Qualitative methods: what are they and why use them?
ABSTRACT To provide an overview of reasons why qualitative methods have been used and can be used in health services and health policy research, to describe a range of specific methods, and to give examples of their application.
Classic and contemporary descriptions of the underpinnings and applications of qualitative research methods and studies that have used such methods to examine important health services and health policy issues.
Qualitative research methods are valuable in providing rich descriptions of complex phenomena; tracking unique or unexpected events; illuminating the experience and interpretation of events by actors with widely differing stakes and roles; giving voice to those whose views are rarely heard; conducting initial explorations to develop theories and to generate and even test hypotheses; and moving toward explanations. Qualitative and quantitative methods can be complementary, used in sequence or in tandem. The best qualitative research is systematic and rigorous, and it seeks to reduce bias and error and to identify evidence that disconfirms initial or emergent hypotheses.
Qualitative methods have much to contribute to health services and health policy research, especially as such research deals with rapid change and develops a more fully integrated theory base and research agenda. However, the field must build on the best traditions and techniques of qualitative methods and must recognize that special training and experience are essential to the application of these methods.
- SourceAvailable from: Theodoros Xanthos
Conference Paper: A new paradigm of Research in Resuscitation EducationProceedings of the Instructor Day for the 2nd Panhellenic Congress of Resuscitation & Emergency Care; 11/2014
Article: Narrative Reviews.[Show abstract] [Hide abstract]
ABSTRACT: Although qualitative researches (QR) are invaluable in understanding complex healthcare situations, the quantitative systematic review could not treat them. To improve quality of healthcare services, results of QR should be considered in healthcare decision-making processes. Several methods and theories for synthesizing evidences of QR have been developed. In order to activate the narrative reviews and mixed methods reviews in Korean healthcare academies, I arranged the related nomenclatures and suggested some issues to conduct them.Epidemiology and health. 09/2014;
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ABSTRACT: The Affordable Care Act includes provisions to standardize the collection of data on health care quality that can be used to measure disparities. We conducted a qualitative study among leaders of Medicaid managed care plans, that currently have access to standardized quality data stratified by race and ethnicity, to learn how they use it to address disparities. We conducted semi-structured interviews with 21 health plan leaders across 9 Medicaid managed care plans in California. We used purposive sampling to maximize heterogeneity in geography and plan type (e.g., non-profit, commercial). We performed a thematic analysis based on iterative coding by two investigators. We found 4 major themes. Improving overall quality was tightly linked to a focus on standardized metrics that are integral to meeting regulatory or financial incentives. However, reducing disparities was not driven by standardized data, but by a mix of factors. Data were frequently only examined by race and ethnicity when overall performance was low. Disparities were attributed to either individual choices or cultural and linguistic factors, with plans focusing interventions on recently immigrated groups. While plans' efforts to address overall quality were often informed by standardized data, actions to reduce disparities were not, at least partly because there were few regulatory or financial incentives driving meaningful use of data on disparities. Standardized data, as envisaged by the Affordable Care Act, could become more useful for addressing disparities if they are combined with policies and regulations that promote health care equity.Medicare & medicaid research review. 01/2012; 2(4).
Qualitative Methods: What Are They
and Why Use Them?
Objective. To provide an overview of reasons why qualitative methods have been
used and canbe used in health services and health policy research, to describe arange
ofspecific methods, and to give examples oftheir application.
Data Sources. Classic and contemporary descriptions of the underpinnings and
applications ofqualitative research methods and studies that have used such methods
to examine important health services and health policy issues.
Principal Findings Qualitative research methods are valuable in providing rich de-
scriptionsofcomplexphenomena; trackingunique orunexpected events; illuminating
the experience and interpretation of events by actors with widely differing stakes
and roles; giving voice to those whose views are rarely heard; conducting initial
explorations to develop theoriesand togenerate andeven testhypotheses;andmoving
toward explanations. Qualitative and quantitative methods can be complementary,
used insequence orin tandem. Thebestqualitative research issystematic andrigorous,
and it seeks to reduce bias and error and to identify evidence that disconfirms initial
or emergent hypotheses.
Condlusions. Qualitative methods have much to contribute to health services and
health policy research, especially as such research deals with rapid change and devel-
ops amore fully integrated theory base and research agenda. However, the field must
build on the best traditions and techniques ofqualitative methods and must recognize
that special training and experience are essential to the application ofthese methods.
Key Words. Qualitative research methods, case study research, key informant inter-
views,focusgroup research, participantobservation
Behind every quantity there must lie a quality.
GertudeJaeger Selznick, Ph.D.
The field ofhealth services research is young. Its multi-disciplinary practition-
ers have borrowed conceptual frameworks and data collection and analytic
methods from a wide range of social and behavioral sciences, as well as
HSR Health Services Research 34:5 Part II (December 1999)
from public health and medicine. Many health services and health policy
researchers have used qualitative methods, either alone or in combination
with quantitative approaches. As the epigram (from a lecture by a revered
epistemologist, sociologist, and survey researcher) indicates, quantification,
which facilitates access to powerful statistical tools, must reston priorwork on
conceptualization and operationalization, and on valid and reliable measure-
ment (e.g., see Babbie 1998). Qualitative methods have the potential to con-
tribute significantly to the development ofmeaningful "quantities"; however,
theyhave inherent aswell asinstrumental value. Somephenomena, including
historical events, are so unusual that by the time one has a way to quantify
them, theyhave eitherchanged ordisappeared.' Quantification is an excellent
way to "slice up" phenomena so that they become manageable and discrete
elements ofan overall conceptual framework or analytic plan. Everythinghas
the defects of its qualities, however, and the defect of quantification is that
it does not always support, as well as qualitative work, the understanding of
complex, dynamic, and multi-dimensional "wholes" (Patton 1975).
In addition, the state-of-the-art of quantification is mixed across poten-
tially important independent and dependent variables. If we focus research
onlyonwhatwe alreadyknowhowto quantify, indeed onlyon thatwhich can
ultimately be reliably quantified, we risk ignoring factors that are more signif-
icant in explainingimportant realities and relationships. Qualitative methods
help provide rich descriptions ofphenomena. They enhance understanding
of the context of events as well as the events themselves. The use of these
methods tends to enhance peripheral vision, which is especially important
at the early stages of inquiry, as noted further on. In addition, qualitative
methods can indeed help to identify patterns and configurations among
variables and to make distinctions. Thus, qualitative research not only serves
the desire to describe; it also helps move inquiry toward more meaningful
For all of these reasons, the use of qualitative methods is growing in
health services and health policy research (Bowling 1997). Unfortunately,
however, we need to appreciate more fully the differences between sys-
tematic, rigorous, well-designed qualitative research and well-intentioned
but poorly implemented attempts to supplement quantification with more
Address correspondence to Shoshanna Sofaer, Dr.P.H., Robert P. Luciano Professor of Health
Care Policy, School ofPublic Affairs, Baruch College, 17 Lexington Ave., Box C4011, New York
NY 10010. This article, submitted to Health Services Research on February 3, 1999, was revised
and accepted for publication onJune 11, 1999.
Qualitative Methods: What and Why?
open-ended interviews. Paradoxically, many decry qualitative methods as
inherently biased because these methods depend so much on the perspective
and skills of the researcher, while others assume that qualitative research
can be carried out by anyone regardless of their training, knowledge, and
This article explores the reasons why and the situations where it is
appropriate to use qualitative methods, and it discusses some common uses
of these methods in health services and health policy research. It presents a
spectrum of qualitative methods that reflect the various ways in which they
can be used. It closes with a few examples of qualitative research to illustrate
WHY USE QUALITATIVE METHODS?
It can be useful to conceptualize research as the process of reducing our
uncertainty about important phenomena or questions. This implies that the
development ofknowledge involves the gradual reduction of uncertainty. If
we adopt such a developmental approach to inquiry, itbecomes evident that,
at the outset, there is uncertainty not only about answers, but about what the
right questions might be; abouthow they should be framed to getmeingful
answers; and about where and to whom questions should be addressed. As
understanding increases, some ofthe right questions emerge, butuncertainty
remains aboutwhether all ofthe right questions havebeen identified. Further
along, confidence grows that almost all ofthe important questions have been
identified and perhaps framed in more specffic terms, but uncertainty still
exists about the range of possible answers to those questions. Eventually, a
high level ofcertainty is reached about the range ofalmost all ofthe possible
answers. In many (butprobably not all) cases, therefore, as inquiry proceeds,
itcan move from being quite unstructured and probably largely qualitative in
nature, to being quite structured and probably largely quantitative in nature.
We can, asAbrahamKaplanputs it (1964), movefromthe context ofdiscovery
to the context ofjustification.
One way to make this more concrete is to put it in terms ofhow to ask
questions. In this developmental framework, initial questions are very open-
ended; often the researcher just asks what appear to be relevant individuals
to describe, in their own way, their experiences and responses concerning a
given situation or issue. Over time, questions remain open-ended butbecome
more specific, either in their initial wording or in accompanying "probes."
HSR: Health ServicesResearch 34:5Part II (December 1999)
As we move to more quantitative research, questions become closed-ended,
that is, they have specified response options; in addition, the sequence of
questions has become predetermined rather than left to the discretion of the
researcher. As Patton has noted (1990: ch. 7), there is a discipline, as well as
an art, to asking truly open-ended questions: genuine awareness of whether
you are asking an open-ended question can be viewed as one of the core
disciplines of the qualitative researcher.
Another way to shed light on reasons to use qualitative methods is to
address theissue oftheory. Health servicesresearchers tend toborrow theories
from social science disciplines (e.g., economics, psychology, organizational
behavior, political science, sociology, and anthropology). They have done
little to develop full-scale, independent theories. It can be argued that the
field has reached the point at which it has become most valuable to pay
greater attention to the construction oftheories that integrate understandings
from our multiple disciplinary roots. A shared set of concepts or constructs
derivedfrommore integrative andgeneric theories couldhelp ensure thatkey
questions are addressed and that key variables are measured, and measured
consistently, across studies in widely different settings and over time. This
would contribute greatly to our ability to build a coherentbody ofknowledge
with perhaps greater staying power.
Qualitative methods are quite useful in constructing or developing
theories or conceptual frameworks or, to put it another way, in generating
hypotheses. These methods can also be used in refining theories and hy-
potheses through preliminary testing. There is an important parallel to be
drawn here between rigorous qualitative and rigorous quantitative research.
In quantitative research, building on epistemological assumptions regarding
whether it is ever possible to confirm (rather than disconfirm) a hypothesis,
researchers typically try to reject anull hypothesis. An important insightfrom
Patton is that when qualitative researchers begin to see a pattern that might
be articulated as a hypothesis, they should then search systematically for
evidence that will lead to the rejection of the hypothesis (Patton 1990: ch.
8). When qualitative researchers embrace this level of discipline, they take
important and concrete steps to protect against bias, whether intentional or
Although qualitative methods are more frequently used in theory de-
velopment and refinement, some argue that they can also be used in test-
ing theory. No less apparently quantitative a social scientist than Donald
Campbell has argued that qualitative methods can be used to collect the
data needed for experimental studies (1975). Some qualitative researchers
QualitativeMethods: What and Why?
may argue that this is an inappropriate use of their approach, because it
involves a significant shift away from the type of research that involves, as
Charles Ragin (1994) has noted, in-depth, multi-dimensional exploration of
a limited number of complex wholes. If one views the use of qualitative
methods as a continuous rather than a dichotomous variable, however, it is
easier to conclude that qualitative methods can inform and be informed by
typical practice in quantitative research, and that it can provide ways to make
reliable observations that would not otherwise be possible.
USING QUALITATIVE METHODS IN
HEALTH SERVICES AND POLICY
In the field of health services research, qualitative methods have been used
to describe many kinds ofcomplex settings and complex interactions. These
include interactions amongpatients, families, and clinicians; within, between,
and among professional groups and organizations; in communities; and in
markets. Classic studies by Anselm Strauss and Barney Glaser, for example,
used qualitative methods (what they called "grounded theory" ) to
elucidate relationships among professionals and between professionals and
patients. Examples of the continuing tradition include Glaser's work (1965)
on the issue of whether or not to tell patients they are dying, Strauss's work
highlightingthevirtuallycontinuousprocess ofnegotiation inthe specification
of roles and relationships in health care settings (1978), and Corbin and
Strauss's more recent work on the life experience of family members who
care for people with chronic illnesses in home settings (1988).
Qualitativeresearch also plays animportantpartin clarifyingthe values,
language, and meanings attributed to people who play different roles in
organizations and communities. They allow people to speak in their own
voice, rather than conforming to categories and terms imposed on them
by others. Often, qualitative researchers find that they are giving voice, in
particular, to thosewho are otherwise rarelyheard, such aspatients orworkers
far down in the hierarchical chain of command. This latter tradition can
be seen as the application of the techniques of anthropology. The research
methods ofanthropology were designed both to describe and to understand
distinctive cultures in far away places. They have proved to be very useful,
as well, in understanding groups ofpeople with similarly distinctive cultures
who live in our nation, who are often either almost invisible (e.g., patients