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: Khameer Kidia[Show abstract] [Hide abstract]
ABSTRACT: Introduction & Objectives: Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process.
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ABSTRACT: Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process. In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16-20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods. Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic. HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.PLoS ONE 01/2014; 9(1):e87322. · 3.73 Impact Factor
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ABSTRACT: Violence is a major cause of morbidity and mortality among adolescents. We conducted serial focus groups with 30 youth from a violence prevention program to discuss violence in their community. We identified four recurrent themes characterizing participant experiences regarding peer decision-making related to violence: (1) youth pursue respect, among other typical tasks of adolescence; (2) youth pursue respect as a means to achieve personal safety; (3) youth recognize pervasive risks to their safety, frequently focusing on the prevalence of firearms; and (4) as youth balance achieving respect in an unsafe setting with limited opportunities, they express conflict and frustration. Participants recognize that peers achieve peer-group respect through involvement in unsafe or unhealthy behavior including violence; however they perceive limited alternative opportunities to gain respect. These findings suggest that even very high risk youth may elect safe and healthy alternatives to violence if these opportunities are associated with respect and other adolescent tasks of development.The Journal of Prevention 10/2013;
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