Qualitative research methods began to appear in nursing in 1960s and 1970s amid cautious and reluctant acceptance. In the 1980s, qualitative health research emerged as a distinctive domain and mode of inquiry.1 Qualitative research refers to any kind of research that produces findings not arrived at by means of statistical analysis or other means of quantification.2,3 It uses a naturalistic approach that seeks to understand phenomena about persons’ lives, stories, and behavior including those related to health, organizational functioning, social movements, or interactional relationships. Qualitative research is underpinned by several theoretical perspectives, namely, constructivist-interpretive, critical, postpositivist, poststructural/postmodern, and feminism.4 One conducts a qualitative study to uncover the nature of the person’s experiences with a phenomenon in context-specific conditions such as illness (acute and chronic), addiction, loss, disability, and end of life. Qualitative research is used to explore, uncover, describe, and understand what lies behind any phenomenon about which maybe little is known. This deeper understanding of the phenomenon in its specific context can be attained only through a qualitative inquiry than mere numbers and statistical models could provide using a quantitative approach. Qualitative inquiry represents a legitimate mode of social and human science exploration, without apology or comparisons to quantitative research.5
This article describes what is qualitative research methodology, the “what,” “why,” “who,” and “how,” including its components. The aim is to simplify the terminology and process of qualitative inquiry to enable novice readers of research to better understand the concepts involved.
WHY DO QUALITATIVE RESEARCH?
The tradition of using qualitative methods to study human phenomena is grounded in the social sciences.6 This methodological revolution has made way for a more interpretative approach because aspects of human values, culture, and relationships are not described fully using quantitative research methods. Unlike quantitative researchers who seek causal determination, prediction, and generalization of findings, qualitative researchers allow for the phenomenon of interest to unfold naturally,7 strive to explore, describe and understand it, and delve into a colorful, deep, contextual world of interpretations.8 Thus, the practice of qualitative research has expanded to clinical settings because empirical approaches have proven to be inadequate in answering questions related to human subjectivity where interpretation is involved.9 Consequently, qualitative health research is a research approach to exploring health and illness as they are perceived by the people themselves rather than from the researcher’s perspective.10 Morse10 further stated that “Researchers use qualitative research methods to illicit emotions and perspectives, beliefs and values, actions, and behaviors and to understand the participant’s responses to health and illness and the meanings they construct about the experience.”10(p21) It provides a rich inductive description that necessitates interpretations. Researchers in the health care arena, practitioners, and policy makers are increasingly pressed to translate these findings for practice, put them to use, and evaluate how useful they actually are in effecting desired change with goal of improving public health and reducing disparities in health care delivery.1 Even though qualitative research has been used for many decades, and it is in fact flourishing, it is not free of criticisms from experts with impoverished view of the methodology.
Despite the current urgency of the utilization of qualitative methodologies in research studies, questions are raised for its lack of objectivity, generalizability, utility, and its tendency to be anecdotal.1 Critics continue to make these charges related to their limited understanding of qualitative designs, approaches, and methods. Sandelowski1 asserted that the current urgency about the utility of qualitative research findings is the result of several converging trends in health care research that include the elevation of practical over basic knowledge as the highest form of knowledge, the proliferation of qualitative health research studies, and the rise of evidence-based practice as a paradigm and methodology for health care.1 Consequently, these events have, in turn, contributed to the growing interest of incorporating qualitative health research findings into evidence-based practice.
Morse10 asserted that there are other reasons for conducting a qualitative inquiry. Others believe that the role of qualitative inquiry is to provide hypothesis and research questions that can be posed from the findings of qualitative research studies. Qualitative research can also serve as a foundation from which surveys and questionnaires could be developed, thus increasing its validity that would produce models for quantitative testing. But, what is really the most important function of qualitative inquiry? According to Morse,10 this key function is the moral imperative of qualitative inquiry to humanize health care. She stated, “The social justice agenda of qualitative health research is one that humanizes health care.”10(p52) So, what is humanizing health care? Morse10 stated, “Humanizing encompasses a perspective on attitudes, beliefs, expectations, practices, and behaviors that influence the quality of care, administration of that care, conditions judged to warrant (or not warrant) empathetic care, responses to care and therapeutics, and anticipated and actual outcomes of patient or community care.”10(pp54,55)
Conducting research should be sort of a social justice project.10 Denzin11 recognizes making social justice a public agenda within qualitative inquiry. He emphasized that qualitative inquiry can contribute to social justice through (a) identifying different definitions of a problem and/or situation that is being evaluated with some agreement that change is required; (b) the assumptions that are held by policy makers, clients, welfare workers, online professionals, and other interested parties can be located and shown to be correct or incorrect; (c) strategic points of interventions can be identified and thus evaluated and improved; (d) suggest alternative moral points of view from which the problem, the policy, and the program can be interpreted and assessed; and (e) the limits of statistics and statistical evaluations can be exposed with the more qualitative materials furnished by this approach.11
WHO DOES QUALITATIVE RESEARCH?
Qualitative research is done by researchers in the social sciences as well as by practitioners in fields that concern themselves with issues related to human behavior and functioning.3 They are also health professionals who are able to identify a research question and able to recognize the particular context and situation that would achieve the best answers.10 According to Morse,10 the qualitative health researcher should be an expert methodologist who should have the understanding of illness, the patient’s condition, and the staff roles and relationships and able to balance the clinical situation from different perspectives.10(p23) A qualitative researcher also requires theoretical and social sensibility, interactional skills, and the ability to maintain analytical distance while drawing upon past experience and theoretical knowledge to interpret what is seen or observed.3
WHAT ARE THE CHARACTERISTICS OF QUALITATIVE RESEARCH?
Creswell12 discussed that qualitative research studies today involve closer attention to the interpretive nature of inquiry and situating the study within the political, social, and cultural context of the researchers, participants, and readers of the study. He presented several characteristics of qualitative research, which are (a) natural setting: data are collected face-to-face in the field at the site where participants experience the phenomenon under study; the inquiry should be conducted in a way that does not disturb the natural context of the phenomenon; (b) researcher as key instrument: the researchers collect the data themselves rather than relying on instruments developed by others; (c) multiple sources of data: researchers gather multiple forms of data including interviews, observations, and examining documents rather than rely on a single source; (d) inductive data analysis: data are organized into abstract units of information (“bottom-up” or moving from specific to general), working back and forth between the themes and the database until a comprehensive set of themes is established and ending up with general conclusions or theories; (e) participant’s meanings: the researchers keep a focus on learning the meaning that the participants hold about the phenomenon, not the meaning that the researchers bring to the study; (f) emergent design: the initial plan for the study cannot be tightly prescribed; rather, it is emergent, and all phases of the process may change or shift after the researchers enter the field and begin to collect the data; (g) theoretical lens: use of a “lens” to view the study such as the concept of culture, gender, race or class differences, and social, political, or historical context of the problem under study; (h) interpretive inquiry: a form of inquiry in which researchers make interpretation of what they see, hear, and understand that cannot be separated from their own background, history, context, and prior understanding; (i) holistic account: reporting multiple perspectives, identifying the many factors involved in a situation, and sketching the larger picture that emerges.12
WHAT ARE THE METHODS FREQUENTLY USED IN QUALITATIVE RESEARCH?
The research question dictates the method to be used for a qualitative study. Qualitative and quantitative questions are distinct and serve different purposes.10 Some of the different types of qualitative research that will be discussed in this article are phenomenology, grounded theory, ethnography, case study, and narrative research. Researchers from different disciplines use these approaches depending on what the purpose of the study is.
Narrative research begins with the experiences as expressed in lived and told stories of individuals. Narrative is a spoken word or written text giving an account of an event/action chronologically connected. Some examples of this approach are biographical studies, autobiographies, and life stories. Kvangarsnes et al13 explored the patient perceptions of chronic obstructive pulmonary disease exacerbation and their experiences of their relations with health personnel during care and treatment using narrative research design. Ten in-depth qualitative interviews were conducted with patients who had been admitted to 2 intensive care units (ICUs) in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyze the interviews. The patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected. This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.
Whereas a narrative approach explores the life of a single person, a phenomenological study describes the meaning for several individuals of their lived experiences of a phenomenon.12 Phenomenology is the most inductive of all qualitative methods.10 The philosophical assumptions of phenomenology rest on some common grounds: the study of the lived experiences of persons, the view that these experiences are conscious ones and the development of descriptions of the essences of these experiences, not explanations or analysis.12 There are different types of phenomenological approaches, namely, descriptive-transcendental (Husserl, Giorgi), interpretive/hermeneutic (Heidegger, Gadamer, Jen-Luc Nancy), descriptive-hermeneutic (van Manen), empirical-transcendental (Moustakas), and existential (Sarte, Heidegger, Merleau-Ponty). A phenomenological study conducted by Cypress14 explored the lived experiences of nurses, patients, and family members during critical illness in the emergency department (ED). Data were collected over a 6-month period by means of in-depth interviews, and thematic analysis was done using van Manen’s15 hermeneutic-phenomenological approach. The findings of this qualitative phenomenological study indicate that the patient’s and family member’s perception of the nurses in the ED relates to their critical thinking skills, communication, sensitivity, and caring abilities. Nurses of this study identified that response to the patient’s physiological deficit is paramount in the ED, and involving the patients and families in the human care processes will help attain this goal.
While phenomenology aims to illuminate themes and describe the meaning of lived experiences of a number of individuals, grounded theory has the intent to move beyond description and to generate or discover a theory, an abstract analytical schema of a process, or interaction shaped by the views of a large number of participants.12 This qualitative method was developed by Glaser and Strauss16 in 1967. Other grounded theorists followed, including Clarke,17 who relies on postmodern perspectives, and Charmaz,18 on constructivist approach. Gallagher et al19 collected and analyzed qualitative data using grounded theory to understand nurses’ end-of-life (EOL) decision-making practices in 5 ICUs in different cultural contexts. Interviews were conducted with 51 experienced ICU nurses in university or hospital premises in 5 countries. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EOL decision-making practices in the ICU. The core category that emerged was “negotiated reorienting.” Gallagher et al19 stated, “Whilst nurses do not make the ‘ultimate’ EOL decisions, they engage in 2 core practices: consensus seeking (involving coaxing, information cuing and voice enabling) and emotional holding (creating time-space and comfort giving).”19(p794)
Although a grounded theory approach examines a number of individuals to develop a theory, participants are not studied as 1 unit. Ethnography uses a larger number of individuals and focuses on an entire cultural group as 1 unit of analysis. This qualitative approach describes and interprets the shared and learned patters of values, behaviors, beliefs, and language of a cultural-sharing group.12 There are many forms of ethnography, namely, confessional, life history, autoethnography, feminist, ethnographic novels, visual ethnography found in photography and video, and electronic media. Price20 explored what aspects affect registered health care professionals’ ability to care for patients within the technological environment of a critical care unit. Ethnography was utilized to focus on the cultural elements within a situation. Data collection involved participant observation, document review, and semistructured interviews. Nineteen participants took part in the study. An overarching theme of the “crafting process” was developed with subthemes of “vigilance,” “focus of attention,” “being present,” and “expectations,” with the ultimate goal of achieving the best interests for the individual patient.
A culture-sharing group in ethnography can be considered a case, but its aim is to ascertain how the culture works rather than understanding 1 or more specific cases within a bounded system. Creswell12 defines case study research as an approach in which the researcher explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed in-depth data collection involving multiple sources of information and reports a case description and case-based themes.12(p73) In terms of intent, there are 3 types of case study: single instrumental, collective or multiple, and the intrinsic case study. Hyde-Wyatt21 studied spinally injured patients on sedation in the ICU. A reflection-on-action exercise was carried out when a spinally injured patient became physically active during a sedation hold. This was attributed to hyperactive delirium. Reflection on this incident led to a literature search for guidance on the likelihood of delirium causing secondary spinal injury in patients with unstable fractures. Through a case study approach, the research was reviewed in relation to a particular patient. This case study illustrated that there was a knowledge deficit when it came to managing the combination of the patient’s spinal injury and delirium. Sedation cessation episodes are an essential part of patient care on intensive care. For spinally injured patients, these may need to be modified to sedation reductions to prevent sudden wakening and uncontrolled movement should the patient be experiencing hyperactive delirium.
WHAT IS THE PROCESS OF CONCEPTUALIZING AND DESIGNING A QUALITATIVE RESEARCH?
Designing a qualitative is not a fully structured, rigid process. Even books and experts vary in their understanding and guides in the “how to” perspective of a qualitative inquiry. Conducting a qualitative study is also extremely difficult.10 Sometimes there is concern about access and the qualitative procedures involved in data collection including disclosure of participant’s identity and confidentiality of data. Nevertheless, qualitative research involves a rigorous and scientific process that serves as guide for researchers who are planning to embark on a journey and complete a naturalistic inquiry.
Unlike quantitative research that involves a fairly linear process, qualitative studies have a flexible approach and flow of activities, and the researchers do not know in advance exactly how the study will unfold.22 The process of designing a qualitative study does not begin with the methods—which in fact is the easiest part of naturalistic research.12 Qualitative researchers usually begin with a broad topic focusing on 1 aspect or a phenomenon of which little is known. The phenomenon may be one in the “real world,” a gap in the literature, or past findings of investigations, for example, in the area of social and human sciences.12 A fairly broad question is then posed to be able to allow the focus to be delineated and sharpened once the study is underway.
Once the research question is posed, the researchers should conduct a brief literature review to inform the question asked and to help establish the significance of the problem. There is a continuous debate about the value of doing a literature review prior to collecting of data and how much of it should be done. Some believe that knowledge about findings of previous studies might influence the conceptualization of the phenomenon of interest, which ideally should be illuminated from the participants rather than on prior findings.22 A grounded theory investigator, for example, may make a point of not conducting a review of literature before beginning the study to avoid “contamination” of the data with preconceived concepts and notions about what might be relevant.2 After the review of literature, the researchers must identify an appropriate site for the study to be conducted.
Selecting and gaining entry to the site require knowledge of settings in which participants in their lifeworld are experiencing the phenomenon under study. For example, research in the area of health is a very broad topic. A researcher should determine definitions, concepts, scope, and theories about health that will be used for the proposed qualitative inquiry. Health can be perceived as absence or presence of illness, physical, psychosocial, psychological, and spiritual health of individuals, families, or groups.10 Morse10 further stated that “Research into the intimate, experiential and interpersonal aspects of illness, into caring for the ill, and into seeking and maintaining wellness introduces extraordinary methodological challenges.”10(p89) Thus, knowledge about the characteristics of participants who will be recruited for the study and the specific context of the settings (ie, hospital/institution, community/outpatient) where they are at the time when research will be conducted is important. To be able to gain entry to the site, the ethical aspect of the study should also be addressed. Approval from the institution’s institutional review board and informed consent from the participants must be obtained. Qualitative studies have special ethical concerns involved because of the more intimate nature of the relationship that typically develop between researchers and participants.22 The researchers must develop specific plans addressing these issues. After addressing the ethical concerns and gaining entry to the site, an overall approach should be planned and developed.
It has been previously addressed that even though the researchers plan for a specific approach to be used, the design can be emergent during the course of data collection. Modifications are made as the need arises. It is rare that a qualitative study has rigidly structured design that will prohibit changes while in the field,22 but being aware that the purposes, questions, and methods of research are all interconnected and interrelated so that the study appears as a cohesive whole rather than fragmented isolated parts.5 For example, patients in hospitals have limited abilities related to their medical condition and the contextual features of a hospital. A patient’s condition may demand a different method be used because of patient fatigue, the interruptions of data collection for treatments, or physician’s rounds and visitors. In this context, the study requires modifications of methods, and participation in a research study has the lowest priority at this specific moment and time.10
In qualitative studies, sampling, data collection, and analysis including interpretation take place repetitively. The sampling method usually used is purposive. Qualitative researchers use rigorous data collection procedures by talking to participants face-to-face, interviewing, and observing them (individual, focus groups, or an entire culture) to be able to explore the phenomenon under study. The discussions and observations are loosely structured, allowing participants full range of beliefs, feelings, and behaviors.22 Other types of information that can be collected are documents, photographs, audiovisual materials, sounds, e-mail massages, digital text messages, and computer software. The backbone of qualitative research is extensive collection of data from multiple sources of information.12 After organizing and storing the data, the researcher will try to make sense of the data, working inductively from particulars to more general perspectives until categories, codes, and themes emerge and are illuminated, which are used to build a rich description of the phenomenon.12,22 The researcher analyzes data using multiple levels of abstraction. Analysis and interpretation are ongoing concurrent activities that guide the researchers about the kinds of questions to ask or observations to make. The kinds of data gathered become increasingly meaningful as the theory emerges. When themes and categories become repetitive and redundant and no new information can be gleaned, the researcher has reached data saturation and thus stops collecting data and recruitment of participants.22 Trustworthiness of the data and rigor have to be then established. Steps have to be taken to confirm that the findings accurately reflect the experiences and perceptions of participants rather than the researcher’s viewpoints. Some of the strategies that can be used are validation techniques that include confirming and triangulating data from several sources, going back to participants, sharing preliminary interpretations with them, asking them whether the researcher’s thematic analysis is consistent with their experiences,22(p55) and having other expert researchers review the procedures undertaken and interpretations made.12
Qualitative research uses a naturalistic approach that seeks to understand phenomena in context-specific settings, attempting to make sense of it and interpreting in terms of meaning people bring to them. It contributes to the humanizing of health care as it addresses content about health and illness. Qualitative research does not have firm or rigid guidelines and takes time to conduct. Some of the methods for a qualitative inquiry are narrative research, phenomenology, grounded theory, case study, and ethnography. Although the study design emerges during the inquiry, it follows the pattern of scientific research. Researchers collect data rigorously in natural settings over a period and analyze them inductively to establish patterns or themes. Ethical decisions and considerations for rigor and trustworthiness are also continuously threaded throughout the study. The final report presents the active voices of participants and the description and interpretation of the meaning of the phenomenon including the reflexivity of the researcher.
1. Sandelowski M. Using qualitative research
. Qual Health Res
. 2003; 14: 1366–1386.
2. Borbasi S, Jackson D. Navigating the Maze of Research
. Chatswood, Sydney, Australia: Mosby Elsevier; 2012.
3. Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques
. Newbury Park, CA: Sage Publications Inc; 1990.
4. Ingham-Broomfield R. A nurses’ guide to qualitative research
. Aust J Adv Nurs
. 2015; 32( 3): 34–40.
5. Creswell JW. Qualitative Inquiry and Research Design: Choosing Among Five Approaches
. 2nd ed. Thousand Oaks, CA: Sage; 2007.
6. 4. Streubert HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative
. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
7. Patton MQ. Qualitative Research and Evaluation Methods
. 2nd ed. Thousand Oaks, CA: Sage Publications; 2001.
8. Golafshani N. Understanding reliability and validity in qualitative research
. The Qual Rep
. 2001; 8( 4): 597–607.
9. Thorne S. The art (and science) of critiquing qualitative research
. In: Morse JM, ed. Completing a Qualitative Project: Details and Dialogue
. Thousand Oaks, CA: Sage; 1997; 117–132.
10. Morse J. Qualitative Health Research: Creating a New Discipline
. Walnut Creek, CA: Left Coast Press Inc; 2012.
11. Denzin N. The Qualitative Manifesto
: A Call to Arms
. Walnut Creek, CA: Left Coast Press Inc; 2010.
12. Creswell JW. Qualitative Inquiry and Research Design: Choosing Among Five Approaches
. 3rd ed. Thousand Oaks, CA: Sage; 2012.
13. Kvangarsnes M, Torheim H, Hole T, Öhlund LS. Narratives of breathlessness in chronic obstructive pulmonary disease. J Clin Nurs
. 2013; 22( 21-22): 3062–3070.
14. Cypress BS. The emergency room: experiences of patients, families, and their nurses. Adv Emerg Nurs J
. 2014; 36( 2): 164–176.
15. van Manen M. Researching Lived Experience: Human Science for an Action Sensitive Pedagogy
. Albany, NY: State University Press; 1990.
16. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research
. Chicago, IL: Aldine; 1967.
17. Clarke A. Situational Analysis: Grounded Theory After the Postmodern Turn
. Thousand Oaks, CA: Sage; 2005.
18. Charmaz K. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis
. Thousand Oaks, CA: Sage; 2006.
19. International Nurses’ End-of-Life Decision-Making in Intensive Care Research Group, Gallagher A, Bousso RS, McCarthy J, et al. Negotiated reorienting: a grounded theory of nurses’ end-of-life decision-making in the intensive care unit. Int J Nurs Stud
. 2015; 52: 794–803.
20. Price AM. Caring and technology in an intensive care unit: an ethnographic study. Nurs Crit Care
. 2013; 18( 6): 278–288.
21. Hyde-Wyatt JP. Managing hyperactive delirium and spinal immobilisation in the intensive care setting: a case study and reflective discussion of the literature. Intensive Crit Care Nurs
. 2014; 30( 3): 138–144.
22. Polit DF, Beck CT. Essentials of Nursing Research: Appraising Evidence for Nursing Practice
. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2014.