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Analyzing Data: Approaches to Thematic Analysis
Abstract
In this chapter, we focus our attention on qualitative research related to healthcare simulation. This chapter explores two related approaches to analysing qualitative data – thematic analysis and qualitative content analysis. Both of these methods are commonly used in qualitative research, and are considered relatively accessible forms of analysis. We provide a logical approach to their use offering references and a worked example. In addition to introducing the each method, we discuss how to ensure rigour and trustworthiness in your research. These issues form an essential part of any qualitative approach.
... We used thematic qualitative analysis to analyze the data. Specifically, we utilized a mix of "directed" and "conventional" qualitative coding (Gormley et al., 2019). Directed coding recognizes that some terms associated with coworker abuse have already been identified in the literature and were included as coding themes from the outset. ...
... Directed coding recognizes that some terms associated with coworker abuse have already been identified in the literature and were included as coding themes from the outset. Conventional coding refers to adding coding themes based on empirical information provided within the data to ensure all reported outcomes are captured (Gormley et al., 2019), a method used heavily in respondents' perceptions of why the abuse was occurring. ...
Purpose
The appalling abuse healthcare workers have endured from patients is long documented in the popular press and social media. Less explored in the healthcare management literature is workplace abuse that professional nurses experience from their coworkers.
Design/methodology/approach
The authors use text-based first-hand accounts from nurses posting on Reddit ( N = 75) to better understand the types and context of abusive acts endured by their coworkers in the contemporary healthcare setting. Each account is content analyzed using two raters, and thematic analysis is utilized to summarize findings.
Findings
Findings indicate that nurse workplace abuse frequently targets new entrants to a work unit (e.g. recent grads), typically is ongoing, takes verbal and nonverbal forms, mainly stems from coworkers (i.e. lateral mistreatment), and frequently takes place in front of other coworkers, mainly in hospital settings.
Practical implications
By applying the lens of mindfulness, healthcare organizations can transform these harmful interactions within the nursing profession. The authors offer administrators and frontline workers practical implications for mitigating workplace abuse, including reshaping the culture, bystander interventions and explicit leadership support.
Originality/value
First-hand accounts from nurses in the frontlines of healthcare provide a rich voice that reveals the reality of ongoing verbal and nonverbal peer abuse in hospitals and healthcare settings.
... A qualitative methodological approach was used to explore attitudes towards a planned co-leadership structure in maternity emergency teams. Using a constructivist paradigm, an interview study and subsequent content analysis was performed (Gormley, Kearney, Johnston, Calhoun, & Nestel, 2019). ...
... After agreeing upon initial coding categories, independent manual coding was performed and updated iteratively with each coding cycle. A recorded log of coding categories as they evolved over cycles was kept in line with conventional content analysis processes (Gormley et al., 2019). ...
Shared leadership improves team performance in many domains and is present in some interprofessional healthcare teams. Despite the dominant paradigm of a singular obstetrician leader in maternity emergencies, co-leadership, a specific form of shared leadership, has been identified as a potentially beneficial to clinical care. This qualitative interview study addresses the gaps in knowledge regarding clinician attitudes toward co-leadership and how a co-leadership structure might be implemented within a maternity care setting. Twenty-five clinicians (midwives, obstetricians and anaesthetists) working in the birthing units of two tertiary maternity units were interviewed and a conventional content analysis conducted. Clinicians viewed co-leadership as potentially beneficial to patient care through improved leadership performance and co-leader back up behavior. Implementation of co-leadership was thought to require a supportive organizational culture, agreed patient management protocols and the participation in simulation training. Enacting co-leadership required adaptable leadership sharing practices, effective communication, and high levels of trust between the co-leaders. These findings inform the future implementation strategies for co-leadership in interprofessional healthcare teams.
... After transcribing the data, patterns in the data were discovered using a thorough process of familiarisation with the data, coding, creation, and revision of themes (Figure 1). Figure 1. Adapted from Gormley et al. (2019) This paper used the TA method since it is a popular method for analysing qualitative data in many disciplines including education where procedures for using TA as a qualitative technique only began to appear in the 1990s (Cohen et al., 2018). The purpose of TA is to find meaningful patterns in a dataset to answer the research questions under consideration. ...
The current National Curriculum 2012 of English (VI- X) in Bangladesh incorporates both listening and speaking skills for its English education. Textbooks have also been designed in accordance with the policy which is set by the National Curriculum and Textbook Broad (NCTB). The English textbook, titled English for Today (EfT), was designed in alignment with the current National Curriculum for English (VI-X) for students in grades 6 through 10. The target of the EfT is to achieve students’ competency in integrated four skills of English language: listening, speaking, reading, and writing. However, although the listening module is now in policy and classroom practice, it is neither assessed in school or in public exams at the secondary level (Kabir, 2020). This study explores the perceptions of policy and practice of listening in secondary English education in Bangladesh. This study may be significant as little research has been done in Bangladesh on listening skill and its significance for language competence, let alone on the teaching of listening in connection to language learning. This qualitative study is based on in-depth interview data collected in 2019. The interviews included pertinent participants of policymakers and secondary English teachers. The findings indicated that there was a disconnect in curriculum, classroom practice and assessment in secondary English education.
... The responses were thematically analyzed. Gormley, Kearney, Johnston, Calhoun, and Nestel (2019) used the thematic analysis framework used by the researcher. The following process was observed: familiarization of the data, preliminary coding, clustering, template development, and interpretation. ...
This mixed-method approach of the study explores the learning outcomes, topics, and assessment methods of Purposive Communication instructional materials in the World Englishes context. Also, it determines the suggestions of Purposive Communication lecturers/instructors in integrating the course into World Englishes. Through Google form, 72 respondents took part in the study. They are all language teachers and are currently handling Purposive Communication in the Philippines' Private/Public Higher Education Institution. The results showed that the respondents are aware of World Englishes concepts and are practicing those concepts in their classroom. However, they have suggestions to publishers/authors of Purposive Communication to integrate other varieties of Englishes in each topic. The researcher suggested that other language courses in the Philippines be evaluated to form a holistic paradigm of World Englishes in the Philippine curriculum.
... Throughout the study, researchers kept reflexive journals to capture initial thoughts, ideas, and patterns within the research, as well as to reflect on how the researchers' positionality may impact the construction and interpretation of data (Gormley et al, 2019;Hill and Dao, 2021). Following completion of the analysis, findings were presented back to the organisation in a lunchtime seminar, and staff were invited to comment. ...
This research explored how staff and families using a Scottish trauma-informed charity, striving to enact antiracism, understand and approach race and antiracism in services for families of colour. Thematic analysis was applied to data from ten interviews with six staff participants and four families. Six interlinking themes emerged. Staff identified the charity as a ‘white organisation’ and sought ‘a common frame of reference’ with families, while families expressed overwhelming ‘gratitude’ to staff. ‘Identities were owned and disowned’, with participants using ‘colour-blind’ racial ideologies. Staff ‘located responsibility’ for bridging cultural gaps in families of colour. White staff, while well-intentioned, did not express a fundamental understanding of racism, impeding their ability to enact antiracism. This reflected wider Scottish policy and lay beliefs of being a post-racist society, and challenged organisational attempts to fully embody trauma-informed practice. Challenges and recommendations for researching racism in the third sector are discussed.
... Thematic analysis was used as a method to identify, analyze, and report the relevant themes/patterns across the dataset of all interviews. Following the existing guidelines for thematic analysis, the coder first became familiarized with the data, developed preliminary codes, and clustered them into themes with which to perform the interpretation of the data (Braun & Clarke, 2006;Gormley et al., 2019). The first author MS who coded all the data is a Ph.D. level evaluator. ...
Person-centered recovery planning (PCRP) has been a key aspect in mental health system transformation and delivering quality health care. Despite the mandate to deliver this practice and a growing evidence base, its implementation and understanding of implementation processes in behavioral health settings remain a challenge. New England Mental Health Technology Transfer Center (MHTTC) launched the PCRP in Behavioral Health Learning Collaborative to support agencies’ implementation efforts through training and technical assistance. In an effort to explore and understand the internal implementation process changes facilitated by the learning collaborative, the authors conducted qualitative key informant interviews with the participants and the leadership of the PCRP learning collaborative. The interviews revealed the processes that are part of the PCRP implementation efforts, including staff training, changing agency policies and procedures, modifying treatment planning tools, and the structure of the electronic health records. The higher prior organizational investment and readiness for change, building staff’s competencies in PCRP, leadership investment, and frontline staff buy-in act as factors that facilitate the implementation of PCRP in behavioral health settings. Our findings inform both the implementation of PCRP in behavioral health settings and future efforts of organizing multi-agency learning collaboratives to support PCRP implementation.
... We applied a qualitative content analysis following the conventional approach. 23 The observations are direct responses to questions by participants that require low inference, which makes a descriptive qualitative approach ideal for this analysis. First, one researcher (SS) read the transcribed debriefings to understand the data. ...
Background
Latent safety threats (LSTs) in healthcare are hazards or conditions that risk patient safety but are not readily apparent without system stress. In situ simulation (ISS), followed by post-scenario debriefing is a common method to identify LSTs within the clinical environment. The function of post-ISS debriefing for LST identification is not well understood.
Objectives
This study aims to qualitatively characterise the types of LSTs identified during ISS debriefing.
Methods
We conducted 12 ISS trauma scenarios followed by debriefing at a Canadian, Level 1 trauma centre. We designed the scenarios and debriefing for 15 and 20 min, respectively. Debriefings focused on LST identification, and each session was audio recorded and transcribed. We used an inductive approach with qualitative content analysis to code text data into an initial coding tree. We generated refined topics from the coded text data.
Results
We identified five major topics: (1) communication and teamwork challenges, (2) system-level issues, (3) resource constraints, (4) positive team performance and (5) potential improvements to the current systems and processes.
Conclusions
During simulation debriefing sessions for LST identification, participants discussed threats related to communication and interpersonal issues. Safety issues relating to equipment, processes and the physical space received less emphasis. These findings may guide health system leaders and simulation experts better understanding of the strengths and limitations of simulation debriefing for LST identification. Further studies are required to compare ISS-based LST identification techniques.
In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter’s change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a “longitudinal prebrief,” a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.
Background:
The transition to consultant practice represents an important transition from the role of trainee to trainer. We used the theoretical framework of Threshold Concepts to better understand this transition by analysing data from a broader qualitative study examining the experience of early career Certified Gynaecological Oncologists (CGOs) in Australia and New Zealand.
Materials and methods:
Semi-structured interviews were conducted with CGOs of <5 years consultant experience. Transcripts were analysed using reflexive thematic analysis, sensitised by the theoretical framework of Threshold Concepts.
Results:
Seven early career CGOs were interviewed. Analysis resulted in the construction of five main themes related to the trainer role, each demonstrating characteristics of Threshold Concepts: 'Part of becoming and being a consultant'; 'Managing complex work environments and training responsibilities'; 'Optimising near peer relationships'; 'Recency informing evolution of training'; and "'Being responsible and letting go…' - the next transition."
Discussion:
The themes offer insights into the areas of the transition to trainer that are troublesome, the impact of negotiating these challenges on professional identity formation, and the strategies used by CGOs to negotiate them. Using the lens of Threshold Concepts, these experiences can be normalised, and supported through efforts to facilitate the development of skills in reflection, feedback, coaching and mentorship.
This paper, on writing research questions, is the first in a series that aims to support novice researchers within clinical education, particularly those undertaking their first qualitative study. Put simply, a research question is a question that a research project sets out to answer. Most research questions will lead to a project that aims to generate new insights, but the target audience and the methodology will vary widely. The term ‘evaluation question’ is used less commonly, but the same principles apply. The key difference is that evaluation questions are typically more focused on the immediate context: for example, the effectiveness of an educational intervention in a particular setting. Whether your ambition is for research or evaluation, we hope that you will find this paper helpful for designing your own educational projects.
A research question is a question that a research project sets out to answer
Background
The dominant frameworks for describing how simulations support learning emphasize increasing access to structured practice and the provision of feedback which are commonly associated with skills-based simulations. By contrast, studies examining student participants’ experiences during scenario-based simulations suggest that learning may also occur through participation. However, studies directly examining student participation during scenario-based simulations are limited. This study examined the types of activities student participants engaged in during scenario-based simulations and then analyzed their patterns of activity to consider how participation may support learning.
Methods
Drawing from Engeström’s first-, second-, and third-generation activity systems analysis, an in-depth descriptive analysis was conducted. The study drew from multiple qualitative methods, namely narrative, video, and activity systems analysis, to examine student participants’ activities and interaction patterns across four video-recorded simulations depicting common motivations for using scenario-based simulations (e.g., communication, critical patient management).
Results
The activity systems analysis revealed that student participants’ activities encompassed three clinically relevant categories, including (a) use of physical clinical tools and artifacts, (b) social interactions, and (c) performance of structured interventions. Role assignment influenced participants’ activities and the complexity of their engagement. Importantly, participants made sense of the clinical situation presented in the scenario by reflexively linking these three activities together. Specifically, student participants performed structured interventions, relying upon the use of physical tools, clinical artifacts, and social interactions together with interactions between students, standardized patients, and other simulated participants to achieve their goals. When multiple student participants were present, such as in a team-based scenario, they distributed the workload to achieve their goals.
Conclusion
The findings suggest that student participants learned as they engaged in these scenario-based simulations when they worked to make sense of the patient’s clinical presentation. The findings may provide insight into how student participants’ meaning-making efforts are mediated by the cultural artifacts (e.g., physical clinical tools) they access, the social interactions they engage in, the structured interventions they perform, and the roles they are assigned. The findings also highlight the complex and emergent properties of scenario-based simulations as well as how activities are nested. Implications for learning, instructional design, and assessment are discussed.
Background:
Despite the rising incidence of melanoma, medical students have progressively fewer opportunities to encounter patients with this important condition. Curricula tend to attach the greatest value to intellectual forms of learning. Compared to intellectual learning, however, experiential learning affords students deep insights about a condition. Doctors who experience ill health are more empathic towards patients. However opportunities to learn about cancer experientially are limited. Temporary transfer tattoos can simulate the ill health associated with melanoma. We reasoned that, if doctors who have been sick are more empathic, temporarily 'having' melanoma might have a similar effect.
Objectives:
Explore the impact of wearing a melanoma tattoo on medical students' understanding of patienthood and attitudes towards patients with melanoma.
Methods:
Ten fourth year medical students were recruited to a simulation. They wore a melanoma tattoo for 24 hours and listened to a patient's account of receiving their diagnosis. Data were captured using audio-diaries and face-to-face interviews, transcribed, and analysed phenomenologically using the template analysis method.
Results:
There were four themes: 1) Melanoma simulation: opening up new experiences. 2) Drawing upon past experiences.3) A transformative introduction to patienthood. 4) Doctors in the making: seeing cancer patients in a new light.
Conclusions:
By means of a novel simulation, medical students were introduced to lived experiences of having a melanoma. Such an inexpensive simulation can prompt students to reflect critically on the empathetic care of such patients in the future This article is protected by copyright. All rights reserved.
Many have called for medical students to learn how to manage complexity in healthcare. This study examines the nuances of students’ challenges in coping with a complex simulation learning activity, using concepts from complexity theory, and suggests strategies to help them better understand and manage complexity.
Wearing video glasses, participants took part in a simulation ward-based exercise that incorporated characteristics of complexity. Video footage was used to elicit interviews, which were transcribed. Using complexity theory as a theoretical lens, an iterative approach was taken to identify the challenges that participants faced and possible coping strategies using both interview transcripts and video footage.
Students’ challenges in coping with clinical complexity included being: a) unprepared for ‘diving in’, b) caught in an escalating system, c) captured by the patient, and d) unable to assert boundaries of acceptable practice.
Many characteristics of complexity can be recreated in a ward-based simulation learning activity, affording learners an embodied and immersive experience of these complexity challenges. Possible strategies for managing complexity themes include: a) taking time to size up the system, b) attuning to what emerges, c) reducing complexity, d) boundary practices, and e) working with uncertainty. This study signals pedagogical opportunities for recognizing and dealing with complexity.
Qualitative content analysis and thematic analysis are two commonly used approaches in data analysis of nursing research, but boundaries between the two have not been clearly specified. In other words, they are being used interchangeably and it seems difficult for the researcher to choose between them. In this respect, this paper describes and discusses the boundaries between qualitative content analysis and thematic analysis and presents implications to improve the consistency between the purpose of related studies and the method of data analyses. This is a discussion paper, comprising an analytical overview and discussion of the definitions, aims, philosophical background, data gathering, and analysis of content analysis and thematic analysis, and addressing their methodological subtleties. It is concluded that in spite of many similarities between the approaches, including cutting across data and searching for patterns and themes, their main difference lies in the opportunity for quantification of data. It means that measuring the frequency of different categories and themes is possible in content analysis with caution as a proxy for significance.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
This article presents a model for quality in qualitative research that is uniquely expansive, yet flexible, in that it makes distinctions among qualitative research’s means (methods and practices) and its ends. The article first provides a contextualization and rationale for the conceptualization. Then the author presents and explores eight key markers of quality in qualitative research including (a) worthy topic, (b) rich rigor, (c) sincerity, (d) credibility, (e) resonance, (f) significant contribution, (g) ethics, and (h) meaningful coherence. This eight-point conceptualization offers a useful pedagogical model and provides a common language of qualitative best practices that can be recognized as integral by a variety of audiences. While making a case for these markers of quality, the article leaves space for dialogue, imagination, growth, and improvisation.
Despite widespread adoption of simulation-based training in medical education, there remains scepticism about its cost-effectiveness and long-term impact on patient outcomes. Medical simulation is well established in anaesthesia where it is considered an important educational tool. This review of key clinical anaesthesia literature is used as a case study of clinician uptake within a specialty and to investigate evidence for translational impact using both qualitative and quantitative data. We examined high-impact journal publications from 2001 to 2010 and extracted data covering authors, institutions, simulation modality, purposes of simulation, and various aspects of study design/methodology used. A total of 320 papers containing primary data were included. We found broad acceptance and uptake in anaesthesia with an increase in publications over the time period, mainly attributable to a steady increase in manikin studies. Studies using manikin technology (130/320; 41%) are distinguished as skills/performance studies (76; 58%) and studies focused on the use, testing, and validation of equipment (52; 40%). A total of 110 papers (34%) assessed the performance of technical and non-technical skills (68% and 32%, respectively). Growth in the use of structured checklists/validated tools to assess performance is mainly observed in the non-technical domain. Only 10% of these papers include follow-up data from the clinical environment. There is a lack of research examining performance transfer, sustainability, and direct patient outcomes and experiences. These publication patterns are instructive for those involved in medical educational and for other clinical specialties developing simulation.
Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design.
To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups).
We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed.
Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting.
The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
Purpose. The purpose of this theoretical article is to demonstrate how activity theory, a neo-Vygotskian sociocultural theory, can be used to analyze learning during simulation-based activities.
Background. Simulations are complex, dynamic environments that evolve and change throughout implementation. Moreover, simulations simultaneously support multiple participants’ assigned different roles. This means that the learning within them is often co-constructed, rather than individually derived. These characteristics complicate understanding the learning within them.
Method. This article presents a summary of the basic tenants of activity theory (AT), followed by a worked example to demonstrate how AT can be used as an analytic lens to generate rich description and analysis of participant activities as embedded in a complex dynamic simulation.
Conclusions. Activity theory can be used as a theoretical lens in order to account for how participants partake in simulation-based learning contexts, which supports the rich description and analysis of how participants accomplish their goals.
Context:
Review studies of simulation-based education (SBE) consistently point out that theory-driven research is lacking. The literature to date is dominated by discourses of fidelity and authenticity - creating the 'real' - with a strong focus on the developing of clinical procedural skills. Little of this writing incorporates the theory and research proliferating in professional studies more broadly, which show how professional learning is embodied, relational and situated in social - material relations. A key concern for medical educators concerns how to better prepare students for the unpredictable and dynamic ambiguity of professional practice; this has stimulated the movement towards socio-material theories in education that address precisely this question.
Objectives and methods:
Among the various socio-material theories that are informing new developments in professional education, complexity theory has been of particular importance for medical educators interested in updating current practices. This paper outlines key elements of complexity theory, illustrated with examples from empirical study, to argue its particular relevance for improving SBE.
Results:
Complexity theory can make visible important material dynamics, and their problematic consequences, that are not often noticed in simulated experiences in medical training. It also offers conceptual tools that can be put to practical use. This paper focuses on concepts of emergence, attunement, disturbance and experimentation. These suggest useful new approaches for designing simulated settings and scenarios, and for effective pedagogies before, during and following simulation sessions.
Conclusions:
Socio-material approaches such as complexity theory are spreading through research and practice in many aspects of professional education across disciplines. Here, we argue for the transformative potential of complexity theory in medical education using simulation as our focus. Complexity tools open questions about the socio-material contradictions inherent in SBE, draw attention to important material dynamics of emergence, and suggest practical educative ways to expand and deepen student learning.
Content analysis and thematic analysis: implications for conducting a qualitative descriptive study
- M Vaismoradi
- H Turenen
- T Bondas