughout the course of the study and how this has influenced the work we did.  Some qualitative research studies include a positionality statement within the final product. This is often toward the beginning of the report or the presentation and includes information about the researcher(s)’s identity and worldview, particularly details relevant to the topic being studied. This can include why you are invested in the study, what experiences have shaped how you have come to think about the topic, and any positions or assumptions you make with respect to the topic.  This is another way to encourage transparency. It can also be a means of relegating or at least acknowledging some of our power in the research process, as it can provide one modest way for us, as the researcher, to be a bit more exposed or vulnerable, although this is a far cry from making the risks of research equitable between the researcher and the researched. However, the positionality statement can be a place to integrate our identities, who we are as an individual, a researcher, and a social work practitioner.  Granted, for some of us that might be volumes, but we need to condense this down to a brief but informative statement – don’t let it eclipse the research! It should just be enough to inform the audience and allow them to draw their own conclusions about who is telling the story of this research and how well they can be trusted. This student provides a helpful discussion of the positionality statement that she developed for her study.  Reviewing your reflexive journal (discussed in chapter  20 as a tool to enhance qualitative rigor) can help in identifying underlying assumptions and positions you might have grounded in your reactions throughout the research process. These insights can be integrated into your positionality statement. Please take a few minutes to watch this informative video of a student further explaining what a positionality statement is and providing a good example of one.

• The products of qualitative research often benefit the researcher disproportionately when compared to research participants or the communities they represent.  Whenever possible, we can seek out ways to disseminate research in ways that addresses this imbalance and supports more tangible and direct benefits to community members.
• Openly positioning ourselves in our dissemination plans can be an important way for qualitative researchers to be transparent and account for our role.

21.3 Informing your dissemination plan

• Appraise important dimensions of planning that will inform their research dissemination plan, including: audience, purpose, context and content
• Apply this appraisal to key decisions they will need to make when designing their qualitative research product(s)

This section will offer you a general overview of points to consider as you form the dissemination plan for your research. We will start with considerations regarding your audience, then turn our attention to the purpose of your research, and finally consider the importance of attending to both content and context as you plan for your final research product(s).

Perhaps the most important consideration you have as you plan how to present your work is your audience. Research is a product that is meant to be consumed, and because of this, we need to be conscious of our consumers. We will speak more extensively about knowing your audience in Chapter 24 , devoted to both sharing and consuming research. Regardless of who your audience is (e.g. community members, classmates, research colleagues, practicing social workers, state legislator), there will be common elements that will be important to convey. While the way you present them will vary greatly according to who is listening, Table 21.1 offers a brief review of the elements that you will want your audience to leave with.

Once we determine who our audience is, we can further tailor our dissemination plan to that specific group.  Of course, we may be presenting our findings in more than one venue, and in that case, we will have multiple plans that will meet the needs of each specific audience.

It’s a good idea to pitch your plan first.  However you plan to present your findings, you will want to have someone preview before you share with a wider audience. Ideally, whoever previews will be a person from your target audience or at least someone who knows them well. Getting feedback can go a long way in helping us with the clarity with which we convey our ideas and the impact they have on our audience. This might involve giving a practice speech, having someone review your article or report, or practice discussing your research one-on-one, as you would with a poster presentation.  Let’s talk about some specific audiences that you may be targeting and their unique needs or expectations.

Below I will go through some brief considerations for each of these different audiences. I have tried to focus this discussion on elements that are relevant specific to qualitative studies since we do revisit this topic in Chapter 24 .

Research community

When presenting your findings to an academic audience or other research-related community, it is probably safe to a make a few assumptions. This audience is likely to have a general understanding of the research process and what it entails.  For this reason, you will have to do less explaining of research-related terms and concepts. However, compared to other audiences, you will probably have to provide a bit more detail about what steps you took in your research process, especially as they relate to qualitative rigor, because this group will want to know about how your research was carried out and how you arrived at your decisions throughout the research process. Additionally, you will want to make a clear connection between which qualitative design you chose and your research question; a methodological justification . Researchers will also want to have a good idea about how your study fits within the wider body of scientific knowledge that it is related to and what future studies you feel are needed based on your findings. You are likely to encounter this audience if you are disseminating through a peer-reviewed journal article, presenting at a research conference, or giving an invited talk in an academic setting.

Professional community

We often find ourselves presenting our research to other professionals, such as social workers in the field. While this group may have some working knowledge of research, they are likely to be much more focused on how your research is related to the work they do and the clients they serve. While you will need to convey your design accurately, this audience is most likely to be invested in what you learned and what it means (especially for practice). You will want to set the stage for the discussion by doing a good job expressing your connection to and passion for the topic (a positionality statemen t might be particularly helpful here), what we know about the issue, and why it is important to their professional lives. You will want to give good contextual information for your qualitative findings so that practitioners can know if these findings might apply to people they work with. Also, as since social work practitioners generally place emphasis on person-centered practice, hearing the direct words of participants (quotes) whenever possible, is likely to be impactful as we present qualitative results.  Where academics and researchers will want to know about implications for future research, professionals will want to know about implications for how this information could help transform services in the future or understand the clients they serve.

Lay community

The lay community are people who don’t necessarily have specialized training or knowledge of the subject, but may be interested or invested for some other reason; perhaps the issue you are studying affects them or a loved one. Since this is the general public, you should expect to spend the most time explaining scientific knowledge and research processes and terminology in accessible terms. Furthermore, you will want to invest some time establishing a personal connection to the topic (like I talked about for the professional community). They will likely want to know why you are interested and why you are a credible source for this information.  While this group may not be experts on research, as potential members of the group(s) that you may be researching, you do want to remember that they are experts in their own community. As such, you will want to be especially mindful of approaching how you present findings with a sense of cultural humility (although hopefully you have this in mind across all audiences). It will be good to discuss what steps you took to ensure that your findings accurately reflect what participants shared with you ( rigor ). You will want to be most clear with this group about what they should take away, without overstating your findings.

Regardless of who your audience is, remember that you are an ambassador.  You may represent a topic, a population, an organization, or the whole institution of research, or any combination of these.  Make sure to present your findings honestly, ethically, and clearly.  Furthermore, I’m assuming that the research you are conducting is important because you have spent a lot of time and energy to arrive at your findings. Make sure that this importance comes through in your dissemination.  Tell a compelling story with your research!  

Who needs to hear the message of your qualitative research?

• Example. If you are presenting your research about caregiver fatigue to a caregiver support group, you won’t need to spend time describing the role of caregivers because your audience will have lived experience.
• Example. If you are presenting your research findings to a group of academics, you wouldn’t have to explain what a sampling frame is, but if you are sharing it with a group of community members from a local housing coalition, you will need to help them understand what this is (or maybe use a phrase that is more meaningful to them).
• Example. If you are speaking to a group of child welfare workers about your study examining trauma-informed communication strategies, they are probably going to want to know how these strategies might impact the work that they do.
• Example. If you are sharing your findings at a meeting with a council member, it may be especially meaningful to share direct quotes from constituents.

Being clear about the purpose of your research from the outset is immeasurably helpful.  What are you hoping to accomplish with your study?  We can certainly look to the overarching purpose of qualitative research, that being to develop/expand/challenge/explore understanding of some topic.  But, what are you specifically attempting to accomplish with your study? Two of the main reasons we conduct research are to raise awareness about a topic and to create change around some issue. Let’s say you are conducting a study to better understand the experience of recidivism in the criminal justice system. This is an example of a study whose main purpose is to better understand and raise awareness around a particular social phenomenon (recidivism). On the other hand, you could also conduct a study that examines the use of strengths-based strategies by probation officers to reduce recidivism. This would fall into the category of research promoting a specific change (the use of strengths-based strategies among probation officers). I would wager that your research topic falls into one of these two very broad categories. If this is the case, how would you answer the corresponding questions below?

Are you seeking to raise awareness of a particular issue with your research? If so,

• Whose awareness needs raising? 
• What will “speak” most effectively to this group? 
• How can you frame your research so that it has the most impact?

Are you seeking to create a specific change with your research? If so,

• What will that change look like? 
• How can your research best support that change occurring? 
• Who has the power to create that change and what will be most compelling in reaching them? 

How you answer these questions will help to inform your dissemination plan.  For instance, your dissemination plan will likely look very different if you are trying to persuade a group of legislators to pass a bill versus trying to share a new model or theory with academic colleagues. Considering your purposes will help you to convey the message of your research most effectively and efficiently. We invest a lot of ourselves in our research, so make sure to keep your sights focused on what you hope to accomplish with it!

Content and context

As a reminder, qualitative research often has a dual responsibility for conveying both content and context. You can think of content as the actual data that is shared with us or that we obtain, while context is the circumstances under which that data sharing occurs. Content conveys the message and context provides us the clues with which we can decode and make sense of that message.

While quantitative research may provide some contextual information, especially in regards to describing its sample, it rarely receives as much attention or detail as it does in qualitative studies. Because of this, you will want to plan for how you will attend to both the content and context of your study in planning for your dissemination.

• Research is an intentional act; you are trying to accomplish something with it. To be successful, you need to approach dissemination planfully.
• Planning the most effective way of sharing our qualitative findings requires looking beyond what is convenient or even conventional, and requires us to consider a number of factors, including our audience, the purpose or intent of our research and the nature of both the content and the context that we are trying to convey.

21.4 Final product taking shape

• Evaluate the various means of disseminating research and consider their applicability for your research project
• Determine appropriate building blocks for designing your qualitative research product

As we have discussed, qualitative research takes many forms. It should then come as no surprise that qualitative research products also come in many different packages. To help guide you as the final products of your research take shape, we will discuss some of the building blocks or elements that you are likely to include as tools in sharing your qualitative findings.  These are the elements that will allow you to flesh out the details of your dissemination plan.

Building blocks

There are many building blocks that are at our disposal as we formulate our qualitative research product(s). Quantitative researchers have charts, graphs, tables, and narrative descriptions of numerical output.  These tools allow the quantitative researcher to tell the story of their research with numbers. As qualitative researchers, we are tasked with telling the story of our research findings as well, but our tools look different.  While this isn’t an exhaustive list of tools that are at our disposal as qualitative researchers, a number of commonly used elements in sharing qualitative findings are discussed here.  Depending on your study design and the type of data you are working with, you may use one or some combination of the building blocks discussed below.

Themes are a very common element when presenting qualitative research findings. They may be called themes, but they may also go by other names: categories, dimensions, main ideas, etc.  Themes offer the qualitative researcher a way to share ideas that emerged from your analysis that were shared by multiple participants or across multiple sources of data.  They help us to distill the large amounts of qualitative data that we might be working with into more concise and manageable pieces of information that are more consumable for our audience. When integrating themes into your qualitative research product, you will want to offer your audience: the title of the theme (try to make this as specific/meaningful as possible), a brief description or definition of the theme, any accompanying dimensions or sub-themes that may be relevant, and examples (when appropriate).

Quotes offer you the opportunity to share participants’ exact words with your audience.  Of course, we can’t only rely on quotes, because we need to knit the information that is shared into one cohesive description of our findings and an endless list of quotes is unlikely to support this. Because of this, you will want to be judicious in selecting your quotes. Choose quotes that can stand on their own, best reflect the sentiment that is being captured by the theme or category of findings that you are discussing, and are likely to speak to and be understood by your audience.  Quotes are a great way to help your findings come alive or to give them greater depth and significance. If you are using quotes, be sure to do so in a balanced manner – don’t only use them in some sections but not others, or use a large number to support one theme and only one or two for another.  Finally, we often provide some brief demographic information in a parenthetical reference following a quote so our reader knows a little bit about the person who shared the information.  This helps to provide some context for the quote.

Kohli and Pizarro (2016) [2] provide a good example of a qualitative study using quotes to exemplify their themes. In their study, they gathered data through short-answer questionnaires and in-depth interviews from racial-justice oriented teachers of Color. Their study explored the experiences and motivations of these teachers and the environments in which they worked. As you might guess, the words of the teacher-participants were especially powerful and the quotes provided in the results section were very informative and important in helping to fulfill the aim of the research study. Take a few minutes to review this article.  Note how the authors provide a good amount of detail as to what each of the themes meant and how they used the quotes to demonstrate and support each theme. The quotes help bring the themes to life and anchor the results in the actual words of the participants (suggesting greater trustworthiness in the findings).   

Figure 21.1 below offers a more extensive example of a theme being reported along with supporting quotes from a study conducted by Karabanow, Gurman, and Naylor (2012) [3] . This study focused on the role of work activities in the lives of “Guatemalan street youth”. One of the important themes had to do with intersection of work and identity for this group.  In this example, brief quotes are used within the body of the description of the theme, and also longer quotes (full sentence(s)) to demonstrate important aspects of the description.

Pictures or videos

If our data collection involves the use of photographs, drawings, videos or other artistic expression of participants or collection of artifacts, we may very well include selections of these in our dissemination of qualitative findings.  In fact, if we failed to include these, it would seem a bit inauthentic.  For the same reason we include quotes as direct representations of participants’ contributions, it is a good idea to provide direct reference to other visual forms of data that support or demonstrate our findings. We might incorporate narrative descriptions of these elements or quotes from participants that help to interpret their meaning. Integrating pictures and quotes is especially common if we are conducting a study using a Photovoice approach, as we discussed in Chapter 17 , where a main goal of the research technique is to bring together participant generated visuals with collaborative interpretation.

Take some time to explore the website linked here. It is the webpage for The Philidelphia Collaborative for Health Equity’s PhotoVoice Exhibit Gallery and offers a good demonstration of research that brings together pictures and text.

Graphic or figure

Qualitative researchers will often create a graphic or figure to visually reflect how the various pieces of your findings come together or relate to each other. Using a visual representation can be especially compelling for people who are visual learners.  When you are using a visual representation, you will want to: label all elements clearly; include all the components or themes that are part of your findings; pay close attention to where you place and how you orient each element (as their spatial arrangement carries meaning); and finally, offer a brief but informative explanation that helps your reader to interpret your representation.   A special subcategory of visual representation is process.  These are especially helpful to lay out a sequential relationship within your findings or a model that has emerged out of your analysis. A process or model will show the ‘flow’ of ideas or knowledge in our findings, the logic of how one concept proceeds to the next and what each step of the model entails.

Noonan and colleagues (2004) [4] conducted a qualitative study that examined the career development of high achieving women with physical and sensory disabilities. Through the analysis of their interviews, they built a model of career development based on these women’s experiences with a figure that helps to conceptually illustrate the model. They place the ‘dyanmic self’ in the center, surrounded by a dotted (permeable) line, with a number of influences outside the line (i.e. family influences, disability impact, career attitudes and behaviors, sociopoltical context, developmental opportunities and social support) and arrows directed inward and outward between each influence and the dynamic self to demonstrate mutual influence/exchange between them.  The image is included in the results section of their study and brings together “core categories” and demonstrates how they work together in the emergent theory or how they relate to each other. Because so many of our findings are dynamic, like Noonan and colleagues, showing interaction and exchange between ideas, figures can be especially helpful in conveying this as we share our results.

Going one step further than the graphic or figure discussed above, qualitative researchers may decide to combine and synthesize findings into one integrated representation. In the case of the graphic or figure, the individual elements still maintain their distinctiveness, but are brought together to reflect how they are related. In a composite however, rather than just showing that they are related (static), the audience actually gets to ‘see’ the elements interacting (dynamic). The integrated and interactive findings of a composite can take many forms.  It might be a written narrative, such as a fictionalized case study that reflects of highlights the many aspects that emerged during analysis. It could be a poem, dance, painting or any other performance or medium. Ultimately, a composite offers an audience a meaningful and comprehensive expression of our findings. If you are choosing to utilize a composite, there is an underlying assumption that is conveyed: you are suggesting that the findings of your study are best understood holistically. By discussing each finding individually, they lose some of their potency or significance, so a composite is required to bring them together.  As an example of a composite, consider that you are conducting research with a number of First Nations Peoples in Canada.  After consulting with a number of Elders and learning about the importance of oral traditions and the significance of storytelling, you collaboratively determine that the best way to disseminate your findings will be to create and share a story as a means of presenting your research findings.  The use of composites also assumes that the ‘truths’ revealed in our data can take many forms. The Transgender Youth Project hosted by the Mandala Center for Change , is an example of legislative theatre combining research, artistic expression, and political advocacy and a good example of action-oriented research.

While you haven’t heard much about numbers in our qualitative chapters, I’m going to break with tradition and speak briefly about them here.  For many qualitative projects we do include some numeric information in our final product(s), mostly in the way of counts. Counts usually show up in the way of frequency of demographic characteristics of our sample or characteristics regarding our artifacts, if they aren’t people.  These may be included as a table or they may be integrated into the narrative we provide, but in either case, our goal in including this information is to offer the reader information so they can better understand who or what our sample is representing.  The other time we sometimes include count information is in respect to the frequency and coverage of the themes or categories that are represented in our data. Frequency information about a theme can help the reader to know how often an idea came up in our analysis, while coverage can help them to know how widely dispersed this idea was (e.g. did nearly everyone mention this, or was it a small group of participants).

• There are a wide variety of means by which you can deliver your qualitative research to the public.  Choose one that takes into account the various considerations that we have discussed above and also honors the ethical commitments that we outlined early in this chapter.
• Presenting qualitative research requires some amount of creativity.  Utilize the building blocks discussed in this chapter to help you consider how to most authentically and effectively convey your message to a wider audience.

What means of delivery will you be choosing for your dissemination plan?

What building blocks will best convey your qualitaitve results to your audience?

• National Association of Social Workers. (2017). NASW code of ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English ↵
• Kohli, R., & Pizarro, M. (2016). Fighting to educate our own: Teachers of Color, relational accountability, and the struggle for racial justice. Equity & Excellence in Education, 49 (1), 72-84. ↵
• Karabanow, J., Gurman, E., & Naylor, T. (2012). Street youth labor as an Expression of survival and self-worth. Critical Social Work, 13 (2). ↵
• Noonan, B. M., Gallor, S. M., Hensler-McGinnis, N. F., Fassinger, R. E., Wang, S., & Goodman, J. (2004). Challenge and success: A Qualitative study of the career development of highly achieving women with physical and sensory disabilities. Journal of Counseling Psychology, 51 (1), 68. ↵
• Ede, L., & Starrin, B. (2014). Unresolved conflicts and shaming processes: risk factors for long-term sick leave for mental-health reasons. Nordic Journal of Social Research, 5 , 39-54. ↵

how you plan to share your research findings

One of the three values indicated in the Belmont report. An obligation to protect people from harm by maximizing benefits and minimizing risks.

A written agreement between parties that want to participate in a collaborative project.

A research journal that helps the researcher to reflect on and consider their thoughts and reactions to the research process and how it may be shaping the study

Context is the circumstances surrounding an artifact, event, or experience.

Rigor is the process through which we demonstrate, to the best of our ability, that our research is empirically sound and reflects a scientific approach to knowledge building.

Content is the substance of the artifact (e.g. the words, picture, scene). It is what can actually be observed.

Graduate research methods in social work Copyright © 2020 by Matthew DeCarlo, Cory Cummings, Kate Agnelli is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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[Guide] How to Present Qualitative Research Findings in PowerPoint?

By: Author Shrot Katewa

As a researcher, it is quite pointless to do the research if we are unable to share the findings with our audience appropriately! Using PowerPoint is one of the best ways to present research outcomes. But, how does one present qualitative research findings using PowerPoint?

In order to present the qualitative research findings using PowerPoint, you need to create a robust structure for your presentation, make it engaging and visually appealing, present the patterns with explanations for it and highlight the conclusion of your research findings.

In this article, we will help you understand the structure of your presentation. Plus, we’ll share some handy tips that will make your qualitative research presentation really effective!

How to Create a Structure for your Qualitative Research Presentation?

Creating the right structure for your presentation is key to ensuring that it is correctly understood by your audience.

The structure of your Research Presentation not only makes it easier for you to create the document, it also makes it simple for the audience to understand what all will be covered in the presentation at the time of presenting it to your audience.

Furthermore, having a robust structure is a great way to ensure that you don’t miss out on any of the points while working on creating the presentation.

But, what structure should one follow?

Creating a good structure can be tricky for some. Thus, I’m sharing what has worked well for me during my previous research projects.

NOTE – It is important to note that although the following structure is highly effective for most research findings presentation, it has been generalized in order to serve a wide range of research projects. You may want to take a look at points that are very specific to the nature of your research project and include them at your discretion.

Here’s my recommended structure to create your Research Findings presentation –

1. Objective of the Research

A great way to start your presentation is to highlight the objective of your research project.

It is important to remember that merely sharing the objective may sometimes not be enough. A short backstory along with the purpose of your research project can pack a powerful punch ! It not only validates the reasoning for your project but also subtly establishes trust with your audience.

However, do make sure that you’re not reading the backstory from the slide. Let it flow naturally when you are delivering the presentation. Keep the presentation as minimalistic as possible.

2. Key Parameters Considered for Measurement

Once you’ve established the objective, the next thing that you may want to do is perhaps share the key parameters considered for the success of your project.

Every research project, including qualitative research, needs to have a few key parameters to measure against the objective of the research.

For example – If the goal of your project is to gather the sentiments of a certain group of people for a particular product, you may need to measure their feelings. Are they happy or unhappy using the product? How do they perceive the branding of the product? Is it affordable?

Make sure that you list down all such key parameters that were considered while conducting the qualitative research.

In general, laying these out before sharing the outcome can help your audience think from your perspective and look at the findings from the correct lens.

3. Research Methodology Adopted

The next thing that you may want to include in your presentation is the methodology that you adopted for conducting the research.

By knowing your approach, the audience can be better prepared for the outcome of your project. Ensure that you provide sound reasoning for the chosen methodology.

This section of your presentation can also showcase some pictures of the research being conducted. If you have captured a video, include that. Doing this provides further validation of your project.

4. Research Outcomes (Presenting Descriptive Analysis)

This is the section that will constitute the bulk of the your presentation.

Use the slides in this section to describe the observations, and the resulting outcomes on each of the key parameters that were considered for the research project.

It is usually a good idea to dedicate at least 1 or more slides for each parameter . Make sure that you present data wherever possible. However, ensure that the data presented can be easily comprehended.

Provide key learnings from the data, highlight any outliers, and possible reasoning for it. Try not to go too in-depth with the stats as this can overwhelm the audience. Remember, a presentation is most helpful when it is used to provide key highlights of the research !

Apart from using the data, make sure that you also include a few quotes from the participants.

5. Summary and Learnings from the Research

Once you’ve taken the audience through the core part of your research findings, it is a good practice to summarize the key learnings from each of the section of your project.

Make sure your touch upon some of the key learnings covered in the research outcome of your presentation.

Furthermore, include any additional observations and key points that you may have had which were previously not covered.

The summary slide also often acts as “Key Takeaways” from the research for your audience. Thus, make sure that you maintain brevity and highlight only the points that you want your audience to remember even after the presentation.

6. Inclusions and Exclusions (if any)

While this can be an optional section for some of the researchers.

However, dedicating a section on inclusions and exclusions in your presentation can be a great value add! This section helps your audience understand the key factors that were excluded (or included) on purpose!

Moreover, it creates a sense of thoroughness in the minds of your audience.

7. Conclusion of the Research

The purpose of the conclusion slide of your research findings presentation is to revisit the objective, and present a conclusion.

A conclusion may simply validate or nullify the objective. It may sometimes do neither. Nevertheless, having a conclusion slide makes your presentation come a full circle. It creates this sense of completion in the minds of your audience.

8. Questions

Finally, since your audience did not spend as much time as you did on the research project, people are bound to have a few questions.

Thus, the last part of your presentation structure should be dedicated to allowing your audience to ask questions.

Tips for Effectively Presenting Qualitative Research Findings using PowerPoint

For a presentation to be effective, it is important that the presentation is not only well structured but also that it is well created and nicely delivered!

While we have already covered the structure, let me share with you some tips that you can help you create and deliver the presentation effectively.

Tip 1 – Use Visuals

Using visuals in your presentation is a great way to keep the presentations engaging!

Visual aids not only help make the presentation less boring, but it also helps your audience in retaining the information better!

So, use images and videos of the actual research wherever possible. If these do not suffice or do not give a professional feel, there are a number of resources online from where you can source royalty-free images.

My recommendation for high-quality royalty-free images would be either Unsplash or Pexels . Both are really good. The only downside is that they often do not provide the perfect image that can be used. That said, it can get the job done for at least half the time.

If you are unable to find the perfect free image, I recommend checking out Dreamstime . They have a huge library of images and are much cheaper than most of the other image banks. I personally use Dreamstime for my presentation projects!

Tip 2 – Tell a Story (Don’t Show Just Data!)

I cannot stress enough on how important it is to give your presentation a human touch. Delivering a presentation in the form of a story does just that! Furthermore, storytelling is also a great tool for visualization .

Data can be hard-hitting, whereas a touching story can tickle the emotions of your audience on various levels!

One of the best ways to present a story with your research project is to start with the backstory of the objective. We’ve already talked about this in the earlier part of this article.

Start with why is this research project is so important. Follow a story arc that provides an exciting experience of the beginning, the middle, and a progression towards a climax; much like a plot of a soap opera.

Tip 3 – Include Quotes of the Participants

Including quotes of the participants in your research findings presentation not only provides evidence but also demonstrates authenticity!

Quotes function as a platform to include the voice of the target group and provide a peek into the mindset of the target audience.

When using quotes, keep these things in mind –

1. Use Quotes in their Unedited Form

When using quotes in your presentation, make sure that you use them in their raw unedited form.

The need to edit quotes should be only restricted to aid comprehension and sometimes coherence.

Furthermore, when editing the quotes, make sure that you use brackets to insert clarifying words. The standard format for using the brackets is to use square brackets for clarifying words and normal brackets for adding a missing explanation.

2. How to Decide which Quotes to Consider?

It is important to know which quotes to include in your presentation. I use the following 3 criteria when selecting the quote –

• Relevance – Consider the quotes that are relevant, and trying to convey the point that you want to establish.
• Length – an ideal quote should be not more than 1-2 sentences long.
• Choose quotes that are well-expressed and striking in nature.

3. Preserve Identity of the Participant

It is important to preserve and protect the identity of the participant. This can be done by maintaining confidentiality and anonymity.

Thus, refrain from using the name of the participant. An alternative could be using codes, using pseudonyms (made up names) or simply using other general non-identifiable parameters.

Do note, when using pseudonyms, remember to highlight it in the presentation.

If, however, you do need to use the name of the respondent, make sure that the participant is okay with it and you have adequate permissions to use their name.

Tip 4 – Make your Presentation Visually Appealing and Engaging

It is quite obvious for most of us that we need to create a visually appealing presentation. But, making it pleasing to the eye can be a bit challenging.

Fortunately, we wrote a detailed blog post with tips on how to make your presentation attractive. It provides you with easy and effective tips that you can use even as a beginner! Make sure you check that article.

7 EASY tips that ALWAYS make your PPT presentation attractive (even for beginners)

In addition to the tips mentioned in the article, let me share a few things that you can do which are specific to research outcome presentations.

4.1 Use a Simple Color Scheme

Using the right colors are key to make a presentation look good.

One of the most common mistakes that people make is use too many colors in their presentation!

My recommendation would be to go with a monochromatic color scheme in PowerPoint .

4.2 Make the Data Tables Simple and Visually Appealing

When making a presentation on research outcomes, you are bound to present some data.

But, when data is not presented in a proper manner, it can easily and quickly make your presentation look displeasing! The video below can be a good starting point.

Using neat looking tables can simply transform the way your presentation looks. So don’t just dump the data from excel on your PowerPoint presentation. Spend a few minutes on fixing it!

4.3 Use Graphs and Charts (wherever necessary)

When presenting data, my recommendation would be that graphs and charts should be your first preference.

Using graphs or charts make it easier to read the data, takes less time for the audience to comprehend, and it also helps to identify a trend.

However, make sure that the correct chart type is used when representing the data. The last thing that you want is to poorly represent a key piece of information.

4.4 Use Icons instead of Bullet Points

Consider the following example –

This slide could have been created just as easily using bullet points. However, using icons and representing the information in a different format makes the slide pleasing on the eye.

Thus, always try to use icons wherever possible instead of bullet points.

Tip 5 – Include the Outliers

Many times, as a research project manager, we tend to focus on the trends extracted from a data set.

While it is important to identify patterns in the data and provide an adequate explanation for the pattern, it is equally important sometimes to highlight the outliers prominently.

It is easy to forget that there may be hidden learnings even in the outliers. At times, the data trend may be re-iterating the common wisdom. However, upon analyzing the outlier data points, you may get insight into how a few participants are doing things successfully despite not following the common knowledge.

That said, not every outlier will reveal hidden information. So, do verify what to include and what to exclude.

Tip 6 – Take Inspiration from other Presentations

I admit, making any presentation can be a tough ask let alone making a presentation for showcasing qualitative research findings. This is especially hard when we don’t have the necessary skills for creating a presentation.

One quick way to overcome this challenge could be take inspiration from other similar presentations that we may have liked.

There is no shame in being inspired from others. If you don’t have any handy references, you can surely Google it to find a few examples.

One trick that almost always works for me is using Pinterest .

But, don’t just directly search for a research presentation. You will have little to no success with it. The key is to look for specific examples for inspiration. For eg. search for Title Slide examples, or Image Layout Examples in Presentation.

Tip 7 – Ask Others to Critic your Presentation

The last tip that I would want to provide is to make sure that you share the presentation with supportive colleagues or mentors to attain feedback.

This step can be critical to iron out the chinks in the armor. As research project manager, it is common for you to get a bit too involved with the project. This can lead to possibilities wherein you miss out on things.

A good way to overcome this challenge is to get a fresh perspective on your project and the presentation once it has been prepared.

Taking critical feedback before your final presentation can also prepare you to handle tough questions in an adept manner.

Final Thoughts

It is quite important to ensure that we get it right when working on a presentation that showcases the findings of our research project. After all, we don’t want to be in a situation wherein we put in all the hard-work in the project, but we fail to deliver the outcome appropriately.

I hope you will find the aforementioned tips and structure useful, and if you do, make sure that you bookmark this page and spread the word. Wishing you all the very best for your project!

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Home » Research Findings – Types Examples and Writing Guide

Research Findings – Types Examples and Writing Guide

Table of Contents

Research Findings

Definition:

Research findings refer to the results obtained from a study or investigation conducted through a systematic and scientific approach. These findings are the outcomes of the data analysis, interpretation, and evaluation carried out during the research process.

Types of Research Findings

There are two main types of research findings:

Qualitative Findings

Qualitative research is an exploratory research method used to understand the complexities of human behavior and experiences. Qualitative findings are non-numerical and descriptive data that describe the meaning and interpretation of the data collected. Examples of qualitative findings include quotes from participants, themes that emerge from the data, and descriptions of experiences and phenomena.

Quantitative Findings

Quantitative research is a research method that uses numerical data and statistical analysis to measure and quantify a phenomenon or behavior. Quantitative findings include numerical data such as mean, median, and mode, as well as statistical analyses such as t-tests, ANOVA, and regression analysis. These findings are often presented in tables, graphs, or charts.

Both qualitative and quantitative findings are important in research and can provide different insights into a research question or problem. Combining both types of findings can provide a more comprehensive understanding of a phenomenon and improve the validity and reliability of research results.

Parts of Research Findings

Research findings typically consist of several parts, including:

• Introduction: This section provides an overview of the research topic and the purpose of the study.
• Literature Review: This section summarizes previous research studies and findings that are relevant to the current study.
• Methodology : This section describes the research design, methods, and procedures used in the study, including details on the sample, data collection, and data analysis.
• Results : This section presents the findings of the study, including statistical analyses and data visualizations.
• Discussion : This section interprets the results and explains what they mean in relation to the research question(s) and hypotheses. It may also compare and contrast the current findings with previous research studies and explore any implications or limitations of the study.
• Conclusion : This section provides a summary of the key findings and the main conclusions of the study.
• Recommendations: This section suggests areas for further research and potential applications or implications of the study’s findings.

How to Write Research Findings

Writing research findings requires careful planning and attention to detail. Here are some general steps to follow when writing research findings:

• Organize your findings: Before you begin writing, it’s essential to organize your findings logically. Consider creating an outline or a flowchart that outlines the main points you want to make and how they relate to one another.
• Use clear and concise language : When presenting your findings, be sure to use clear and concise language that is easy to understand. Avoid using jargon or technical terms unless they are necessary to convey your meaning.
• Use visual aids : Visual aids such as tables, charts, and graphs can be helpful in presenting your findings. Be sure to label and title your visual aids clearly, and make sure they are easy to read.
• Use headings and subheadings: Using headings and subheadings can help organize your findings and make them easier to read. Make sure your headings and subheadings are clear and descriptive.
• Interpret your findings : When presenting your findings, it’s important to provide some interpretation of what the results mean. This can include discussing how your findings relate to the existing literature, identifying any limitations of your study, and suggesting areas for future research.
• Be precise and accurate : When presenting your findings, be sure to use precise and accurate language. Avoid making generalizations or overstatements and be careful not to misrepresent your data.
• Edit and revise: Once you have written your research findings, be sure to edit and revise them carefully. Check for grammar and spelling errors, make sure your formatting is consistent, and ensure that your writing is clear and concise.

Research Findings Example

Following is a Research Findings Example sample for students:

Title: The Effects of Exercise on Mental Health

Sample : 500 participants, both men and women, between the ages of 18-45.

Methodology : Participants were divided into two groups. The first group engaged in 30 minutes of moderate intensity exercise five times a week for eight weeks. The second group did not exercise during the study period. Participants in both groups completed a questionnaire that assessed their mental health before and after the study period.

Findings : The group that engaged in regular exercise reported a significant improvement in mental health compared to the control group. Specifically, they reported lower levels of anxiety and depression, improved mood, and increased self-esteem.

Conclusion : Regular exercise can have a positive impact on mental health and may be an effective intervention for individuals experiencing symptoms of anxiety or depression.

Applications of Research Findings

Research findings can be applied in various fields to improve processes, products, services, and outcomes. Here are some examples:

• Healthcare : Research findings in medicine and healthcare can be applied to improve patient outcomes, reduce morbidity and mortality rates, and develop new treatments for various diseases.
• Education : Research findings in education can be used to develop effective teaching methods, improve learning outcomes, and design new educational programs.
• Technology : Research findings in technology can be applied to develop new products, improve existing products, and enhance user experiences.
• Business : Research findings in business can be applied to develop new strategies, improve operations, and increase profitability.
• Public Policy: Research findings can be used to inform public policy decisions on issues such as environmental protection, social welfare, and economic development.
• Social Sciences: Research findings in social sciences can be used to improve understanding of human behavior and social phenomena, inform public policy decisions, and develop interventions to address social issues.
• Agriculture: Research findings in agriculture can be applied to improve crop yields, develop new farming techniques, and enhance food security.
• Sports : Research findings in sports can be applied to improve athlete performance, reduce injuries, and develop new training programs.

When to use Research Findings

Research findings can be used in a variety of situations, depending on the context and the purpose. Here are some examples of when research findings may be useful:

• Decision-making : Research findings can be used to inform decisions in various fields, such as business, education, healthcare, and public policy. For example, a business may use market research findings to make decisions about new product development or marketing strategies.
• Problem-solving : Research findings can be used to solve problems or challenges in various fields, such as healthcare, engineering, and social sciences. For example, medical researchers may use findings from clinical trials to develop new treatments for diseases.
• Policy development : Research findings can be used to inform the development of policies in various fields, such as environmental protection, social welfare, and economic development. For example, policymakers may use research findings to develop policies aimed at reducing greenhouse gas emissions.
• Program evaluation: Research findings can be used to evaluate the effectiveness of programs or interventions in various fields, such as education, healthcare, and social services. For example, educational researchers may use findings from evaluations of educational programs to improve teaching and learning outcomes.
• Innovation: Research findings can be used to inspire or guide innovation in various fields, such as technology and engineering. For example, engineers may use research findings on materials science to develop new and innovative products.

Purpose of Research Findings

The purpose of research findings is to contribute to the knowledge and understanding of a particular topic or issue. Research findings are the result of a systematic and rigorous investigation of a research question or hypothesis, using appropriate research methods and techniques.

The main purposes of research findings are:

• To generate new knowledge : Research findings contribute to the body of knowledge on a particular topic, by adding new information, insights, and understanding to the existing knowledge base.
• To test hypotheses or theories : Research findings can be used to test hypotheses or theories that have been proposed in a particular field or discipline. This helps to determine the validity and reliability of the hypotheses or theories, and to refine or develop new ones.
• To inform practice: Research findings can be used to inform practice in various fields, such as healthcare, education, and business. By identifying best practices and evidence-based interventions, research findings can help practitioners to make informed decisions and improve outcomes.
• To identify gaps in knowledge: Research findings can help to identify gaps in knowledge and understanding of a particular topic, which can then be addressed by further research.
• To contribute to policy development: Research findings can be used to inform policy development in various fields, such as environmental protection, social welfare, and economic development. By providing evidence-based recommendations, research findings can help policymakers to develop effective policies that address societal challenges.

Characteristics of Research Findings

Research findings have several key characteristics that distinguish them from other types of information or knowledge. Here are some of the main characteristics of research findings:

• Objective : Research findings are based on a systematic and rigorous investigation of a research question or hypothesis, using appropriate research methods and techniques. As such, they are generally considered to be more objective and reliable than other types of information.
• Empirical : Research findings are based on empirical evidence, which means that they are derived from observations or measurements of the real world. This gives them a high degree of credibility and validity.
• Generalizable : Research findings are often intended to be generalizable to a larger population or context beyond the specific study. This means that the findings can be applied to other situations or populations with similar characteristics.
• Transparent : Research findings are typically reported in a transparent manner, with a clear description of the research methods and data analysis techniques used. This allows others to assess the credibility and reliability of the findings.
• Peer-reviewed: Research findings are often subject to a rigorous peer-review process, in which experts in the field review the research methods, data analysis, and conclusions of the study. This helps to ensure the validity and reliability of the findings.
• Reproducible : Research findings are often designed to be reproducible, meaning that other researchers can replicate the study using the same methods and obtain similar results. This helps to ensure the validity and reliability of the findings.

Advantages of Research Findings

Research findings have many advantages, which make them valuable sources of knowledge and information. Here are some of the main advantages of research findings:

• Evidence-based: Research findings are based on empirical evidence, which means that they are grounded in data and observations from the real world. This makes them a reliable and credible source of information.
• Inform decision-making: Research findings can be used to inform decision-making in various fields, such as healthcare, education, and business. By identifying best practices and evidence-based interventions, research findings can help practitioners and policymakers to make informed decisions and improve outcomes.
• Identify gaps in knowledge: Research findings can help to identify gaps in knowledge and understanding of a particular topic, which can then be addressed by further research. This contributes to the ongoing development of knowledge in various fields.
• Improve outcomes : Research findings can be used to develop and implement evidence-based practices and interventions, which have been shown to improve outcomes in various fields, such as healthcare, education, and social services.
• Foster innovation: Research findings can inspire or guide innovation in various fields, such as technology and engineering. By providing new information and understanding of a particular topic, research findings can stimulate new ideas and approaches to problem-solving.
• Enhance credibility: Research findings are generally considered to be more credible and reliable than other types of information, as they are based on rigorous research methods and are subject to peer-review processes.

Limitations of Research Findings

While research findings have many advantages, they also have some limitations. Here are some of the main limitations of research findings:

• Limited scope: Research findings are typically based on a particular study or set of studies, which may have a limited scope or focus. This means that they may not be applicable to other contexts or populations.
• Potential for bias : Research findings can be influenced by various sources of bias, such as researcher bias, selection bias, or measurement bias. This can affect the validity and reliability of the findings.
• Ethical considerations: Research findings can raise ethical considerations, particularly in studies involving human subjects. Researchers must ensure that their studies are conducted in an ethical and responsible manner, with appropriate measures to protect the welfare and privacy of participants.
• Time and resource constraints : Research studies can be time-consuming and require significant resources, which can limit the number and scope of studies that are conducted. This can lead to gaps in knowledge or a lack of research on certain topics.
• Complexity: Some research findings can be complex and difficult to interpret, particularly in fields such as science or medicine. This can make it challenging for practitioners and policymakers to apply the findings to their work.
• Lack of generalizability : While research findings are intended to be generalizable to larger populations or contexts, there may be factors that limit their generalizability. For example, cultural or environmental factors may influence how a particular intervention or treatment works in different populations or contexts.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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• Open access
• Published: 11 May 2024

Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

• Jacqueline Maria Dias 1 ,
• Muhammad Arsyad Subu 1 ,
• Nabeel Al-Yateem 1 ,
• Fatma Refaat Ahmed 1 ,
• Syed Azizur Rahman 1 , 2 ,
• Mini Sara Abraham 1 ,
• Sareh Mirza Forootan 1 ,
• Farzaneh Ahmad Sarkhosh 1 &
• Fatemeh Javanbakh 1  

BMC Nursing volume  23 , Article number:  322 ( 2024 ) Cite this article

257 Accesses

Metrics details

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Peer Review reports

Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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The authors are grateful to all second year nursing students who voluntarily participated in the study.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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Dias, J.M., Subu, M.A., Al-Yateem, N. et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs 23 , 322 (2024). https://doi.org/10.1186/s12912-024-01962-5

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

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

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

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

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

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

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

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

Plain English Summary

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

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Introduction

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

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

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

Public involvement

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

Search strategy

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

Inclusion criteria

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

Quality appraisal

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

Data extraction

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

Data analysis

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

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

PRISMA flowchart of the study selection process

Study characteristics

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

Types of creative methods

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

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

Thematic analysis

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

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

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

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

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

Creative PPI lacks generalisation

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

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

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

Creative PPI has ethical issues

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

The use of creative PPI methods is impeded by external factors

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

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

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

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

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

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

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

Creative PPI allows the unsayable to be said

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

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

Creative PPI methods are inclusive

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

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

Creative PPI methods are engaging

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

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

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

Creative PPI methods are cost and time efficient

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

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

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

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

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

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

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

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

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

Strengths and limitations of this review

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

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

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

Research recommendations

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

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

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

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Coulman K, Nicholson A, Shaw A, Daykin A, Selman L, Macefield R, Shorter G, Cramer H, Sydes M, Gamble C, Pick M, Taylor G, Lane J. Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials. Trials. 2020. https://doi.org/10.1186/s13063-020-04495-9

Ocloo J, Garfield S, Franklin B, Dawson S. Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews. Health Res Policy Sys. 2021. https://doi.org/10.1186/s12961-020-00644-3

National Institute for Health and Care Research. Briefing notes for researchers - public involvement in NHS, health and social care research. https://www.nihr.ac.uk/documents/briefing-notes-for-researchers-public-involvement-in-nhs-health-and-social-care-research/27371 Accessed 01 Nov 2023.

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Acknowledgements

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

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

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

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

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

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

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

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

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

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

Jo Leonardi-Bee

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

Joanne R. Morling

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

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Additional file 1: Search strings: Description of data: the search strings and filters used in each of the 5 databases in this review

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Additional file 3: Table 1: Description of data: elements of the data extraction table that are not in the main manuscript

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

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A Practical Guide to Writing Quantitative and Qualitative Research Questions and Hypotheses in Scholarly Articles

Edward barroga.

1 Department of General Education, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan.

Glafera Janet Matanguihan

2 Department of Biological Sciences, Messiah University, Mechanicsburg, PA, USA.

The development of research questions and the subsequent hypotheses are prerequisites to defining the main research purpose and specific objectives of a study. Consequently, these objectives determine the study design and research outcome. The development of research questions is a process based on knowledge of current trends, cutting-edge studies, and technological advances in the research field. Excellent research questions are focused and require a comprehensive literature search and in-depth understanding of the problem being investigated. Initially, research questions may be written as descriptive questions which could be developed into inferential questions. These questions must be specific and concise to provide a clear foundation for developing hypotheses. Hypotheses are more formal predictions about the research outcomes. These specify the possible results that may or may not be expected regarding the relationship between groups. Thus, research questions and hypotheses clarify the main purpose and specific objectives of the study, which in turn dictate the design of the study, its direction, and outcome. Studies developed from good research questions and hypotheses will have trustworthy outcomes with wide-ranging social and health implications.

INTRODUCTION

Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses. 1 , 2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results. 3 , 4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the inception of novel studies and the ethical testing of ideas. 5 , 6

It is crucial to have knowledge of both quantitative and qualitative research 2 as both types of research involve writing research questions and hypotheses. 7 However, these crucial elements of research are sometimes overlooked; if not overlooked, then framed without the forethought and meticulous attention it needs. Planning and careful consideration are needed when developing quantitative or qualitative research, particularly when conceptualizing research questions and hypotheses. 4

There is a continuing need to support researchers in the creation of innovative research questions and hypotheses, as well as for journal articles that carefully review these elements. 1 When research questions and hypotheses are not carefully thought of, unethical studies and poor outcomes usually ensue. Carefully formulated research questions and hypotheses define well-founded objectives, which in turn determine the appropriate design, course, and outcome of the study. This article then aims to discuss in detail the various aspects of crafting research questions and hypotheses, with the goal of guiding researchers as they develop their own. Examples from the authors and peer-reviewed scientific articles in the healthcare field are provided to illustrate key points.

DEFINITIONS AND RELATIONSHIP OF RESEARCH QUESTIONS AND HYPOTHESES

A research question is what a study aims to answer after data analysis and interpretation. The answer is written in length in the discussion section of the paper. Thus, the research question gives a preview of the different parts and variables of the study meant to address the problem posed in the research question. 1 An excellent research question clarifies the research writing while facilitating understanding of the research topic, objective, scope, and limitations of the study. 5

On the other hand, a research hypothesis is an educated statement of an expected outcome. This statement is based on background research and current knowledge. 8 , 9 The research hypothesis makes a specific prediction about a new phenomenon 10 or a formal statement on the expected relationship between an independent variable and a dependent variable. 3 , 11 It provides a tentative answer to the research question to be tested or explored. 4

Hypotheses employ reasoning to predict a theory-based outcome. 10 These can also be developed from theories by focusing on components of theories that have not yet been observed. 10 The validity of hypotheses is often based on the testability of the prediction made in a reproducible experiment. 8

Conversely, hypotheses can also be rephrased as research questions. Several hypotheses based on existing theories and knowledge may be needed to answer a research question. Developing ethical research questions and hypotheses creates a research design that has logical relationships among variables. These relationships serve as a solid foundation for the conduct of the study. 4 , 11 Haphazardly constructed research questions can result in poorly formulated hypotheses and improper study designs, leading to unreliable results. Thus, the formulations of relevant research questions and verifiable hypotheses are crucial when beginning research. 12

CHARACTERISTICS OF GOOD RESEARCH QUESTIONS AND HYPOTHESES

Excellent research questions are specific and focused. These integrate collective data and observations to confirm or refute the subsequent hypotheses. Well-constructed hypotheses are based on previous reports and verify the research context. These are realistic, in-depth, sufficiently complex, and reproducible. More importantly, these hypotheses can be addressed and tested. 13

There are several characteristics of well-developed hypotheses. Good hypotheses are 1) empirically testable 7 , 10 , 11 , 13 ; 2) backed by preliminary evidence 9 ; 3) testable by ethical research 7 , 9 ; 4) based on original ideas 9 ; 5) have evidenced-based logical reasoning 10 ; and 6) can be predicted. 11 Good hypotheses can infer ethical and positive implications, indicating the presence of a relationship or effect relevant to the research theme. 7 , 11 These are initially developed from a general theory and branch into specific hypotheses by deductive reasoning. In the absence of a theory to base the hypotheses, inductive reasoning based on specific observations or findings form more general hypotheses. 10

TYPES OF RESEARCH QUESTIONS AND HYPOTHESES

Research questions and hypotheses are developed according to the type of research, which can be broadly classified into quantitative and qualitative research. We provide a summary of the types of research questions and hypotheses under quantitative and qualitative research categories in Table 1 .

Research questions in quantitative research

In quantitative research, research questions inquire about the relationships among variables being investigated and are usually framed at the start of the study. These are precise and typically linked to the subject population, dependent and independent variables, and research design. 1 Research questions may also attempt to describe the behavior of a population in relation to one or more variables, or describe the characteristics of variables to be measured ( descriptive research questions ). 1 , 5 , 14 These questions may also aim to discover differences between groups within the context of an outcome variable ( comparative research questions ), 1 , 5 , 14 or elucidate trends and interactions among variables ( relationship research questions ). 1 , 5 We provide examples of descriptive, comparative, and relationship research questions in quantitative research in Table 2 .

Hypotheses in quantitative research

In quantitative research, hypotheses predict the expected relationships among variables. 15 Relationships among variables that can be predicted include 1) between a single dependent variable and a single independent variable ( simple hypothesis ) or 2) between two or more independent and dependent variables ( complex hypothesis ). 4 , 11 Hypotheses may also specify the expected direction to be followed and imply an intellectual commitment to a particular outcome ( directional hypothesis ) 4 . On the other hand, hypotheses may not predict the exact direction and are used in the absence of a theory, or when findings contradict previous studies ( non-directional hypothesis ). 4 In addition, hypotheses can 1) define interdependency between variables ( associative hypothesis ), 4 2) propose an effect on the dependent variable from manipulation of the independent variable ( causal hypothesis ), 4 3) state a negative relationship between two variables ( null hypothesis ), 4 , 11 , 15 4) replace the working hypothesis if rejected ( alternative hypothesis ), 15 explain the relationship of phenomena to possibly generate a theory ( working hypothesis ), 11 5) involve quantifiable variables that can be tested statistically ( statistical hypothesis ), 11 6) or express a relationship whose interlinks can be verified logically ( logical hypothesis ). 11 We provide examples of simple, complex, directional, non-directional, associative, causal, null, alternative, working, statistical, and logical hypotheses in quantitative research, as well as the definition of quantitative hypothesis-testing research in Table 3 .

Research questions in qualitative research

Unlike research questions in quantitative research, research questions in qualitative research are usually continuously reviewed and reformulated. The central question and associated subquestions are stated more than the hypotheses. 15 The central question broadly explores a complex set of factors surrounding the central phenomenon, aiming to present the varied perspectives of participants. 15

There are varied goals for which qualitative research questions are developed. These questions can function in several ways, such as to 1) identify and describe existing conditions ( contextual research question s); 2) describe a phenomenon ( descriptive research questions ); 3) assess the effectiveness of existing methods, protocols, theories, or procedures ( evaluation research questions ); 4) examine a phenomenon or analyze the reasons or relationships between subjects or phenomena ( explanatory research questions ); or 5) focus on unknown aspects of a particular topic ( exploratory research questions ). 5 In addition, some qualitative research questions provide new ideas for the development of theories and actions ( generative research questions ) or advance specific ideologies of a position ( ideological research questions ). 1 Other qualitative research questions may build on a body of existing literature and become working guidelines ( ethnographic research questions ). Research questions may also be broadly stated without specific reference to the existing literature or a typology of questions ( phenomenological research questions ), may be directed towards generating a theory of some process ( grounded theory questions ), or may address a description of the case and the emerging themes ( qualitative case study questions ). 15 We provide examples of contextual, descriptive, evaluation, explanatory, exploratory, generative, ideological, ethnographic, phenomenological, grounded theory, and qualitative case study research questions in qualitative research in Table 4 , and the definition of qualitative hypothesis-generating research in Table 5 .

Qualitative studies usually pose at least one central research question and several subquestions starting with How or What . These research questions use exploratory verbs such as explore or describe . These also focus on one central phenomenon of interest, and may mention the participants and research site. 15

Hypotheses in qualitative research

Hypotheses in qualitative research are stated in the form of a clear statement concerning the problem to be investigated. Unlike in quantitative research where hypotheses are usually developed to be tested, qualitative research can lead to both hypothesis-testing and hypothesis-generating outcomes. 2 When studies require both quantitative and qualitative research questions, this suggests an integrative process between both research methods wherein a single mixed-methods research question can be developed. 1

FRAMEWORKS FOR DEVELOPING RESEARCH QUESTIONS AND HYPOTHESES

Research questions followed by hypotheses should be developed before the start of the study. 1 , 12 , 14 It is crucial to develop feasible research questions on a topic that is interesting to both the researcher and the scientific community. This can be achieved by a meticulous review of previous and current studies to establish a novel topic. Specific areas are subsequently focused on to generate ethical research questions. The relevance of the research questions is evaluated in terms of clarity of the resulting data, specificity of the methodology, objectivity of the outcome, depth of the research, and impact of the study. 1 , 5 These aspects constitute the FINER criteria (i.e., Feasible, Interesting, Novel, Ethical, and Relevant). 1 Clarity and effectiveness are achieved if research questions meet the FINER criteria. In addition to the FINER criteria, Ratan et al. described focus, complexity, novelty, feasibility, and measurability for evaluating the effectiveness of research questions. 14

The PICOT and PEO frameworks are also used when developing research questions. 1 The following elements are addressed in these frameworks, PICOT: P-population/patients/problem, I-intervention or indicator being studied, C-comparison group, O-outcome of interest, and T-timeframe of the study; PEO: P-population being studied, E-exposure to preexisting conditions, and O-outcome of interest. 1 Research questions are also considered good if these meet the “FINERMAPS” framework: Feasible, Interesting, Novel, Ethical, Relevant, Manageable, Appropriate, Potential value/publishable, and Systematic. 14

As we indicated earlier, research questions and hypotheses that are not carefully formulated result in unethical studies or poor outcomes. To illustrate this, we provide some examples of ambiguous research question and hypotheses that result in unclear and weak research objectives in quantitative research ( Table 6 ) 16 and qualitative research ( Table 7 ) 17 , and how to transform these ambiguous research question(s) and hypothesis(es) into clear and good statements.

a These statements were composed for comparison and illustrative purposes only.

b These statements are direct quotes from Higashihara and Horiuchi. 16

a This statement is a direct quote from Shimoda et al. 17

The other statements were composed for comparison and illustrative purposes only.

CONSTRUCTING RESEARCH QUESTIONS AND HYPOTHESES

To construct effective research questions and hypotheses, it is very important to 1) clarify the background and 2) identify the research problem at the outset of the research, within a specific timeframe. 9 Then, 3) review or conduct preliminary research to collect all available knowledge about the possible research questions by studying theories and previous studies. 18 Afterwards, 4) construct research questions to investigate the research problem. Identify variables to be accessed from the research questions 4 and make operational definitions of constructs from the research problem and questions. Thereafter, 5) construct specific deductive or inductive predictions in the form of hypotheses. 4 Finally, 6) state the study aims . This general flow for constructing effective research questions and hypotheses prior to conducting research is shown in Fig. 1 .

Research questions are used more frequently in qualitative research than objectives or hypotheses. 3 These questions seek to discover, understand, explore or describe experiences by asking “What” or “How.” The questions are open-ended to elicit a description rather than to relate variables or compare groups. The questions are continually reviewed, reformulated, and changed during the qualitative study. 3 Research questions are also used more frequently in survey projects than hypotheses in experiments in quantitative research to compare variables and their relationships.

Hypotheses are constructed based on the variables identified and as an if-then statement, following the template, ‘If a specific action is taken, then a certain outcome is expected.’ At this stage, some ideas regarding expectations from the research to be conducted must be drawn. 18 Then, the variables to be manipulated (independent) and influenced (dependent) are defined. 4 Thereafter, the hypothesis is stated and refined, and reproducible data tailored to the hypothesis are identified, collected, and analyzed. 4 The hypotheses must be testable and specific, 18 and should describe the variables and their relationships, the specific group being studied, and the predicted research outcome. 18 Hypotheses construction involves a testable proposition to be deduced from theory, and independent and dependent variables to be separated and measured separately. 3 Therefore, good hypotheses must be based on good research questions constructed at the start of a study or trial. 12

In summary, research questions are constructed after establishing the background of the study. Hypotheses are then developed based on the research questions. Thus, it is crucial to have excellent research questions to generate superior hypotheses. In turn, these would determine the research objectives and the design of the study, and ultimately, the outcome of the research. 12 Algorithms for building research questions and hypotheses are shown in Fig. 2 for quantitative research and in Fig. 3 for qualitative research.

EXAMPLES OF RESEARCH QUESTIONS FROM PUBLISHED ARTICLES

• EXAMPLE 1. Descriptive research question (quantitative research)
• - Presents research variables to be assessed (distinct phenotypes and subphenotypes)
• “BACKGROUND: Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts.
• RESEARCH QUESTION: Does the clinical spectrum of patients with COVID-19 contain distinct phenotypes and subphenotypes? ” 19
• EXAMPLE 2. Relationship research question (quantitative research)
• - Shows interactions between dependent variable (static postural control) and independent variable (peripheral visual field loss)
• “Background: Integration of visual, vestibular, and proprioceptive sensations contributes to postural control. People with peripheral visual field loss have serious postural instability. However, the directional specificity of postural stability and sensory reweighting caused by gradual peripheral visual field loss remain unclear.
• Research question: What are the effects of peripheral visual field loss on static postural control ?” 20
• EXAMPLE 3. Comparative research question (quantitative research)
• - Clarifies the difference among groups with an outcome variable (patients enrolled in COMPERA with moderate PH or severe PH in COPD) and another group without the outcome variable (patients with idiopathic pulmonary arterial hypertension (IPAH))
• “BACKGROUND: Pulmonary hypertension (PH) in COPD is a poorly investigated clinical condition.
• RESEARCH QUESTION: Which factors determine the outcome of PH in COPD?
• STUDY DESIGN AND METHODS: We analyzed the characteristics and outcome of patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) with moderate or severe PH in COPD as defined during the 6th PH World Symposium who received medical therapy for PH and compared them with patients with idiopathic pulmonary arterial hypertension (IPAH) .” 21
• EXAMPLE 4. Exploratory research question (qualitative research)
• - Explores areas that have not been fully investigated (perspectives of families and children who receive care in clinic-based child obesity treatment) to have a deeper understanding of the research problem
• “Problem: Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment? This review aims to explore the scope of perspectives reported by families of children with obesity who have received individualized outpatient clinic-based obesity treatment.” 22
• EXAMPLE 5. Relationship research question (quantitative research)
• - Defines interactions between dependent variable (use of ankle strategies) and independent variable (changes in muscle tone)
• “Background: To maintain an upright standing posture against external disturbances, the human body mainly employs two types of postural control strategies: “ankle strategy” and “hip strategy.” While it has been reported that the magnitude of the disturbance alters the use of postural control strategies, it has not been elucidated how the level of muscle tone, one of the crucial parameters of bodily function, determines the use of each strategy. We have previously confirmed using forward dynamics simulations of human musculoskeletal models that an increased muscle tone promotes the use of ankle strategies. The objective of the present study was to experimentally evaluate a hypothesis: an increased muscle tone promotes the use of ankle strategies. Research question: Do changes in the muscle tone affect the use of ankle strategies ?” 23

EXAMPLES OF HYPOTHESES IN PUBLISHED ARTICLES

• EXAMPLE 1. Working hypothesis (quantitative research)
• - A hypothesis that is initially accepted for further research to produce a feasible theory
• “As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness .” 24
• “In conclusion, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response . The difference in perceived safety of these agents in COVID-19 illness could be related to the more potent efficacy to reduce fever with ibuprofen compared to acetaminophen. Compelling data on the benefit of fever warrant further research and review to determine when to treat or withhold ibuprofen for early stage fever for COVID-19 and other related viral illnesses .” 24
• EXAMPLE 2. Exploratory hypothesis (qualitative research)
• - Explores particular areas deeper to clarify subjective experience and develop a formal hypothesis potentially testable in a future quantitative approach
• “We hypothesized that when thinking about a past experience of help-seeking, a self distancing prompt would cause increased help-seeking intentions and more favorable help-seeking outcome expectations .” 25
• “Conclusion
• Although a priori hypotheses were not supported, further research is warranted as results indicate the potential for using self-distancing approaches to increasing help-seeking among some people with depressive symptomatology.” 25
• EXAMPLE 3. Hypothesis-generating research to establish a framework for hypothesis testing (qualitative research)
• “We hypothesize that compassionate care is beneficial for patients (better outcomes), healthcare systems and payers (lower costs), and healthcare providers (lower burnout). ” 26
• Compassionomics is the branch of knowledge and scientific study of the effects of compassionate healthcare. Our main hypotheses are that compassionate healthcare is beneficial for (1) patients, by improving clinical outcomes, (2) healthcare systems and payers, by supporting financial sustainability, and (3) HCPs, by lowering burnout and promoting resilience and well-being. The purpose of this paper is to establish a scientific framework for testing the hypotheses above . If these hypotheses are confirmed through rigorous research, compassionomics will belong in the science of evidence-based medicine, with major implications for all healthcare domains.” 26
• EXAMPLE 4. Statistical hypothesis (quantitative research)
• - An assumption is made about the relationship among several population characteristics ( gender differences in sociodemographic and clinical characteristics of adults with ADHD ). Validity is tested by statistical experiment or analysis ( chi-square test, Students t-test, and logistic regression analysis)
• “Our research investigated gender differences in sociodemographic and clinical characteristics of adults with ADHD in a Japanese clinical sample. Due to unique Japanese cultural ideals and expectations of women's behavior that are in opposition to ADHD symptoms, we hypothesized that women with ADHD experience more difficulties and present more dysfunctions than men . We tested the following hypotheses: first, women with ADHD have more comorbidities than men with ADHD; second, women with ADHD experience more social hardships than men, such as having less full-time employment and being more likely to be divorced.” 27
• “Statistical Analysis
• ( text omitted ) Between-gender comparisons were made using the chi-squared test for categorical variables and Students t-test for continuous variables…( text omitted ). A logistic regression analysis was performed for employment status, marital status, and comorbidity to evaluate the independent effects of gender on these dependent variables.” 27

EXAMPLES OF HYPOTHESIS AS WRITTEN IN PUBLISHED ARTICLES IN RELATION TO OTHER PARTS

• EXAMPLE 1. Background, hypotheses, and aims are provided
• “Pregnant women need skilled care during pregnancy and childbirth, but that skilled care is often delayed in some countries …( text omitted ). The focused antenatal care (FANC) model of WHO recommends that nurses provide information or counseling to all pregnant women …( text omitted ). Job aids are visual support materials that provide the right kind of information using graphics and words in a simple and yet effective manner. When nurses are not highly trained or have many work details to attend to, these job aids can serve as a content reminder for the nurses and can be used for educating their patients (Jennings, Yebadokpo, Affo, & Agbogbe, 2010) ( text omitted ). Importantly, additional evidence is needed to confirm how job aids can further improve the quality of ANC counseling by health workers in maternal care …( text omitted )” 28
• “ This has led us to hypothesize that the quality of ANC counseling would be better if supported by job aids. Consequently, a better quality of ANC counseling is expected to produce higher levels of awareness concerning the danger signs of pregnancy and a more favorable impression of the caring behavior of nurses .” 28
• “This study aimed to examine the differences in the responses of pregnant women to a job aid-supported intervention during ANC visit in terms of 1) their understanding of the danger signs of pregnancy and 2) their impression of the caring behaviors of nurses to pregnant women in rural Tanzania.” 28
• EXAMPLE 2. Background, hypotheses, and aims are provided
• “We conducted a two-arm randomized controlled trial (RCT) to evaluate and compare changes in salivary cortisol and oxytocin levels of first-time pregnant women between experimental and control groups. The women in the experimental group touched and held an infant for 30 min (experimental intervention protocol), whereas those in the control group watched a DVD movie of an infant (control intervention protocol). The primary outcome was salivary cortisol level and the secondary outcome was salivary oxytocin level.” 29
• “ We hypothesize that at 30 min after touching and holding an infant, the salivary cortisol level will significantly decrease and the salivary oxytocin level will increase in the experimental group compared with the control group .” 29
• EXAMPLE 3. Background, aim, and hypothesis are provided
• “In countries where the maternal mortality ratio remains high, antenatal education to increase Birth Preparedness and Complication Readiness (BPCR) is considered one of the top priorities [1]. BPCR includes birth plans during the antenatal period, such as the birthplace, birth attendant, transportation, health facility for complications, expenses, and birth materials, as well as family coordination to achieve such birth plans. In Tanzania, although increasing, only about half of all pregnant women attend an antenatal clinic more than four times [4]. Moreover, the information provided during antenatal care (ANC) is insufficient. In the resource-poor settings, antenatal group education is a potential approach because of the limited time for individual counseling at antenatal clinics.” 30
• “This study aimed to evaluate an antenatal group education program among pregnant women and their families with respect to birth-preparedness and maternal and infant outcomes in rural villages of Tanzania.” 30
• “ The study hypothesis was if Tanzanian pregnant women and their families received a family-oriented antenatal group education, they would (1) have a higher level of BPCR, (2) attend antenatal clinic four or more times, (3) give birth in a health facility, (4) have less complications of women at birth, and (5) have less complications and deaths of infants than those who did not receive the education .” 30

Research questions and hypotheses are crucial components to any type of research, whether quantitative or qualitative. These questions should be developed at the very beginning of the study. Excellent research questions lead to superior hypotheses, which, like a compass, set the direction of research, and can often determine the successful conduct of the study. Many research studies have floundered because the development of research questions and subsequent hypotheses was not given the thought and meticulous attention needed. The development of research questions and hypotheses is an iterative process based on extensive knowledge of the literature and insightful grasp of the knowledge gap. Focused, concise, and specific research questions provide a strong foundation for constructing hypotheses which serve as formal predictions about the research outcomes. Research questions and hypotheses are crucial elements of research that should not be overlooked. They should be carefully thought of and constructed when planning research. This avoids unethical studies and poor outcomes by defining well-founded objectives that determine the design, course, and outcome of the study.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

• Conceptualization: Barroga E, Matanguihan GJ.
• Methodology: Barroga E, Matanguihan GJ.
• Writing - original draft: Barroga E, Matanguihan GJ.
• Writing - review & editing: Barroga E, Matanguihan GJ.

• Open access
• Published: 11 May 2024

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

• Lissa Moran 1 ,
• Jeff Ondocsin 1 , 2 ,
• Simon Outram 1 ,
• Daniel Ciccarone 2 ,
• Daniel Werb 3 , 4 ,
• Nicole Holm 2 &
• Emily A. Arnold 1  

Harm Reduction Journal volume  21 , Article number:  92 ( 2024 ) Cite this article

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Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.

We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.

We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

The opioid crisis in the U.S. consists of multiple overlapping and inter-related waves of surging opioid exposure, dependency, overdose, and death rates. Each wave has emerged from different eras of an evolving drug market and multiple intersecting contextual factors such as trends in pharmaceutical manufacturing and prescription, socioeconomic inequities, and positive supply shocks of both licit and illicit opioids [ 1 , 2 , 3 ]. Though its history can be traced back to the 1980s and 1990s, the past decade has redefined the crisis [ 4 ].

By the time the U.S. Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency in 2017 [ 5 ], a wave of unprecedented magnitude had been on the rise for nearly 4 years, marked by the rapid proliferation of fentanyl and synthetic analogues into the drug market [ 4 , 6 ]. Even as mortality from heroin and prescription opioids leveled off or decreased, opioid overdose and death rates rose precipitously [ 6 ]. From 2018 to 2021, the rates of opioid overdose deaths in the U.S. nearly doubled, and by 2021, roughly 9 out of every 10 opioid overdoses in the country (88%) were fentanyl-related [ 7 ].

In California, home to the highest number of opioid-related deaths in the U.S. [ 8 ], the opioid overdose death rate curve from 2011 to 2021 tells a harrowing story. The third wave was later to arrive in California than the national average, but its onset was rapid and dramatic. Opioid overdose death rates more than tripled from 2018 to 2021, and synthetic opioid (e.g., fentanyl) deaths increased 7.2 times, responsible for 37% of opioid overdose deaths in 2018, and 86% just three years later [ 9 ].

In response, the California Department of Public Health has committed to the expansion and promotion of policies, programs, and services to combat the overdose epidemic, with a special focus on harm reduction and drug checking strategies [ 10 ].

Drug checking services

Drug checking services (DCS) have garnered particular interest as an expansion of harm reduction strategies, as they offer the opportunity for people who use drugs to test the chemical content of their own supply [ 11 , 12 ]. In doing so, people who use drugs may be afforded the possibility of changing their use behavior to remove or reduce the likelihood of harm [ 13 , 14 ]. Multiple DCS have been operating in Europe for years—particularly in venues known for high rates of recreational drug use like music festivals [ 14 , 15 ]—but are less common in North America. In the U.S. and Canada, DCS have emerged primarily in response to the needs of marginalized people who use opioids, and operate predominantly within the context of frontline services [ 16 , 17 , 18 ].

Though not mainstream or broadly implemented, studies from North America indicate that DCS are generally acceptable among people who use drugs [ 19 , 20 ], and report that both service users and providers have expressed desire for better access to DCS, legal protections for those providing and using drug checking, and advanced technologies that provide information on drug concentrations—not just drugs present—at the point of care [ 21 , 22 , 23 , 24 ]. Several studies explore the potential impact of drug checking when used at various points along the supply chain [ 25 , 26 ], with findings that suggest feasibility, acceptability, and uptake of DCS among drug sellers [ 27 ], noting particular importance to drug sellers who are embedded in their community and hold long-term trusted relationships with customers [ 28 , 29 ].

Arguably the most common and well-known drug checking modality in North America are fentanyl testing strips (FTS), or lateral flow assays, which were originally designed for the clinical use of detecting fentanyl in urine samples, but have been publicly available for several years for modified use with drug samples [ 30 , 31 , 32 , 33 ]. FTS have been a powerful tool to combat accidental fentanyl exposure: they are small, portable, relatively accessible, and detect fentanyl in minute concentrations that could still be enough to trigger an overdose in an opiate-naïve individual [ 31 , 34 ]. They have been found to be particularly useful for outreach and street use [ 13 , 25 , 35 ]. That said, FTS are not useful in the same way for those who intend to use fentanyl, where the overdose risk is not in the presence of fentanyl, but in the concentration and presence of additional adulterants like sedatives [ 36 ].

Drug checking technology has advanced, and continues to advance, such that a greater amount can be known about the chemical components of a drug sample in a shorter period of time, in a broader array of environments [ 37 ]. Multiple drug checking modalities can inform people who use drugs about the presence of unexpected adulterants, such as benzodiazepines and xylazine, among others. Technologies that offer the greatest specificity and sensitivity include Gas Chromatography Mass Spectrometry and High-Performance Liquid Chromatography, which can detect the presence and concentrations of a wide array of chemicals present in even small amounts in a sample, but must be used in a laboratory setting by a trained technician [ 37 ]. More flexible technologies have emerged, like Fourier-Transform Infrared Spectroscopy (FTIR) [ 38 ], which is semi-portable, and returns information on the main chemical components of a drug sample (above 5% concentration) in a matter of minutes [ 31 ]. Paper spray mass spectrometry is more expensive than FTIR but is just as fast, and provides quantitative results [ 39 ]. Today, multi-technology-based drug checking services are available in some areas as standalone programs, or as added components to existing harm reduction centers [ 30 , 40 ].

These innovations continue to advance amidst complex and evolving social, legal, political, and funding conditions [ 11 , 21 , 41 , 42 ]. Legally, drug checking can be complicated as a public service, requiring the handling and, often, exchange of illicit drug material, of which possession and distribution is often criminalized [ 21 ]. Harm reduction initiatives more broadly—DCS, syringe access services, naloxone distribution, HIV/HCV testing, wound care, supervised consumption sites, and medications for opioid use disorder (MOUD), among others—can at times be unpopular socially and politically, as stigma associated with addiction and drug use combined with concerns about the goals and practices of harm reduction can generate powerful community pushback [ 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Legislators and policymakers at local, state, and federal levels who rely on constituent support may therefore shy away from supporting various harm reduction strategies, despite endorsement from public health officials and robust evidence showing that harm reduction improves the health, survival, and recovery potential for people who use drugs, without compromising community safety [ 48 , 49 ]. At the same time, California was one of several states to bring lawsuits against opioid manufacturers, distributors, and pharmacy chains, alleging that they played an active and/or negligent role in the genesis and exacerbation of the opioid crisis [ 50 ]. Of the $43.3 billion in settlement funds that have been awarded thus far, California may receive nearly $4 billion [ 51 ]. These funds are specifically earmarked for activities that are to include “prevention, intervention, harm reduction, treatment and recovery services.” [ 52 ].

As the opioid crisis reaches an unprecedented magnitude and strategies to address it are at once both a priority and a topic of controversy, we aimed to explore the value of drug checking services and their role within harm reduction more broadly. In this study, we report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. We aim to contribute to an existing qualitative evidence base exploring the value and utility of drug checking services, particularly as data are leveraged to inform political narratives, legislation, and funding allocation.

For this study, we conducted in-depth semi-structured key informant interviews across two samples: a “provider” sample and a “client” sample. The “provider” sample consisted of individuals providing clinical and harm reduction services to people who use drugs, as well as drug checking subject matter experts such as researchers and program heads. The “client” sample consisted of individuals who use drugs and were receiving harm reduction services at an agency where multiple forms of drug checking were included in the services provided.

From June to November 2022, two authors (DC & LM) conducted in-depth semi-structured key informant interviews with 11 providers—8 working in the U.S., 2 working in Canada, and one working in both countries. Included in the sample were 2 clinical providers, 4 researchers, and 5 harm reduction service providers [Table  1 ].

We employed purposive sampling of known providers first, then snowball sampling, contacting additional potential participants at informants’ recommendation. All potential participants were contacted via email and invited to participate. If the participant agreed, an appointment was made for the interview to take place over Zoom. Interviews lasted between approximately 45 and 60 min, and solicited provider perspectives on the state of the drug market in their area, the perceived needs of and challenges faced by their local client population, and their attitudes and experiences with drug checking methods and programs and integrating such programs into existing services. Verbal consent was collected at the outset of the interviews, which were then recorded. Audio from the recordings was isolated and transcribed using a secure third-party professional transcription service. All transcripts were deidentified and researchers created unique anonymous ID numbers for each participant. Participating providers were offered an honorarium of $100 in the form of a gift card. The study protocol was reviewed by the University of California San Francisco Institutional Review Board (IRB #22-36262).

Client participant ( n  = 13) recruitment and data collection took place over a one-week period in November 2022 [Table  2 ].

We employed a non-random convenience sample, recruiting from four harm reduction programs in San Francisco, where clients were approached either by interviewers (NH & JO) or program staff who had been instructed on eligibility requirements. Eligible participants were at least 18 years of age, and currently using fentanyl, heroin, or methamphetamine. Clients were excluded from eligibility if they were intoxicated or otherwise unable to provide informed consent. Given that current drug use was an eligibility requirement, we assessed “intoxicated” as an inability to respond to simple questions, providing responses that are incoherent or unintelligible, or if the participant indicates that they are too high to continue. Potential participants who were eligible and interested were then formally verbally consented and interviewed on-site. Client interviews explored participants’ history of drug use and experiences with harm reduction services, as well as their awareness of, attitudes about, and experiences with various drug checking modalities. Interviews lasted approximately 30–60 min and were recorded, then submitted to the same external third-party transcription service being used for provider interviews. Participants were provided a $25 cash incentive as a token of appreciation for their time and expertise, and were provided unique ID numbers to anonymize their data. This study protocol, distinct from the protocol covering provider interviews, was reviewed and approved as well by the UCSF IRB (#22-36640).

Client interview transcripts were uploaded to Dedoose, a qualitative analytic program [ 53 ]. Four analysts (EA, LM, SO, and JO), two of whom were involved in data collection (LM & JO), read transcribed interviews from both client and provider data sets and drafted summaries which were then systematically reviewed as a team. Following the tenets of thematic analysis and adopting the framework developed by Miles and Huberman (1994) [ 54 ], the team collaboratively identified cross-cutting themes from interview summaries, covering areas of concordance, discordance, and particular importance, as well as exemplar and negative cases. Once major themes and sub-themes were identified and articulated, authors drafted analytic memos which consolidated and explored in detail each major theme.

Following publication of an article focused on findings from the provider data set [ 55 ], further analysis of the client data set included the development of a formal coding scheme (SO), based on a priori codes extracted from the interview guide, as well as codes reflecting themes and sub-themes identified in the summarizing process and further refined via ongoing weekly analytic meetings. Coding was led by the primary qualitative analyst [SO] with secondary coding by client interviewer and author [JO]. The application of codes was discussed regularly among all team members, focusing on discrepancies between primary and secondary coders, insights developed, and the potential emergent themes. Discrepancies occurred approximately 10% of the time, and these were resolved through group consensus in accordance with established qualitative research methods [ 56 ].

Through key informant interviews, we captured diverse perspectives on how existing and emerging drug checking services are being used, and their potential for future impact within the harm reduction suite of services.

We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

The role of drug checking in overdose prevention

Service providers and clients expressed varying opinions on the extent to which information from drug checking services would prevent overdose and, indeed, whether overdose prevention is the appropriate metric by which drug checking’s impact should be measured. Clients reported diverse experiences and perspectives on how they use (or don’t use) drug checking, and expectations for their own future use.

Fentanyl test strips

Almost all client participants reported having had some experience with fentanyl testing strips (FTS), either using them personally or seeing others use them. Attitudes about FTS varied. Some expressed concern that they are difficult to use correctly or that they have heard they may be unreliable (prone to false positives or negatives):

We were using them constantly when they were telling us that all the drugs had fentanyl in them. But then we found out that if you don’t put enough water on speed, that it can come up positive because of some chemical. [Client, 40, female].

Others reported relying on them heavily and using them often:

I’ve just got to have that insurance that there’s no fentanyl in [my drugs]. … I have a drawer. Like that? That’s all full of test strips. Usually every time I come to a needle exchange, if they have them, I grab as many as I can and just put them in the drawer. [Client, 43, male].

Spectrometry

Although many had not heard of spectrometry, spectroscopy, or anything beyond FTS, once it was described what a range of drug checking services could look like, clients were interested and excited about the possibilities. Some expressed interest in using mobile or site-based spectroscopy, but were concerned about their safety, one expressing worry about “ judgment from the community ” or bystanders taking videos and calling the police, another wondering if they would be an “ easy target ” for law enforcement harassment. Those who reported having used FTIR as part of their harm reduction visits, however, had positive things to say:

Interviewer: And how do you feel about that testing service at the van? Participant: I think it’s remarkably great. Interviewer: yeah? Participant: Yeah. They answered my questions, exactly what I wanted to know. [Client, 66, male]

Some participants described high percentages of testing experiences coming back with a positive or unexpected result, like a client who said that he’d used the FTIR mobile service four times with meth from four different suppliers, and “ only one came back pure .”

Using drug checking results

What participants reported doing with the results of checking their drugs varied as well. Some participants spoke about specific situations where drug checking prompted them to avoid buying contaminated drugs.

Actually I just used [drug checking] yesterday. Luckily, I didn’t buy the heroin I was going to, because it tested for fentanyl . [Client, 32, male]

Other community members expressed disinterest in checking drugs, often citing a lack of realistic options for using test results in a way that made sense for them. One participant stated directly that they didn’t want to test because they didn’t want to have to not use drugs if they got a result they didn’t like:

What if it comes up with fentanyl in it? Then I bought it but I can’t do it? They’re not going to take it back, the people I bought it from. I mean even if I get them to write me a receipt, you know? [Client, 49, male]

Another client said that she was interested in drug checking generally, but wouldn’t bother if she only had a little bit and was relying on it to keep her from getting sick:

If I was trying to [check my drugs], I would do it when I had enough to do that, you know. Because if I was dope sick and I only had two hits of fentanyl, I probably would not [test]. [Client, 24, female]

Data from service provider interviews echoed these dynamics. We heard from provider participants that, broadly, drug checking services prevent overdose directly some of the time, but not all the time, by way of individual behavior change on a case-by-case basis. One provider—a clinician with a lengthy career in addiction medicine and harm reduction—echoed doubts about how common it would be for a patient to make use choices based on drug checking results, broadening the focus to personal harm reduction behavior change rather than abstinence behavior alone:

And then the question is, what do you do about it? I’ve had a patient who is, like, yeah, I tested it. It was positive for fentanyl. I go, well, what did you do? Well, we just used anyway because it’s all we had. And we had, like, the Narcan out, and I – I just felt really sleepy afterwards. … So I guess that’s the other question – if you do drug testing and it isn’t what you expect, like, you can’t take it back to the dealer and say, hey, this isn’t – I want a refund; right? So what do you do with that information? And if, you know, if you’re in withdrawal and you really need to use that drug, like, what kind of safeguards are you going to take if you decide, yeah, I’m going to go ahead and use this; right? [Clinician, U.S.]

Other service providers similarly drew a distinction between drug checking sparking behavior change that prevents overdose versus behavior change that reduces the risk of death from overdose, situating drug checking services as a set of tools that dovetail with existing personal harm reduction strategies.

The reality is, you know, people still are using their drugs. Now, a large proportion of people who use our service say that they’ll do something differently after, you know, accessing our service, so they maybe will do a test dose first, or start, like, start with a smaller dose, or use with a friend, or use at an SCS [supervised consumption site]. [Direct service provider, Canada].

Overdose prevention versus overdose rates

Interestingly, many service providers when asked for their perspective on the role of drug checking services in overdose prevention expressed concern about a gulf between the overdose prevention they observe at the service level versus what they see represented in population-level data.

Will drug checking save a life? Absolutely. Yes, for sure. Will it, at a population level, drop overdose rates? I don’t know the answer to that. [Researcher, U.S.]

Participants offered multiple explanations for this. One described challenges inherent in proving prevention, while another explained how population overdose rates can obscure the impact of drug checking programs when they operate within a rapidly-changing drug supply:

It will be very hard to prove within these prevention paradoxes. I think prevention is one of those things that is so important, but within our scientific frameworks … preventable events are so rare and on the grand scheme of things, they’re really hard to prove. … But will [DCS] save lives? Yeah. [Clinician, U.S.] The numbers aren’t showing [an overall decrease in overdose], right, because at the same time, even though we’re offering this service, the supply is just getting worse and worse, so overdose rates are rising. [Direct service provider, Canada].

Not every participant who commented on this gulf found it to be wide or troubling, but instead remarked on it as a neutral distance between two related but distinct constructs, one of which is a measure of what outcomes drug checking information could yield, and the other of which is a fundamental right to that information.

It’s really a great question if we’re going to see things pan out in the numbers. I certainly hope so and I certainly think so, but I think that we just have the right to know what we’re putting into our bodies, regardless of what outcome measures are. We deserve to know what’s in our drugs . [Direct service provider, U.S.]

Similarly, a direct service provider offered a structural perspective on overdose prevention, decoupling the value of drug checking services from overdose outcomes, prioritizing instead the intrinsic value of equipping people with critical information about what they are putting in their body and the importance of empowering people to make decisions with as much information as possible.

I don’t really know if [drug checking] is going to decrease the rate of overdose. In my mind, the problems that contribute to overdose are prohibition, law enforcement harassment, and everything that surrounds that that creates a shitty drug supply and then prevents people from investigating it. But what [drug checking] does do, again, is this piece around like, people should know that they can find out there’s more in their drug. … I think that it just enables people to make better educated decisions around their substance use and to understand their bodies better . [Direct service provider, U.S.]

Benefits to the overall agency, health, and wellbeing of people who use drugs

Drug checking services offer users the tools to independently identify risks in the drug supply and make decisions about what to do with that information in the short and long term. Many of the service providers interviewed for this study, when asked how drug checking would impact overdose rates, gave some version of a reframed response, repositioning the focus from the drug use decisions themselves to the importance of information in fortifying the overall agency, health, and wellbeing of people who use drugs.

The provider quoted in the above section went on to reflect on the intrinsic value of giving people information, arguing that it contributes to essential experiences of bodily autonomy and health equity:

What’s really important to me as well is just sort of building this momentum around people feeling entitled to bodily autonomy and seeing that [drug checking] is a part of [that], and having folks know that, yeah, they fucking deserve to have this information. They are entitled to know what is in their stuff. And so, that’s not the only piece to health equity and justice around substances and substance use, but I think that it’s a significant piece. [Direct service provider, U.S.]

Knowledge of what is in their drugs can also confirm users’ internal experience. One provider, who had piloted an early drug checking intervention in a major metropolitan area in the U.S., believed that drug checking for people who use drugs offers confirmation of the embodied experience of their substance use, which in this provider’s experience was often regarded with skepticism by health workers:

I think that people are able to connect experiences that they’re feeling in their body with real information. And I think that actually validates the really organic knowledge and experiential knowledge of drug users as the true experts about drugs. You know, when we were doing our project in [city] and fentanyl was not everywhere [yet]—almost 100% of the time, if someone brought us a sample and said, “I think this has fentanyl in it,” it was true. … It validates experience where people’s experiential knowledge is not really validated by an educational system. It’s always this kind of thing where public health people are telling drug users what’s true. And drug checking sort of validates that drug users actually know what’s true, and we’re just using science to confirm it.” [Direct service provider, U.S.]

Client interviews echoed this theme. Several clients recounted experiences that illustrated how navigating the drug market is becoming increasingly difficult, and that drug checking provides an important tool that they can pair with their own instincts and expertise as they try to keep themselves safe.

I can look at it and I can be like, “Wait a minute, we might want to test that.” Because speed and fentanyl are different. They actually look different than the other one, so when I start seeing traces of fentanyl being in the speed, I go, “We need to check that before we do any of it.” And, hey, sometimes I’m wrong. [Client, 43, male] The [meth] that was in the medicine bottle [tested positive for fentanyl], yeah. But I kind of knew it was going to because I packed a bowl right before and if it’s dirty … yeah, the color starts changing wrong right away. [Client, 43, male] I like that [drug checking] gives us some certainty of what’s in the drug … like with the heroin, there was stuff in that that just did not feel good. I’d love to know what they were cutting that stuff with. We used to joke it was shoe polish because it was so dark and dirty, but it’s really important what you put in your body . [Client, 48, female]

Our client data further provide evidence that people who use drugs are making health-related decisions for themselves and care about their own health and wellbeing. Woven throughout community member interviews were examples of health-seeking decision-making in users’ everyday lives, demonstrating agency in considering health behaviors and expressing both implicitly and explicitly a desire to care for themselves. Examples of these pro-health micro-decisions include choosing not to smoke out of foil (it’s “ not healthy to smoke out of ” and “ it’s going to give us Alzheimer’s or something ”) or reducing smoking marijuana due to a “ sensitive ” respiratory system. One informant laid out explicitly their hopes for their future, shaped too by an acute awareness of the risks of the current drug market:

I don’t want to be a statistic out here. I want to go back to regular life and experience all the rest of the highs that there still are out there before I die. I want to jump out of an airplane, or take a balloon ride, or ride more rollercoasters. … I don’t want to limit myself to one freaking high. … it’s not worth it anymore at all. … You’d never OD on meth before. Meth and weed were two things you just didn’t overdose on. If you did too much, you passed out and you slept it off and that was it. Now, no matter what drugs you’re doing, every time you use, it’s a 50–50 chance that you could die. [Client, 49, female]

These excerpts from client interviews highlight the demand among potential DCS users for strategies that contribute to their agency, health, and wellbeing, even within the context of continued drug use in the short- or long-term.

Impacts of drug checking services at community and systems levels

In addition to use at the individual level, participants talked extensively about the ways that they experience and imagine DCS having an impact at community and systems levels. They described the ways that drug checking could facilitate upstream regulation of the drug market, how the information and transparency made possible by checking drugs can fill a policy and regulatory vacuum, and how drug checking can empower public health surveillance systems and clinical response.

Community level regulation of the drug market

Multiple informants, both service providers and clients, reflected on the use—or potential use—of drug checking as a grassroots tool to regulate the drug market.

Participants talked about using, or thinking one could use, DCS as a vetting tool for sellers or suppliers.

And if people could get their shit tested, almost every time if not every time, not only would it help them to be safer by them regulating themselves and knowing what’s in their stuff … But I feel like if they knew exactly what was in it, they could go tell their guys that they got it from, “Look, man, I’m not buying that shit anymore if it’s like that. If that shit -- if this or that’s in it or whatever. Or if you don’t, whatever, I’m not buying it from you. I’m buying it from someone else.” And that might even make them be… It’ll hold them more accountable. [Client, 32, male]

This use was so important to one participant that they expressed interest in their samples being sent for more extensive in-lab spectrometry testing that could give them greater detail about the compounds and amounts in their sample:

Hey, [a full spectrometry report] may take a week, but at least in that week, I find out if I should go back to that person or not. [Client, 43, male]

Client participants frequently referred to DCS as a tool to “keep [suppliers] honest”; that is, as informal regulatory pressure on currently unregulated illegal drug markets. Some reported that they spread the word if drugs from a supplier come up contaminated or low-grade. One participant, who uses fentanyl, reported using FTS to ensure that what they are about to buy is, indeed, fentanyl:

I keep them [FTS] around. … Then I say, “Can I test it?” and I test it in front of them. And like some of it’s turned up negative. And so I totally outed them out on the block with it. It pisses them off – it kind of keeps them honest. … When you got a bunch of test strips, I can go down the line and keep, yeah, at least trying to keep them honest, you know. I got a pile of those things right now. That’s actually what I use them for. [Client, 40, male]

Of particular value, according to our participants, was the idea that spectrometry would provide formal documentation of drugs’ contents. Analytical evidence that something was either dangerously contaminated or not what the seller claimed it to be can shift the balance of power in the transactional dynamic, placing upstream pressure on suppliers to better monitor what they are contributing to the market.

If you could get results that are on paper or on a text or on a whatever, then you could bring it to them that, “Look, dude. I’m not fucking around. You need to make this shit right or I’m not buying it anymore.” That would be a game-changer . [Client, 32, male]

From the service provider standpoint, one participant, a drug checking technician and program manager with a longstanding history in their city’s drug scene, identified similar opportunities for DCS to impact the drug market, were it made easily accessible to those at multiple points in the drug supply chain in addition to consumers.

It’s not just people who are consuming the drugs that can use the service. It’s also people who are selling them. And so, oftentimes people who are not essentially the first or second hands that are creating the substance and then moving it down the chain towards the end consumer, they don’t know what is in their product. For folks who are selling drugs, if they’re able to come and get an ingredient list, they can then kind of know what to say to folks who are buying. [Direct service provider, U.S.]

This was not discussed as just a hypothetical. One informant who sells drugs validated this use as feasible and valuable:

I want to make sure what I’m buying is what it is. … I do sell it myself, so [spectrometry]’s a good service because that’s what I want to know is the chemical balance as to how much it is and how much it isn’t and whether it’s good every time. [Client, 66, male]

Filling a policy and regulatory vacuum

In the absence of a government or regulatory body that will monitor and report on the verified contents of illicit drugs, our data suggest that drug checking services, and spectrometry in particular, may be filling a policy and regulatory vacuum.

Clients likened the idea of having access to a list of drugs present in a sample to knowing ingredients of something that they would eat.

I mean we know what’s in our food, right? The packaging is all labeled and the ingredients are listed. It’s just too important, especially with drugs. Especially because we don’t know who’s making them. We don’t know exactly where they’re coming from. And every single one is different. Every week is different. Even if you buy it from the same person all the time, they’re always having something different. Maybe you’ll have the same thing twice or three times but that’s it. [Client, 48, female]

Providers, meanwhile, explicitly framed the value of drug checking within the context of an unmet regulatory need. One service provider qualified many of their statements about drug checking services with “until prohibition goes away,” situating DCS as being necessary only in a regulatory vacuum. Another spoke more directly to the relationship between drug checking and regulation:

And with drugs, because of prohibition, we just have this unknown, unregulated supply, and people are – what they’re putting in their bodies and what they’re purchasing is obscured, right? And so, drug checking is like a series of sort of imperfect tools to help consumers of drugs regain a little bit of control in the form of information around what it is that they are using. …. And there’s a very good argument that, if we had some kind of safe, regulated supply, we wouldn’t need drug checking at all, which is true . [Direct service provider, U.S.]

Empowering public health surveillance systems and clinical response

Data from our interviews suggest that drug checking technologies and programming may also contribute meaningfully at a structural level, to public health surveillance systems and clinical response. Aggregated sample results provide real-time data about what drug compositions are trending across regions, and what the clinical implications may be for providers treating clients who use drugs [ 57 ]. One drug checking program team posted results to their website in the hopes of informing local clinicians and public health policy makers about what was circulating in the drug supply. This program manager talked about making results available “at the societal level”:

And then at the kind of societal level what we do … [is] every other week we take all of the results from the samples that we’ve checked, and we combine them, and then we put out a report and update our website about, like, what’s circulating in the drug supply. So we talk about, you know, trends in the drug supply over that period, and new drugs that have been introduced, and what those drugs could mean, that type of thing. So service doesn’t only benefit individuals, but it also benefits the larger community by being able to say, okay, this is what we’re seeing. If you can’t access the service, you still at least know, you know, what is circulating. [Direct service provider, Canada]

Community members expressed an awareness of this function. One participant cited drug checking’s role in a larger tracking network as one of the things they value most about the service:

I liked a lot about [drug checking]. One, that it was available in the first place. Two, that it was not just doing its own thing. It was part of a larger network that was keeping track of what drugs were popping up on the streets and what their makeup was. I really like that that’s happening. [Client, 30, male]

At the point-of-service level, provider informants discussed significant benefits that drug checking could provide to clinicians and other medical professionals who work closely with people who use drugs. This informant posited specifically that having more detailed knowledge about what was circulating in the drug supply could help clinicians better formulate strategies for managing opioid use disorder and transitioning patients onto MOUD:

Understanding what’s actually in the supply… allows clinicians to tailor the care that they are providing to people who use drugs. So, you know, if they know that the average amount of fentanyl in a fentanyl sample is this and they want to transition someone off the unregulated drug supply onto, like, a pharmaceutical alternative, well, what pharmaceutical alternative is actually suitable based on what they’ve been using? [Direct service provider, Canada]

This is especially critical given the significant difficulties that have been recently reported when transitioning people using fentanyl to appropriate longitudinal services [ 58 ]. A provider we interviewed who runs a mail-based drug checking service in the U.S. reported that developing a more thorough knowledge of the drug supply outside of the current surveillance panoply may provide important clinical toxicology assistance to help physicians connect health outcomes to specific substances or components of the drug supply, and more quickly provide tailored treatment:

There’s one other really big one for me, which is that it allows us to link specific physiological harms with specific chemicals. So, we’re not just talking about dope anymore. We’re talking about this component of dope causing this specific reaction. What we have been able to do is, we’ll get calls from our central hospital on campus, and they’ll say, “We have this patient with an idiosyncratic presentation. Boom, boom, boom, boom, boom, boom. Here it is. We think it might be… You know, they’ve been injecting this, this, and this. We have some of their samples. Can we get them tested?” Or if they don’t have the samples, they’re like, “This is what the symptoms are. This is where they’re from. What are you seeing about the drug supply in their area?” And I can be like, “Well, yeah, there’s been a spike in levamisole in that area or xylazine,” you know, whatever it is. And then they can get to treatment quicker because the physicians have a more specific knowledge about the ideology of the harm that they’re observing in clinic. [Researcher, U.S.]

Negative cases

While the vast majority of participant responses reflected positive experiences with or attitudes about DCS, some participants additionally expressed ambivalence or concern. Many of these perspectives are embedded within the themes reported above, but deserve reiteration: service users expressed concerns about the accuracy of drug checking technologies, their privacy and safety relative to community stigma and law enforcement, and anxiety about having to make hard choices about drug use in the face of an unexpected result. Service providers expressed concern about the “then what” of drug checking, citing constrained choices and limits to what could be realistically expected in terms of behavior change without other supports in place. Some further lamented the challenges of translating the benefits of what they were seeing in practice to what is visible to a broader audience.

Not included in the above findings, but important to note, are two additional concerns that arose in interviews. First, service users and providers cautioned that the street drug supply changes so quickly that new compounds may be showing up on the street before they are identified in spectrometry libraries, potentially limiting their ability to accurately identify contaminants. Finally, one provider, a clinician with a longstanding career in addiction medicine and harm reduction, closed their interview with a somber caution against decontextualizing drug checking from a broader commitment to multi-method harm reduction, health equity, and social justice.

[I worry that] we’re just throwing yet another technology at a much bigger problem. My fear is that people will say, oh, now we have drug checking, so now we can stop trying to dismantle, you know, structures of racism and oppression in society, right? We can stop looking for homes for people because we have this technology that’s going to prevent people from dying. … It doesn’t work that way. [Clinician, U.S.]

While the magnitude of the opioid crisis is often communicated in terms of overdose and death rates, the harms associated with opioid use—intentional or unintentional—in an unregulated drug market extend far beyond those data points alone, and so too must the strategies leveed to combat them. Our findings demonstrate that drug checking services offer diverse benefits at the individual, community, public health, and health systems levels.

Overdose prevention and beyond

If the question is, do and will these technologies contribute to overdose prevention , our findings suggest that the answer is yes, with some important caveats. The first being that, according to our participants, they do not prevent overdose all the time. Our findings reflect that individuals make complex and highly contextualized decisions regarding their use behavior each time they use drugs. Information about the chemical composition of a drug sample sometimes leads to decisions to abstain, but more often leads to decisions to engage in other types of harm reduction behaviors—like using with a friend rather than alone, making sure to have naloxone on hand, using at a supervised consumption site, alerting others to a bad batch, using a tester first, or avoiding a certain supplier in the future. Sometimes it leads to no observable behavior change at all.

Further, DCS have not been scaled up to meet the needs of everyone at risk for overdose; until it is, it is premature to discuss population-level prevention. This study does not purport DCS to be in and of themselves sufficient to prevent overdose, but they are clearly part of a continuum of services that can prevent overdose mortality.

Many participants took care to note as well that the needs of people who use drugs are not solely to avoid overdose; people navigating drug use are whole people, and the stigmatization and criminalization of drug use regulates their access to a multitude of essential needs and liberties, like health care, housing, employment, agency, and a host of social and legal protections. Access to information that contributes to agency and autonomy, and enables more informed decision-making, is an essential service regardless of other outcomes.

Of course, among harm reductionists and researchers acquainted with the diverse and dynamic ways that harm reduction functions within communities, this is not news. Our findings reflect and reinforce much of the existing evidence from studies aiming to understand the role of drug checking within the larger constellation of harm reduction and, indeed, the role of harm reduction itself.

One recent qualitative study in particular reported themes with striking similarities to the prevailing themes from our interviews. Wallace et al. [ 59 ] explored the potential impacts of community drug checking on prospective service users, finding drug checking to “increase quality control in an unregulated market,” “improve the health and wellbeing of people who use substances,” and “mediate policies around substance use.”

Our findings further add to existing evidence that links drug checking with consumer empowerment within an opaque drug market [ 25 , 26 , 29 ] and underlines the reciprocal relationship between individual agency and the adoption of harm reduction strategies [ 46 , 60 , 61 ].

Of note is the shifting context in which many existing drug checking studies, including ours, are situated. In some areas, fentanyl appears most often as an unwanted adulterant in another drug—be it a non-opioid or a less potent opioid like heroin—and DCS are used primarily for fentanyl avoidance [ 13 , 19 ]. Increasingly, however, pockets of consumers are preferring fentanyl, as seen in our San Francisco client sample and within populations reflected in recent drug checking studies. Our data echo the broader finding that drug checking technologies are likely to be used differently by fentanyl-seeking opioid users versus fentanyl-avoiding opioid users, and differently still among those using stimulants, psychedelics, or other non-opioid drugs [ 22 , 62 ].

On the subject of behavior change—whether and how drug checking can be understood to prompt changes in drug use behavior—our findings align with existing evidence showing that drug checking is at times followed by contaminated drug disposal, and at times followed by the employment of personal harm reduction techniques such as spreading information within the community [ 30 , 63 ], and reduction in polysubstance use or dosage [ 13 , 14 , 15 , 64 ]. Lacking as we do a robust methodological-empirical foundation to assess this type of causality, whether and to what extent drug checking in various contexts leads to less use or more safe use among different populations cannot be stated concretely [ 16 , 65 , 66 ]. Whether individuals change their use behavior based on drug checking results is highly informed by such matters as how limited their access to drugs is, realistic options for modified use, and their perceived relative risks of knowingly ingesting a potentially dangerous compound or compounds versus not.

The tension at the center of harm reduction policy

The role of harm reduction services within communities have long reflected a central tension: in contrast with abstinence and criminalization models, harm reduction is often socially and politically criticized as enabling drug use and making neighborhoods less safe [ 67 , 68 , 69 ], while research consistently finds harm reduction to yield positive outcomes for both service users and surrounding communities [ 70 , 71 ]. In addition to improving the health and wellbeing of people using drugs, evidence suggests that those accessing harm reduction services are more likely to ultimately seek treatment and pursue recovery [ 49 , 70 , 72 , 73 ]. Concerns about public safety, too, while in many cases expressed in good faith, have been shown to be largely misplaced: multiple studies show harm reduction programs to have no significant impact on nearby violent or property-related crime, with some findings suggesting improved indicators of public order and safety [ 48 , 49 , 74 , 75 ]. Harm reduction strategies have additionally been found to be cost-effective in the short term and cost-saving to public monies in the medium- and long-term [ 76 ]. Nonetheless, public perception of harm reduction has historically been interwoven with deeply entrenched cultural stigmas related to race and ethnicity, socioeconomics, and an imprecise moralism that positions access to health and protection as a privilege that should be earned or denied based on behavior [ 67 , 69 , 71 ].

This tension plays out most concretely in the public policy space. Even as the opioid crisis dominates public health discourse and funding is earmarked for research and programming to combat it [ 77 ], harm reduction programs on the ground are under siege. At the federal level, the House Appropriations bill for the Fiscal Year 2024 HHS budget dramatically cuts funding to HIV/AIDS programs—a budget umbrella under which many harm reduction, substance use support and treatment programs are funded [ 78 , 79 ]. In California, a $15.2 million state grant supporting syringe access services has dried up amidst an overdose crisis at its peak, with no plans for replacement [ 80 ]. In 2022, a landmark bill (SB58) that would have authorized overdose prevention programs with supervised consumption in Los Angeles, Oakland, and San Francisco was vetoed by the Governor, despite broad support and robust evidence behind it [ 81 ]. Funds for such safe consumption sites have further been excluded from receiving opioid settlement funds in San Francisco [ 82 ], and in September of 2023, a bill was put forth by the San Francisco Mayor’s office to require drug screening and mandatory treatment for anyone receiving public services [ 83 ]. This, despite the expressly articulated commitment to and acknowledged necessity of harm reduction services—services explicitly aimed at helping people who use drugs to be more safe rather than abstaining from use—highlighted in policy language across multiple levels of government and legislature [ 10 , 84 , 85 , 86 , 87 ].

It is worth noting that one of the harm reduction sites where several of this study’s client participants were receiving services was defunded shortly after we completed data collection, and since then, overdose death rates in the city have climbed [ 88 ] and public order in that area has reportedly deteriorated [ 89 ].

The framing of effectiveness is crucial in this policy environment

In light of these tensions, we offer the findings of this study as a contribution to an evidence base that may play an increasingly central role in California’s—and the nation’s—opioid crisis response. The allowable expenditures for opioid settlement funds list “evidence-informed programs to reduce the harms associated with intravenous drug use” as a focus area [ 51 ] and California’s Overdose Prevention Initiative describes its approach as being “data-driven.” [ 10 ] The proposed HHS FY2024 budget, in addition to cutting much of the funding that covers harm reduction programming, proposes the rejection of “controversial programs” while maintaining funding for “an effective opioid response.” [ 78 ] As California faces a $68 billion budget deficit [ 90 ] and supplementary federal and settlement funds are to be apportioned based on strategy effectiveness and the body of scientific evidence, the role of research comes into sharper focus. It is the strength or weakness of the evidence base—of the complexity of the research inquiry and integrity of the data—that may ultimately frame which initiatives are eligible for support.

When asked about the place and promise of drug checking within the broader constellation of harm reduction services, it was drug users’ humanity and right to health, more so than the public health implications, that grounded many of our participants’ responses. Their responses implicated, too, the underlying operating principle that, ultimately, people make choices that make sense for them. Whether by the hand of addiction or desire, constrained options or access, or every individual’s complex hierarchy of relative dangers and needs, people’s choices are reflections of their full humanity. Approaches to stemming the tide of this crisis cannot be effective unless they are built on respect for the individuals living it, and focused on understanding their needs.

We encourage continued research and reporting on drug checking services and emerging technologies, with an emphasis on exploring effectiveness within a broad scope, reflective of the impacts of these services on whole lives and systems.

Limitations

Many of the community members we interviewed had not heard of spectrometry or spectroscopy, and the interview represented the first time they were introduced to the technology as a concept and the first time they considered whether and how they could see themselves using it in their own lives. This limits the range of our findings among the client sample, given that much of our qualitative data speaks to hypothetical future use rather than past or current use of emerging technologies. The absence of data on client use should not be interpreted to mean that participants chose not to use DCS.

Additionally, the sampling frame for clients was limited to one setting, while providers were sampled from across North America, and the small sample size for both groups may have limited saturation. Finally, providers did not reflect all North American regions where drug checking has been implemented, nor all DCS models, limiting the generalizability of findings.

Our manuscript contributes to growing evidence of the effectiveness of drug checking services in mitigating a range of risks associated with substance use, including overdose, and offer diverse benefits at the individual, community, public health, and health systems levels. For that reason, policymakers should consider allocating resources towards its implementation and scale-up in settings impacted by overdose mortality.

Data availability

Due to ethical restrictions, the data generated and analyzed during the current study are not available to those outside the study team. Data and materials are of a sensitive nature, and participants did not consent to transcripts of their interviews being publicly available. Portions of interviews about which editors have questions or concerns may be provided upon request after any details that may risk the confidentiality of the participants beyond de-identification have been removed. Researchers who meet the criteria for access to confidential data may send requests for the interview transcripts to the Human Research Protection Program (HRPP)/IRB at the University of California, San Francisco at 415-476-1814 or [email protected].

Abbreviations

Fourier–Transform Infrared Spectroscopy

Fentanyl testing strips

US Department of Health and Human Services

Medications for opioid use disorder

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Acknowledgements

This study would not have been possible without the client participants who so generously shared insights about their lives and how they access harm reduction services, and our provider key informants and their work on behalf of people who use drugs. The authors would also like to thank the staff of the Northern California HIV/AIDS Policy Research Center who supported the project during its inception, data collection, and writing.

This research was funded by the California HIV/AIDS Research Program (CHRP) to the Northern California HIV/AIDS Policy Research Center (PI Arnold), H21PC3238. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, 94143, USA

Lissa Moran, Jeff Ondocsin, Simon Outram & Emily A. Arnold

Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA

Jeff Ondocsin, Daniel Ciccarone & Nicole Holm

Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, M5B 1W8, Canada

Daniel Werb

Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA, 92093, USA

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Contributions

E.A.A. and D.C. conceptualized and designed the study; J.O., L.M., D.C., and N.H. were responsible for data collection, each conducting in-depth key informant interviews. L.M., J.O., S.O., and E.A.A. analyzed the data. L.M. led the writing of the original manuscript draft with significant contributions from J.O., S.O., and E.A.A. L.M., J.O., D.C., S.O., D.W., N.H., and E.A.A. were directly involved in iterative review and revision. E.A.A. provided supervision, project administration, and funding acquisition. All authors have read and agreed to the submitted version of the manuscript.

Corresponding author

Correspondence to Lissa Moran .

Ethics declarations

Ethics approval and consent to participate.

The study was conducted in accordance with the Declaration of Helsinki and informed consent was obtained from all subjects involved in the study. The study protocol and consent procedures were reviewed and approved by the UCSF IRB (#22-36640) on 12 September 2022.

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Not applicable.

Competing interests

D.W. is a founder of DoseCheck, a commercial entity that is developing a mobile drug checking technology. D.C. reports the following relevant financial relationships during the past 12 months: (1) he is a scientific advisor to Celero Systems; and (2) he has been retained as an expert witness in ongoing prescription opioid litigation by Motley Rice, LLP. The remaining authors have no relevant financial or non-financial interests to disclose. The remaining authors have no relevant financial or non-financial interests to disclose.

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Moran, L., Ondocsin, J., Outram, S. et al. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J 21 , 92 (2024). https://doi.org/10.1186/s12954-024-01014-w

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Received : 23 January 2024

Accepted : 02 May 2024

Published : 11 May 2024

DOI : https://doi.org/10.1186/s12954-024-01014-w

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