qualitative research methods in social work

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Qualitative Methods in Social Work Research

• Deborah K. Padgett - New York University, USA
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“Padgett is the ultimate ‘pro’ researcher, methods expert, and communicator. This is the one book you need for master's study, professional practice research, doctoral study, and your continuing research agenda!”

“Dr. Padgett’s text Qualitative Methods in Social Work Research is informative and easy for students to read and understand. The book offers clear advice to students about how to design and execute qualitative research studies.” 

“Padgett uses her extensive experience to expertly achieve two seemingly contradictory ends: educate about the conceptual underpinnings of qualitative research methods, and provide the concrete steps needed to carry them out. As a research discipline that is often not fully understood by many, Qualitative Methods in Social Work Research will be appreciated by academics and students alike.”

“Padgett knows how to make students and even lecturers curious about qualitative methods and she copes in her book very well the gap between an overview and a deeper understanding of research methods.”

The book offers a good overview of qualitative methods that can be used within and beyond the field of social work- I think students struggling with the aims and methods of qualitative research can find it very helpful

A very informative and accessible resource for research and teaching!

Received too late for current class. However, I would strongly recommend this text for any social research methods class. The book is filled with excellent examples and wonderful suggested readings at the end of each chapter. This is one of the most comprehensive approaches to qualitative research methods I have ever read. I believe this text would serve upper-division undergraduates and grasduate stduents very well.

• Expanded discussions of the six most commonly used qualitative approaches address ethnography, grounded theory, case study analysis, narrative approaches, phenomenological approaches, and action-oriented research.
• Additional comprehensive coverage of topics includes action-oriented research, innovations in visual (photography and video) and Internet/online data collection, and recent advancements in meta-syntheses and implementation science.
• Early introductions on ethical issues and strategies for rigor cover emotional issues for both researchers and study participants.
• More in-depth discussion on cross-cultural and cross-language research prepares readers for engagement in community and multinational research.   
• Data collection techniques in one chapter create a single point of reference for students and faculty to find examples of coding, use of ATLAS.ti software (including screenshots), codebook development, and online data collection.
• A broad multidisciplinary perspective rooted in social work is applicable to other practice professions such as nursing, education, family and community medicine, public health, psychology, and public administration.
• An emphasis on practical use is seen through exemplars of qualitative studies, information on computer software for qualitative data analysis, and detailed guidelines for writing a qualitative research proposal (Appendix).
• Specific illustrative case examples from the literature and the author’s own research aid readers in understanding concepts.
• A straightforward and conversational style makes this book accessible and engaging for readers.
• Chapters thoughtfully organized follow the sequence of conducting a qualitative study, encouraging proper application of representative research methods.

Sample Materials & Chapters

For instructors, select a purchasing option, related products.

Social Work Research Methods That Drive the Practice

Social workers advocate for the well-being of individuals, families and communities. But how do social workers know what interventions are needed to help an individual? How do they assess whether a treatment plan is working? What do social workers use to write evidence-based policy?

Social work involves research-informed practice and practice-informed research. At every level, social workers need to know objective facts about the populations they serve, the efficacy of their interventions and the likelihood that their policies will improve lives. A variety of social work research methods make that possible.

Data-Driven Work

Data is a collection of facts used for reference and analysis. In a field as broad as social work, data comes in many forms.

Quantitative vs. Qualitative

As with any research, social work research involves both quantitative and qualitative studies.

Quantitative Research

Answers to questions like these can help social workers know about the populations they serve — or hope to serve in the future.

• How many students currently receive reduced-price school lunches in the local school district?
• How many hours per week does a specific individual consume digital media?
• How frequently did community members access a specific medical service last year?

Quantitative data — facts that can be measured and expressed numerically — are crucial for social work.

Quantitative research has advantages for social scientists. Such research can be more generalizable to large populations, as it uses specific sampling methods and lends itself to large datasets. It can provide important descriptive statistics about a specific population. Furthermore, by operationalizing variables, it can help social workers easily compare similar datasets with one another.

Qualitative Research

Qualitative data — facts that cannot be measured or expressed in terms of mere numbers or counts — offer rich insights into individuals, groups and societies. It can be collected via interviews and observations.

• What attitudes do students have toward the reduced-price school lunch program?
• What strategies do individuals use to moderate their weekly digital media consumption?
• What factors made community members more or less likely to access a specific medical service last year?

Qualitative research can thereby provide a textured view of social contexts and systems that may not have been possible with quantitative methods. Plus, it may even suggest new lines of inquiry for social work research.

Mixed Methods Research

Combining quantitative and qualitative methods into a single study is known as mixed methods research. This form of research has gained popularity in the study of social sciences, according to a 2019 report in the academic journal Theory and Society. Since quantitative and qualitative methods answer different questions, merging them into a single study can balance the limitations of each and potentially produce more in-depth findings.

However, mixed methods research is not without its drawbacks. Combining research methods increases the complexity of a study and generally requires a higher level of expertise to collect, analyze and interpret the data. It also requires a greater level of effort, time and often money.

The Importance of Research Design

Data-driven practice plays an essential role in social work. Unlike philanthropists and altruistic volunteers, social workers are obligated to operate from a scientific knowledge base.

To know whether their programs are effective, social workers must conduct research to determine results, aggregate those results into comprehensible data, analyze and interpret their findings, and use evidence to justify next steps.

Employing the proper design ensures that any evidence obtained during research enables social workers to reliably answer their research questions.

Research Methods in Social Work

The various social work research methods have specific benefits and limitations determined by context. Common research methods include surveys, program evaluations, needs assessments, randomized controlled trials, descriptive studies and single-system designs.

Surveys involve a hypothesis and a series of questions in order to test that hypothesis. Social work researchers will send out a survey, receive responses, aggregate the results, analyze the data, and form conclusions based on trends.

Surveys are one of the most common research methods social workers use — and for good reason. They tend to be relatively simple and are usually affordable. However, surveys generally require large participant groups, and self-reports from survey respondents are not always reliable.

Program Evaluations

Social workers ally with all sorts of programs: after-school programs, government initiatives, nonprofit projects and private programs, for example.

Crucially, social workers must evaluate a program’s effectiveness in order to determine whether the program is meeting its goals and what improvements can be made to better serve the program’s target population.

Evidence-based programming helps everyone save money and time, and comparing programs with one another can help social workers make decisions about how to structure new initiatives. Evaluating programs becomes complicated, however, when programs have multiple goal metrics, some of which may be vague or difficult to assess (e.g., “we aim to promote the well-being of our community”).

Needs Assessments

Social workers use needs assessments to identify services and necessities that a population lacks access to.

Common social work populations that researchers may perform needs assessments on include:

• People in a specific income group
• Everyone in a specific geographic region
• A specific ethnic group
• People in a specific age group

In the field, a social worker may use a combination of methods (e.g., surveys and descriptive studies) to learn more about a specific population or program. Social workers look for gaps between the actual context and a population’s or individual’s “wants” or desires.

For example, a social worker could conduct a needs assessment with an individual with cancer trying to navigate the complex medical-industrial system. The social worker may ask the client questions about the number of hours they spend scheduling doctor’s appointments, commuting and managing their many medications. After learning more about the specific client needs, the social worker can identify opportunities for improvements in an updated care plan.

In policy and program development, social workers conduct needs assessments to determine where and how to effect change on a much larger scale. Integral to social work at all levels, needs assessments reveal crucial information about a population’s needs to researchers, policymakers and other stakeholders. Needs assessments may fall short, however, in revealing the root causes of those needs (e.g., structural racism).

Randomized Controlled Trials

Randomized controlled trials are studies in which a randomly selected group is subjected to a variable (e.g., a specific stimulus or treatment) and a control group is not. Social workers then measure and compare the results of the randomized group with the control group in order to glean insights about the effectiveness of a particular intervention or treatment.

Randomized controlled trials are easily reproducible and highly measurable. They’re useful when results are easily quantifiable. However, this method is less helpful when results are not easily quantifiable (i.e., when rich data such as narratives and on-the-ground observations are needed).

Descriptive Studies

Descriptive studies immerse the researcher in another context or culture to study specific participant practices or ways of living. Descriptive studies, including descriptive ethnographic studies, may overlap with and include other research methods:

• Informant interviews
• Census data
• Observation

By using descriptive studies, researchers may glean a richer, deeper understanding of a nuanced culture or group on-site. The main limitations of this research method are that it tends to be time-consuming and expensive.

Single-System Designs

Unlike most medical studies, which involve testing a drug or treatment on two groups — an experimental group that receives the drug/treatment and a control group that does not — single-system designs allow researchers to study just one group (e.g., an individual or family).

Single-system designs typically entail studying a single group over a long period of time and may involve assessing the group’s response to multiple variables.

For example, consider a study on how media consumption affects a person’s mood. One way to test a hypothesis that consuming media correlates with low mood would be to observe two groups: a control group (no media) and an experimental group (two hours of media per day). When employing a single-system design, however, researchers would observe a single participant as they watch two hours of media per day for one week and then four hours per day of media the next week.

These designs allow researchers to test multiple variables over a longer period of time. However, similar to descriptive studies, single-system designs can be fairly time-consuming and costly.

Learn More About Social Work Research Methods

Social workers have the opportunity to improve the social environment by advocating for the vulnerable — including children, older adults and people with disabilities — and facilitating and developing resources and programs.

Learn more about how you can earn your  Master of Social Work online at Virginia Commonwealth University . The highest-ranking school of social work in Virginia, VCU has a wide range of courses online. That means students can earn their degrees with the flexibility of learning at home. Learn more about how you can take your career in social work further with VCU.

From M.S.W. to LCSW: Understanding Your Career Path as a Social Worker

How Palliative Care Social Workers Support Patients With Terminal Illnesses

How to Become a Social Worker in Health Care

Gov.uk, Mixed Methods Study

MVS Open Press, Foundations of Social Work Research

Open Social Work Education, Scientific Inquiry in Social Work

Open Social Work, Graduate Research Methods in Social Work: A Project-Based Approach

Routledge, Research for Social Workers: An Introduction to Methods

SAGE Publications, Research Methods for Social Work: A Problem-Based Approach

Theory and Society, Mixed Methods Research: What It Is and What It Could Be

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Graduate research methods in social work

(2 reviews)

Matt DeCarlo, La Salle University

Cory Cummings, Nazareth University

Kate Agnelli, Virginia Commonwealth University

Copyright Year: 2021

ISBN 13: 9781949373219

Publisher: Open Social Work Education

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Laura Montero, Full-time Lecturer and Course Lead, Metropolitan State University of Denver on 12/23/23

Graduate Research Methods in Social Work by DeCarlo, et al., is a comprehensive and well-structured guide that serves as an invaluable resource for graduate students delving into the intricate world of social work research. The book is divided... read more

Comprehensiveness rating: 4 see less

Graduate Research Methods in Social Work by DeCarlo, et al., is a comprehensive and well-structured guide that serves as an invaluable resource for graduate students delving into the intricate world of social work research. The book is divided into five distinct parts, each carefully curated to provide a step-by-step approach to mastering research methods in the field. Topics covered include an intro to basic research concepts, conceptualization, quantitative & qualitative approaches, as well as research in practice. At 800+ pages, however, the text could be received by students as a bit overwhelming.

Content Accuracy rating: 5

Content appears consistent and reliable when compared to similar textbooks in this topic.

Relevance/Longevity rating: 5

The book's well-structured content begins with fundamental concepts, such as the scientific method and evidence-based practice, guiding readers through the initiation of research projects with attention to ethical considerations. It seamlessly transitions to detailed explorations of both quantitative and qualitative methods, covering topics like sampling, measurement, survey design, and various qualitative data collection approaches. Throughout, the authors emphasize ethical responsibilities, cultural respectfulness, and critical thinking. These are crucial concepts we cover in social work and I was pleased to see these being integrated throughout.

Clarity rating: 5

The level of the language used is appropriate for graduate-level study.

Consistency rating: 5

Book appears to be consistent in the tone and terminology used.

Modularity rating: 4

The images and videos included, help to break up large text blocks.

Organization/Structure/Flow rating: 5

Topics covered are well-organized and comprehensive. I appreciate the thorough preamble the authors include to situate the role of the social worker within a research context.

Interface rating: 4

When downloaded as a pdf, the book does not begin until page 30+ so it may be a bit difficult to scroll so long for students in order to access the content for which they are searching. Also, making the Table of Contents clickable, would help in navigating this very long textbook.

Grammatical Errors rating: 5

I did not find any grammatical errors or typos in the pages reviewed.

Cultural Relevance rating: 5

I appreciate the efforts made to integrate diverse perspectives, voices, and images into the text. The discussion around ethics and cultural considerations in research was nuanced and comprehensive as well.

Overall, the content of the book aligns with established principles of social work research, providing accurate and up-to-date information in a format that is accessible to graduate students and educators in the field.

Reviewed by Elisa Maroney, Professor, Western Oregon University on 1/2/22

With well over 800 pages, this text is beyond comprehensive! read more

Comprehensiveness rating: 5 see less

With well over 800 pages, this text is beyond comprehensive!

I perused the entire text, but my focus was on "Part 4: Using qualitative methods." This section seems accurate.

As mentioned above, my primary focus was on the qualitative methods section. This section is relevant to the students I teach in interpreting studies (not a social sciences discipline).

This book is well-written and clear.

Navigating this text is easy, because the formatting is consistent

Modularity rating: 5

My favorite part of this text is that I can be easily customized, so that I can use the sections on qualitative methods.

The text is well-organized and easy to find and link to related sections in the book.

Interface rating: 5

There are no distracting or confusing features. The book is long; being able to customize makes it easier to navigate.

I did not notice grammatical errors.

The authors offer resources for Afrocentricity for social work practice (among others, including those related to Feminist and Queer methodologies). These are relevant to the field of interpreting studies.

I look forward to adopting this text in my qualitative methods course for graduate students in interpreting studies.

Table of Contents

• 1. Science and social work
• 2. Starting your research project
• 3. Searching the literature
• 4. Critical information literacy
• 5. Writing your literature review
• 6. Research ethics
• 7. Theory and paradigm
• 8. Reasoning and causality
• 9. Writing your research question
• 10. Quantitative sampling
• 11. Quantitative measurement
• 12. Survey design
• 13. Experimental design
• 14. Univariate analysis
• 15. Bivariate analysis
• 16. Reporting quantitative results
• 17. Qualitative data and sampling
• 18. Qualitative data collection
• 19. A survey of approaches to qualitative data analysis
• 20. Quality in qualitative studies: Rigor in research design
• 21. Qualitative research dissemination
• 22. A survey of qualitative designs
• 23. Program evaluation
• 24. Sharing and consuming research

Ancillary Material

About the book.

We designed our book to help graduate social work students through every step of the research process, from conceptualization to dissemination. Our textbook centers cultural humility, information literacy, pragmatism, and an equal emphasis on quantitative and qualitative methods. It includes extensive content on literature reviews, cultural bias and respectfulness, and qualitative methods, in contrast to traditionally used commercial textbooks in social work research.  

Our author team spans across academic, public, and nonprofit social work research. We love research, and we endeavored through our book to make research more engaging, less painful, and easier to understand. Our textbook exercises direct students to apply content as they are reading the book to an original research project. By breaking it down step-by-step, writing in approachable language, as well as using stories from our life, practice, and research experience, our textbook helps professors overcome students’ research methods anxiety and antipathy.  

If you decide to adopt our resource, we ask that you complete this short  Adopter’s Survey  that helps us keep track of our community impact. You can also contact  [email protected]  for a student workbook, homework assignments, slideshows, a draft bank of quiz questions, and a course calendar. 

About the Contributors

Matt DeCarlo , PhD, MSW is an assistant professor in the Department of Social Work at La Salle University. He is the co-founder of Open Social Work (formerly Open Social Work Education), a collaborative project focusing on open education, open science, and open access in social work and higher education. His first open textbook, Scientific Inquiry in Social Work, was the first developed for social work education, and is now in use in over 60 campuses, mostly in the United States. He is a former OER Research Fellow with the OpenEd Group. Prior to his work in OER, Dr. DeCarlo received his PhD from Virginia Commonwealth University and has published on disability policy.

Cory Cummings , Ph.D., LCSW is an assistant professor in the Department of Social Work at Nazareth University. He has practice experience in community mental health, including clinical practice and administration. In addition, Dr. Cummings has volunteered at safety net mental health services agencies and provided support services for individuals and families affected by HIV. In his current position, Dr. Cummings teaches in the BSW program and MSW programs; specifically in the Clinical Practice with Children and Families concentration. Courses that he teaches include research, social work practice, and clinical field seminar. His scholarship focuses on promoting health equity for individuals experiencing symptoms of severe mental illness and improving opportunities to increase quality of life. Dr. Cummings received his PhD from Virginia Commonwealth University.

Kate Agnelli , MSW, is an adjunct professor at VCU’s School of Social Work, teaching masters-level classes on research methods, public policy, and social justice. She also works as a senior legislative analyst with the Joint Legislative Audit and Review Commission (JLARC), a policy research organization reporting to the Virginia General Assembly. Before working for JLARC, Ms. Agnelli worked for several years in government and nonprofit research and program evaluation. In addition, she has several publications in peer-reviewed journals, has presented at national social work conferences, and has served as a reviewer for Social Work Education. She received her MSW from Virginia Commonwealth University.

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The Oxford Handbook of Qualitative Research, second edition, presents a comprehensive retrospective and prospective review of the field of qualitative research. Original, accessible chapters written by interdisciplinary leaders in the field make this a critical reference work. Filled with robust examples from real-world research; ample discussion of the historical, theoretical, and methodological foundations of the field; and coverage of key issues including data collection, interpretation, representation, assessment, and teaching, this handbook aims to be a valuable text for students, professors, and researchers. This newly revised and expanded edition features up-to-date examples and topics, including seven new chapters on duoethnography, team research, writing ethnographically, creative approaches to writing, writing for performance, writing for the public, and teaching qualitative research.

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Qualitative methods in social work research

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T1 - Qualitative methods in social work research

AU - Padgett, Deborah

N1 - Includes bibliographical references and index

N2 - "Revised and updated, this essential resource - Qualitative Methods in Social Work Research - promotes new ways of thinking by offering new perspectives and collecting the most up-to-date information on qualitative research methods. With this Second Edition, noted author and researcher Deborah K. Padgett continues to deliver a highly readable, tightly woven book that helps humanize data in a meaningful way, linking experiences and perceptions to ideas relevant to a multitude of disciplines." "This multidisciplinary text is essential for advanced students and researchers in social work, nursing, community psychology, and other practice-based disciplines."--Jacket

AB - "Revised and updated, this essential resource - Qualitative Methods in Social Work Research - promotes new ways of thinking by offering new perspectives and collecting the most up-to-date information on qualitative research methods. With this Second Edition, noted author and researcher Deborah K. Padgett continues to deliver a highly readable, tightly woven book that helps humanize data in a meaningful way, linking experiences and perceptions to ideas relevant to a multitude of disciplines." "This multidisciplinary text is essential for advanced students and researchers in social work, nursing, community psychology, and other practice-based disciplines."--Jacket

KW - Social service

KW - Socialt arbete

SN - 1412951933

SN - 1412951925

SN - 9781412951920

SN - 9781412951937

T3 - Sage sourcebooks for the human services

BT - Qualitative methods in social work research

PB - Sage Publications

CY - Thousand Oaks, CA

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In This Article Expand or collapse the "in this article" section Social Work Research Methods

Introduction.

• History of Social Work Research Methods
• Feasibility Issues Influencing the Research Process
• Measurement Methods
• Existing Scales
• Group Experimental and Quasi-Experimental Designs for Evaluating Outcome
• Single-System Designs for Evaluating Outcome
• Program Evaluation
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• Introductory Statistics Texts
• Advanced Aspects of Inferential Statistics
• Qualitative Research Methods
• Qualitative Data Analysis
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• Meta-Analysis and Systematic Reviews
• Research Ethics
• Culturally Competent Research Methods
• Teaching Social Work Research Methods

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Social Work Research Methods by Allen Rubin LAST REVIEWED: 14 December 2009 LAST MODIFIED: 14 December 2009 DOI: 10.1093/obo/9780195389678-0008

Social work research means conducting an investigation in accordance with the scientific method. The aim of social work research is to build the social work knowledge base in order to solve practical problems in social work practice or social policy. Investigating phenomena in accordance with the scientific method requires maximal adherence to empirical principles, such as basing conclusions on observations that have been gathered in a systematic, comprehensive, and objective fashion. The resources in this entry discuss how to do that as well as how to utilize and teach research methods in social work. Other professions and disciplines commonly produce applied research that can guide social policy or social work practice. Yet no commonly accepted distinction exists at this time between social work research methods and research methods in allied fields relevant to social work. Consequently useful references pertaining to research methods in allied fields that can be applied to social work research are included in this entry.

This section includes basic textbooks that are used in courses on social work research methods. Considerable variation exists between textbooks on the broad topic of social work research methods. Some are comprehensive and delve into topics deeply and at a more advanced level than others. That variation is due in part to the different needs of instructors at the undergraduate and graduate levels of social work education. Most instructors at the undergraduate level prefer shorter and relatively simplified texts; however, some instructors teaching introductory master’s courses on research prefer such texts too. The texts in this section that might best fit their preferences are by Yegidis and Weinbach 2009 and Rubin and Babbie 2007 . The remaining books might fit the needs of instructors at both levels who prefer a more comprehensive and deeper coverage of research methods. Among them Rubin and Babbie 2008 is perhaps the most extensive and is often used at the doctoral level as well as the master’s and undergraduate levels. Also extensive are Drake and Jonson-Reid 2007 , Grinnell and Unrau 2007 , Kreuger and Neuman 2006 , and Thyer 2001 . What distinguishes Drake and Jonson-Reid 2007 is its heavy inclusion of statistical and Statistical Package for the Social Sciences (SPSS) content integrated with each chapter. Grinnell and Unrau 2007 and Thyer 2001 are unique in that they are edited volumes with different authors for each chapter. Kreuger and Neuman 2006 takes Neuman’s social sciences research text and adapts it to social work. The Practitioner’s Guide to Using Research for Evidence-based Practice ( Rubin 2007 ) emphasizes the critical appraisal of research, covering basic research methods content in a relatively simplified format for instructors who want to teach research methods as part of the evidence-based practice process instead of with the aim of teaching students how to produce research.

Drake, Brett, and Melissa Jonson-Reid. 2007. Social work research methods: From conceptualization to dissemination . Boston: Allyn and Bacon.

This introductory text is distinguished by its use of many evidence-based practice examples and its heavy coverage of statistical and computer analysis of data.

Grinnell, Richard M., and Yvonne A. Unrau, eds. 2007. Social work research and evaluation: Quantitative and qualitative approaches . 8th ed. New York: Oxford Univ. Press.

Contains chapters written by different authors, each focusing on a comprehensive range of social work research topics.

Kreuger, Larry W., and W. Lawrence Neuman. 2006. Social work research methods: Qualitative and quantitative applications . Boston: Pearson, Allyn, and Bacon.

An adaptation to social work of Neuman's social sciences research methods text. Its framework emphasizes comparing quantitative and qualitative approaches. Despite its title, quantitative methods receive more attention than qualitative methods, although it does contain considerable qualitative content.

Rubin, Allen. 2007. Practitioner’s guide to using research for evidence-based practice . Hoboken, NJ: Wiley.

This text focuses on understanding quantitative and qualitative research methods and designs for the purpose of appraising research as part of the evidence-based practice process. It also includes chapters on instruments for assessment and monitoring practice outcomes. It can be used at the graduate or undergraduate level.

Rubin, Allen, and Earl R. Babbie. 2007. Essential research methods for social work . Belmont, CA: Thomson Brooks Cole.

This is a shorter and less advanced version of Rubin and Babbie 2008 . It can be used for research methods courses at the undergraduate or master's levels of social work education.

Rubin, Allen, and Earl R. Babbie. Research Methods for Social Work . 6th ed. Belmont, CA: Thomson Brooks Cole, 2008.

This comprehensive text focuses on producing quantitative and qualitative research as well as utilizing such research as part of the evidence-based practice process. It is widely used for teaching research methods courses at the undergraduate, master’s, and doctoral levels of social work education.

Thyer, Bruce A., ed. 2001 The handbook of social work research methods . Thousand Oaks, CA: Sage.

This comprehensive compendium includes twenty-nine chapters written by esteemed leaders in social work research. It covers quantitative and qualitative methods as well as general issues.

Yegidis, Bonnie L., and Robert W. Weinbach. 2009. Research methods for social workers . 6th ed. Boston: Allyn and Bacon.

This introductory paperback text covers a broad range of social work research methods and does so in a briefer fashion than most lengthier, hardcover introductory research methods texts.

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How to use and assess qualitative research methods

Loraine busetto.

1 Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany

Wolfgang Wick

2 Clinical Cooperation Unit Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany

Christoph Gumbinger

Associated data.

Not applicable.

This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.

The aim of this paper is to provide an overview of qualitative research methods, including hands-on information on how they can be used, reported and assessed. This article is intended for beginning qualitative researchers in the health sciences as well as experienced quantitative researchers who wish to broaden their understanding of qualitative research.

What is qualitative research?

Qualitative research is defined as “the study of the nature of phenomena”, including “their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived” , but excluding “their range, frequency and place in an objectively determined chain of cause and effect” [ 1 ]. This formal definition can be complemented with a more pragmatic rule of thumb: qualitative research generally includes data in form of words rather than numbers [ 2 ].

Why conduct qualitative research?

Because some research questions cannot be answered using (only) quantitative methods. For example, one Australian study addressed the issue of why patients from Aboriginal communities often present late or not at all to specialist services offered by tertiary care hospitals. Using qualitative interviews with patients and staff, it found one of the most significant access barriers to be transportation problems, including some towns and communities simply not having a bus service to the hospital [ 3 ]. A quantitative study could have measured the number of patients over time or even looked at possible explanatory factors – but only those previously known or suspected to be of relevance. To discover reasons for observed patterns, especially the invisible or surprising ones, qualitative designs are needed.

While qualitative research is common in other fields, it is still relatively underrepresented in health services research. The latter field is more traditionally rooted in the evidence-based-medicine paradigm, as seen in " research that involves testing the effectiveness of various strategies to achieve changes in clinical practice, preferably applying randomised controlled trial study designs (...) " [ 4 ]. This focus on quantitative research and specifically randomised controlled trials (RCT) is visible in the idea of a hierarchy of research evidence which assumes that some research designs are objectively better than others, and that choosing a "lesser" design is only acceptable when the better ones are not practically or ethically feasible [ 5 , 6 ]. Others, however, argue that an objective hierarchy does not exist, and that, instead, the research design and methods should be chosen to fit the specific research question at hand – "questions before methods" [ 2 , 7 – 9 ]. This means that even when an RCT is possible, some research problems require a different design that is better suited to addressing them. Arguing in JAMA, Berwick uses the example of rapid response teams in hospitals, which he describes as " a complex, multicomponent intervention – essentially a process of social change" susceptible to a range of different context factors including leadership or organisation history. According to him, "[in] such complex terrain, the RCT is an impoverished way to learn. Critics who use it as a truth standard in this context are incorrect" [ 8 ] . Instead of limiting oneself to RCTs, Berwick recommends embracing a wider range of methods , including qualitative ones, which for "these specific applications, (...) are not compromises in learning how to improve; they are superior" [ 8 ].

Research problems that can be approached particularly well using qualitative methods include assessing complex multi-component interventions or systems (of change), addressing questions beyond “what works”, towards “what works for whom when, how and why”, and focussing on intervention improvement rather than accreditation [ 7 , 9 – 12 ]. Using qualitative methods can also help shed light on the “softer” side of medical treatment. For example, while quantitative trials can measure the costs and benefits of neuro-oncological treatment in terms of survival rates or adverse effects, qualitative research can help provide a better understanding of patient or caregiver stress, visibility of illness or out-of-pocket expenses.

How to conduct qualitative research?

Given that qualitative research is characterised by flexibility, openness and responsivity to context, the steps of data collection and analysis are not as separate and consecutive as they tend to be in quantitative research [ 13 , 14 ]. As Fossey puts it : “sampling, data collection, analysis and interpretation are related to each other in a cyclical (iterative) manner, rather than following one after another in a stepwise approach” [ 15 ]. The researcher can make educated decisions with regard to the choice of method, how they are implemented, and to which and how many units they are applied [ 13 ]. As shown in Fig.  1 , this can involve several back-and-forth steps between data collection and analysis where new insights and experiences can lead to adaption and expansion of the original plan. Some insights may also necessitate a revision of the research question and/or the research design as a whole. The process ends when saturation is achieved, i.e. when no relevant new information can be found (see also below: sampling and saturation). For reasons of transparency, it is essential for all decisions as well as the underlying reasoning to be well-documented.

Iterative research process

While it is not always explicitly addressed, qualitative methods reflect a different underlying research paradigm than quantitative research (e.g. constructivism or interpretivism as opposed to positivism). The choice of methods can be based on the respective underlying substantive theory or theoretical framework used by the researcher [ 2 ].

Data collection

The methods of qualitative data collection most commonly used in health research are document study, observations, semi-structured interviews and focus groups [ 1 , 14 , 16 , 17 ].

Document study

Document study (also called document analysis) refers to the review by the researcher of written materials [ 14 ]. These can include personal and non-personal documents such as archives, annual reports, guidelines, policy documents, diaries or letters.

Observations

Observations are particularly useful to gain insights into a certain setting and actual behaviour – as opposed to reported behaviour or opinions [ 13 ]. Qualitative observations can be either participant or non-participant in nature. In participant observations, the observer is part of the observed setting, for example a nurse working in an intensive care unit [ 18 ]. In non-participant observations, the observer is “on the outside looking in”, i.e. present in but not part of the situation, trying not to influence the setting by their presence. Observations can be planned (e.g. for 3 h during the day or night shift) or ad hoc (e.g. as soon as a stroke patient arrives at the emergency room). During the observation, the observer takes notes on everything or certain pre-determined parts of what is happening around them, for example focusing on physician-patient interactions or communication between different professional groups. Written notes can be taken during or after the observations, depending on feasibility (which is usually lower during participant observations) and acceptability (e.g. when the observer is perceived to be judging the observed). Afterwards, these field notes are transcribed into observation protocols. If more than one observer was involved, field notes are taken independently, but notes can be consolidated into one protocol after discussions. Advantages of conducting observations include minimising the distance between the researcher and the researched, the potential discovery of topics that the researcher did not realise were relevant and gaining deeper insights into the real-world dimensions of the research problem at hand [ 18 ].

Semi-structured interviews

Hijmans & Kuyper describe qualitative interviews as “an exchange with an informal character, a conversation with a goal” [ 19 ]. Interviews are used to gain insights into a person’s subjective experiences, opinions and motivations – as opposed to facts or behaviours [ 13 ]. Interviews can be distinguished by the degree to which they are structured (i.e. a questionnaire), open (e.g. free conversation or autobiographical interviews) or semi-structured [ 2 , 13 ]. Semi-structured interviews are characterized by open-ended questions and the use of an interview guide (or topic guide/list) in which the broad areas of interest, sometimes including sub-questions, are defined [ 19 ]. The pre-defined topics in the interview guide can be derived from the literature, previous research or a preliminary method of data collection, e.g. document study or observations. The topic list is usually adapted and improved at the start of the data collection process as the interviewer learns more about the field [ 20 ]. Across interviews the focus on the different (blocks of) questions may differ and some questions may be skipped altogether (e.g. if the interviewee is not able or willing to answer the questions or for concerns about the total length of the interview) [ 20 ]. Qualitative interviews are usually not conducted in written format as it impedes on the interactive component of the method [ 20 ]. In comparison to written surveys, qualitative interviews have the advantage of being interactive and allowing for unexpected topics to emerge and to be taken up by the researcher. This can also help overcome a provider or researcher-centred bias often found in written surveys, which by nature, can only measure what is already known or expected to be of relevance to the researcher. Interviews can be audio- or video-taped; but sometimes it is only feasible or acceptable for the interviewer to take written notes [ 14 , 16 , 20 ].

Focus groups

Focus groups are group interviews to explore participants’ expertise and experiences, including explorations of how and why people behave in certain ways [ 1 ]. Focus groups usually consist of 6–8 people and are led by an experienced moderator following a topic guide or “script” [ 21 ]. They can involve an observer who takes note of the non-verbal aspects of the situation, possibly using an observation guide [ 21 ]. Depending on researchers’ and participants’ preferences, the discussions can be audio- or video-taped and transcribed afterwards [ 21 ]. Focus groups are useful for bringing together homogeneous (to a lesser extent heterogeneous) groups of participants with relevant expertise and experience on a given topic on which they can share detailed information [ 21 ]. Focus groups are a relatively easy, fast and inexpensive method to gain access to information on interactions in a given group, i.e. “the sharing and comparing” among participants [ 21 ]. Disadvantages include less control over the process and a lesser extent to which each individual may participate. Moreover, focus group moderators need experience, as do those tasked with the analysis of the resulting data. Focus groups can be less appropriate for discussing sensitive topics that participants might be reluctant to disclose in a group setting [ 13 ]. Moreover, attention must be paid to the emergence of “groupthink” as well as possible power dynamics within the group, e.g. when patients are awed or intimidated by health professionals.

Choosing the “right” method

As explained above, the school of thought underlying qualitative research assumes no objective hierarchy of evidence and methods. This means that each choice of single or combined methods has to be based on the research question that needs to be answered and a critical assessment with regard to whether or to what extent the chosen method can accomplish this – i.e. the “fit” between question and method [ 14 ]. It is necessary for these decisions to be documented when they are being made, and to be critically discussed when reporting methods and results.

Let us assume that our research aim is to examine the (clinical) processes around acute endovascular treatment (EVT), from the patient’s arrival at the emergency room to recanalization, with the aim to identify possible causes for delay and/or other causes for sub-optimal treatment outcome. As a first step, we could conduct a document study of the relevant standard operating procedures (SOPs) for this phase of care – are they up-to-date and in line with current guidelines? Do they contain any mistakes, irregularities or uncertainties that could cause delays or other problems? Regardless of the answers to these questions, the results have to be interpreted based on what they are: a written outline of what care processes in this hospital should look like. If we want to know what they actually look like in practice, we can conduct observations of the processes described in the SOPs. These results can (and should) be analysed in themselves, but also in comparison to the results of the document analysis, especially as regards relevant discrepancies. Do the SOPs outline specific tests for which no equipment can be observed or tasks to be performed by specialized nurses who are not present during the observation? It might also be possible that the written SOP is outdated, but the actual care provided is in line with current best practice. In order to find out why these discrepancies exist, it can be useful to conduct interviews. Are the physicians simply not aware of the SOPs (because their existence is limited to the hospital’s intranet) or do they actively disagree with them or does the infrastructure make it impossible to provide the care as described? Another rationale for adding interviews is that some situations (or all of their possible variations for different patient groups or the day, night or weekend shift) cannot practically or ethically be observed. In this case, it is possible to ask those involved to report on their actions – being aware that this is not the same as the actual observation. A senior physician’s or hospital manager’s description of certain situations might differ from a nurse’s or junior physician’s one, maybe because they intentionally misrepresent facts or maybe because different aspects of the process are visible or important to them. In some cases, it can also be relevant to consider to whom the interviewee is disclosing this information – someone they trust, someone they are otherwise not connected to, or someone they suspect or are aware of being in a potentially “dangerous” power relationship to them. Lastly, a focus group could be conducted with representatives of the relevant professional groups to explore how and why exactly they provide care around EVT. The discussion might reveal discrepancies (between SOPs and actual care or between different physicians) and motivations to the researchers as well as to the focus group members that they might not have been aware of themselves. For the focus group to deliver relevant information, attention has to be paid to its composition and conduct, for example, to make sure that all participants feel safe to disclose sensitive or potentially problematic information or that the discussion is not dominated by (senior) physicians only. The resulting combination of data collection methods is shown in Fig.  2 .

Possible combination of data collection methods

Attributions for icons: “Book” by Serhii Smirnov, “Interview” by Adrien Coquet, FR, “Magnifying Glass” by anggun, ID, “Business communication” by Vectors Market; all from the Noun Project

The combination of multiple data source as described for this example can be referred to as “triangulation”, in which multiple measurements are carried out from different angles to achieve a more comprehensive understanding of the phenomenon under study [ 22 , 23 ].

Data analysis

To analyse the data collected through observations, interviews and focus groups these need to be transcribed into protocols and transcripts (see Fig.  3 ). Interviews and focus groups can be transcribed verbatim , with or without annotations for behaviour (e.g. laughing, crying, pausing) and with or without phonetic transcription of dialects and filler words, depending on what is expected or known to be relevant for the analysis. In the next step, the protocols and transcripts are coded , that is, marked (or tagged, labelled) with one or more short descriptors of the content of a sentence or paragraph [ 2 , 15 , 23 ]. Jansen describes coding as “connecting the raw data with “theoretical” terms” [ 20 ]. In a more practical sense, coding makes raw data sortable. This makes it possible to extract and examine all segments describing, say, a tele-neurology consultation from multiple data sources (e.g. SOPs, emergency room observations, staff and patient interview). In a process of synthesis and abstraction, the codes are then grouped, summarised and/or categorised [ 15 , 20 ]. The end product of the coding or analysis process is a descriptive theory of the behavioural pattern under investigation [ 20 ]. The coding process is performed using qualitative data management software, the most common ones being InVivo, MaxQDA and Atlas.ti. It should be noted that these are data management tools which support the analysis performed by the researcher(s) [ 14 ].

From data collection to data analysis

Attributions for icons: see Fig. ​ Fig.2, 2 , also “Speech to text” by Trevor Dsouza, “Field Notes” by Mike O’Brien, US, “Voice Record” by ProSymbols, US, “Inspection” by Made, AU, and “Cloud” by Graphic Tigers; all from the Noun Project

How to report qualitative research?

Protocols of qualitative research can be published separately and in advance of the study results. However, the aim is not the same as in RCT protocols, i.e. to pre-define and set in stone the research questions and primary or secondary endpoints. Rather, it is a way to describe the research methods in detail, which might not be possible in the results paper given journals’ word limits. Qualitative research papers are usually longer than their quantitative counterparts to allow for deep understanding and so-called “thick description”. In the methods section, the focus is on transparency of the methods used, including why, how and by whom they were implemented in the specific study setting, so as to enable a discussion of whether and how this may have influenced data collection, analysis and interpretation. The results section usually starts with a paragraph outlining the main findings, followed by more detailed descriptions of, for example, the commonalities, discrepancies or exceptions per category [ 20 ]. Here it is important to support main findings by relevant quotations, which may add information, context, emphasis or real-life examples [ 20 , 23 ]. It is subject to debate in the field whether it is relevant to state the exact number or percentage of respondents supporting a certain statement (e.g. “Five interviewees expressed negative feelings towards XYZ”) [ 21 ].

How to combine qualitative with quantitative research?

Qualitative methods can be combined with other methods in multi- or mixed methods designs, which “[employ] two or more different methods [ …] within the same study or research program rather than confining the research to one single method” [ 24 ]. Reasons for combining methods can be diverse, including triangulation for corroboration of findings, complementarity for illustration and clarification of results, expansion to extend the breadth and range of the study, explanation of (unexpected) results generated with one method with the help of another, or offsetting the weakness of one method with the strength of another [ 1 , 17 , 24 – 26 ]. The resulting designs can be classified according to when, why and how the different quantitative and/or qualitative data strands are combined. The three most common types of mixed method designs are the convergent parallel design , the explanatory sequential design and the exploratory sequential design. The designs with examples are shown in Fig.  4 .

Three common mixed methods designs

In the convergent parallel design, a qualitative study is conducted in parallel to and independently of a quantitative study, and the results of both studies are compared and combined at the stage of interpretation of results. Using the above example of EVT provision, this could entail setting up a quantitative EVT registry to measure process times and patient outcomes in parallel to conducting the qualitative research outlined above, and then comparing results. Amongst other things, this would make it possible to assess whether interview respondents’ subjective impressions of patients receiving good care match modified Rankin Scores at follow-up, or whether observed delays in care provision are exceptions or the rule when compared to door-to-needle times as documented in the registry. In the explanatory sequential design, a quantitative study is carried out first, followed by a qualitative study to help explain the results from the quantitative study. This would be an appropriate design if the registry alone had revealed relevant delays in door-to-needle times and the qualitative study would be used to understand where and why these occurred, and how they could be improved. In the exploratory design, the qualitative study is carried out first and its results help informing and building the quantitative study in the next step [ 26 ]. If the qualitative study around EVT provision had shown a high level of dissatisfaction among the staff members involved, a quantitative questionnaire investigating staff satisfaction could be set up in the next step, informed by the qualitative study on which topics dissatisfaction had been expressed. Amongst other things, the questionnaire design would make it possible to widen the reach of the research to more respondents from different (types of) hospitals, regions, countries or settings, and to conduct sub-group analyses for different professional groups.

How to assess qualitative research?

A variety of assessment criteria and lists have been developed for qualitative research, ranging in their focus and comprehensiveness [ 14 , 17 , 27 ]. However, none of these has been elevated to the “gold standard” in the field. In the following, we therefore focus on a set of commonly used assessment criteria that, from a practical standpoint, a researcher can look for when assessing a qualitative research report or paper.

Assessors should check the authors’ use of and adherence to the relevant reporting checklists (e.g. Standards for Reporting Qualitative Research (SRQR)) to make sure all items that are relevant for this type of research are addressed [ 23 , 28 ]. Discussions of quantitative measures in addition to or instead of these qualitative measures can be a sign of lower quality of the research (paper). Providing and adhering to a checklist for qualitative research contributes to an important quality criterion for qualitative research, namely transparency [ 15 , 17 , 23 ].

Reflexivity

While methodological transparency and complete reporting is relevant for all types of research, some additional criteria must be taken into account for qualitative research. This includes what is called reflexivity, i.e. sensitivity to the relationship between the researcher and the researched, including how contact was established and maintained, or the background and experience of the researcher(s) involved in data collection and analysis. Depending on the research question and population to be researched this can be limited to professional experience, but it may also include gender, age or ethnicity [ 17 , 27 ]. These details are relevant because in qualitative research, as opposed to quantitative research, the researcher as a person cannot be isolated from the research process [ 23 ]. It may influence the conversation when an interviewed patient speaks to an interviewer who is a physician, or when an interviewee is asked to discuss a gynaecological procedure with a male interviewer, and therefore the reader must be made aware of these details [ 19 ].

Sampling and saturation

The aim of qualitative sampling is for all variants of the objects of observation that are deemed relevant for the study to be present in the sample “ to see the issue and its meanings from as many angles as possible” [ 1 , 16 , 19 , 20 , 27 ] , and to ensure “information-richness [ 15 ]. An iterative sampling approach is advised, in which data collection (e.g. five interviews) is followed by data analysis, followed by more data collection to find variants that are lacking in the current sample. This process continues until no new (relevant) information can be found and further sampling becomes redundant – which is called saturation [ 1 , 15 ] . In other words: qualitative data collection finds its end point not a priori , but when the research team determines that saturation has been reached [ 29 , 30 ].

This is also the reason why most qualitative studies use deliberate instead of random sampling strategies. This is generally referred to as “ purposive sampling” , in which researchers pre-define which types of participants or cases they need to include so as to cover all variations that are expected to be of relevance, based on the literature, previous experience or theory (i.e. theoretical sampling) [ 14 , 20 ]. Other types of purposive sampling include (but are not limited to) maximum variation sampling, critical case sampling or extreme or deviant case sampling [ 2 ]. In the above EVT example, a purposive sample could include all relevant professional groups and/or all relevant stakeholders (patients, relatives) and/or all relevant times of observation (day, night and weekend shift).

Assessors of qualitative research should check whether the considerations underlying the sampling strategy were sound and whether or how researchers tried to adapt and improve their strategies in stepwise or cyclical approaches between data collection and analysis to achieve saturation [ 14 ].

Good qualitative research is iterative in nature, i.e. it goes back and forth between data collection and analysis, revising and improving the approach where necessary. One example of this are pilot interviews, where different aspects of the interview (especially the interview guide, but also, for example, the site of the interview or whether the interview can be audio-recorded) are tested with a small number of respondents, evaluated and revised [ 19 ]. In doing so, the interviewer learns which wording or types of questions work best, or which is the best length of an interview with patients who have trouble concentrating for an extended time. Of course, the same reasoning applies to observations or focus groups which can also be piloted.

Ideally, coding should be performed by at least two researchers, especially at the beginning of the coding process when a common approach must be defined, including the establishment of a useful coding list (or tree), and when a common meaning of individual codes must be established [ 23 ]. An initial sub-set or all transcripts can be coded independently by the coders and then compared and consolidated after regular discussions in the research team. This is to make sure that codes are applied consistently to the research data.

Member checking

Member checking, also called respondent validation , refers to the practice of checking back with study respondents to see if the research is in line with their views [ 14 , 27 ]. This can happen after data collection or analysis or when first results are available [ 23 ]. For example, interviewees can be provided with (summaries of) their transcripts and asked whether they believe this to be a complete representation of their views or whether they would like to clarify or elaborate on their responses [ 17 ]. Respondents’ feedback on these issues then becomes part of the data collection and analysis [ 27 ].

Stakeholder involvement

In those niches where qualitative approaches have been able to evolve and grow, a new trend has seen the inclusion of patients and their representatives not only as study participants (i.e. “members”, see above) but as consultants to and active participants in the broader research process [ 31 – 33 ]. The underlying assumption is that patients and other stakeholders hold unique perspectives and experiences that add value beyond their own single story, making the research more relevant and beneficial to researchers, study participants and (future) patients alike [ 34 , 35 ]. Using the example of patients on or nearing dialysis, a recent scoping review found that 80% of clinical research did not address the top 10 research priorities identified by patients and caregivers [ 32 , 36 ]. In this sense, the involvement of the relevant stakeholders, especially patients and relatives, is increasingly being seen as a quality indicator in and of itself.

How not to assess qualitative research

The above overview does not include certain items that are routine in assessments of quantitative research. What follows is a non-exhaustive, non-representative, experience-based list of the quantitative criteria often applied to the assessment of qualitative research, as well as an explanation of the limited usefulness of these endeavours.

Protocol adherence

Given the openness and flexibility of qualitative research, it should not be assessed by how well it adheres to pre-determined and fixed strategies – in other words: its rigidity. Instead, the assessor should look for signs of adaptation and refinement based on lessons learned from earlier steps in the research process.

Sample size

For the reasons explained above, qualitative research does not require specific sample sizes, nor does it require that the sample size be determined a priori [ 1 , 14 , 27 , 37 – 39 ]. Sample size can only be a useful quality indicator when related to the research purpose, the chosen methodology and the composition of the sample, i.e. who was included and why.

Randomisation

While some authors argue that randomisation can be used in qualitative research, this is not commonly the case, as neither its feasibility nor its necessity or usefulness has been convincingly established for qualitative research [ 13 , 27 ]. Relevant disadvantages include the negative impact of a too large sample size as well as the possibility (or probability) of selecting “ quiet, uncooperative or inarticulate individuals ” [ 17 ]. Qualitative studies do not use control groups, either.

Interrater reliability, variability and other “objectivity checks”

The concept of “interrater reliability” is sometimes used in qualitative research to assess to which extent the coding approach overlaps between the two co-coders. However, it is not clear what this measure tells us about the quality of the analysis [ 23 ]. This means that these scores can be included in qualitative research reports, preferably with some additional information on what the score means for the analysis, but it is not a requirement. Relatedly, it is not relevant for the quality or “objectivity” of qualitative research to separate those who recruited the study participants and collected and analysed the data. Experiences even show that it might be better to have the same person or team perform all of these tasks [ 20 ]. First, when researchers introduce themselves during recruitment this can enhance trust when the interview takes place days or weeks later with the same researcher. Second, when the audio-recording is transcribed for analysis, the researcher conducting the interviews will usually remember the interviewee and the specific interview situation during data analysis. This might be helpful in providing additional context information for interpretation of data, e.g. on whether something might have been meant as a joke [ 18 ].

Not being quantitative research

Being qualitative research instead of quantitative research should not be used as an assessment criterion if it is used irrespectively of the research problem at hand. Similarly, qualitative research should not be required to be combined with quantitative research per se – unless mixed methods research is judged as inherently better than single-method research. In this case, the same criterion should be applied for quantitative studies without a qualitative component.

The main take-away points of this paper are summarised in Table ​ Table1. 1 . We aimed to show that, if conducted well, qualitative research can answer specific research questions that cannot to be adequately answered using (only) quantitative designs. Seeing qualitative and quantitative methods as equal will help us become more aware and critical of the “fit” between the research problem and our chosen methods: I can conduct an RCT to determine the reasons for transportation delays of acute stroke patients – but should I? It also provides us with a greater range of tools to tackle a greater range of research problems more appropriately and successfully, filling in the blind spots on one half of the methodological spectrum to better address the whole complexity of neurological research and practice.

Take-away-points

Acknowledgements

Abbreviations, authors’ contributions.

LB drafted the manuscript; WW and CG revised the manuscript; all authors approved the final versions.

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Peer-reviewed

Research Article

"You don’t get side effects from social prescribing”—A qualitative study exploring community pharmacists’ attitudes to social prescribing

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing

Roles Writing – review & editing

Affiliation Independent Research Pharmacist, United Kingdom

Roles Writing – original draft, Writing – review & editing

Affiliation Nuffield Department of Primary Care Science, University of Oxford, Oxford, United Kingdom

Roles Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing

Roles Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

• Adam Pattison Rathbone, 
• Harry Pearson, 
• Oluwafunmi Akinyemi, 
• Nia Cartwright, 
• Stephanie Tierney, 
• Gill Rowlands, 
• Laura Lindsey

• Published: May 16, 2024
• https://doi.org/10.1371/journal.pone.0301076
• Reader Comments

Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies.

Study design

A qualitative phenomenological approach was used.

A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed.

The sample included largely male pharmacists (63.3%) with less than five years’ experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team’s role to optimise health outcomes.

Conclusions

The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

Citation: Rathbone AP, Pearson H, Akinyemi O, Cartwright N, Tierney S, Rowlands G, et al. (2024) "You don’t get side effects from social prescribing”—A qualitative study exploring community pharmacists’ attitudes to social prescribing. PLoS ONE 19(5): e0301076. https://doi.org/10.1371/journal.pone.0301076

Editor: Simon White, Keele University, UNITED KINGDOM

Received: September 18, 2023; Accepted: March 9, 2024; Published: May 16, 2024

Copyright: © 2024 Rathbone et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: There are ethical and legal restrictions on sharing the de-identified data set. Participants did not give explicit consent for the de-identified data set to be shared as participants were told the data would be kept confidential. Anonymized data is held at an online repository under embargo. This restriction is imposed by the University Ethics Committee. Please contact [email protected] for further information.

Funding: The author(s0 received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Social prescribing has been described as: “ a means for health-care workers to connect patients to a range of non-clinical services in the community to improve health and well-being . Social prescribing can help to address the underlying causes of patients’ health and well-being issues , as opposed to simply treating symptoms .” [ 1 ]. It has become a cornerstone of healthcare policy in the UK [ 2 ] and overseas [ 3 ]. Patients are often referred for social prescribing by a General Practitioner (GP), who contacts a link worker to meet with the patient to identify appropriate support for their non-medical needs [ 3 ]. Exercise classes, arts and crafts, volunteering, gardening, and cookery classes, as well as accommodation and debt management services, are among the types of support patients might be connected to by a link worker [ 4 – 6 ].

It is argued that social prescribing can be useful for people living with long-term health conditions, mental health problems, socioeconomic struggles and social isolation–the latter of which has become more prevalent following the COVID-19 pandemic [ 7 ]. There is some evidence suggesting engagement in social prescribing may reduce demand for non-elective healthcare [ 8 ] and GP attendances [ 9 ]. Hence, it may be a means of addressing demand on overstretched healthcare services, supporting the broader well-being of vulnerable, socioeconomically disadvantaged communities. However, it should be noted, claims social prescribing reduces health inequalities for socioeconomically deprived communities are still considered contentious and their impact on reducing demand of some healthcare services, such as pharmacies, is not known [ 10 – 13 ].

Approaches to expanding access to social prescribing are being explored in the UK through ‘proactive social prescribing’ [ 14 ], where patient populations are screened by primary care professionals to identify target groups with unmet needs. Other examples of improving access to social prescribing are schemes such as digital self-referrals, where an app matches patients with appropriate support in the community [ 15 ]. In addition, an appeal for further healthcare professionals, including pharmacists, to take a role in social prescribing has been made [ 16 ].

Pharmacies offer open access to healthcare for a wide range of people, in both rural and urban settings. Pharmacies are known to be more accessible than GPs in areas of high socioeconomic deprivation [ 17 ]. Evidence suggests during the pandemic in the UK in 2020, over a third of patients visited their community pharmacy instead of their GP practice [ 18 ] although it was unclear if this prevented follow-up visits to GP practices. Although pharmacies are reporting high workloads [ 19 – 21 ], their accessibility makes them suitable for healthcare initiatives to reduce demand on existing health services [ 15 , 17 ]. Despite this, funding for pharmacies in the UK is focused primarily on dispensing medications rather than patient-facing services [ 22 ]. Recent changes to policy, such as the NHS Long Term Plan, Healthy Living Pharmacy Framework, Pharmacy First and the Community Pharmacy Consultation Scheme, indicate pharmacies will be an increasingly important place for the delivery of healthcare services, both urgent and preventative, in the future [ 2 , 23 – 26 ].

The evidence evaluating social prescribing interventions in pharmacy is limited. A systematic review in 2017 found little evidence of the efficacy of social prescribing in community settings, due to the short-term nature of the evaluations [ 27 ]. Other work focusing specifically on pharmacies found similarly limited literature [ 28 ]. To improve the existing evidence for social prescribing in pharmacy, evaluations must start from the foundations and work up; identifying capabilities, opportunities and motivations of pharmacy teams as well as the impact on patients, community groups and other health and social care professionals in the system. Little is known about pharmacists’ awareness and understanding of social prescribing and what factors influence their involvement in this non-clinical activity [ 28 , 29 ]. What evidence does exist suggests workload and funding may limit the involvement of pharmacists, and that these professionals may have limited awareness of what social prescribing is [ 29 ]. This existing evidence is based on quantitative methods and, thus, did not provide a detailed description of pharmacists’ experiences of social prescribing in practice. Hence, the aim of our study was to explore community pharmacists’ experiences, perspectives and attitudes to social prescribing in practice.

A qualitative phenomenological approach was adopted, which drew on the Capability Opportunity Motivation–Behaviour (COM-B) model [ 30 ]. A phenomenological approach allowed the study to focus on community pharmacists’ experiences of what happens in practice and how it happens [ 31 ]. Specifically, the COM-B model was used to create a topic guide to use during interviews and added structure to the findings following the identification of themes. As evidence in relation to pharmacists’ roles in social prescribing is limited, an exploratory design was appropriate [ 30 ].

Participants and recruitment

A convenience sampling method was adopted. A form was posted on social media (Twitter and Facebook) to allow participants to self-screen against inclusion criteria. The criteria included having experience working as a community pharmacist in Northern England, conversant in English, and capacity to consent to research. Snowball sampling was also used to recruit participants to the study.

The form was created and posted on social media via the research team (APR, HP, LL) outlining the study. Users completed screening questions for eligibility and were prompted to give an email address and telephone number to be contacted. The decision to limit to Northern England was pragmatic as researchers were based there. It also allowed the study to recruit pharmacists practicing in areas of high deprivation, where pharmacists are known to be more readily accessed by patients than in areas of low deprivation [ 17 ]. A participant information sheet was provided to interviewees in advance, and verbal consent was taken prior to participation, which was recorded by the interviewer (HP) and witnessed by the supervisor (APR).

Methods of data collection

Semi-structured interviews were conducted via the online platforms Zoom and Microsoft Teams, and over the telephone between Monday 5th October 2020 and Friday 29 th January 2021. The semi-structured nature of the interviews allowed for an in-depth exploration of pharmacists’ views, which would be unobtainable via a survey [ 32 ]. Interviews were conducted at a time convenient to the participant. Interviews lasted between 30 and 45 minutes (average = 39 minutes). A topic guide was used (see Tables 1 and 2 ) that included questions such as: i) What are your experiences of social prescribing? ii) What do you understand as the advantages of social prescribing in community pharmacy? iii) What do you think are the barriers to implementing social prescribing in community pharmacy?

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One-to-one interviews were conducted by a final year pharmacy student (HP). He was trained by experienced qualitative health researchers (LL, GR, APR). Interviews were audio-recorded and transcribed manually by one author (HP) with a 10% sample quality checked by listening back to the audio and reading the transcript (APR) [ 33 , 34 ]. Transcripts were anonymised by removing the names of participants, people, and places [ 33 , 34 ]. Data collection ceased at the point of theoretical data sufficiency [ 35 ], which occurred after ten interviews; one additional interview was conducted to confirm this was the case. Theoretical data sufficiency relates to the point in the study at which no new findings are being identified in the data. This was operationalised in the study through regular weekly supervision meetings during data collection and analysis to interrogate, explore and identify when no new findings were being found. This point indicates the research team had access to sufficient data to draw conclusions, though due to the nature of qualitative inquiry, further findings may be found by new researchers looking at the same data.

Data processing and analysis

Transcripts were imported into NVivo and inductive thematic analysis was completed by three researchers (HP, APR, LL) using the method outlined by Braun and Clarke (33). The first step of this analysis began with familiarisation with the data, next there was generation of initial codes, then clusters were created, and finally themes. A constant comparative approach was adopted, which meant codes, clusters and themes were compared with one another and findings interrogated in data presentation meetings involving the authors. This process was underpinned by a phenomenological understanding of experiences, which focuses on what the essence of an experience is and how this happens–i.e., what was happening and how was it happening. The COM-B Model was then used to contextualise the themes to link what happened to behavioural theory.

As part of the analysis, participants were categorised based on their role within community pharmacy and the length of time since registration. Participants with experience of less than five years were classified as ‘pharmacists with less experience’. This classification is in line with The Royal Pharmaceutical Society (RPS) Foundation Pharmacist Framework [ 36 ]. Participants with experience greater than this were categorised as ‘pharmacists with more experience’. This follows the RPS Advanced Pharmacy Framework [ 37 ]. Credibility was defined as the ability of the findings of the study to be reasonably believed and dependability was defined as the ability to trust the research process was carried out accurately. Credibility and dependability were established by involving more than one person in the analysis (sometimes referred to as analytical triangulation), through presentation and discussion of data at regular coding meetings with the research team. Weekly meetings were also used to ensure senior authors (LL, GR, APR) provided suitable training, support, supervision and accountability to the team (HP, NC). The study processes and findings were also reviewed by external collaborators (OA, ST) which further enhanced the credibility and dependability of the findings.

Reflexivity

Reflexivity allows research authors to become aware of, respond to and acknowledge how their own personal characteristics, identity and perspectives influences research [ 38 ]. In this study, the authors came from working class, middle class and upper middle-class backgrounds, where mostly White and came from Britain. Two authors were not from Britain and two authors were not White. Three authors were pharmacists, one was a general practitioner and one a psychologist. Four authors had completed, and one author was completing, a PhD. The research was led by a team based in a School of Pharmacy and this meant members of the research team may have been well known to participants as former educators (LL, APR) or colleagues (HP, OA). This meant there was a shared understanding of language and terminology between participants and researchers which enriched the subjectivity of the study during data collection. However, other members of the research team (NC, ST, GR) were less professionally connected to the pharmacy sector and so provided an objective perspective during data analysis and interpretation.

Research ethics

Ethical approval for this study was obtained through Newcastle University (reference number 6162/2020).

Participant demographics

Eleven participants were recruited and demographics are summarised in Table 1 .

Thematic findings

Findings are described below, with codes, clusters and themes shown in Table 2 . Data extracts describe findings in participants’ own words. Quotes denote if participants were employee, locum or owner pharmacists and which ‘type’ of pharmacy they worked in–either an ‘independent’ pharmacy which refers to a small chain, local, or single pharmacy business or a ‘multiple’ pharmacy chain which refers to a large, multi-national pharmacy corporation with many pharmacy businesses operating under a single banner.

Theme 1) Varied knowledge and understanding of social prescribing.

Most participants seemed to have an awareness of and enthusiasm for social prescribing, although they reported little knowledge of it. The setting where participants worked, their status or level of experience did not appear to influence knowledge or reported beliefs about social prescribing. Participants who were aware of social prescribing appeared to know about it either from involvement in a social prescribing event, through prescribing community-based, non-clinical support themselves, or having heard about the process in previous employment.

“ I was running group clinics…where we don’t just talk about their medicines, we talk about interventions like exercise, or lifestyle advice or diet. It was much more informal, but we would make recommendations to patients like a Tai Chi class for example, that you would benefit from, or you might be better off doing some core strengthening exercises given your type of arthritis.” Participant 6 (Pharmacist, Independent)

Despite a limited understanding, pharmacists appeared to believe they had capability to support social prescribing. However, they appeared to view it as a clinician-led approach, focusing on the physical symptoms of disease, rather than a person-centred approach to address socioeconomic factors of health and well-being, directed by the patient to address their specific needs. This indicated social prescribing was being conflated with public health promotion, lifestyle campaigns.

“ I can really see where [social prescribing] would fit in that remit, so the kind of physical and the recommendation for physical activity, how it can help with a number of different medical conditions… we’ve got a really good knowledge base of different health conditions and generally kind of how the body works. So why not use that and I don’t think we’re using it a lot at the minute.” Participant 1 (Locum, Independent)

These findings demonstrate the nuance of pharmacists’ approach to social prescribing, in that, enthusiasm toward social prescribing was reported, but that this appeared to be based on an understanding of social prescribing as an aspect of health promotion and lifestyle interventions based on physical disease states, rather than socio-economic circumstances of the patient.

Theme 2) Factors influencing involvement in social prescribing.

Concern about the economics of a pharmacy businesses, the balance of workload and funding, was a recurring factor which appeared to shape participants’ thoughts about involvement in social prescribing. Participants reported the busy nature of community pharmacy and highlighted how much additional time would be needed to engage with social prescribing.

“ Well with the increase of both dispensing items, the more and more consultations that we are having to do, as well as the fact some stores due to cuts [to funding] have had to get rid of managers, that then falls on the pharmacist’s desk, there’s a lot less time for patient-pharmacist discussions. So timing is going to be a major issue I think.” Participant 11 (Employee, Multiple)

Additional demands and additional time pressure, following on from the relentless experience encountered during the pandemic for many pharmacists through involvement in vaccination and increased workload, were concerns participants shared.

“ I certainly have worked over the COVID-19 pandemic in community myself, I know how ridiculously busy we’ve been. You know to try and fit in another additional service on top of all of the ones that are already being offered… but I think currently I’ve never known pharmacy this busy in my entire career…” Participant 6 (Employee, Independent)

Hesitancy also related to patients’ responses to being offered social prescribing in a pharmacy setting.

“ They might feel embarrassed to accept that help. And they might find it quite intrusive, they might not expect a pharmacist to be involved and…nobody wants to be categorised as a vulnerable or isolated patient particularly.” Participant 4 (Employee, Multiple)

Participants reported feeling that larger ‘multiples’ companies had greater resources and financial capital and would therefore find it easier to implement social prescribing services than independent organisations.

“ And the small pharmacies I worry that because they’re so, their [funding is] so tight they are trying to make the best they can being an independent that they won’t sort of have the capacity necessary to widen to some of these sorts of wider societal things that they can have input in.” Participant 5 (Employee, Multiple)

Conversely, others suggested larger organisations with more capital may focus on profits rather than supporting patient communities, unlike independent organisations.

“ I’ve worked for [supermarket pharmacy 1] and [supermarket pharmacy 2] before which are bigger companies, and I know they’re much more focused around [funding]…rather than the kind of community support and health advice [in social prescribing]. I think an independent might do it because of the benefit to the community and to be seen to be giving extra services which might attract and keep their customer base.” Participant 6 (Employee, Independent)

The only participant who was a pharmacy owner (and therefore responsible for organisational structure and financial targets of a community pharmacy business) reported social prescribing was an individual, professional decision of the pharmacist in charge, rather than the priorities of the business or owner. This appeared to diminish the role of organizational policy, working conditions (such as opening times and staffing levels), and the funding landscape, suggesting engagement with social prescribing will come down to personal preference of the individual pharmacist.

“ There’s no [funding] difference between the individual pharmacists, whoever they work for. So, under those circumstances it doesn’t matter if it’s an independent or a multiple pharmacy, they will organise themselves differently, but it’ll come down to the individuals, not the policy of the owner.” Participant 10 (Owner, Independent)

Collectively, these findings indicate pharmacists’ motivations to deliver social prescribing services are influenced by access to appropriate levels of economic capital and resources to manage workload and patient expectations.

Theme 3) Outcomes of social prescribing in community pharmacy.

This theme describes social prescribing as an opportunity for pharmacies to improve patient outcomes by involving all members of the pharmacy team, not just pharmacists. The inclusion of all staff into social prescribing was raised by participants. The knowledge and trust shared with patients was considered to make them a good resource to facilitate social prescribing. Participants felt dispensing staff, delivery drivers, and pharmacy technicians, as well as pharmacists, represented valuable assets to facilitate social prescribing, if given appropriate training and links to social prescribing networks.

Participants appeared to clearly understand the accessibility of pharmacy and highlighted the patient-centeredness of pharmacies, in comparison to other healthcare settings for patients, was aligned to social prescribing principles.

“ We are the most accessible healthcare professional in every community, and patients know they can just pop in for that source of advice. We have a lot more time [than other healthcare professionals] to tailor to individual patients” Participant 11 (Employee, Multiple)

Participants reported valuing the role that social prescribing could play in improving health outcomes for patients, lessening the need for medication and expensive treatments.

“ …you’ve got the obvious benefits to the patients around outcomes…it might be that they are prescribed metformin for type 2 diabetes, which alongside social prescribing around diet and exercise…as a result of the diet and exercise intervention that the whole…type 2 diabetes will be better off.” Participant 5 (Employee, Multiple)

Additionally, participants appeared to recognise opportunities to improve patient care by providing an alternative to medications.

“ You know it’s got loads of benefits for patients because you know you don’t get side effects from social prescribing.” Participant 6 (Employee, Independent)

Pharmacistsreported the need to work with others who are already social prescribing to learn, share best practice and develop a common understanding.

“ Ultimately though this isn’t something pharmacies could just do on their own, we need to be linked up with other people doing this, like is there a national body of social prescribers or like standardised training about how to do it? If we knew more about social prescribers we would be linked in with that network more.” Participant 10 (Owner, Independent)

Collectively this theme demonstrates complexity in pharmacists’ views of the outcomes of social prescribing, primarily being reliant on the social capital pharmacists have with patients and other staff in their premises but also on building social capital by engaging with other social prescribing networks and experts.

Discussion and conclusion

Summary of findings.

The key finding of this study is participants appeared to recognise, understand and value social prescribing as a means of supporting patients’ health and well-being, but misunderstood social prescribing as a form of disease-focused, public health promotion. Limited training, experience and resources to facilitate social prescribing in practice were identified as learning needs in this study. Participants reported willing to be involved in social prescribing, reporting interests to better understand the process of social prescribing and expressing beliefs that this could expand the current role of community pharmacists and their team members. Many participants reported limited exposure to or involvement with social prescribing in current practice and education. This indicates a need for further collaboration and involvement in social prescribing networks. Professional bodies may also need to support education, learning and training of pharmacists and their teams to implement social prescribing services. The unique accessibility of community pharmacy teams and the rapport they have with their patients were seen as opportunities to contribute to social prescribing to improve patient outcomes.

A strength of the study is it provides a conceptualization of pharmacists’ understanding of social prescribing. The study met theoretical data sufficiency and used qualitative methods to identify insights. Additionally, the sample included pharmacists from a range of practice settings across North East England, which means the findings may be transferable to different contexts of practice. However, using convenience sampling meant these findings may not include the range of views across the pharmacy profession–particularly from those outside of North East England. Additionally, recruitment via social media introduces self-selection bias (whereby pharmacists with little interest in social prescribing would have been recruited) which may positively skew the findings in terms of participants’ reported willingness and enthusiasm for social prescribing rather than the reported limited exposure and understanding of it.

Comparison to existing literature

The findings presented here add to the literature, demonstrating pharmacists are enthusiastic, but do not fully appreciate the scope and impact of social prescribing. The findings are congruent with a survey completed by 120 pharmacists, showing poor understanding of social prescribing, and the need for increased staff training and funding [ 29 ]. Existing literature has suggested pharmacists could adopt multiple roles to implement social prescribing–as screeners, identifiers, link workers or providers of social interventions [ 28 , 39 ] to reduce the demand on existing health services [ 8 ]. However, with such a limited understanding shown in this research, the role pharmacists could adopt to implement social prescribing at present may be limited.

Some existing literature has stated that the impact of social prescribing may be overestimated [ 13 ]. A key reason for this, put forward by Gibson, Pollard (13), using a Bourdieuan lens, is focused on patients’ structural contexts; access to economic, social and cultural capital influences engagement with social prescribing interventions. Our study extends the argument from patients to pharmacists, highlighting that structural context also influences professional engagement with social prescribing interventions. Our study demonstrated that pharmacists have little cultural, economic and social capital to invest in social prescribing—their conceptualisation of it is limited (cultural capital), funding is poor and workload is high (economic capital) and their connections to professional social prescribing networks and bodies is poor (social capital) [ 40 , 41 ]. This may hinder the capability, opportunity and motivation for pharmacists to engage in social prescribing. Further research such as feasibility and pilot studies, as well as trials, are needed to understand and consider the effectiveness of pharmacists and their teams bridging the gap between health and social care to help communities most in need.

Implications for policy and practice

The NHS has made a commitment to increase social prescribing activity and expand the number of link workers [ 2 , 42 ]. Pharmacists, with adequate economic, social and cultural capital, could support this—either by identifying patients for referral to link workers or providing link worker services ‘in house’ [ 28 ]. However, this study has shown that although pharmacists are interested in social prescribing, it appears to be positioned within current pharmacy practice as ‘healthy lifestyle changes’, ‘health promotion’ and ‘public health’ initiative, rather than supporting patients to deal with broader socioeconomic determinants of health, such as poor housing, economic hardship, and abusive relationships–which many link workers currently deal with through social prescribing [ 9 , 10 , 43 ]. If pharmacists are going to refer patients to social prescribing, then additional training, access and engagement with link workers will be needed to upskill the current workforce. Furthermore, establishing ways to build social connections of pharmacists with those involved in delivering social prescribing are required. If pharmacists themselves are going to act as link workers ‘in house’, then the findings suggest a much greater effort will be needed to enable them to have the skills, expertise, supervision and support structures to build their cultural capital to deal with non-clinical social issues to optimise health outcomes. Our findings show pharmacists believe they know what social prescribing is but their beliefs are not aligned to what social prescribing link workers actually do in reality. It shows there is a gap between pharmacists’ beliefs and social prescribing practice. This provides a very specific target for educators and policy makers to create an intervention to change pharmacists’ perceptions of social prescribing from a ‘healthy lifestyle intervention’ to a new praxis of ‘social pharmaceutical care’. This raises questions for policy makers and practitioners, and the profession as a whole–is social prescribing something community pharmacy teams want to do, given current high workloads in the sector?

This study aimed to explore community pharmacists’ experiences of social prescribing. It has shown how they recognise and value social prescribing, but currently have limited understanding, training, experience and resources to incorporate it into their practice. These findings provide an insight into pharmacists understanding but may not be generalisable or transferable. Further work is therefore needed to explore if, when and how pharmacists and their teams could engage with social prescribing.

Acknowledgments

The authors would like to thank the participants for taking part in this study.

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