An introduction to reading and appraising qualitative research

What’s so different about qualitative research?

The differences between what are commonly called quantitative and qualitative research run deeper than the presence and absence of numbers. In general, quantitative research focuses on answering the questions “what?” “how much?” and “why?” whereas qualitative research focuses on answering the questions “why?” and “how?” Qualitative research also allows for the generation of rich data and the exploration of “real life” behaviour, enabling research participants to speak for themselves. Box 1 contains recent examples of questions examined in studies using qualitative research methods.

Many quantitative researchers in the health sciences work from the assumption that there is an absolute truth, a “reality,” which they are trying to discover. For these researchers, knowledge is objective and neutral. This belief about knowledge has been called “objectivism” and the theoretical framework it implies is called “positivism” (see table 2⇓). However, the relevance of this objectivist belief about knowledge has been the subject of challenges since the end of the 19th century. Many of these challenges have come from studies of social phenomena, such as individual and group behaviour. Most qualitative researchers today share a different belief about knowledge, called “constructivism,” which holds that the reality we perceive is constructed by our social, historical, and individual contexts.

Most of the qualitative research theories and methodologies that will be discussed in this series assume this constructivist approach to the nature of knowledge. As table 2⇑ shows, constructivism encompasses many theories, which differ on such matters as how much of someone’s perception of reality results from aspects of that individual and how much from aspects of the society that surrounds him or her. Some theories (such as interactionism) also assume that there is one shared reality for a group of people, while others (such as postmodernism) assume that multiple realities exist in parallel because of the differences between individuals. However, in all of these theoretical frameworks, individuals create, negotiate, and interpret meanings for their actions and for the social situations in which they exist. This does not usually imply the lack of the real physical world around us, just that our interpretations of that world can differ depending on our social contexts.

Importantly, researchers can also use quantitative methods (such as statistics) and believe that reality is constructed. For example, the items contained in a survey of patient satisfaction are constructed by researchers and will reflect their understanding of the range of possible things about which a patient might be satisfied (or not). Table 2⇑ summarises a comparison between objectivist and constructivist approaches.

How does qualitative research work?

Qualitative research aims to generate in-depth accounts from individuals and groups by talking with them, watching their behaviour, and analysing their artefacts (such as diaries, meeting minutes, photographs) and taking into account the different contexts in which they are based. Qualitative researchers primarily gather data from interviews (semistructured or unstructured), focus groups, observations, or documents and other written artefacts. Their data analysis is largely inductive, allowing meaning to emerge from the data, rather than the more deductive, hypothesis centred approach favoured by quantitative researchers. Analysis in qualitative research is also theory based and often iterative, moving between empirical findings and conceptual frameworks.

Understanding the context in which people live is a central concern for qualitative researchers. Qualitative researchers need to identify their own contexts so that they understand how their own views and beliefs may influence the interactions they have with their participants (a process often referred to as “situating” themselves). Research questions and findings are therefore invariably and directly influenced by the researchers’ perspectives and by the unique perspectives of their research participants. This influence should be made explicit in qualitative research papers. It is distinctly different from what the quantitative world would call “bias,” because the term bias implies that there is a true reality that the researchers’ perspectives are hindering them from seeing.

Qualitative researchers, in contrast, generally believe that such “reality” is a construction. In the qualitative paradigm, the goal is precisely to understand, not erase, differing perspectives. These perspectives are accepted as inescapably affecting all research (both qualitative and quantitative), whether through choice of research questions and methods, through the process of data interpretation, or through the choice of which results to publish. The process of situating the researcher’s viewpoint allows readers to decide for themselves the effect such perspectives might have had on the research. The findings of a qualitative study are also not intended to be generalisable in the same way as the results of a quantitative study. They may, however, be transferable to other contexts, and readers can assess their applicability to their own settings. Study results can also be used to extend or modify existing theories; as theories are often used across multiple domains, changes in such theories can in turn affect thinking in other research areas (the use of theories in qualitative research is the topic of a later paper in this series).

Conclusions

Qualitative methods are becoming increasingly prevalent in medical and related research. They provide additional ways for health researchers to explore and explain the contexts in which they and their patients function, enabling a more comprehensive understanding of many aspects of the healthcare system. The biggest challenge facing a new reader in this field is the plethora of unfamiliar terms and concepts in the qualitative approach. This series is intended to help readers to understand the qualitative research that may be relevant to their clinical practice.