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How to write qualitative research questions.

11 min read Here’s how to write effective qualitative research questions for your projects, and why getting it right matters so much.

What is qualitative research?

Qualitative research is a blanket term covering a wide range of research methods and theoretical framing approaches. The unifying factor in all these types of qualitative study is that they deal with data that cannot be counted. Typically this means things like people’s stories, feelings, opinions and emotions , and the meanings they ascribe to their experiences.

Qualitative study is one of two main categories of research, the other being quantitative research. Quantitative research deals with numerical data – that which can be counted and quantified, and which is mostly concerned with trends and patterns in large-scale datasets.

What are research questions?

Research questions are questions you are trying to answer with your research. To put it another way, your research question is the reason for your study, and the beginning point for your research design. There is normally only one research question per study, although if your project is very complex, you may have multiple research questions that are closely linked to one central question.

A good qualitative research question sums up your research objective. It’s a way of expressing the central question of your research, identifying your particular topic and the central issue you are examining.

Research questions are quite different from survey questions, questions used in focus groups or interview questions. A long list of questions is used in these types of study, as opposed to one central question. Additionally, interview or survey questions are asked of participants, whereas research questions are only for the researcher to maintain a clear understanding of the research design.

Research questions are used in both qualitative and quantitative research , although what makes a good research question might vary between the two.

In fact, the type of research questions you are asking can help you decide whether you need to take a quantitative or qualitative approach to your research project.

Discover the fundamentals of qualitative research

Quantitative vs. qualitative research questions

Writing research questions is very important in both qualitative and quantitative research, but the research questions that perform best in the two types of studies are quite different.

Quantitative research questions

Quantitative research questions usually relate to quantities, similarities and differences.

It might reflect the researchers’ interest in determining whether relationships between variables exist, and if so whether they are statistically significant. Or it may focus on establishing differences between things through comparison, and using statistical analysis to determine whether those differences are meaningful or due to chance.

• How much? This kind of research question is one of the simplest. It focuses on quantifying something. For example:

How many Yoruba speakers are there in the state of Maine?

• What is the connection?

This type of quantitative research question examines how one variable affects another.

For example:

How does a low level of sunlight affect the mood scores (1-10) of Antarctic explorers during winter?

• What is the difference? Quantitative research questions in this category identify two categories and measure the difference between them using numerical data.

Do white cats stay cooler than tabby cats in hot weather?

If your research question fits into one of the above categories, you’re probably going to be doing a quantitative study.

Qualitative research questions

Qualitative research questions focus on exploring phenomena, meanings and experiences.

Unlike quantitative research, qualitative research isn’t about finding causal relationships between variables. So although qualitative research questions might touch on topics that involve one variable influencing another, or looking at the difference between things, finding and quantifying those relationships isn’t the primary objective.

In fact, you as a qualitative researcher might end up studying a very similar topic to your colleague who is doing a quantitative study, but your areas of focus will be quite different. Your research methods will also be different – they might include focus groups, ethnography studies, and other kinds of qualitative study.

A few example qualitative research questions:

• What is it like being an Antarctic explorer during winter?
• What are the experiences of Yoruba speakers in the USA?
• How do white cat owners describe their pets?

Qualitative research question types

Marshall and Rossman (1989) identified 4 qualitative research question types, each with its own typical research strategy and methods.

• Exploratory questions

Exploratory questions are used when relatively little is known about the research topic. The process researchers follow when pursuing exploratory questions might involve interviewing participants, holding focus groups, or diving deep with a case study.

• Explanatory questions

With explanatory questions, the research topic is approached with a view to understanding the causes that lie behind phenomena. However, unlike a quantitative project, the focus of explanatory questions is on qualitative analysis of multiple interconnected factors that have influenced a particular group or area, rather than a provable causal link between dependent and independent variables.

• Descriptive questions

As the name suggests, descriptive questions aim to document and record what is happening. In answering descriptive questions , researchers might interact directly with participants with surveys or interviews, as well as using observational studies and ethnography studies that collect data on how participants interact with their wider environment.

• Predictive questions

Predictive questions start from the phenomena of interest and investigate what ramifications it might have in the future. Answering predictive questions may involve looking back as well as forward, with content analysis, questionnaires and studies of non-verbal communication (kinesics).

Why are good qualitative research questions important?

We know research questions are very important. But what makes them so essential? (And is that question a qualitative or quantitative one?)

Getting your qualitative research questions right has a number of benefits.

• It defines your qualitative research project Qualitative research questions definitively nail down the research population, the thing you’re examining, and what the nature of your answer will be.This means you can explain your research project to other people both inside and outside your business or organization. That could be critical when it comes to securing funding for your project, recruiting participants and members of your research team, and ultimately for publishing your results. It can also help you assess right the ethical considerations for your population of study.
• It maintains focus Good qualitative research questions help researchers to stick to the area of focus as they carry out their research. Keeping the research question in mind will help them steer away from tangents during their research or while they are carrying out qualitative research interviews. This holds true whatever the qualitative methods are, whether it’s a focus group, survey, thematic analysis or other type of inquiry.That doesn’t mean the research project can’t morph and change during its execution – sometimes this is acceptable and even welcome – but having a research question helps demarcate the starting point for the research. It can be referred back to if the scope and focus of the project does change.
• It helps make sure your outcomes are achievable

Because qualitative research questions help determine the kind of results you’re going to get, it helps make sure those results are achievable. By formulating good qualitative research questions in advance, you can make sure the things you want to know and the way you’re going to investigate them are grounded in practical reality. Otherwise, you may be at risk of taking on a research project that can’t be satisfactorily completed.

Developing good qualitative research questions

All researchers use research questions to define their parameters, keep their study on track and maintain focus on the research topic. This is especially important with qualitative questions, where there may be exploratory or inductive methods in use that introduce researchers to new and interesting areas of inquiry. Here are some tips for writing good qualitative research questions.

1. Keep it specific

Broader research questions are difficult to act on. They may also be open to interpretation, or leave some parameters undefined.

Strong example: How do Baby Boomers in the USA feel about their gender identity?

Weak example: Do people feel different about gender now?

2. Be original

Look for research questions that haven’t been widely addressed by others already.

Strong example: What are the effects of video calling on women’s experiences of work?

Weak example: Are women given less respect than men at work?

3. Make it research-worthy

Don’t ask a question that can be answered with a ‘yes’ or ‘no’, or with a quick Google search.

Strong example: What do people like and dislike about living in a highly multi-lingual country?

Weak example: What languages are spoken in India?

4. Focus your question

Don’t roll multiple topics or questions into one. Qualitative data may involve multiple topics, but your qualitative questions should be focused.

Strong example: What is the experience of disabled children and their families when using social services?

Weak example: How can we improve social services for children affected by poverty and disability?

4. Focus on your own discipline, not someone else’s

Avoid asking questions that are for the politicians, police or others to address.

Strong example: What does it feel like to be the victim of a hate crime?

Weak example: How can hate crimes be prevented?

5. Ask something researchable

Big questions, questions about hypothetical events or questions that would require vastly more resources than you have access to are not useful starting points for qualitative studies. Qualitative words or subjective ideas that lack definition are also not helpful.

Strong example: How do perceptions of physical beauty vary between today’s youth and their parents’ generation?

Weak example: Which country has the most beautiful people in it?

Related resources

Qualitative research design 12 min read, primary vs secondary research 14 min read, business research methods 12 min read, qualitative research interviews 11 min read, market intelligence 10 min read, marketing insights 11 min read, ethnographic research 11 min read, request demo.

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Research methods--quantitative, qualitative, and more: overview.

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About Research Methods

This guide provides an overview of research methods, how to choose and use them, and supports and resources at UC Berkeley. 

As Patten and Newhart note in the book Understanding Research Methods , "Research methods are the building blocks of the scientific enterprise. They are the "how" for building systematic knowledge. The accumulation of knowledge through research is by its nature a collective endeavor. Each well-designed study provides evidence that may support, amend, refute, or deepen the understanding of existing knowledge...Decisions are important throughout the practice of research and are designed to help researchers collect evidence that includes the full spectrum of the phenomenon under study, to maintain logical rules, and to mitigate or account for possible sources of bias. In many ways, learning research methods is learning how to see and make these decisions."

The choice of methods varies by discipline, by the kind of phenomenon being studied and the data being used to study it, by the technology available, and more.  This guide is an introduction, but if you don't see what you need here, always contact your subject librarian, and/or take a look to see if there's a library research guide that will answer your question. 

Suggestions for changes and additions to this guide are welcome! 

START HERE: SAGE Research Methods

Without question, the most comprehensive resource available from the library is SAGE Research Methods.  HERE IS THE ONLINE GUIDE  to this one-stop shopping collection, and some helpful links are below:

• SAGE Research Methods
• Little Green Books  (Quantitative Methods)
• Little Blue Books  (Qualitative Methods)
• Dictionaries and Encyclopedias  
• Case studies of real research projects
• Sample datasets for hands-on practice
• Streaming video--see methods come to life
• Methodspace- -a community for researchers
• SAGE Research Methods Course Mapping

Library Data Services at UC Berkeley

Library Data Services Program and Digital Scholarship Services

The LDSP offers a variety of services and tools !  From this link, check out pages for each of the following topics:  discovering data, managing data, collecting data, GIS data, text data mining, publishing data, digital scholarship, open science, and the Research Data Management Program.

Be sure also to check out the visual guide to where to seek assistance on campus with any research question you may have!

Library GIS Services

Other Data Services at Berkeley

D-Lab Supports Berkeley faculty, staff, and graduate students with research in data intensive social science, including a wide range of training and workshop offerings Dryad Dryad is a simple self-service tool for researchers to use in publishing their datasets. It provides tools for the effective publication of and access to research data. Geospatial Innovation Facility (GIF) Provides leadership and training across a broad array of integrated mapping technologies on campu Research Data Management A UC Berkeley guide and consulting service for research data management issues

General Research Methods Resources

Here are some general resources for assistance:

• Assistance from ICPSR (must create an account to access): Getting Help with Data , and Resources for Students
• Wiley Stats Ref for background information on statistics topics
• Survey Documentation and Analysis (SDA) .  Program for easy web-based analysis of survey data.

Consultants

• D-Lab/Data Science Discovery Consultants Request help with your research project from peer consultants.
• Research data (RDM) consulting Meet with RDM consultants before designing the data security, storage, and sharing aspects of your qualitative project.
• Statistics Department Consulting Services A service in which advanced graduate students, under faculty supervision, are available to consult during specified hours in the Fall and Spring semesters.

Related Resourcex

• IRB / CPHS Qualitative research projects with human subjects often require that you go through an ethics review.
• OURS (Office of Undergraduate Research and Scholarships) OURS supports undergraduates who want to embark on research projects and assistantships. In particular, check out their "Getting Started in Research" workshops
• Sponsored Projects Sponsored projects works with researchers applying for major external grants.
• Next: Quantitative Research >>
• Last Updated: Apr 25, 2024 11:09 AM
• URL: https://guides.lib.berkeley.edu/researchmethods

Qualitative vs Quantitative Research Methods & Data Analysis

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

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

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

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

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

On This Page:

What is the difference between quantitative and qualitative?

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

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

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

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

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

What Is Qualitative Research?

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

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

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

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

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

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

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

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

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

Qualitative Methods

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

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

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

Here are some examples of qualitative data:

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

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

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

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

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

Qualitative Data Analysis

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

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

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

Key Features

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

Limitations of Qualitative Research

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

Advantages of Qualitative Research

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

What Is Quantitative Research?

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

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

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

Quantitative Methods

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

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

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

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

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

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

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

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

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

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

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

Quantitative Data Analysis

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

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

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

Limitations of Quantitative Research

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

Advantages of Quantitative Research

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

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

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

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

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

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

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

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

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

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

Further Information

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

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Chapter 2. Research Design

Getting started.

When I teach undergraduates qualitative research methods, the final product of the course is a “research proposal” that incorporates all they have learned and enlists the knowledge they have learned about qualitative research methods in an original design that addresses a particular research question. I highly recommend you think about designing your own research study as you progress through this textbook. Even if you don’t have a study in mind yet, it can be a helpful exercise as you progress through the course. But how to start? How can one design a research study before they even know what research looks like? This chapter will serve as a brief overview of the research design process to orient you to what will be coming in later chapters. Think of it as a “skeleton” of what you will read in more detail in later chapters. Ideally, you will read this chapter both now (in sequence) and later during your reading of the remainder of the text. Do not worry if you have questions the first time you read this chapter. Many things will become clearer as the text advances and as you gain a deeper understanding of all the components of good qualitative research. This is just a preliminary map to get you on the right road.

Research Design Steps

Before you even get started, you will need to have a broad topic of interest in mind. [1] . In my experience, students can confuse this broad topic with the actual research question, so it is important to clearly distinguish the two. And the place to start is the broad topic. It might be, as was the case with me, working-class college students. But what about working-class college students? What’s it like to be one? Why are there so few compared to others? How do colleges assist (or fail to assist) them? What interested me was something I could barely articulate at first and went something like this: “Why was it so difficult and lonely to be me?” And by extension, “Did others share this experience?”

Once you have a general topic, reflect on why this is important to you. Sometimes we connect with a topic and we don’t really know why. Even if you are not willing to share the real underlying reason you are interested in a topic, it is important that you know the deeper reasons that motivate you. Otherwise, it is quite possible that at some point during the research, you will find yourself turned around facing the wrong direction. I have seen it happen many times. The reason is that the research question is not the same thing as the general topic of interest, and if you don’t know the reasons for your interest, you are likely to design a study answering a research question that is beside the point—to you, at least. And this means you will be much less motivated to carry your research to completion.

Researcher Note

Why do you employ qualitative research methods in your area of study? What are the advantages of qualitative research methods for studying mentorship?

Qualitative research methods are a huge opportunity to increase access, equity, inclusion, and social justice. Qualitative research allows us to engage and examine the uniquenesses/nuances within minoritized and dominant identities and our experiences with these identities. Qualitative research allows us to explore a specific topic, and through that exploration, we can link history to experiences and look for patterns or offer up a unique phenomenon. There’s such beauty in being able to tell a particular story, and qualitative research is a great mode for that! For our work, we examined the relationships we typically use the term mentorship for but didn’t feel that was quite the right word. Qualitative research allowed us to pick apart what we did and how we engaged in our relationships, which then allowed us to more accurately describe what was unique about our mentorship relationships, which we ultimately named liberationships ( McAloney and Long 2021) . Qualitative research gave us the means to explore, process, and name our experiences; what a powerful tool!

How do you come up with ideas for what to study (and how to study it)? Where did you get the idea for studying mentorship?

Coming up with ideas for research, for me, is kind of like Googling a question I have, not finding enough information, and then deciding to dig a little deeper to get the answer. The idea to study mentorship actually came up in conversation with my mentorship triad. We were talking in one of our meetings about our relationship—kind of meta, huh? We discussed how we felt that mentorship was not quite the right term for the relationships we had built. One of us asked what was different about our relationships and mentorship. This all happened when I was taking an ethnography course. During the next session of class, we were discussing auto- and duoethnography, and it hit me—let’s explore our version of mentorship, which we later went on to name liberationships ( McAloney and Long 2021 ). The idea and questions came out of being curious and wanting to find an answer. As I continue to research, I see opportunities in questions I have about my work or during conversations that, in our search for answers, end up exposing gaps in the literature. If I can’t find the answer already out there, I can study it.

—Kim McAloney, PhD, College Student Services Administration Ecampus coordinator and instructor

When you have a better idea of why you are interested in what it is that interests you, you may be surprised to learn that the obvious approaches to the topic are not the only ones. For example, let’s say you think you are interested in preserving coastal wildlife. And as a social scientist, you are interested in policies and practices that affect the long-term viability of coastal wildlife, especially around fishing communities. It would be natural then to consider designing a research study around fishing communities and how they manage their ecosystems. But when you really think about it, you realize that what interests you the most is how people whose livelihoods depend on a particular resource act in ways that deplete that resource. Or, even deeper, you contemplate the puzzle, “How do people justify actions that damage their surroundings?” Now, there are many ways to design a study that gets at that broader question, and not all of them are about fishing communities, although that is certainly one way to go. Maybe you could design an interview-based study that includes and compares loggers, fishers, and desert golfers (those who golf in arid lands that require a great deal of wasteful irrigation). Or design a case study around one particular example where resources were completely used up by a community. Without knowing what it is you are really interested in, what motivates your interest in a surface phenomenon, you are unlikely to come up with the appropriate research design.

These first stages of research design are often the most difficult, but have patience . Taking the time to consider why you are going to go through a lot of trouble to get answers will prevent a lot of wasted energy in the future.

There are distinct reasons for pursuing particular research questions, and it is helpful to distinguish between them.  First, you may be personally motivated.  This is probably the most important and the most often overlooked.   What is it about the social world that sparks your curiosity? What bothers you? What answers do you need in order to keep living? For me, I knew I needed to get a handle on what higher education was for before I kept going at it. I needed to understand why I felt so different from my peers and whether this whole “higher education” thing was “for the likes of me” before I could complete my degree. That is the personal motivation question. Your personal motivation might also be political in nature, in that you want to change the world in a particular way. It’s all right to acknowledge this. In fact, it is better to acknowledge it than to hide it.

There are also academic and professional motivations for a particular study.  If you are an absolute beginner, these may be difficult to find. We’ll talk more about this when we discuss reviewing the literature. Simply put, you are probably not the only person in the world to have thought about this question or issue and those related to it. So how does your interest area fit into what others have studied? Perhaps there is a good study out there of fishing communities, but no one has quite asked the “justification” question. You are motivated to address this to “fill the gap” in our collective knowledge. And maybe you are really not at all sure of what interests you, but you do know that [insert your topic] interests a lot of people, so you would like to work in this area too. You want to be involved in the academic conversation. That is a professional motivation and a very important one to articulate.

Practical and strategic motivations are a third kind. Perhaps you want to encourage people to take better care of the natural resources around them. If this is also part of your motivation, you will want to design your research project in a way that might have an impact on how people behave in the future. There are many ways to do this, one of which is using qualitative research methods rather than quantitative research methods, as the findings of qualitative research are often easier to communicate to a broader audience than the results of quantitative research. You might even be able to engage the community you are studying in the collecting and analyzing of data, something taboo in quantitative research but actively embraced and encouraged by qualitative researchers. But there are other practical reasons, such as getting “done” with your research in a certain amount of time or having access (or no access) to certain information. There is nothing wrong with considering constraints and opportunities when designing your study. Or maybe one of the practical or strategic goals is about learning competence in this area so that you can demonstrate the ability to conduct interviews and focus groups with future employers. Keeping that in mind will help shape your study and prevent you from getting sidetracked using a technique that you are less invested in learning about.

STOP HERE for a moment

I recommend you write a paragraph (at least) explaining your aims and goals. Include a sentence about each of the following: personal/political goals, practical or professional/academic goals, and practical/strategic goals. Think through how all of the goals are related and can be achieved by this particular research study . If they can’t, have a rethink. Perhaps this is not the best way to go about it.

You will also want to be clear about the purpose of your study. “Wait, didn’t we just do this?” you might ask. No! Your goals are not the same as the purpose of the study, although they are related. You can think about purpose lying on a continuum from “ theory ” to “action” (figure 2.1). Sometimes you are doing research to discover new knowledge about the world, while other times you are doing a study because you want to measure an impact or make a difference in the world.

Basic research involves research that is done for the sake of “pure” knowledge—that is, knowledge that, at least at this moment in time, may not have any apparent use or application. Often, and this is very important, knowledge of this kind is later found to be extremely helpful in solving problems. So one way of thinking about basic research is that it is knowledge for which no use is yet known but will probably one day prove to be extremely useful. If you are doing basic research, you do not need to argue its usefulness, as the whole point is that we just don’t know yet what this might be.

Researchers engaged in basic research want to understand how the world operates. They are interested in investigating a phenomenon to get at the nature of reality with regard to that phenomenon. The basic researcher’s purpose is to understand and explain ( Patton 2002:215 ).

Basic research is interested in generating and testing hypotheses about how the world works. Grounded Theory is one approach to qualitative research methods that exemplifies basic research (see chapter 4). Most academic journal articles publish basic research findings. If you are working in academia (e.g., writing your dissertation), the default expectation is that you are conducting basic research.

Applied research in the social sciences is research that addresses human and social problems. Unlike basic research, the researcher has expectations that the research will help contribute to resolving a problem, if only by identifying its contours, history, or context. From my experience, most students have this as their baseline assumption about research. Why do a study if not to make things better? But this is a common mistake. Students and their committee members are often working with default assumptions here—the former thinking about applied research as their purpose, the latter thinking about basic research: “The purpose of applied research is to contribute knowledge that will help people to understand the nature of a problem in order to intervene, thereby allowing human beings to more effectively control their environment. While in basic research the source of questions is the tradition within a scholarly discipline, in applied research the source of questions is in the problems and concerns experienced by people and by policymakers” ( Patton 2002:217 ).

Applied research is less geared toward theory in two ways. First, its questions do not derive from previous literature. For this reason, applied research studies have much more limited literature reviews than those found in basic research (although they make up for this by having much more “background” about the problem). Second, it does not generate theory in the same way as basic research does. The findings of an applied research project may not be generalizable beyond the boundaries of this particular problem or context. The findings are more limited. They are useful now but may be less useful later. This is why basic research remains the default “gold standard” of academic research.

Evaluation research is research that is designed to evaluate or test the effectiveness of specific solutions and programs addressing specific social problems. We already know the problems, and someone has already come up with solutions. There might be a program, say, for first-generation college students on your campus. Does this program work? Are first-generation students who participate in the program more likely to graduate than those who do not? These are the types of questions addressed by evaluation research. There are two types of research within this broader frame; however, one more action-oriented than the next. In summative evaluation , an overall judgment about the effectiveness of a program or policy is made. Should we continue our first-gen program? Is it a good model for other campuses? Because the purpose of such summative evaluation is to measure success and to determine whether this success is scalable (capable of being generalized beyond the specific case), quantitative data is more often used than qualitative data. In our example, we might have “outcomes” data for thousands of students, and we might run various tests to determine if the better outcomes of those in the program are statistically significant so that we can generalize the findings and recommend similar programs elsewhere. Qualitative data in the form of focus groups or interviews can then be used for illustrative purposes, providing more depth to the quantitative analyses. In contrast, formative evaluation attempts to improve a program or policy (to help “form” or shape its effectiveness). Formative evaluations rely more heavily on qualitative data—case studies, interviews, focus groups. The findings are meant not to generalize beyond the particular but to improve this program. If you are a student seeking to improve your qualitative research skills and you do not care about generating basic research, formative evaluation studies might be an attractive option for you to pursue, as there are always local programs that need evaluation and suggestions for improvement. Again, be very clear about your purpose when talking through your research proposal with your committee.

Action research takes a further step beyond evaluation, even formative evaluation, to being part of the solution itself. This is about as far from basic research as one could get and definitely falls beyond the scope of “science,” as conventionally defined. The distinction between action and research is blurry, the research methods are often in constant flux, and the only “findings” are specific to the problem or case at hand and often are findings about the process of intervention itself. Rather than evaluate a program as a whole, action research often seeks to change and improve some particular aspect that may not be working—maybe there is not enough diversity in an organization or maybe women’s voices are muted during meetings and the organization wonders why and would like to change this. In a further step, participatory action research , those women would become part of the research team, attempting to amplify their voices in the organization through participation in the action research. As action research employs methods that involve people in the process, focus groups are quite common.

If you are working on a thesis or dissertation, chances are your committee will expect you to be contributing to fundamental knowledge and theory ( basic research ). If your interests lie more toward the action end of the continuum, however, it is helpful to talk to your committee about this before you get started. Knowing your purpose in advance will help avoid misunderstandings during the later stages of the research process!

The Research Question

Once you have written your paragraph and clarified your purpose and truly know that this study is the best study for you to be doing right now , you are ready to write and refine your actual research question. Know that research questions are often moving targets in qualitative research, that they can be refined up to the very end of data collection and analysis. But you do have to have a working research question at all stages. This is your “anchor” when you get lost in the data. What are you addressing? What are you looking at and why? Your research question guides you through the thicket. It is common to have a whole host of questions about a phenomenon or case, both at the outset and throughout the study, but you should be able to pare it down to no more than two or three sentences when asked. These sentences should both clarify the intent of the research and explain why this is an important question to answer. More on refining your research question can be found in chapter 4.

Chances are, you will have already done some prior reading before coming up with your interest and your questions, but you may not have conducted a systematic literature review. This is the next crucial stage to be completed before venturing further. You don’t want to start collecting data and then realize that someone has already beaten you to the punch. A review of the literature that is already out there will let you know (1) if others have already done the study you are envisioning; (2) if others have done similar studies, which can help you out; and (3) what ideas or concepts are out there that can help you frame your study and make sense of your findings. More on literature reviews can be found in chapter 9.

In addition to reviewing the literature for similar studies to what you are proposing, it can be extremely helpful to find a study that inspires you. This may have absolutely nothing to do with the topic you are interested in but is written so beautifully or organized so interestingly or otherwise speaks to you in such a way that you want to post it somewhere to remind you of what you want to be doing. You might not understand this in the early stages—why would you find a study that has nothing to do with the one you are doing helpful? But trust me, when you are deep into analysis and writing, having an inspirational model in view can help you push through. If you are motivated to do something that might change the world, you probably have read something somewhere that inspired you. Go back to that original inspiration and read it carefully and see how they managed to convey the passion that you so appreciate.

At this stage, you are still just getting started. There are a lot of things to do before setting forth to collect data! You’ll want to consider and choose a research tradition and a set of data-collection techniques that both help you answer your research question and match all your aims and goals. For example, if you really want to help migrant workers speak for themselves, you might draw on feminist theory and participatory action research models. Chapters 3 and 4 will provide you with more information on epistemologies and approaches.

Next, you have to clarify your “units of analysis.” What is the level at which you are focusing your study? Often, the unit in qualitative research methods is individual people, or “human subjects.” But your units of analysis could just as well be organizations (colleges, hospitals) or programs or even whole nations. Think about what it is you want to be saying at the end of your study—are the insights you are hoping to make about people or about organizations or about something else entirely? A unit of analysis can even be a historical period! Every unit of analysis will call for a different kind of data collection and analysis and will produce different kinds of “findings” at the conclusion of your study. [2]

Regardless of what unit of analysis you select, you will probably have to consider the “human subjects” involved in your research. [3] Who are they? What interactions will you have with them—that is, what kind of data will you be collecting? Before answering these questions, define your population of interest and your research setting. Use your research question to help guide you.

Let’s use an example from a real study. In Geographies of Campus Inequality , Benson and Lee ( 2020 ) list three related research questions: “(1) What are the different ways that first-generation students organize their social, extracurricular, and academic activities at selective and highly selective colleges? (2) how do first-generation students sort themselves and get sorted into these different types of campus lives; and (3) how do these different patterns of campus engagement prepare first-generation students for their post-college lives?” (3).

Note that we are jumping into this a bit late, after Benson and Lee have described previous studies (the literature review) and what is known about first-generation college students and what is not known. They want to know about differences within this group, and they are interested in ones attending certain kinds of colleges because those colleges will be sites where academic and extracurricular pressures compete. That is the context for their three related research questions. What is the population of interest here? First-generation college students . What is the research setting? Selective and highly selective colleges . But a host of questions remain. Which students in the real world, which colleges? What about gender, race, and other identity markers? Will the students be asked questions? Are the students still in college, or will they be asked about what college was like for them? Will they be observed? Will they be shadowed? Will they be surveyed? Will they be asked to keep diaries of their time in college? How many students? How many colleges? For how long will they be observed?

Recommendation

Take a moment and write down suggestions for Benson and Lee before continuing on to what they actually did.

Have you written down your own suggestions? Good. Now let’s compare those with what they actually did. Benson and Lee drew on two sources of data: in-depth interviews with sixty-four first-generation students and survey data from a preexisting national survey of students at twenty-eight selective colleges. Let’s ignore the survey for our purposes here and focus on those interviews. The interviews were conducted between 2014 and 2016 at a single selective college, “Hilltop” (a pseudonym ). They employed a “purposive” sampling strategy to ensure an equal number of male-identifying and female-identifying students as well as equal numbers of White, Black, and Latinx students. Each student was interviewed once. Hilltop is a selective liberal arts college in the northeast that enrolls about three thousand students.

How did your suggestions match up to those actually used by the researchers in this study? It is possible your suggestions were too ambitious? Beginning qualitative researchers can often make that mistake. You want a research design that is both effective (it matches your question and goals) and doable. You will never be able to collect data from your entire population of interest (unless your research question is really so narrow to be relevant to very few people!), so you will need to come up with a good sample. Define the criteria for this sample, as Benson and Lee did when deciding to interview an equal number of students by gender and race categories. Define the criteria for your sample setting too. Hilltop is typical for selective colleges. That was a research choice made by Benson and Lee. For more on sampling and sampling choices, see chapter 5.

Benson and Lee chose to employ interviews. If you also would like to include interviews, you have to think about what will be asked in them. Most interview-based research involves an interview guide, a set of questions or question areas that will be asked of each participant. The research question helps you create a relevant interview guide. You want to ask questions whose answers will provide insight into your research question. Again, your research question is the anchor you will continually come back to as you plan for and conduct your study. It may be that once you begin interviewing, you find that people are telling you something totally unexpected, and this makes you rethink your research question. That is fine. Then you have a new anchor. But you always have an anchor. More on interviewing can be found in chapter 11.

Let’s imagine Benson and Lee also observed college students as they went about doing the things college students do, both in the classroom and in the clubs and social activities in which they participate. They would have needed a plan for this. Would they sit in on classes? Which ones and how many? Would they attend club meetings and sports events? Which ones and how many? Would they participate themselves? How would they record their observations? More on observation techniques can be found in both chapters 13 and 14.

At this point, the design is almost complete. You know why you are doing this study, you have a clear research question to guide you, you have identified your population of interest and research setting, and you have a reasonable sample of each. You also have put together a plan for data collection, which might include drafting an interview guide or making plans for observations. And so you know exactly what you will be doing for the next several months (or years!). To put the project into action, there are a few more things necessary before actually going into the field.

First, you will need to make sure you have any necessary supplies, including recording technology. These days, many researchers use their phones to record interviews. Second, you will need to draft a few documents for your participants. These include informed consent forms and recruiting materials, such as posters or email texts, that explain what this study is in clear language. Third, you will draft a research protocol to submit to your institutional review board (IRB) ; this research protocol will include the interview guide (if you are using one), the consent form template, and all examples of recruiting material. Depending on your institution and the details of your study design, it may take weeks or even, in some unfortunate cases, months before you secure IRB approval. Make sure you plan on this time in your project timeline. While you wait, you can continue to review the literature and possibly begin drafting a section on the literature review for your eventual presentation/publication. More on IRB procedures can be found in chapter 8 and more general ethical considerations in chapter 7.

Once you have approval, you can begin!

Research Design Checklist

Before data collection begins, do the following:

• Write a paragraph explaining your aims and goals (personal/political, practical/strategic, professional/academic).
• Define your research question; write two to three sentences that clarify the intent of the research and why this is an important question to answer.
• Review the literature for similar studies that address your research question or similar research questions; think laterally about some literature that might be helpful or illuminating but is not exactly about the same topic.
• Find a written study that inspires you—it may or may not be on the research question you have chosen.
• Consider and choose a research tradition and set of data-collection techniques that (1) help answer your research question and (2) match your aims and goals.
• Define your population of interest and your research setting.
• Define the criteria for your sample (How many? Why these? How will you find them, gain access, and acquire consent?).
• If you are conducting interviews, draft an interview guide.
•  If you are making observations, create a plan for observations (sites, times, recording, access).
• Acquire any necessary technology (recording devices/software).
• Draft consent forms that clearly identify the research focus and selection process.
• Create recruiting materials (posters, email, texts).
• Apply for IRB approval (proposal plus consent form plus recruiting materials).
• Block out time for collecting data.
• At the end of the chapter, you will find a " Research Design Checklist " that summarizes the main recommendations made here ↵
• For example, if your focus is society and culture , you might collect data through observation or a case study. If your focus is individual lived experience , you are probably going to be interviewing some people. And if your focus is language and communication , you will probably be analyzing text (written or visual). ( Marshall and Rossman 2016:16 ). ↵
• You may not have any "live" human subjects. There are qualitative research methods that do not require interactions with live human beings - see chapter 16 , "Archival and Historical Sources." But for the most part, you are probably reading this textbook because you are interested in doing research with people. The rest of the chapter will assume this is the case. ↵

One of the primary methodological traditions of inquiry in qualitative research, ethnography is the study of a group or group culture, largely through observational fieldwork supplemented by interviews. It is a form of fieldwork that may include participant-observation data collection. See chapter 14 for a discussion of deep ethnography. 

A methodological tradition of inquiry and research design that focuses on an individual case (e.g., setting, institution, or sometimes an individual) in order to explore its complexity, history, and interactive parts.  As an approach, it is particularly useful for obtaining a deep appreciation of an issue, event, or phenomenon of interest in its particular context.

The controlling force in research; can be understood as lying on a continuum from basic research (knowledge production) to action research (effecting change).

In its most basic sense, a theory is a story we tell about how the world works that can be tested with empirical evidence.  In qualitative research, we use the term in a variety of ways, many of which are different from how they are used by quantitative researchers.  Although some qualitative research can be described as “testing theory,” it is more common to “build theory” from the data using inductive reasoning , as done in Grounded Theory .  There are so-called “grand theories” that seek to integrate a whole series of findings and stories into an overarching paradigm about how the world works, and much smaller theories or concepts about particular processes and relationships.  Theory can even be used to explain particular methodological perspectives or approaches, as in Institutional Ethnography , which is both a way of doing research and a theory about how the world works.

Research that is interested in generating and testing hypotheses about how the world works.

A methodological tradition of inquiry and approach to analyzing qualitative data in which theories emerge from a rigorous and systematic process of induction.  This approach was pioneered by the sociologists Glaser and Strauss (1967).  The elements of theory generated from comparative analysis of data are, first, conceptual categories and their properties and, second, hypotheses or generalized relations among the categories and their properties – “The constant comparing of many groups draws the [researcher’s] attention to their many similarities and differences.  Considering these leads [the researcher] to generate abstract categories and their properties, which, since they emerge from the data, will clearly be important to a theory explaining the kind of behavior under observation.” (36).

An approach to research that is “multimethod in focus, involving an interpretative, naturalistic approach to its subject matter.  This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them.  Qualitative research involves the studied use and collection of a variety of empirical materials – case study, personal experience, introspective, life story, interview, observational, historical, interactional, and visual texts – that describe routine and problematic moments and meanings in individuals’ lives." ( Denzin and Lincoln 2005:2 ). Contrast with quantitative research .

Research that contributes knowledge that will help people to understand the nature of a problem in order to intervene, thereby allowing human beings to more effectively control their environment.

Research that is designed to evaluate or test the effectiveness of specific solutions and programs addressing specific social problems.  There are two kinds: summative and formative .

Research in which an overall judgment about the effectiveness of a program or policy is made, often for the purpose of generalizing to other cases or programs.  Generally uses qualitative research as a supplement to primary quantitative data analyses.  Contrast formative evaluation research .

Research designed to improve a program or policy (to help “form” or shape its effectiveness); relies heavily on qualitative research methods.  Contrast summative evaluation research

Research carried out at a particular organizational or community site with the intention of affecting change; often involves research subjects as participants of the study.  See also participatory action research .

Research in which both researchers and participants work together to understand a problematic situation and change it for the better.

The level of the focus of analysis (e.g., individual people, organizations, programs, neighborhoods).

The large group of interest to the researcher.  Although it will likely be impossible to design a study that incorporates or reaches all members of the population of interest, this should be clearly defined at the outset of a study so that a reasonable sample of the population can be taken.  For example, if one is studying working-class college students, the sample may include twenty such students attending a particular college, while the population is “working-class college students.”  In quantitative research, clearly defining the general population of interest is a necessary step in generalizing results from a sample.  In qualitative research, defining the population is conceptually important for clarity.

A fictional name assigned to give anonymity to a person, group, or place.  Pseudonyms are important ways of protecting the identity of research participants while still providing a “human element” in the presentation of qualitative data.  There are ethical considerations to be made in selecting pseudonyms; some researchers allow research participants to choose their own.

A requirement for research involving human participants; the documentation of informed consent.  In some cases, oral consent or assent may be sufficient, but the default standard is a single-page easy-to-understand form that both the researcher and the participant sign and date.   Under federal guidelines, all researchers "shall seek such consent only under circumstances that provide the prospective subject or the representative sufficient opportunity to consider whether or not to participate and that minimize the possibility of coercion or undue influence. The information that is given to the subject or the representative shall be in language understandable to the subject or the representative.  No informed consent, whether oral or written, may include any exculpatory language through which the subject or the representative is made to waive or appear to waive any of the subject's rights or releases or appears to release the investigator, the sponsor, the institution, or its agents from liability for negligence" (21 CFR 50.20).  Your IRB office will be able to provide a template for use in your study .

An administrative body established to protect the rights and welfare of human research subjects recruited to participate in research activities conducted under the auspices of the institution with which it is affiliated. The IRB is charged with the responsibility of reviewing all research involving human participants. The IRB is concerned with protecting the welfare, rights, and privacy of human subjects. The IRB has the authority to approve, disapprove, monitor, and require modifications in all research activities that fall within its jurisdiction as specified by both the federal regulations and institutional policy.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

• Open access
• Published: 27 May 2020

How to use and assess qualitative research methods

• Loraine Busetto   ORCID: orcid.org/0000-0002-9228-7875 1 ,
• Wolfgang Wick 1 , 2 &
• Christoph Gumbinger 1  

Neurological Research and Practice volume  2 , Article number:  14 ( 2020 ) Cite this article

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This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.

The aim of this paper is to provide an overview of qualitative research methods, including hands-on information on how they can be used, reported and assessed. This article is intended for beginning qualitative researchers in the health sciences as well as experienced quantitative researchers who wish to broaden their understanding of qualitative research.

What is qualitative research?

Qualitative research is defined as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” , but excluding “their range, frequency and place in an objectively determined chain of cause and effect” [ 1 ]. This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ].

Why conduct qualitative research?

Because some research questions cannot be answered using (only) quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ]. A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors – but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed.

While qualitative research is common in other fields, it is still relatively underrepresented in health services research. The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs (...) " [ 4 ]. This focus on quantitative research and specifically randomised controlled trials (RCT) is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ]. Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand – "questions before methods" [ 2 , 7 , 8 , 9 ]. This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them. Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention – essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ] . Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, (...) are not compromises in learning how to improve; they are superior" [ 8 ].

Research problems that can be approached particularly well using qualitative methods include assessing complex multi-component interventions or systems (of change), addressing questions beyond “what works”, towards “what works for whom when, how and why”, and focussing on intervention improvement rather than accreditation [ 7 , 9 , 10 , 11 , 12 ]. Using qualitative methods can also help shed light on the “softer” side of medical treatment. For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

How to conduct qualitative research?

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. As Fossey puts it : “sampling, data collection, analysis and interpretation are related to each other in a cyclical (iterative) manner, rather than following one after another in a stepwise approach” [ 15 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.  1 , this can involve several back-and-forth steps between data collection and analysis where new insights and experiences can lead to adaption and expansion of the original plan. Some insights may also necessitate a revision of the research question and/or the research design as a whole. The process ends when saturation is achieved, i.e. when no relevant new information can be found (see also below: sampling and saturation). For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented.

Iterative research process

While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research (e.g. constructivism or interpretivism as opposed to positivism). The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ].

Data collection

The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study

Document study (also called document analysis) refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.

Observations

Observations are particularly useful to gain insights into a certain setting and actual behaviour – as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. In non-participant observations, the observer is “on the outside looking in”, i.e. present in but not part of the situation, trying not to influence the setting by their presence. Observations can be planned (e.g. for 3 h during the day or night shift) or ad hoc (e.g. as soon as a stroke patient arrives at the emergency room). During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups. Written notes can be taken during or after the observations, depending on feasibility (which is usually lower during participant observations) and acceptability (e.g. when the observer is perceived to be judging the observed). Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions. Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Semi-structured interviews

Hijmans & Kuyper describe qualitative interviews as “an exchange with an informal character, a conversation with a goal” [ 19 ]. Interviews are used to gain insights into a person’s subjective experiences, opinions and motivations – as opposed to facts or behaviours [ 13 ]. Interviews can be distinguished by the degree to which they are structured (i.e. a questionnaire), open (e.g. free conversation or autobiographical interviews) or semi-structured [ 2 , 13 ]. Semi-structured interviews are characterized by open-ended questions and the use of an interview guide (or topic guide/list) in which the broad areas of interest, sometimes including sub-questions, are defined [ 19 ]. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e.g. document study or observations. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different (blocks of) questions may differ and some questions may be skipped altogether (e.g. if the interviewee is not able or willing to answer the questions or for concerns about the total length of the interview) [ 20 ]. Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher. This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ].

Focus groups

Focus groups are group interviews to explore participants’ expertise and experiences, including explorations of how and why people behave in certain ways [ 1 ]. Focus groups usually consist of 6–8 people and are led by an experienced moderator following a topic guide or “script” [ 21 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ]. Depending on researchers’ and participants’ preferences, the discussions can be audio- or video-taped and transcribed afterwards [ 21 ]. Focus groups are useful for bringing together homogeneous (to a lesser extent heterogeneous) groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ]. Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i.e. “the sharing and comparing” among participants [ 21 ]. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ]. Moreover, attention must be paid to the emergence of “groupthink” as well as possible power dynamics within the group, e.g. when patients are awed or intimidated by health professionals.

Choosing the “right” method

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this – i.e. the “fit” between question and method [ 14 ]. It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results.

Let us assume that our research aim is to examine the (clinical) processes around acute endovascular treatment (EVT), from the patient’s arrival at the emergency room to recanalization, with the aim to identify possible causes for delay and/or other causes for sub-optimal treatment outcome. As a first step, we could conduct a document study of the relevant standard operating procedures (SOPs) for this phase of care – are they up-to-date and in line with current guidelines? Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs. These results can (and should) be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation? It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Are the physicians simply not aware of the SOPs (because their existence is limited to the hospital’s intranet) or do they actively disagree with them or does the infrastructure make it impossible to provide the care as described? Another rationale for adding interviews is that some situations (or all of their possible variations for different patient groups or the day, night or weekend shift) cannot practically or ethically be observed. In this case, it is possible to ask those involved to report on their actions – being aware that this is not the same as the actual observation. A senior physician’s or hospital manager’s description of certain situations might differ from a nurse’s or junior physician’s one, maybe because they intentionally misrepresent facts or maybe because different aspects of the process are visible or important to them. In some cases, it can also be relevant to consider to whom the interviewee is disclosing this information – someone they trust, someone they are otherwise not connected to, or someone they suspect or are aware of being in a potentially “dangerous” power relationship to them. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT. The discussion might reveal discrepancies (between SOPs and actual care or between different physicians) and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves. For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by (senior) physicians only. The resulting combination of data collection methods is shown in Fig.  2 .

Possible combination of data collection methods

Attributions for icons: “Book” by Serhii Smirnov, “Interview” by Adrien Coquet, FR, “Magnifying Glass” by anggun, ID, “Business communication” by Vectors Market; all from the Noun Project

The combination of multiple data source as described for this example can be referred to as “triangulation”, in which multiple measurements are carried out from different angles to achieve a more comprehensive understanding of the phenomenon under study [ 22 , 23 ].

Data analysis

To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts (see Fig.  3 ). Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour (e.g. laughing, crying, pausing) and with or without phonetic transcription of dialects and filler words, depending on what is expected or known to be relevant for the analysis. In the next step, the protocols and transcripts are coded , that is, marked (or tagged, labelled) with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. Jansen describes coding as “connecting the raw data with “theoretical” terms” [ 20 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources (e.g. SOPs, emergency room observations, staff and patient interview). In a process of synthesis and abstraction, the codes are then grouped, summarised and/or categorised [ 15 , 20 ]. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ]. The coding process is performed using qualitative data management software, the most common ones being InVivo, MaxQDA and Atlas.ti. It should be noted that these are data management tools which support the analysis performed by the researcher(s) [ 14 ].

From data collection to data analysis

Attributions for icons: see Fig. 2 , also “Speech to text” by Trevor Dsouza, “Field Notes” by Mike O’Brien, US, “Voice Record” by ProSymbols, US, “Inspection” by Made, AU, and “Cloud” by Graphic Tigers; all from the Noun Project

How to report qualitative research?

Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i.e. to pre-define and set in stone the research questions and primary or secondary endpoints. Rather, it is a way to describe the research methods in detail, which might not be possible in the results paper given journals’ word limits. Qualitative research papers are usually longer than their quantitative counterparts to allow for deep understanding and so-called “thick description”. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation. The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ]. It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement (e.g. “Five interviewees expressed negative feelings towards XYZ”) [ 21 ].

How to combine qualitative with quantitative research?

Qualitative methods can be combined with other methods in multi- or mixed methods designs, which “[employ] two or more different methods [ …] within the same study or research program rather than confining the research to one single method” [ 24 ]. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of (unexpected) results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 , 25 , 26 ]. The resulting designs can be classified according to when, why and how the different quantitative and/or qualitative data strands are combined. The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig.  4 .

Three common mixed methods designs

In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results. Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. Amongst other things, this would make it possible to assess whether interview respondents’ subjective impressions of patients receiving good care match modified Rankin Scores at follow-up, or whether observed delays in care provision are exceptions or the rule when compared to door-to-needle times as documented in the registry. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved. In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed. Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different (types of) hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups.

How to assess qualitative research?

A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ]. However, none of these has been elevated to the “gold standard” in the field. In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper.

Assessors should check the authors’ use of and adherence to the relevant reporting checklists (e.g. Standards for Reporting Qualitative Research (SRQR)) to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research (paper). Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ].

Reflexivity

While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research. This includes what is called reflexivity, i.e. sensitivity to the relationship between the researcher and the researched, including how contact was established and maintained, or the background and experience of the researcher(s) involved in data collection and analysis. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ]. It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

Sampling and saturation

The aim of qualitative sampling is for all variants of the objects of observation that are deemed relevant for the study to be present in the sample “ to see the issue and its meanings from as many angles as possible” [ 1 , 16 , 19 , 20 , 27 ] , and to ensure “information-richness [ 15 ]. An iterative sampling approach is advised, in which data collection (e.g. five interviews) is followed by data analysis, followed by more data collection to find variants that are lacking in the current sample. This process continues until no new (relevant) information can be found and further sampling becomes redundant – which is called saturation [ 1 , 15 ] . In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. This is generally referred to as “ purposive sampling” , in which researchers pre-define which types of participants or cases they need to include so as to cover all variations that are expected to be of relevance, based on the literature, previous experience or theory (i.e. theoretical sampling) [ 14 , 20 ]. Other types of purposive sampling include (but are not limited to) maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ]. In the above EVT example, a purposive sample could include all relevant professional groups and/or all relevant stakeholders (patients, relatives) and/or all relevant times of observation (day, night and weekend shift).

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ].

Good qualitative research is iterative in nature, i.e. it goes back and forth between data collection and analysis, revising and improving the approach where necessary. One example of this are pilot interviews, where different aspects of the interview (especially the interview guide, but also, for example, the site of the interview or whether the interview can be audio-recorded) are tested with a small number of respondents, evaluated and revised [ 19 ]. In doing so, the interviewer learns which wording or types of questions work best, or which is the best length of an interview with patients who have trouble concentrating for an extended time. Of course, the same reasoning applies to observations or focus groups which can also be piloted.

Ideally, coding should be performed by at least two researchers, especially at the beginning of the coding process when a common approach must be defined, including the establishment of a useful coding list (or tree), and when a common meaning of individual codes must be established [ 23 ]. An initial sub-set or all transcripts can be coded independently by the coders and then compared and consolidated after regular discussions in the research team. This is to make sure that codes are applied consistently to the research data.

Member checking

Member checking, also called respondent validation , refers to the practice of checking back with study respondents to see if the research is in line with their views [ 14 , 27 ]. This can happen after data collection or analysis or when first results are available [ 23 ]. For example, interviewees can be provided with (summaries of) their transcripts and asked whether they believe this to be a complete representation of their views or whether they would like to clarify or elaborate on their responses [ 17 ]. Respondents’ feedback on these issues then becomes part of the data collection and analysis [ 27 ].

Stakeholder involvement

In those niches where qualitative approaches have been able to evolve and grow, a new trend has seen the inclusion of patients and their representatives not only as study participants (i.e. “members”, see above) but as consultants to and active participants in the broader research process [ 31 , 32 , 33 ]. The underlying assumption is that patients and other stakeholders hold unique perspectives and experiences that add value beyond their own single story, making the research more relevant and beneficial to researchers, study participants and (future) patients alike [ 34 , 35 ]. Using the example of patients on or nearing dialysis, a recent scoping review found that 80% of clinical research did not address the top 10 research priorities identified by patients and caregivers [ 32 , 36 ]. In this sense, the involvement of the relevant stakeholders, especially patients and relatives, is increasingly being seen as a quality indicator in and of itself.

How not to assess qualitative research

The above overview does not include certain items that are routine in assessments of quantitative research. What follows is a non-exhaustive, non-representative, experience-based list of the quantitative criteria often applied to the assessment of qualitative research, as well as an explanation of the limited usefulness of these endeavours.

Protocol adherence

Given the openness and flexibility of qualitative research, it should not be assessed by how well it adheres to pre-determined and fixed strategies – in other words: its rigidity. Instead, the assessor should look for signs of adaptation and refinement based on lessons learned from earlier steps in the research process.

Sample size

For the reasons explained above, qualitative research does not require specific sample sizes, nor does it require that the sample size be determined a priori [ 1 , 14 , 27 , 37 , 38 , 39 ]. Sample size can only be a useful quality indicator when related to the research purpose, the chosen methodology and the composition of the sample, i.e. who was included and why.

Randomisation

While some authors argue that randomisation can be used in qualitative research, this is not commonly the case, as neither its feasibility nor its necessity or usefulness has been convincingly established for qualitative research [ 13 , 27 ]. Relevant disadvantages include the negative impact of a too large sample size as well as the possibility (or probability) of selecting “ quiet, uncooperative or inarticulate individuals ” [ 17 ]. Qualitative studies do not use control groups, either.

Interrater reliability, variability and other “objectivity checks”

The concept of “interrater reliability” is sometimes used in qualitative research to assess to which extent the coding approach overlaps between the two co-coders. However, it is not clear what this measure tells us about the quality of the analysis [ 23 ]. This means that these scores can be included in qualitative research reports, preferably with some additional information on what the score means for the analysis, but it is not a requirement. Relatedly, it is not relevant for the quality or “objectivity” of qualitative research to separate those who recruited the study participants and collected and analysed the data. Experiences even show that it might be better to have the same person or team perform all of these tasks [ 20 ]. First, when researchers introduce themselves during recruitment this can enhance trust when the interview takes place days or weeks later with the same researcher. Second, when the audio-recording is transcribed for analysis, the researcher conducting the interviews will usually remember the interviewee and the specific interview situation during data analysis. This might be helpful in providing additional context information for interpretation of data, e.g. on whether something might have been meant as a joke [ 18 ].

Not being quantitative research

Being qualitative research instead of quantitative research should not be used as an assessment criterion if it is used irrespectively of the research problem at hand. Similarly, qualitative research should not be required to be combined with quantitative research per se – unless mixed methods research is judged as inherently better than single-method research. In this case, the same criterion should be applied for quantitative studies without a qualitative component.

The main take-away points of this paper are summarised in Table 1 . We aimed to show that, if conducted well, qualitative research can answer specific research questions that cannot to be adequately answered using (only) quantitative designs. Seeing qualitative and quantitative methods as equal will help us become more aware and critical of the “fit” between the research problem and our chosen methods: I can conduct an RCT to determine the reasons for transportation delays of acute stroke patients – but should I? It also provides us with a greater range of tools to tackle a greater range of research problems more appropriately and successfully, filling in the blind spots on one half of the methodological spectrum to better address the whole complexity of neurological research and practice.

Availability of data and materials

Not applicable.

Abbreviations

Endovascular treatment

Randomised Controlled Trial

Standard Operating Procedure

Standards for Reporting Qualitative Research

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Qualitative vs. Quantitative: Key Differences in Research Types

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Let's say you want to learn how a group will vote in an election. You face a classic decision of gathering qualitative vs. quantitative data.

With one method, you can ask voters open-ended questions that encourage them to share how they feel, what issues matter to them and the reasons they will vote in a specific way. With the other, you can ask closed-ended questions, giving respondents a list of options. You will then turn that information into statistics.

Neither method is more right than the other, but they serve different purposes. Learn more about the key differences between qualitative and quantitative research and how you can use them.

What Is Qualitative Research?

What is quantitative research, qualitative vs. quantitative research: 3 key differences, benefits of combining qualitative and quantitative research.

Qualitative research aims to explore and understand the depth, context and nuances of human experiences, behaviors and phenomena. This methodological approach emphasizes gathering rich, nonnumerical information through methods such as interviews, focus groups , observations and content analysis.

In qualitative research, the emphasis is on uncovering patterns and meanings within a specific social or cultural context. Researchers delve into the subjective aspects of human behavior , opinions and emotions.

This approach is particularly valuable for exploring complex and multifaceted issues, providing a deeper understanding of the intricacies involved.

Common qualitative research methods include open-ended interviews, where participants can express their thoughts freely, and thematic analysis, which involves identifying recurring themes in the data.

Examples of How to Use Qualitative Research

The flexibility of qualitative research allows researchers to adapt their methods based on emerging insights, fostering a more organic and holistic exploration of the research topic. This is a widely used method in social sciences, psychology and market research.

Here are just a few ways you can use qualitative research.

• To understand the people who make up a community : If you want to learn more about a community, you can talk to them or observe them to learn more about their customs, norms and values.
• To examine people's experiences within the healthcare system : While you can certainly look at statistics to gauge if someone feels positively or negatively about their healthcare experiences, you may not gain a deep understanding of why they feel that way. For example, if a nurse went above and beyond for a patient, they might say they are content with the care they received. But if medical professional after medical professional dismissed a person over several years, they will have more negative comments.
• To explore the effectiveness of your marketing campaign : Marketing is a field that typically collects statistical data, but it can also benefit from qualitative research. For example, if you have a successful campaign, you can interview people to learn what resonated with them and why. If you learn they liked the humor because it shows you don't take yourself too seriously, you can try to replicate that feeling in future campaigns.

Types of Qualitative Data Collection

Qualitative data captures the qualities, characteristics or attributes of a subject. It can take various forms, including:

• Audio data : Recordings of interviews, discussions or any other auditory information. This can be useful when dealing with events from the past. Setting up a recording device also allows a researcher to stay in the moment without having to jot down notes.
• Observational data : With this type of qualitative data analysis, you can record behavior, events or interactions.
• Textual data : Use verbal or written information gathered through interviews, open-ended surveys or focus groups to learn more about a topic.
• Visual data : You can learn new information through images, photographs, videos or other visual materials.

Quantitative research is a systematic empirical investigation that involves the collection and analysis of numerical data. This approach seeks to understand, explain or predict phenomena by gathering quantifiable information and applying statistical methods for analysis.

Unlike qualitative research, which focuses on nonnumerical, descriptive data, quantitative research data involves measurements, counts and statistical techniques to draw objective conclusions.

Examples of How to Use Quantitative Research

Quantitative research focuses on statistical analysis. Here are a few ways you can employ quantitative research methods.

• Studying the employment rates of a city : Through this research you can gauge whether any patterns exist over a given time period.
• Seeing how air pollution has affected a neighborhood : If the creation of a highway led to more air pollution in a neighborhood, you can collect data to learn about the health impacts on the area's residents. For example, you can see what percentage of people developed respiratory issues after moving to the neighborhood.

Types of Quantitative Data

Quantitative data refers to numerical information you can measure and count. Here are a few statistics you can use.

• Heights, yards, volume and more : You can use different measurements to gain insight on different types of research, such as learning the average distance workers are willing to travel for work or figuring out the average height of a ballerina.
• Temperature : Measure in either degrees Celsius or Fahrenheit. Or, if you're looking for the coldest place in the universe , you may measure in Kelvins.
• Sales figures : With this information, you can look at a store's performance over time, compare one company to another or learn what the average amount of sales is in a specific industry.

Quantitative and qualitative research methods are both valid and useful ways to collect data. Here are a few ways that they differ.

• Data collection method : Quantitative research uses standardized instruments, such as surveys, experiments or structured observations, to gather numerical data. Qualitative research uses open-ended methods like interviews, focus groups or content analysis.
• Nature of data : Quantitative research involves numerical data that you can measure and analyze statistically, whereas qualitative research involves exploring the depth and richness of experiences through nonnumerical, descriptive data.
• Sampling : Quantitative research involves larger sample sizes to ensure statistical validity and generalizability of findings to a population. With qualitative research, it's better to work with a smaller sample size to gain in-depth insights into specific contexts or experiences.

You can simultaneously study qualitative and quantitative data. This method , known as mixed methods research, offers several benefits, including:

• A comprehensive understanding : Integration of qualitative and quantitative data provides a more comprehensive understanding of the research problem. Qualitative data helps explain the context and nuances, while quantitative data offers statistical generalizability.
• Contextualization : Qualitative data helps contextualize quantitative findings by providing explanations into the why and how behind statistical patterns. This deeper understanding contributes to more informed interpretations of quantitative results.
• Triangulation : Triangulation involves using multiple methods to validate or corroborate findings. Combining qualitative and quantitative data allows researchers to cross-verify results, enhancing the overall validity and reliability of the study.

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• Introduction

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

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

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

Qualitative Research Approaches

Ethnography

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

Grounded theory

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

Phenomenology

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

Narrative research

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

Research Paradigm

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

Positivist versus postpositivist

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

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

Constructivist

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

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

Data Sampling 

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

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

Data Collection and Analysis

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

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

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

Dissemination

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

Applications

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

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

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

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

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

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

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

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

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

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

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

• Issues of Concern

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

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

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

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

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

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

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

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

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

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

• Enhancing Healthcare Team Outcomes

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

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

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

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

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Choosing an optimal research methodology is crucial for the success of any research project. The methodology you select will determine the type of data you collect, how you collect it, and how you analyse it. Understanding the different types of research methods available along with their strengths and weaknesses, is thus imperative to make an informed decision.

Understanding different research methods:

There are several research methods available depending on the type of study you are conducting, i.e., whether it is laboratory-based, clinical, epidemiological, or survey based . Some common methodologies include qualitative research, quantitative research, experimental research, survey-based research, and action research. Each method can be opted for and modified, depending on the type of research hypotheses and objectives.

Qualitative vs quantitative research:

When deciding on a research methodology, one of the key factors to consider is whether your research will be qualitative or quantitative. Qualitative research is used to understand people’s experiences, concepts, thoughts, or behaviours . Quantitative research, on the contrary, deals with numbers, graphs, and charts, and is used to test or confirm hypotheses, assumptions, and theories. 

Qualitative research methodology:

Qualitative research is often used to examine issues that are not well understood, and to gather additional insights on these topics. Qualitative research methods include open-ended survey questions, observations of behaviours described through words, and reviews of literature that has explored similar theories and ideas. These methods are used to understand how language is used in real-world situations, identify common themes or overarching ideas, and describe and interpret various texts. Data analysis for qualitative research typically includes discourse analysis, thematic analysis, and textual analysis. 

Quantitative research methodology:

The goal of quantitative research is to test hypotheses, confirm assumptions and theories, and determine cause-and-effect relationships. Quantitative research methods include experiments, close-ended survey questions, and countable and numbered observations. Data analysis for quantitative research relies heavily on statistical methods.

Analysing qualitative vs quantitative data:

The methods used for data analysis also differ for qualitative and quantitative research. As mentioned earlier, quantitative data is generally analysed using statistical methods and does not leave much room for speculation. It is more structured and follows a predetermined plan. In quantitative research, the researcher starts with a hypothesis and uses statistical methods to test it. Contrarily, methods used for qualitative data analysis can identify patterns and themes within the data, rather than provide statistical measures of the data. It is an iterative process, where the researcher goes back and forth trying to gauge the larger implications of the data through different perspectives and revising the analysis if required.

When to use qualitative vs quantitative research:

The choice between qualitative and quantitative research will depend on the gap that the research project aims to address, and specific objectives of the study. If the goal is to establish facts about a subject or topic, quantitative research is an appropriate choice. However, if the goal is to understand people’s experiences or perspectives, qualitative research may be more suitable. 

Conclusion:

In conclusion, an understanding of the different research methods available, their applicability, advantages, and disadvantages is essential for making an informed decision on the best methodology for your project. If you need any additional guidance on which research methodology to opt for, you can head over to Elsevier Author Services (EAS). EAS experts will guide you throughout the process and help you choose the perfect methodology for your research goals.

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• What Is Quantitative Research? | Definition, Uses & Methods

What Is Quantitative Research? | Definition, Uses & Methods

Published on June 12, 2020 by Pritha Bhandari . Revised on June 22, 2023.

Quantitative research is the process of collecting and analyzing numerical data. It can be used to find patterns and averages, make predictions, test causal relationships, and generalize results to wider populations.

Quantitative research is the opposite of qualitative research , which involves collecting and analyzing non-numerical data (e.g., text, video, or audio).

Quantitative research is widely used in the natural and social sciences: biology, chemistry, psychology, economics, sociology, marketing, etc.

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Table of contents

Quantitative research methods, quantitative data analysis, advantages of quantitative research, disadvantages of quantitative research, other interesting articles, frequently asked questions about quantitative research.

You can use quantitative research methods for descriptive, correlational or experimental research.

• In descriptive research , you simply seek an overall summary of your study variables.
• In correlational research , you investigate relationships between your study variables.
• In experimental research , you systematically examine whether there is a cause-and-effect relationship between variables.

Correlational and experimental research can both be used to formally test hypotheses , or predictions, using statistics. The results may be generalized to broader populations based on the sampling method used.

To collect quantitative data, you will often need to use operational definitions that translate abstract concepts (e.g., mood) into observable and quantifiable measures (e.g., self-ratings of feelings and energy levels).

Note that quantitative research is at risk for certain research biases , including information bias , omitted variable bias , sampling bias , or selection bias . Be sure that you’re aware of potential biases as you collect and analyze your data to prevent them from impacting your work too much.

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Once data is collected, you may need to process it before it can be analyzed. For example, survey and test data may need to be transformed from words to numbers. Then, you can use statistical analysis to answer your research questions .

Descriptive statistics will give you a summary of your data and include measures of averages and variability. You can also use graphs, scatter plots and frequency tables to visualize your data and check for any trends or outliers.

Using inferential statistics , you can make predictions or generalizations based on your data. You can test your hypothesis or use your sample data to estimate the population parameter .

First, you use descriptive statistics to get a summary of the data. You find the mean (average) and the mode (most frequent rating) of procrastination of the two groups, and plot the data to see if there are any outliers.

You can also assess the reliability and validity of your data collection methods to indicate how consistently and accurately your methods actually measured what you wanted them to.

Quantitative research is often used to standardize data collection and generalize findings . Strengths of this approach include:

• Replication

Repeating the study is possible because of standardized data collection protocols and tangible definitions of abstract concepts.

• Direct comparisons of results

The study can be reproduced in other cultural settings, times or with different groups of participants. Results can be compared statistically.

• Large samples

Data from large samples can be processed and analyzed using reliable and consistent procedures through quantitative data analysis.

• Hypothesis testing

Using formalized and established hypothesis testing procedures means that you have to carefully consider and report your research variables, predictions, data collection and testing methods before coming to a conclusion.

Despite the benefits of quantitative research, it is sometimes inadequate in explaining complex research topics. Its limitations include:

• Superficiality

Using precise and restrictive operational definitions may inadequately represent complex concepts. For example, the concept of mood may be represented with just a number in quantitative research, but explained with elaboration in qualitative research.

• Narrow focus

Predetermined variables and measurement procedures can mean that you ignore other relevant observations.

• Structural bias

Despite standardized procedures, structural biases can still affect quantitative research. Missing data , imprecise measurements or inappropriate sampling methods are biases that can lead to the wrong conclusions.

• Lack of context

Quantitative research often uses unnatural settings like laboratories or fails to consider historical and cultural contexts that may affect data collection and results.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Chi square goodness of fit test
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

In mixed methods research , you use both qualitative and quantitative data collection and analysis methods to answer your research question .

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

Operationalization means turning abstract conceptual ideas into measurable observations.

For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioral avoidance of crowded places, or physical anxiety symptoms in social situations.

Before collecting data , it’s important to consider how you will operationalize the variables that you want to measure.

Reliability and validity are both about how well a method measures something:

• Reliability refers to the  consistency of a measure (whether the results can be reproduced under the same conditions).
• Validity   refers to the  accuracy of a measure (whether the results really do represent what they are supposed to measure).

If you are doing experimental research, you also have to consider the internal and external validity of your experiment.

Hypothesis testing is a formal procedure for investigating our ideas about the world using statistics. It is used by scientists to test specific predictions, called hypotheses , by calculating how likely it is that a pattern or relationship between variables could have arisen by chance.

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Research Writing and Analysis

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Qualitative Research Questions

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What’s in a Qualitative Research Question?

Qualitative research questions are driven by the need for the study. Ideally, research questions are formulated as a result of the problem and purpose, which leads to the identification of the methodology. When a qualitative methodology is chosen, research questions should be exploratory and focused on the actual phenomenon under study.

From the Dissertation Center, Chapter 1: Research Question Overview , there are several considerations when forming a qualitative research question. Qualitative research questions should

Below is an example of a qualitative phenomenological design. Note the use of the term “lived experience” in the central research question. This aligns with phenomenological design.

RQ1: “ What are the lived experiences of followers of mid-level managers in the financial services sector regarding their well-being on the job?”

If the researcher wants to focus on aspects of the theory used to support the study or dive deeper into aspects of the central RQ, sub-questions might be used. The following sub-questions could be formulated to seek further insight:

RQ1a.   “How do followers perceive the quality and adequacy of the leader-follower exchanges between themselves and their novice leaders?”

RQ1b.  “Under what conditions do leader-member exchanges affect a follower’s own level of well-being?”

Qualitative research questions also display the desire to explore or describe phenomena. Qualitative research seeks the lived experience, the personal experiences, the understandings, the meanings, and the stories associated with the concepts present in our studies.

We want to ensure our research questions are answerable and that we are not making assumptions about our sample. View the questions below:

How do healthcare providers perceive income inequality when providing care to poor patients?

In Example A, we see that there is no specificity of location or geographic areas. This could lead to findings that are varied, and the researcher may not find a clear pattern. Additionally, the question implies the focus is on “income inequality” when the actual focus is on the provision of care. The term “poor patients” can also be offensive, and most providers will not want to seem insensitive and may perceive income inequality as a challenge (of course!).

How do primary care nurses in outreach clinics describe providing quality care to residents of low-income urban neighborhoods?

In Example B, we see that there is greater specificity in the type of care provider. There is also a shift in language so that the focus is on how the individuals describe what they think about, experience, and navigate providing quality care.

Other Qualitative Research Question Examples

Vague : What are the strategies used by healthcare personnel to assist injured patients?

Try this : What is the experience of emergency room personnel in treating patients with a self-inflicted household injury?

The first question is general and vague. While in the same topic area, the second question is more precise and gives the reader a specific target population and a focus on the phenomenon they would have experienced. This question could be in line with a phenomenological study as we are seeking their experience or a case study as the ER personnel are a bounded entity.

Unclear : How do students experience progressing to college?

Try this : How do first-generation community members describe the aspects of their culture that promote aspiration to postsecondary education?

The first question does not have a focus on what progress is or what students are the focus. The second question provides a specific target population and provides the description to be provided by the participants. This question could be in line with a descriptive study.

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When Does a Researcher Choose a Quantitative, Qualitative, or Mixed Research Approach?

• Published: 26 November 2021
• Volume 53 , pages 113–131, ( 2022 )

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• Feyisa Mulisa   ORCID: orcid.org/0000-0002-0738-6554 1  

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In educational studies, the paradigm war over quantitative and qualitative research approaches has raged for more than half a century. The focus in the late twentieth century was on the distinction between the two approaches, and the motivation was to retain one of the approaches’ supremacy. Since the early twenty-first century, there has been a growing interest in situating in the middle position and combining both approaches into a single study or a series of studies. Despite these signs of progress, when it comes to using the appropriate research approach at the right time, beginner educational researchers remain perplexed. This paper, therefore, provides useful guidelines that facilitate the choice of quantitative, qualitative, or mixed research approaches in educational inquiry. To achieve this objective, this article comprises three distinct and underlying areas of interest, which have been structured into three sections. The first section highlights the distinctions between quantitative and qualitative research approaches. The second section discusses the paradigm views that underpin the choice of a particular research approach. Finally, an effort has been made to determine the appropriate time to opt for any of the research approaches that facilitate successful educational investigations. Since truth and the means used to discover it are both dynamic, it is also essential to foresight innovative approaches to research with distinguishing features of applications to educational research.

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Mulisa, F. When Does a Researcher Choose a Quantitative, Qualitative, or Mixed Research Approach?. Interchange 53 , 113–131 (2022). https://doi.org/10.1007/s10780-021-09447-z

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Exploring the use of body worn cameras in acute mental health wards: a mixed-method evaluation of a pilot intervention

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Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals.

This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.

The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research.

Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented.

This study sheds light on the complexities of using such BWCs as a tool for ‘maximising safety’ on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.

Peer Review reports

Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. In England, these have been introduced in the National Health Service (NHS) as part of a violence reduction strategy [ 1 ] which emphasises the reduction of aggression and violence against staff. The NHS Staff Survey 2022 found that 14.7% of NHS staff had experienced at least one incident of physical violence from patients, relatives or other members of the public in the previous 12 months. Violent attacks on staff were found to contribute to almost half of staff illness [ 2 ]. Levels of violence against staff working in mental health trusts remain much higher than other types of healthcare providers [ 3 ]. Numerous reports internationally highlight the increased risks faced by staff working in psychiatric care [ 4 ], though studies have reported that both ward staff and mental health patients experience violence and feeling unsafe on inpatient wards [ 5 , 6 ].

Body worn cameras have been in use for over a decade within law enforcement, where they hoped to provide transparency and accountability within use-of-force incidents and in the event of citizen complaints against police [ 7 ]. It was believed that video surveillance would help identify integral problems within the organisation, improve documentation of evidence, reduce use-of-force incidents, improve police-community relations, and provide training opportunities for officers [ 8 ]. However, a recent extensive international systematic review by Lum et al. [ 9 ], found that despite the successes noted in early evaluations, the way BWCs are currently used by police may not substantially affect most officer or citizen behaviours. Irrespective of these findings, other public services such as train operators have been implementing BWCs for security purposes, with reductions reported in the number of assaults on railway staff [ 10 ].

A recent systematic review of BWC use in public sector services established that there is a poor evidence base supporting the use of BWCs in the reduction of violence and aggression [ 11 ]. Yet, we are seeing a swift increase in the use of BWCs in mental health settings with that aim, with few studies conducted on the use of BWC technology in inpatient mental health wards, and even fewer studies exploring staff or patients’ views. Two evaluations conducted in England reported mixed results with both increases and decreases in violence and aggression found, and variation between types of wards. There is some suggestion of a reduction in more serious incidents and the use of restraint, but quality of evidence is low [ 12 , 13 ].

The use of BWCs in mental healthcare settings for safety and security remains a contentious topic due to the lack of evidence regarding the influence that such technology has on preventing violence and aggression and the complex philosophical and ethical issues raised, particularly where many patients may lack capacity and/or are detained under mental health legislation [ 14 ]. Additionally, there are concerns that BWCs may be used as a ‘quick fix’ for staff shortages rather than addressing the wider systemic and resourcing issues facing services [ 15 ]. With little independent evaluation of body-worn cameras in mental health settings, many of these concerns remain unanswered. There is also limited understanding of this technology from an implementation perspective. Therefore, in this study we aimed to conduct an independent evaluation of the introduction of BWCs as a violence reduction intervention on two inpatient mental health wards during a six-month pilot period to explore the impact of using the technology, alongside an exploration of the facilitators and barriers to implementation.

Research aim(s)

To evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.

Patient and public involvement

The research team included a researcher and independent consultant, each with lived experience of mental health inpatient care. In addition, we recruited and facilitated a six member Lived Experience Advisory Panel (LEAP). This group was made up of patients and carers, some of whom had experienced the use of BWCs. Members were of diverse ethnic backgrounds and included four women and two men. The LEAP provided guidance and support for the research team in developing an understanding of the various potential impacts of the use of BWCs on inpatient mental health wards. Members contributed to the design of the study, development of the interview schedule, practice interviews prior to data collection on the wards, and supported the analysis and interpretation of the data, taking part in coding sessions to identify themes in the interview transcripts. The LEAP met once a month for two hours and was chaired by the Lived Experience Research Assistant and Lived Experience Consultant. Participants in the LEAP were provided with training and paid for their time.

The pilot introduction of the body worn cameras was conducted within a London mental health Trust consisting of four hospital sites with 17 acute wards. The research team were made aware of extensive preparatory work and planning that was conducted at a directorate and senior management level prior to camera implementation, including lived experience involvement and consultation, and the development of relevant policies and protocols inclusive of a human rights assessment and legal consultation.

The pilot period ran from 25th April to 25th October 2022. Reveal (a company who supply BWCs nationally across the UK) provided the Trust with 12 Calla BWCs for a flat fee that covered use of the cameras, cloud-based storage of footage, management software, and any support/maintenance required during the pilot period. Cameras were introduced to two wards based on two hospital sites, with six cameras provided to each of the wards on the same date. Training on using the BWCs was provided by the BWC company to staff working on both wards prior to starting the pilot period. Ward one was a 20-bed male acute inpatient ward, representing the most common ward setting where cameras have been introduced. Ward two was a ten-bed male Psychiatric Intensive Care Unit (PICU), representing smaller and more secure wards in which patients are likely to present as more unwell and where there are higher staff to patient ratios.

To answer our research questions, we used a mixed-methods design [ 16 ]. Using this design allowed us to investigate the impact of implementing BWCs in mental health settings on a range of quantitative and qualitative outcomes. This mixed methods design allows the study to statistically evaluate the effectiveness of using BWCs in these settings on key dependent variables (i.e., rates of violence and aggression, and incidents of conflict and containment) alongside qualitatively exploring the impact that the implementation of such technology has on patients and staff.

To ensure that the study was able to capture the impact and effect of implementation of the cameras, a repeated measures design was utilised to capture data at three phases on these wards:

Pre-pilot data: data prior of the implementation of the BWCs (quantitative and qualitative data).

Pilot period data: data collected during the six-month pilot period when BWCs were implemented on the wards (quantitative and qualitative data).

Post-pilot: data collected after the pilot period ended and cameras had been removed from the wards (quantitative data only).

Quantitative methods

Quantitative data was collected at all three data collection periods:

Pre-period: Data spanning six months prior to the implementation of BWCs (Nov 21 to May 22).

Pilot period: Data spanning the six months of the Trusts pilot period of using BWCs on the wards (June 22 to Nov 22).

Post-pilot: Data spanning the six months following the pilot period, when BWCs had been removed (Dec 22 to May 23).

Quantitative measures

To analyse the impact of BWC implementation, we collected two types of incident data related to violence and aggression and use of containment measures, including BWCs. Combined, these data provide a view of a wide range of incidents and events happening across the wards prior to, during, and after the implementation and removal of the BWCs.

The patient-staff conflict checklist

The Patient-staff Conflict Checklist (PCC-SR) [ 17 ] is an end of shift report that is completed by nurses to collate the frequency of conflict and containment events. This measure has been used successfully in several studies on inpatient wards [ 18 , 19 , 20 ].The checklist consists of 21 conflict behaviour items, including physical and verbal aggression, general rule breaking (e.g., smoking, refusing to attend to personal hygiene), eight containment measures (e.g., special observation, seclusion, physical restraint, time out), and staffing levels. In tests based on use with case note material, the PCC-SR has demonstrated an interrater reliability of 0.69 [ 21 ] and has shown a significant association with rates of officially reported incidents [ 22 ].

The checklist was revised for this study to include questions related to the use of BWCs ( e.g., how many uses of BWCs happened during the shift when a warning was given and the BWC was not used; when a warning was given and the BWC was used; when the BWC was switched on with no warning given ) in order to provide insight into how the cameras were being used on each ward (see appendix 1). Ward staff were asked to complete the checklist online at the end of each shift.

Routinely collected incident data (via datix system)

To supplement the PCC-SR-R, we also used routinely collected incident data from both wards for all three data collection phases. This data is gathered as part of routine practice by ward staff members via the Datix system Datix [ 23 ] is a risk management system used widely across mental health wards and Trusts in the UK to gather information on processes and errors. Previous studies have utilised routinely collect data via this system [ 24 , 25 ]. Incidents recorded in various Datix categories were included in this study (see Table  1 ). Incidents were anonymised before being provided to the research team to ensure confidentiality.

Routinely collected data included:

Recorded incidents of violence and aggression.

Recorded use of restrictive practices including seclusion, restraint, and intra-muscular medication/rapid tranquilisations.

Patient numbers.

Staffing levels.

Numbers of staff attending BWC training.

Quantitative data analysis

Incident reports.

Incident reports retrieved from Datix were binary coded into aggregate variables to examine violence and aggression, self-harm, and other conflict as outlined in Table  1 . Multivariate analyses of variance (MANOVA) were used to identify differences in type of incident (violence against person, violence against object, verbal aggression, self-harm, conflict) for each ward. MANOVA was also used to examine differences in incident outcomes (severity, use of restrictive practice, police involvement) across pre-trial, trial, and post-trial periods for each ward. Incident severity was scored by ward staff on a four-point scale (1 = No adverse outcome, 2 = Low severity, 3 = Moderate severity, 4 = Severe). Use of restrictive practice and police involvement were binary coded for presence or absence. Analyses were conducted using SPSS [ 26 ].

Patient-staff conflict checklist shift-report – revised (PCC-SR-R; )

Data were condensed into weeks for analysis rather than shifts to account for variability in PCC-SR-R submission by shift. Linear regressions assessed the relationship between BWC use and incident outcome (severity, use of restrictive practice, police involvement).

Qualitative methods

We used semi-structured qualitative interviews to explore participants’ experiences of BWCs on the ward to understand the impact of their use as well as to identify any salient issues for patients, staff and visitors that align with the measures utilised within the quantitative aspect of this study. These interviews were conducted at two time points: pre-pilot and at the end of the six-month pilot period.

Sample selection, eligibility, and recruitment

Convenience sampling was used to recruit staff and patients on wards. Researchers approached ward managers to distribute information sheets to staff, who shared that information with patients. Staff self-selected to participate in the study by liaising directly with the research team. Patients that were identified as close to discharge and having capacity to consent were approached by a clinical member of the team who was briefed on the study inclusion criteria (see Table  2 ). The staff member spoke with the patient about the study and provided them with a copy of the information sheet to consider. If patients consented, a member of the research team approached the participant to provide more information on the study and answer questions. After initial contact with the research team, participants were given a 24-hour period to consider whether they wanted to participate before being invited for an interview.

Participants were invited to take part in an interview within a private space on the ward. Interviews were scheduled for one hour with an additional 15 min before and after to obtain informed consent and answer any questions. Participation was voluntary and participants were free to withdraw at any time. To thank patients for their time, we offered a £10 voucher following the interview. Interviews were audio-recorded and saved to an encrypted server. Interview recordings were transcribed by an external company, and the research team checked the transcripts for accuracy and pseudonymised all participants. All transcripts were allocated a unique ID number and imported to MicroSoft Excel [ 27 ] for analysis.

Qualitative data analysis

Qualitative data were analysed using a framework analysis [ 28 ] informed by implementation science frameworks. Our coding framework used the Consolidated Framework for Implementation Research (CFIR) [ 29 ], which is comprised of five major domains including: Intervention Characteristics, Implementation Processes, Outer Setting, Inner Setting, and Characteristics of the Individual. Each domain consists of several constructs that reflect the evidence base of the types of factors that are most likely to influence implementation of interventions. The CFIR is frequently used to design and conduct implementation evaluations and is commonly used for complex health care delivery interventions to understand barriers and facilitators to implementation. Based on its description, the CFIR is an effective model to address our research question, particularly given the complexity of the implementation of surveillance technology such as BWCs in this acute care setting.

The initial analytic stage was undertaken by eight members of the study team with each researcher charting data summaries onto the framework for each of the interviews they had conducted on MicroSoft Excel [ 27 ]. Sub-themes within each broad deductive theme from our initial framework were then derived inductively through further coding and collaborative discussion within the research team, inclusive of Lived Experience Researcher colleagues. Pseudonyms were assigned to each participant during the anonymisation of transcripts along with key identifiers to provide context for illustrative quotes (e.g., P = patient, S = staff, A = acute ward, I = Intensive Care, Pre = pre-BWC implementation interview, Post = Post BWC implementation interview).

All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Health Research Authority: London - Camden & Kings Cross Research Ethics Committee (IRAS Project ID 322,268, REC Reference 23/LO/0337).

Quantitative results

Exploring how body worn cameras were used during the pilot period.

Analysis of the PCC-SR-R provides information about how the BWCs were used on a day-to-day basis during the pilot period. Out of 543 total shift reports completed, BWC use was reported 50 times, indicating that BWCs were used on less than 10% of shifts overall; 78% of those deployments were on the Acute ward (see Figure 1 ). Overall, the majority of deployments happened as activations without a warning being given ( n  = 30, 60% of activations), 19 times the BWC was deployed with a warning but the camera was not activated (38%), and only one was the camera activated without a warning being given (2%).

BWC use by ward per week of pilot (no data available before week 6 on Ward 1)

According to the PCC-SR-R, a total of 227 incidents of aggression occurred during the pilot period across both wards (see Table  3 ). Overall, there were small statistically significant correlations between BWC usage and certain types of conflict, aggression, and restrictive practice. Results found that BWC use was positively correlated with verbal aggression and use of physical restraint. BWC use was moderately positively correlated with verbal aggression ( r  = .37, p  < .001). This indicates that BWCs were more likely to be used in incidents involving verbal aggression, which do not tend to be documented in Datix. Similarly, BWC use was moderately positively correlated with physical restraint ( r  = .31, p  < .001) indicating that they were also more likely to be used alongside physical restraint.

Exploring the impact of BWCs utilising routinely collected ward data

Acute ward results.

Routine data collected via Datix records were used to examine differences in frequency of conflict and aggression, incident severity, and use of containment measures before, during, and after introduction of BWCs on each trial ward (see Table  4 ).

There was no effect of trial period on incident type ( F (10, 592) = 1.703, p  = .077, Wilk’s Λ = 0.945), meaning there was no discernible difference in the type of incidents that occurred (E.g., verbal aggression, physical aggression) before, during, and after the pilot phase.

Incident outcomes

There was an effect of trial period on incident outcomes ( F (6, 596) = 10.900, p  < .001, Wilk’s Λ = 0.812). Incident severity was statistically significantly higher in the trial and post-trial periods compared to the pre-trial period. Use of restrictive practice was significantly lower in the post-trial period compared to the pre-trial and trial period. Police involvement was also lower in the post-trial period compared to the pre-trial and trial periods (see Table  5 ).

Results for the psychiatric intensive care unit

There was an effect of trial period on incident type ( F (10, 490) = 4.252, p  < .001, Wilk’s Λ = 0.847). Verbal aggression was statistically significantly higher in the post-trial period compared to the pre and trial periods. Self-harm was statistically significantly higher in the trial period compared to the pre-trial and post-trial periods. There were no differences in violence against a person ( p  = .162), violence against an object or conflict behaviour (see Table  4 ).

There was a statistically significant difference in incident outcome across the trial periods ( F (6, 494) = 12.907, p  < .001, Wilk’s Λ = 0.747). There was no difference in incident severity or police involvement. However, use of restrictive practice was statistically significantly higher in the pre-trial period, reducing in the test period, and reducing further in the post-trial period (see Table  5 ).

Qualitative findings

A total of 22 participants took part in interviews: five patients and 16 staff members. During the pre-pilot interviews a total of nine staff took part (five in the acute ward, four in the PICU ward) and two patients (both from the acute ward). After the pilot period, a total of eight staff took part (four from each ward) and three patients (all from the acute ward). Table  6 includes a full description of participants.

Below we have presented the key themes aligning to the five core CFIR categories of Intervention Characteristics, Characteristics of Individuals, The Process of Implementation, the Inner Setting, and The Outer Setting (see Table  7 ).

Intervention characteristics

Design and usability of wearing a bwc on the ward.

When discussing the use of the BWCs, staff noted a range of design issues related to the cameras that they said impacted on their use and acceptance of the cameras. This included the nature of the camera pulling on clothing necklines (a particular issue for female staff working on male wards), and overheating causing discomfort and irritation to skin, challenges with infection control, as well as the issue of cameras in a mental health setting where they can be easily grabbed, thrown and broken during an incident. Staff often cited these design issues as related to the lack of proactive use of the cameras on the wards.

There were issues around the devices getting overheated or about it going on your clothing, it pulls down the top… we had one person who was leading on it, whenever he was around, of course, the camera was being used, but if he wasn’t there, people weren’t as proactive in using the camera. Petra (f), Staff, A, Post.

There were also issues with staff forgetting to wear the cameras, forgetting to switch them on during incidents, and forgetting to charge them at the end of the shift, reducing the potential use of the cameras by other staff. These were perceived as key logistical issues prior to the pilot and were reported as issues at the end of the pilot by several staff on the wards.

The practicalities of will they actually turn it on in those sorts of incidents, I don’t know. Just little stuff as well, like if they don’t put it back on the docking station, so you think you’re charging it for next shift but then it’s not charged and the battery is dead, that’s one less camera to use, so little stuff. Jamal (m), Staff, A, Pre.

In relation to usability, staff noted that the cameras were small and easy to use given their simple single switch interface. It was felt that not having to upload and manage the data themselves made cameras more user friendly and usable by staff members. Protocols put into place such as signing the cameras in and out, and allocation for use during shifts were likened to procedures in place for other security measures therefore the implementation of this for the BWCs was viewed as easy for many staff.

It’s just like the ASCOM alarms that we wear. There’s a system to sign in and sign out, and that’s it. Alice (f), Staff, A, Pre.

While staff were generally positive about the usability of the cameras, some were cautious of with concerns for those less confident with technology.

… you have to be conscious that there’s some people – it’s quite easy to use, but I can say that because I’m alright using devices and all that but there’s some that are older age or not that familiar with using devices that may struggle with using it… they’re feeling a bit anxious and a bit scared, if they’re not familiar with it then they won’t use it. Jamal (m), Staff, A, Pre.

Evidence strength and quality: do BWCs change anything?

There were conflicting reports regarding the potential benefits of using BWCs on the wards, with both staff and patients reporting mixed perceptions as to whether the cameras might reduce violence and aggression. In the pre-pilot interviews, some staff reported feeling that the BWCs may have a positive impact on reducing physical violence.

I think it’s going to reduce violence and aggression on the ward…I don’t think they’ll want to punch you…they might be verbally abusive but in terms of physical that might reduce. Sarah (f), Staff, I, Pre.

Patients however noted that the cameras might hold staff to account of their own behaviours and therefore may improve care, however they felt that this impact would wear off after the first few months after which people might forget about the cameras being there.

Now they’ve got the body cams, it’s going to be a lot of changes. They’ll think, ‘Ooh well he’s on tape’. So, it might do something to their conscience, they actually start to listen to patients… until the novelty wears off and it might go back to square one again. Ian (m), Patient, A, Pre.

One staff member suggested that incident rates had reduced following introduction of the BWCs, but they remained unsure as to whether this was due to the cameras, reflecting that violence and aggression on wards can be related to many factors.

I know our violence and aggression has reduced significantly since the start of the cameras pilot… I don’t know, because obviously wearing the camera’s one thing, but if they weren’t in use, I don’t know maybe just the presence of the camera made a difference. But yeah, it’s hard to tell. Petra (f), Staff, A, Post.

In contrast, several staff reported that they had seen limited evidence for such changes.

I used it yesterday. He was aggressive and I used it, but he even when I was using [it] he doesn’t care about the camera… it didn’t make any difference… It doesn’t stop them to do anything, this camera does not stop them to do anything. Abraham (m), Staff, I, Post.

Some staff suggested that in some circumstances the cameras increased patient agitation and created incidents, so there was a need to consider whether the BWCs were going to instigate aggression in some circumstances.

There has been with a few patients because they will threaten you. They will tell you, ‘if you turn it on, I’m gonna smash your head in’. So incidents like that, I will not turn it on… Yeah, or some of them will just tell you, ‘if you come close by, I’m going to pull that off your chest’. So things like that, I just stay back. Ada (f), Staff, A, Post.

One rationale for a potential lack of effectiveness was noted by both staff and patients and was related to the levels of acute illness being experienced by patients which meant that for many they were too unwell to have insight into their own actions or those of staff switching on the cameras.

We’ve had instances where patients are so unwell that they just don’t care. You switch on the camera, whether you switch it on or not, it doesn’t really change the behaviour. ‘All right, okay, whatever switch it on’. They’re so unwell, they’re not really understanding. Petra (f), Staff, A, Post. It might make [staff] feel safer as a placebo effect, but I don’t think it would necessarily make them safer… I think the people that are likely to attack a member of staff are crazy enough that they’re not gonna even consider the camera as a factor. Harry (m), Patient, A, Pre.

This lack of evidence that the cameras were necessarily effective in reducing incident rates or severity of incidents may have had an impact on staff buy-in and the use of the cameras as a result. One staff member reflected that having feedback from senior management about the impact and evidence would have been useful during the pilot period to inform ward staff whether the cameras were influencing things or not.

Staff want feedback. I don’t think we’ve had any since we’ve had the cameras… it would be nice to get feedback from, I don’t know, whoever is watching it, and stuff like that. Ada (f), Staff, A, Post.

Relative advantage: are BWCs effective and efficient for the ward?

Due to a combination of personal beliefs related to BWCs, the lack of evidence of their impact on violence and aggression, and other elements of care and culture on the wards, a number of staff and patients explored alternative interventions and approaches that may be more beneficial than BWCs. Both staff and patients suggested that Closed Circuit Television (CCTV) as an intervention that provided the transparency of using cameras and video footage but with an independent perspective. This was felt by many to remove the bias that could be introduced in BWC use as the video capture didn’t require staff control of the filming.

I feel like [BWCs] puts all the power and trust into the hands of the staff and I feel that it would be better to have CCTV on the ward because CCTV is neutral. Harry (m), Patient, A, Pre. I have control over that [BWC recording] … It kind of gives that split as well between staff and patients. You can tell me or I can tell you when to switch it on. Whereas I feel like a CCTV camera is there all the time. Nobody’s asking to switch it on. It’s there. If you wanted to review the footage you can request it, anyone can request to view the footage for a legitimate reason. Whereas the camera can come across as if you’re threatening. Petra (f), Staff, A, Post.

In addition, some participants reflected that the nature and design of BWCs meant that unless staff were present for an incident it wouldn’t be captured, whereas CCTV has the advantage of being always present.

If there’s CCTV, then it’s the same thing, you get me. Like, if its body worn cameras that people can always do things away from staff. They can always go down to that corridor to have their fight or go to the side where staff ain’t gonna see them to have their fight, but with CCTV you can’t do that. Elijah (m), Patient, A, Post.

In addition to exploring technological and video-based interventions, many staff noted that the key tool to violence reduction had to be the use of de-escalation skills, noting that the use of communication and positive relationships had to be the primary tool before other interventions such as BWCs or CCTV.

We do a lot of verbal de-escalation. So we got our destress room now still open. That has a punch bag, and it’s got sensory tiles, and the aim and hope is that when people do get frustrated, because we’re all human. We all get annoyed at anything or many little things in life. There is the aim that they go into that room and start punching the bag instead of property and damaging furniture. But we also are working really hard on verbal de-escalation and actually trying to listen to patients and talk to them before anything else. And that’s helped a lot. And between this kind of shared, or role modelling, where while we’re showing staff, actually even spending an extra 20 min is okay. If it means you’re not going to end up having to restrain a patient. Petra (f), Staff, A, Post.

By using communication skills and de-escalation techniques skilfully, some staff felt there was no need to utilise the BWCs. One concern with the introduction of the BWCs for staff was that the use of this technology may negatively impact on trust and relationships and the use of de-escalation.

Some situations I feel like it can make a situation worse sometimes… I think a lot of situations can be avoided if you just talk with people…. Trying to find out why they’re angry, trying to just kind of see it from their point of view, understand them… I think maybe additional training for verbal de-escalation is needed first. Patrick (m), Staff, A, Post.

Characteristics of individuals

Staff and patients’ knowledge and beliefs about the intervention.

Overall, there were mixed views among both staff and patients as to whether cameras would reduce incidents, prior to and after the pilot period. When considering the possible impact on violence and aggressive incidents there was a view among staff that there was the need for a nuanced and person-centred view.

All the patients that come in, they’re different you know. They have different perceptions; they like different things… everyone is different. So, it just depends. We might go live, and then we have good feedback because the patients they are open and the understand why we have it, and then as they get discharged and new patients come in it might not go as well. It just depends. Serene (f), Staff, A, Pre.

As a result of the desire to be person-centred in the use of such interventions, one staff member noted that they weighed-up such consequences for the patient before using the BWC and would make decisions not to use the camera where they thought it may have a negative impact.

Actually, with this body worn camera, as I did mention, if a patient is unwell, that doesn’t, the patient will not have the capacity to I mean, say yes, you cannot just put it on like that. Yeah, I know it’s for evidence, but when something happens, you first have to attend to the patient. You first have to attend to the patient before this camera is, for me. Ruby (f), Staff, I, Post.

Some staff questioned the existing evidence and theories as to why BWCs work to reduce incidents, and instead noted that for some people it will instigate an incident, while others may be triggered by a camera.

I’m on the fence of how that is going to work because I know the evidence is that by telling a patient ‘look if you keep escalating I’m gonna have to turn this on’, but I know several of our patients would kind of take that as a dare and escalate just to spite so that you would turn it on. Diana (f), Staff, A, Pre.

In contrast, some staff felt the cameras helped them feel safer on wards due to transparency of footage as evidence for both staff and patients.

They [staff] need to use it for protection, for recording evidence, that type of thing… They can record instances for later evidence. Yeah, for them as well. Safer for them and for patients because you can also have the right to get them to record, because a patient might be in the wrong but sometimes it may be the staff is in the wrong position. And that’s achieving safety for patients as well. Yeah, I think it works both ways. Dylan (m), Patient, A, Post.

Positive buy-in was also related to the potential use of the intervention as a training, learning or reflective tool for staff to improve practice and care and promote positive staff behaviour.

If you know that your actions might be filmed one way or the other, that would make me to step up your behaviour to patients… if you know that your actions can be viewed, if the authority wants to, then you behave properly with patients so I think that will improve the quality of the care to patient. Davide (m), Staff, I, Pre.

While there were some positive attitudes towards the cameras, there remained considerable concerns among participants regarding the transparency of camera use to collate evidence in relation to incidents as it was widely noted that the cameras remain in staff control therefore there is an issue in relation to bias and power.

I do think my gut would say that it wouldn’t necessarily be well received. Because also I think people feel like prisoners in here, that’s how some of the patients have described their experience, so in terms of the power dynamic and also just – I think that can make one feel a bit, even worse, basically, you know? Leslie (m), Staff, A, Pre.

These issues lead to staff reporting they didn’t want to wear the camera.

I’d feel quite uncomfortable wearing one to be honest. Leslie (m), Staff, A, Pre.

The staff control of the cameras had a particular impact on patient acceptability of the intervention as it led to some patients viewing BWCs as being an intervention for staff advantage and staff safety, thus increasing a ‘them and us’ culture and leading to patient resistance to the cameras. This was particularly salient for those with prior negative experiences of police use of cameras or mistrust in staff.

I feel like the fact that the body worn cameras is gonna be similar to how the police use them, if a staff member has negative intent toward a patient, they would be able to instigate an incident and then turn the camera on and use the consequences of what they’ve instigated to expect restraint or injection or whatever else might happen. So, I feel like it would be putting all the power and trust into the hands of the staff and I feel that it would be better to have CCTV on the ward because CCTV is neutral. Whereas, the body worn camera, especially with some of the personality conflicts/bad attitudes, impressions I’ve had from certain members of staff since I’ve been here, I feel like body worn cameras might be abused in that way possible. Harry (m), Patient, A, Pre.

Perceived unintended consequences and impact on care

Prior to the implementation there were concerns from staff that the introduction of BWCs could have consequences beyond the intended use of reducing violence and aggression, unintentionally affecting a range of factors that may impact on the overall delivery of care. There was a key concern regarding the potential negative impact that cameras may have for patients who have paranoia or psychosis as well as for those who may have prior traumatic experiences of being filmed.

It might have negative impacts on these patients because I’m thinking about kind of patients with schizophrenia and things like that who already have paranoid delusions, thinking that people are after them, thinking that people are spying on them, people are watching them, and then seeing kind of cameras around. It might have negative impacts on them. Tayla (f), Staff, I, Pre. When I was admitted I was going through psychosis… I don’t want to be filmed and things like that. So you just see a camera, a guy with a camera on, you are like, are you filming me? Elijah (m), Patient, A, Post.

There was also a considerable concern among both staff and patients that the use of cameras would have a negative impact on the therapeutic relationship between staff and patients. This was felt to be related to the implication that the cameras enhanced a ‘them and us’ dynamic due to the power differential that staff controlling the cameras can create, likened to policing and criminalisation of patients. With the potential of a negative impact on relationships between staff and patients, staff suggested they may be disinclined to use BWCs if it would stop patients speaking to them or approaching them if they needed support.

Yeah, I think it would probably damage [the therapeutic relationship] because I think what’s probably quite helpful is things that maybe create less of a power difference. I think to some extent, [the BWC] might hinder that ability. Like for example imagine going to a therapist and them just like ‘I’ve got this camera in the corner of the room and it’s gonna be filming our session and just in case – or like, just in case I feel that you might get aggressive with me’. Um, I don’t think that’s going to help the therapeutic relationship! Jamal (m), Staff, A, Pre. When you get body worn cameras on there, the relationship as well between staff and patients, is just gonna instantly change because you’re looking like police! Elijah (m), Patient, A, Post.

In contrast, a minority of staff felt that the presence of cameras may improve relationships as they provide transparency of staff behaviour and would encourage staff to behave well and provide high quality care for patients.

It will also help how, improve the way we look at the patients… because if you know that your actions might be filmed one way or the other, that would make me to step up your behaviour you know… you behave properly with patients so I think that will improve the quality of the care to patient. More efficiently, more caring to patient. Davide (m), Staff, I, Pre.

The process of implementation

Planning: top-down implementation.

Staff perceived that BWC implementation directives had been given by senior management or policy stakeholders whom they felt viewed the process from a position of limited understanding due to a lack of ‘frontline’ mental health service experience. This led to a lack of faith amongst staff, and a perception that funds were being misspent.

They sit up there, they just roll it out and see how it works, how it goes. They waste a whole lot of money, millions or whatever, thousands of pounds in it, and then they see that ‘Oh, it’s not gonna work’. They take it back and all of that. Before coming out with it, you need to come speak to us… they just sit up there drinking tea and coffee, and then they’re just like, Oh, yeah, well, let’s do it this way…come stay with these people, work with them, for just I give you a 12 h shift, stay with them. Richard (m), Staff, I, Post.

This was exacerbated when staff felt there was a lack of consultation or explanation.

we don’t always get the ins and outs of certain things…We know that the cameras are coming in and stuff like that, but you know, and obviously it’s gone through every avenue to make sure that it’s fine. But then sometimes we don’t always know the ins and outs to then explain to people why we have the cameras. Patrick (m), Staff, A, Post.

It was also highlighted that due to multiple initiatives being implemented and directives handed down in parallel, staff felt negative towards interventions more widely, with the BWCs being ‘ just another thing to do’ , adding to workload for staff and reducing enthusiasm to use the cameras.

it’s not just to do with the camera, I just think there’s lots of changes happening at once, and there’s loads of new things being constantly introduced that people are just thinking oh it’s another thing. I think that’s what it is more than the camera itself. Alice (f), Staff, A, Pre.

Execution: training, Use and Ward Visibility

Overall, there was a lack of consistency amongst staff in their understanding of the purpose and processes of using the BWCs on the wards.

What do you do, do you record every single thing or, I don’t know. Do you record like, if a patient said, I want to talk to you, confidential, you go sit in a room, do you record things like those or is it just violence and aggression? Ada (f), Staff, A, Post.

The lack of clarity regarding the purpose of the intervention and the appropriate use of the cameras was felt to impact staffs’ attitudes and acceptance of using them and contributed to a lack of transparency or perhaps trust regarding the use of any subsequent video footage.

I think if the importance of the recording was explained a bit more…and how it would improve things, I think people would use it more… that’s why I don’t think it’s always used sometimes… if you’re not sure why some of it’s important, then you’re not going to see the value…I think if you’re gonna keep with them, it’s about updating the training, teaching staff when to use it, then where does that information go? How does that look in terms of improving? Just a bit of transparency, I think. But when you don’t know certain things it’s a bit hard to get behind something or back it, you know? Patrick (m), Staff, A, Post.

The lack of information about the purpose and processes related to the intervention was also seen among patients, with most patients noting that they hadn’t received information about the cameras during their admissions.

No information at all. I don’t think any of the patients know about it. Toby (m), Patient, A, Post.

While training was provided it was widely felt that it was insufficient to provide understanding about the purpose of the cameras or the more in-depth processes beyond operational aspects such as charging and docking. Several staff interviewed were unaware of the training, while others noted that they had an informal run-through by colleagues rather than anything formal.

What training are you talking about?… I wasn’t here, so I was taught by my colleague. I mean, from what I was taught, to operate the camera, and to give a warning to the patient that you’re going to use the camera. Nevis (f), Staff, A, Post.

Longer training with further details beyond operational use was felt to be needed by staff.

I think the training should have to be longer, even if it’s like an hour or something… Like what situations deem the camera to be… more information on the cameras, when to use it, why it’s used, and I think if the importance of the recording was explained a bit more and what it was doing and how that recording would go and how it would improve things. Patrick (m), Staff, A, Post.

Furthermore, there was a need for training to be on a rolling basis given the use of bank staff who were not trained to use the cameras or to understand the proper processes or purpose of using the BWCs, which could leave them vulnerable to misuse or abuse.

We have bank staff [who aren’t trained] so they say ‘I don’t know how to use that camera you are giving me’. Nevis (f), Staff, A, Post.

The inner setting

Ward context: acceptance of violence and aggression is part of the job.

It was widely believed by staff that the nature of working on a mental health ward included accepting that violence and aggression was part of the job. This was not seen as an acceptance of violence but more that the job was providing care for individuals who are mentally unwell, and confusion, fear, frustration and aggression can be part of that. As a result, there was an ambivalence among some staff that the introduction of cameras would change this.

I think like in this line of work, there’s always that potential for like risky behaviours to happen. I’m not sure if putting the camera on will make much difference. Patrick (m), Staff, A, Post.

Staff noted that because of the nature of the job, staff are used to managing these situations and they understood that it was part of the job; therefore, it was unlikely that they would record everything that on paper might be considered an incident.

There’s also enough things that happen here, so I don’t think they would record [the incidents] because it’s just another day here. You know what I’m saying… [staff] can just say, ‘Stop, go back to your room and leave it at that and that kind of be the end of it’. Dylan (m), Patient, A, Post. We are trained for it. Eveline (f), Staff, I, Pre.

This acceptance that incidents are a hazard of mental healthcare was linked to staff’s acknowledgment that many factors make up the complexity of violence and aggression including the nature of individual patients, acuity levels, ward atmosphere, staffing levels, access to activities, leave and outside space. The interplay of multiple factors creates a context in which frustrations and incidents are likely, thus become part of the everyday and ‘normal’ life on the ward for staff and patients alike.

I feel like, you know, how in GP services you say, zero tolerance to abusive language, or any kind of harassment. I don’t think there is that on a psychiatric ward you are kind of expected to take all the abuse and just get on with it. Petra (f), Staff, A, Post.

With staff reported having a higher threshold for these behaviours it was perceived that this was likely to impact on the efficiency of the intervention as staff would be less likely to consider a situation as violent but more ‘ part of the job’ .

Reactive nature of the ward and incidents

Most participants noted that the ward context is always changing with people being admitted and discharged, with daily staff changes and wider turnover of staff, so things are never static and can change at any point. This reflects the dynamic nature of the ward which creates a complex moving picture that staff need to consider and react to.

[the atmosphere] it’s very good at the moment. If you had asked me this two weeks ago, I would say, ‘Oh, my gosh’. But it changes… The type of patient can make your whole ward change… it depends on the client group we have at the time. Nevis (f), Staff, A, Post.

Staff noted that a key limitation of using the cameras to reduce incidents was the reactive nature of the environment and care being provided. This was felt to impact on the feasibility and use of the cameras as staff noted that they often react to what is happening rather than thinking to ‘ put the camera on first ’. It was felt by staff with experience of reacting to incidents that the failure to use BWCs during these processes were linked to staff’s instincts and training to focus on patients as a priority.

Say for instance, you’re in the office, and two patients start fighting, or a patient attacks someone and, all you’re thinking about is to go there to stop the person. You’re not thinking about putting on any camera. You understand? So sometimes it’s halfway through it, somebody might say, ‘Has anybody switched the camera on’? And that’s the time you start recording… If something happens immediately, you’re not thinking about the camera at that time, you’re just thinking to just go, so yeah. Nevis (f), Staff, A, Post.

Incidents happen quickly and often surprise staff, therefore staff react instantly so are not thinking about new processes such as recording on the cameras as this would slow things down or is not in the reactive nature needed by staff during such incidents.

When you’re in the middle of an incident and your adrenaline’s high, you’re focusing on the incident itself. It’s very difficult for you to now remember, remind yourself to switch on the camera because you’re thinking, patient safety, staff safety, who’s coming to relieve you? What’s going on? Who’s at the door? Petra (f), Staff, A, Post.

In addition, the need for an immediate response meant that it was felt that by the time staff remember to, or have the chance to, switch the camera on it was often too late.

Sometimes in the heat of moments and stuff like that, or if the situation’s happening, sometimes you don’t always think to, you know, put your camera on. Patrick (m), Staff, A, Post.

Outer setting

Resources: staffing.

Issues related to staffing were highlighted by several participants as a key problem facing mental health wards thus leading to staff having higher workloads, and higher rates of bank and agency staff being used on shift and feeling burnt-out.

Out of all the wards I’ve been on I’d say this is the worst. It’s primarily because the staff are overworked…it seems like they spend more time doing paperwork than they do interacting with the patients. Harry (m), Patient, A, Pre. We’re in a bit of a crisis at the minute, we’re really, really understaffed. We’re struggling to cover shifts, so the staff are generally quite burnt out. We’ve had a number of people that have just left all at once, so that had an impact… Staff do get frustrated if they’re burnt out from lack of staff and what have you. Alice (f), Staff, A, Pre.

It was noted by one participant that the link of a new intervention with extra workload was likely to have a negative impact on its acceptability due to these increasing demands.

People automatically link the camera to then the additional paperwork that goes alongside it. It’s like, ‘Oh god, if we do this, we’ve got to do that’, and that could play a part. Petra (f), Staff, A, Post.

One staff member noted that the staffing issue meant there were more likely to be bank staff on wards so the care of patients may be affected as temporary staff may be less able to build meaningful therapeutic relationships.

So obviously there is the basic impact on safety of not having adequate staffing, but then there’s the impact of having a lot of bank staff. So obviously when you have permanent staff they get to know the patients more, we’re able to give them the more individualised care that we ideally should be giving them, but we can’t do that with bank staff. Diana (f), Staff, A, Pre.

It was also suggested that staffing levels and mix often made it more difficult to provide activities or facilitate escorted leave which can lead to patients feeling frustrated and becoming more aggressive.

So you know there is enough staff to facilitate the actual shift, so you know when there’s less staff like you say you’ve got people knocking at the door, but then you don’t have staff to take people out on leave straight away, that all has a rippling effect! Serene (f), Staff, A, Pre.

Wider systemic issues

Overall, there was a concern that the introduction of BWCs would not impact on wider, underlying factors that may contribute to frustration, aggression and incidents on wards. Providing a more enhanced level of care and better addressing the needs of patients was felt to be central to helping people but also reducing the frustration that patients feel when on the ward.

… for violence and aggression, [focus on] the mental health side of things like therapy and psychology should be compulsory. It shouldn’t be something you apply for and have to wait three or four weeks for. I think every person should, more than three or four weeks even, months even… we need psychology and therapists. That’s what will stop most violence, because psychologists and a therapist can edit the way that they speak to people because they’ve been given that skill depending on the way the person behaves. So that’s what we need regularly… not like all this dancing therapy, yoga therapy. That’s a person, that you come and you actually sit down and talk through your shit with them. That will help! Elijah (m), Patient, A, Post. There’s a lack of routine and I think there’s a lack of positive interaction between the patient and the staff as well. The only time you interact with a member of staff is if you’re hassling them for something, you have to hassle for every little thing, and it becomes a sort of, frustration inducing and like I’m a very calm person, but I found myself getting very fucking angry, to be honest, on this ward just because out of pure frustration… there’s bigger problems than body worn cameras going on. Harry (m), Patient, A, Pre.

Staff agreed that there was a need to invest in staff and training rather than new technologies or innovations as it is staff and their skills behind the camera.

It’s not the camera that will do all of that. It’s not making the difference. It’s a very good, very beautiful device, probably doing its job in its own way. But it’s more about investing in the staff, giving them that training and making them reflect on every day-to-day shift. Richard (m), Staff, I, Post.

There was felt to be a need to support staff more in delivering care within wards that can be challenging and where patients are unwell to ensure that staff feel safe. While in some circumstances the cameras made some staff feel safer, greater support from management would be more beneficial in making staff feel valued.

In this study exploring the implementation and use of body-worn cameras on mental health wards, we employed two methods for collecting and comparing data on incidents and use of containment measures, including BWCs, on one acute ward and one psychiatric intensive care unit. We found no clear relationship between the use of BWCs and rates or severity of incidents on either ward. While BWCs may be used when there are incidents of both physical and verbal aggression, results indicate that they may also provoke verbal aggression, as was suggested during some interviews within this study. This should be a concern, as strong evidence that being repeatedly subject to verbal aggression and abuse can lead to burnout and withdrawal of care by staff [ 30 ]. These mixed findings reflect results that were reported in two earlier studies of BWCs on mental health wards [ 12 , 13 ]. However, the very low use of the cameras, on just 10 per cent of the shifts where data was obtained, makes it even more difficult to draw any conclusions.

While the data shows limited impact of using BWCs on levels of incidents, we did find that during the pilot period BWC use tended to occur alongside physical restraint, but the direction of relationship is unclear as staff were asked to use BWCs when planning an intervention such as restraint. This relationship with restraint reflected the findings on several wards in a previous study [ 13 ], while contrasting with those reported in a second study that found reductions in incidents involving restraint during the evaluation period [ 12 ]. Such a mix of findings highlights the complexity of using BWCs as a violence reduction method within a busy healthcare setting in which several interacting components and contextual factors, and behaviours by staff and patients can affect outcomes [ 31 ]. The qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may have a confounding impact on the incident data presented in this simple form.

The findings presented within this evaluation provide some insights into the process of implementing BWCs as a safety intervention in mental health services and highlight some of the challenges and barriers faced. The use of implementation science to evaluate the piloting of BWCs on wards helps to demonstrate how multiple elements including a variety of contextual and systemic factors can have a considerable impact and thus change how a technology may vary not only between hospitals, but even across wards in the same hospital. By understanding the elements that may and do occur during the process of implementing such interventions, we can better understand if and how BWCs might be used in the future.

Within this pilot, extensive preparatory work conducted at a directorate and senior management level did not translate during the process of implementation at a ward level, which appeared to impact on the use of BWCs by individuals on the wards. This highlights that there is a need to utilise implementation science approaches in planning the implementation of new technologies or interventions and to investigate elements related to behavioural change and context rather than just the desired and actual effects of the intervention itself.

While ward staff and patients identified the potential for BWCs to enhance safety on the wards, participants distrusted their deployment and expressed concerns about ethical issues and possible harmful consequences of their use on therapeutic relationships, care provided and patient wellbeing. These themes reflect previous findings from a national interview study of patient and staff perspectives and experiences of BWCs in inpatient mental health wards [ 14 ]. Given these issues, alternatives such as increasing de-escalation skills were identified by staff as possible routes that may be more beneficial in these settings. Furthermore, other approaches such as safety huddles have also been highlighted within the literature as potential means to improve patient safety by looking ahead at what can be attended to or averted [ 32 ].

Furthermore, it is important to consider that the presence of power imbalances and the pre-existing culture on the ward have considerable implications for safety approaches and must be considered, as exemplified by the preferences by both staff and patients in this evaluation for more perceived ‘impartial’ interventions such as CCTV. As identified within previous studies [ 14 ], BWCs can have different implications for psychological safety, particularly for vulnerable patients who already feel criminalised in an environment with asymmetrical power imbalances between staff and patients. This is particularly salient when considering aspects of identity such as race, ethnicity, and gender both in terms of the identities of the patient group but also in terms of the staff/patient relationship.

While preferences in this study note CCTV as more ‘impartial’, work by Desai [ 33 ] draws on the literature about the use of surveillance cameras in other settings (such as public streets) as well as on psychiatric wards and concludes that CCTV monitoring is fraught with difficulties and challenges, and that ‘watching’ patients and staff through the lens of a camera can distort the reality of what is happening within a ward environment. In her recently published book, Desai [ 34 ] develops this theme to explore the impacts of being watched on both patients and staff through her ethnographic research in psychiatric intensive care units. She highlights concerns over the criminalisation of patient behaviour, safeguarding concerns in relation to the way women’s bodies and behaviours are viewed and judged, and the undermining by CCTV of ethical mental health practice by staff who attempt to engage in thoughtful, constructive, therapeutic interactions with patients in face-to-face encounters. Appenzeller et al.’s [ 35 ] review found that whilst the presence of CCTV appeared to increase subjective feelings of safety amongst patients and visitors, there was no objective evidence that video surveillance increases security, and that staff may develop an over-reliance on the technology.

In addition, our findings add to the existing literature which notes that alternative interventions and approaches that address underlying contextual and systemic issues related to improving care on inpatient wards require attention to address the underlying factors related to incidents, e.g., flashpoints [ 36 ]. Evidence suggests that factors leading to incidents can be predicted; therefore, there is a need to enable staff to work in a proactive way to anticipate and prevent incidents rather than view incidents as purely reactive [ 37 , 38 , 39 ]. Such skills-based and relational approaches are likely to impact more on improving safety and reducing incidents by addressing the complex and multi-faceted issue of incidents on inpatient mental health wards [ 40 ].

These findings highlight that interventions such as BWCs are not used within a vacuum, and that hospitals are complex contexts in which there are a range of unique populations, processes, and microsystems that are multi-faceted [ 41 ]. As a result, interventions will encounter both universal, specific, and local barriers that will impact on its functioning in the real world. This is salient because research suggests that camera use inside mental health wards is based on a perception of the violent nature of the mental health patient, a perception that not only influences practice but also impacts how patients experience the ward [ 33 ]. As a result, there needs to be careful consideration of the use of any new and innovative intervention aimed at improving safety within mental health settings that have limited research supporting their efficacy.

Limitations

While the study provides important insights into the efficacy and acceptability of introducing BWCs onto inpatient mental health wards, there were several limitations. Firstly, the analysis of incident data is limited in its nature as it only presents surface level information about incidents without wider contextual information. Results using such data should be cautiously interpreted as they do not account for confounding factors, such as staffing, acuity, ward culture or ward atmosphere, that are likely to contribute to incidents of violence and aggression. For example, while there was a statistically significant decrease in restrictive practice on the PICU across the study period, we know that BWCs were not widely used on that ward, so this is likely due to a confounding variable that was not accounted for in the study design.

Secondly, the study faced limitations in relation to recruitment, particularly with patients. Researchers’ access to wards was challenging due to high staff turnover and high rates of acuity, meaning many patients were not deemed well enough to be able to consent to take part in the study. In addition, the low use of the cameras on wards meant that many patients, and some staff, had not seen the BWCs in use. Similarly, patients had been provided limited information about the pilot, so their ability to engage in the research and describe their own experiences with BWCs was restricted.

Thirdly, analysis captures the active use of the BWC, however it does not fully capture the impact of staff wearing the cameras even where they do not actively use them. While our qualitative analysis provides insight into the limitation of such passive use, it is likely that the presence of the cameras being worn by staff, even when turned off, may have an impact on both staff and patient behaviours. This may explain trends in the data that did not reach significance but warrant further investigation in relation to the presence of BWCs, nonetheless.

Finally, researchers had planned to collect quantitative surveys from staff and patients in relation to their experiences of the ward atmosphere and climate, views related to therapeutic relationships on the ward, levels of burnout among staff, views on care, and attitudes to containment measures. Due to issues related to staff time, patient acuity, and poor engagement from staff leading to challenges accessing the wards, the collection of such survey data was unfeasible, and this element of the study was discontinued. As a result, we have not reported this aspect in our paper. This limitation reflects the busy nature of inpatient mental health wards with pressures on staff and high levels of ill health among patients. As such, traditional methodologies for evaluation are unlikely to elicit data that is comprehensive and meaningful. Alternative approaches may need to be considered.

Future directions

With BWCs being increasingly used across inpatient mental health services [ 14 ], it is important that further research and evaluation is conducted. To date, there is limited data regarding the effectiveness of this technology in relation to violence reduction; however, there may be other beneficial uses in relation to safeguarding and training [ 13 ]. Future research should consider alternative methods that ensure contextual factors are accounted for and that patient voices can be maximised. For example, focus groups with patients currently admitted to a mental health ward or interviews with those who have recently been on a ward that has used the cameras, would bypass problems encountered with capacity to consent in the present study. Furthermore, ethnographic approaches may provide a deeper understanding of the implementation, deployment and impact that BWCs have on wards.

Overall, this research sheds light on the complexities of using BWCs as a tool for ‘maximising safety’ in mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors, including the staff and patient populations on the wards. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility. Furthermore, the findings point towards the need for more consideration to be placed on processes of implementation and the complex ethical discussions regarding BWC use from both a patient and a staff perspective.

In conclusion, while there have been advances in digital applications and immersive technologies showing promise of therapeutic benefits for patients and staff more widely, whether BWCs and other surveillance approaches are to be part of that picture remains to be seen and needs to be informed by high-quality, co-produced research that focuses on wider therapeutic aspects of mental healthcare.

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We would like to thank The Burdett Trust for Nursing for funding this work. We would also like to acknowledge our wider Lived Experience Advisory Panel and Project Advisory Panel for their contributions and support and would like to thank the staff and service users on the wards we attended for their warmth and participation.

Funding was provided by The Burdett Trust of Nursing. Funders were independent of the research and did not impact findings.

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Una Foye, Keiran Wilson, Jessica Jepps, James Blease, Geoff Brennan & Alan Simpson

Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King’s College London, London, UK

Una Foye, Keiran Wilson, Jessica Jepps, Geoff Brennan & Alan Simpson

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All authors have read and approved the manuscript. Authors AS, UF, KW, GB created the protocol for the study. KW, JJ, UF conducted the recruitment for the study, and conducted the interviews. UF, JJ, JB, LMA, LU, SMK, KB, ET coded data, and contributed to the analysis. All authors supported drafting and development of the manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical. Ethical approval was granted by the Health Research Authority: London - Camden & Kings Cross Research Ethics Committee (IRAS PROJECT ID 322268, REC Reference 23/LO/0337). All participants provided informed consent prior to enrolment in the study, including consent for publication of anonymised quotes.

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Foye, U., Wilson, K., Jepps, J. et al. Exploring the use of body worn cameras in acute mental health wards: a mixed-method evaluation of a pilot intervention. BMC Health Serv Res 24 , 681 (2024). https://doi.org/10.1186/s12913-024-11085-x

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Received : 03 January 2024

Accepted : 07 May 2024

Published : 29 May 2024

DOI : https://doi.org/10.1186/s12913-024-11085-x

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