Chapter 1: The why of qualitative research in health and social care

Health and social care is complex

Practitioners and researchers in health and social care work across different specialisations in the health system (primary care, tertiary care) and in different settings, including community and residential settings, disability support, aged care, early childhood and other educational settings, health and social service settings, preventive services and supportive services settings. Health and social care encompasses a broad range of disciplines, from medicine, nursing and allied health (e.g. physiotherapy, podiatry, dentistry, occupational therapists) to social work, health promotion, public health and many others.¹

The word ‘care’ is at the heart of health and social care— a system of care professions that are relevant across the life span, socio-economic boundaries and social settings. Practitioners and researchers recognise that individuals seeking to access supportive services, such as disability services, are the same individuals who are attending hospitals for treatment and management. While to a great extent the health and social care systems operate in silos, the people for whom the systems seek to care are accessing many components of the system.

Hence, health and social care practices are inherently complex, and so is researching these practices. Health and social care systems are dynamic, unpredictable, non-linear and ‘messy’. The people working in these services and those who access them add greater levels of complexity.² It is important to measure and understand the experiences of those who provide and access services; to explore multiple perspectives (e.g. of people receiving care and delivering care) and, in doing so, to recognise that truth is socially constructed and subjective; to understand what drives behaviours and why interventions are effective, partially effective or not effective at all.^3-5 As the fields of health care and social care work to innovate, implement and evaluate programs and practices to identify an evidence base for care, we need to measure what we previously thought was not measurable. We need a way to explore and understand experience – this is qualitative research.

Quantitative research has dominated research in health and social care

Quantitative research has dominated approaches to research in health care and social care. This is possibly due to the sector’s familiarity with the research designs and the ease of accessing numerical data through health system medical records and processes which in turn are due to preferencing of the scientific method and medicine. Health and medical research, in particular, have tended to preference the generalisability and ‘objectivity’ of quantitative research as fact and truth. The curricula of health and social care courses are dominated by data and information derived through quantitative research methods, with limited attention given to teaching qualitative research methods and evidence in medical and biomedical degrees. However, the vast array of health and social care phenomena is not amenable to rigorous experimental research design or objective measurement. The complexity inherent in the systems of health care, behavioural aspects of interventions (clinician behaviour, patient behaviour, organisational change) and knowledge of why interventions do or do not work, need a different approach – a qualitative approach. Numbers cannot provide the data needed to understand these aspects of health care and social care. The knowledge required can be acquired through experiential and subjective means, thereby recognising that experiences differ and truth in evidence is socially constructed.

What is qualitative research?

Qualitative research designs are appropriate when we do not know much about the phenomenon (concept) under investigation, and when we may not even know what we are trying to find out.^5,6 Qualitative research is suitable for seeking to understand a phenomenon from the perspectives of the persons experiencing it – for example, the phenomenon of presenting to a hospital’s emergency department can be explored from the perspectives of patients, caregivers and staff. The phenomenon of living in out-of-home care can be explored from the perspective of the person living in care as well as that of the care workers.

Quantitative research is objective, hypothesis-testing and deductive; it seeks to assess, make associations, examine causation, relationships and effects; and seeks to answer questions of ‘what?’ (prevalence/incidence) and ‘do/does?’ (effectiveness). In contrast, qualitative research is subjective, hypothesis-generating and inductive; it seeks to describe, understand, explore, discover, generate and examine; and to answer questions of ‘why’, ‘how’ and what (experience).^5-8

Qualitative research is often given ‘lip service’

Qualitative research is often framed as a toolbox of interviews, focus groups and observations that are devoid of philosophical, methodological or theoretical underpinnings. This perception of qualitative research can lead practitioners and researchers to describe their qualitative study as an ‘interview study’ or a ‘focus group study’. However, clinical and health service research journals are increasingly requesting that researchers undertaking qualitative research complete the 32-item Consolidated Criteria for Reporting Qualitative Studies (COREQ)⁹ or the Standards for Reporting Qualitative Research (SRQR).¹⁰ Both of these have items asking specifically about the methodological approach and the research paradigm. The rationale for justifying the research approach (or theoretical framework in the COREQ) is so that ‘readers can understand how the researchers explored their research questions and aims’ and to provide ‘readers the opportunity to evaluate the fidelity of the research approach to the research question(s) and consider the rationale for modifications and deviations from the selected approach’.^9,10

Many researchers unfamiliar with or new to qualitative research do not know what qualitative research questions to ask. These questions are not about the interview or focus group questions but rather the fundamental question of – what do you want to find out through this research? When researchers and practitioners know which qualitative research paradigms and designs underpin a given study:

1. The scope of research questions is more likely to be broad.
2. They are better equipped to choose the appropriate qualitative methods that strengthen the rigour of health care and social care research.

Numerous problems in health care and social care need a qualitative lens to explore and understand the complexity of experiences and perspectives. The answers to these questions help in identifying the core issues or problems and provide insights into possible solutions. For instance, in the examples of research questions from out-of-home care (‘What are the barriers and enablers to implementing a trauma-informed model of care?’)¹¹; intensive care (‘What are the important aspects to care and recovery?’ ‘What was the patient experience of ICU?’)¹²; post-partum care (‘How do women diagnosed with depression experience their body image in the post-partum period?’)¹³; in-hospital falls prevention programs (‘What are the perceived barriers to the implementation of the 6-PACK nurse-led falls prevention program?’).¹⁴

In Table 1.1 we compare and contrast quantitative research with qualitative research, to demonstrate the philosophies, methodologies and paradigms underpinning the different research approaches and the typical words used in the corresponding aims and research questions.

Table 1.1. Comparing quantitative and qualitative research

This book aims to provide an introduction to the why and how of qualitative research for health and social care researchers, students and practitioners. Resources and links to open-access sources are provided throughout for further information.

Section 1 is an introduction to qualitative research including brief explanations of research paradigms, theories and frameworks.

Section 2 is an overview of the six key qualitative research designs, mixed methods research and evaluation approaches in health and social care. A table summarising the key elements of each of the six qualitative research designs with prompting questions is provided as a guide to choosing a study design.

Section 3 covers data collection methods including traditional qualitative methods of interviews and focus groups and more recent methods of arts-based methods.

Section 4 is a summary of key analysis processes and techniques and includes a summary table as a guide for approaching the different analysis approaches.

Section 5 explains rigour in qualitative research including researcher positionality, triangulation and reflexivity.

Section 6 is an overview of ethics including practical tips and lessons from our experiences.

Section 7 the final section, is a guide on how to write qualitative research for publication.

References

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13. Hartley E, Fuller-Tyszkiewicz M, Skouteris H, Hill B. A qualitative insight into the relationship between postpartum depression and body image. J Reprod Infant Psychol. 2021;39(3):288-300. doi:10.1080/02646838.2019.1710119
14. Ayton DR, Barker AL, Morello RT, et al. Barriers and enablers to the implementation of the 6-PACK falls prevention program: a pre-implementation study in hospitals participating in a cluster randomised controlled trial. PLoS One. 2017;12(2):e0171932. doi:10.1371/journal.pone.0171932