qualitative research is underpinned by a mixed methods worldview

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Elsevier - PMC COVID-19 Collection

Combining qualitative and quantitative research within mixed method research designs: A methodological review

Ulrika Östlund.

a Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

b Institute for Applied Health Research/School of Health, Glasgow Caledonian University, United Kingdom

Yvonne Wengström

c Division of Nursing, Department or Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

Neneh Rowa-Dewar

d Public Health Sciences, University of Edinburgh, United Kingdom

It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses.

This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009.

In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided.

A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.

What is already known about the topic?

• • Mixed methods research, where quantitative and qualitative methods are combined, is increasingly recognized as valuable, because it can potentially capitalize on the respective strengths of quantitative and qualitative approaches.
• • There is a lack of pragmatic guidance in the research literature as how to combine qualitative and quantitative approaches and how to integrate qualitative and quantitative findings.
• • Analytical approaches used in mixed-methods studies differ on the basis of the sequence in which the components occur and the emphasis given to each, e.g. parallel, sequential or concurrent.

What this paper adds

• • A trend for conducting parallel analysis on quantitative and qualitative data in healthcare research is apparent within the literature.
• • Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings and help researchers to clearly present both their theoretical propositions and the basis of their results.
• • Using triangulation as a methodological metaphor may also support a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and aid the development of new theory.

1. Introduction

Mixed methods research has been widely used within healthcare research for a variety of reasons. The integration of qualitative and quantitative approaches is an interesting issue and continues to be one of much debate ( Bryman, 2004 , Morgan, 2007 , Onwuegbuzie and Leech, 2005 ). In particular, the different epistemological and ontological assumptions and paradigms associated with qualitative and quantitative research have had a major influence on discussions on whether the integration of the two is feasible, let alone desirable ( Morgan, 2007 , Sale et al., 2002 ). Proponents of mixed methods research suggest that the purist view, that quantitative and qualitative approaches cannot be merged, poses a threat to the advancement of science ( Onwuegbuzie and Leech, 2005 ) and that while epistemological and ontological commitments may be associated with certain research methods, the connections are not necessary deterministic ( Bryman, 2004 ). Mixed methods research can be viewed as an approach which draws upon the strengths and perspectives of each method, recognising the existence and importance of the physical, natural world as well as the importance of reality and influence of human experience ( Johnson and Onquegbuzie, 2004 ). Rather than continue these debates in this paper, we aim to explore the approaches used to integrate qualitative and quantitative data within healthcare research to date. Accordingly, this paper focuses on the practical issues of conducting mixed methods studies and the need to develop a rigorous framework for designing and interpreting mixed methods studies to advance the field. In this paper, we will attempt to offer some guidance for those interested in mixed methods research on ways to combine qualitative and quantitative methods.

The concept of mixing methods was first introduced by Jick (1979) , as a means for seeking convergence across qualitative and quantitative methods within social science research ( Creswell, 2003 ). It has been argued that mixed methods research can be particularly useful in healthcare research as only a broader range of perspectives can do justice to the complexity of the phenomena studied ( Clarke and Yaros, 1988 , Foss and Ellefsen, 2002 , Steckler et al., 1992 ). By combining qualitative and quantitative findings, an overall or negotiated account of the findings can be forged, not possible by using a singular approach ( Bryman, 2007 ). Mixed methods can also help to highlight the similarities and differences between particular aspects of a phenomenon ( Bernardi et al., 2007 ). Interest in, and expansion of, the use of mixed methods designs have most recently been fuelled by pragmatic issues: the increasing demand for cost effective research and the move away from theoretically driven research to research which meets policymakers’ and practitioners’ needs and the growing competition for research funding ( Brannen, 2009 , O’Cathain et al., 2007 ).

Tashakkori and Creswell (2007) broadly define mixed methods research as “research in which the investigator collects and analyses data, integrates the findings and draws inferences using both qualitative and quantitative approaches” (2007:3). In any mixed methods study, the purpose of mixing qualitative and quantitative methods should be clear in order to determine how the analytic techniques relate to one another and how, if at all, the findings should be integrated ( O’Cathain et al., 2008 , Onwuegbuzie and Teddlie, 2003 ). It has been argued that a characteristic of truly mixed methods studies are those which involve integration of the qualitative and quantitative findings at some stage of the research process, be that during data collection, analysis or at the interpretative stage of the research ( Kroll and Neri, 2009 ). An example of this is found in mixed methods studies which use a concurrent data analysis approach, in which each data set is integrated during the analytic stage to provide a complete picture developed from both data sets after data has been qualitised or quantitised (i.e. where both forms of data have been converted into either qualitative or quantitative data so that it can be easily merged) ( Onwuegbuzie and Teddlie, 2003 ). Other analytic approaches have been identified including; parallel data analysis, in which collection and analysis of both data sets is carried out separately and the findings are not compared or consolidated until the interpretation stage, and finally sequential data analysis, in which data are analysed in a particular sequence with the purpose of informing, rather than being integrated with, the use of, or findings from, the other method ( Onwuegbuzie and Teddlie, 2003 ). An example of sequential data analysis might be where quantitative findings are intended to lead to theoretical sampling in an in depth qualitative investigation or where qualitative data is used to generate items for the development of quantitative measures.

When qualitative and quantitative methods are mixed in a single study, one method is usually given priority over the other. In such cases, the aim of the study, the rationale for employing mixed methods, and the weighting of each method determine whether, and how, the empirical findings will be integrated. This is less challenging in sequential mixed methods studies where one approach clearly informs the other, however, guidance on combining qualitative and quantitative data of equal weight, for example, in concurrent mixed methods studies, is rather less clear ( Foss and Ellefsen, 2002 ). This is made all the more challenging by a common flaw which is to insufficiently and inexplicitly identify the relationships between the epistemological and methodological concepts in a particular study and the theoretical propositions about the nature of the phenomena under investigation ( Kelle, 2001 ).

One approach to combining different data of equal weight and which facilitate clear identification of the links between the different levels of theory, epistemology, and methodology could be to frame triangulation as a ‘methodological metaphor’, as argued by Erzberger and Kelle (2003) . This can help to; describe the logical relations between the qualitative and quantitative findings and the theoretical concepts in a study; demonstrate the way in which both qualitative and quantitative data can be combined to facilitate an improved understanding of particular phenomena; and, can also be used to help generate new theory ( Erzberger and Kelle, 2003 ) (see Fig. 1 ). The points of the triangle represent theoretical propositions and empirical findings from qualitative and quantitative data while the sides of the triangle represent the logical relationships between these propositions and findings. The nature and use of the triangle depends upon the outcome from the analysis, whether that be convergent , where qualitative and quantitative findings lead to the same conclusion; complementary, where qualitative and quantitative results can be used to supplement each other or; divergent , where the combination of qualitative and quantitative results provides different (and at times contradictory) findings. Each of these outcomes requires a different way of using the triangulation metaphor to link theoretical propositions to empirical findings ( Erzberger and Kelle, 2003 ).

Illustrating the triangulation triangle ( Erzberger and Kelle, 2003 )

1.1. Purpose of this paper

In the following paper, we identify the analytical approaches used in mixed methods healthcare research and exemplify the use of triangulation ( Erzberger and Kelle, 2003 ) as a methodological metaphor for drawing inferences from qualitative and quantitative findings. Papers reporting on mixed methods studies within healthcare research were reviewed to (i) determine the type of analysis approach used, i.e. parallel, concurrent, or sequential data analysis and, (ii) identify studies which could be used to illustrate the use of the methodological metaphor of triangulation suggested by Erzberger and Kelle (2003) . Four papers were selected to illustrate the application of the triangulation metaphor on complementary, convergent and divergent outcomes and to develop theory.

This literature review has used systematic principles ( Cochrane, 2009 , Khan, 2001 ) to search for mixed methods studies within healthcare research. The first search was conducted in September 2009 in the data bases CINAHL, Medline and PsycINFO on papers published in English language between 1999 and 2009. To identify mixed methods studies, the search terms (used as keywords and where possible as MeSH terms) were: “mixed methods”, “mixed research methods”, “mixed research”, “triangulation”, “complementary methods”, “concurrent mixed analysis” and “multi-strategy research.” These terms were searched individually and then combined (with OR). This resulted in 1896 hits in CINAHL, 1177 in Medline and 1943 in PsycINFO.

To focus on studies within, or relevant to, a healthcare context the following search terms were used (as keywords or as MeSH terms and combined with OR): “health care research”; “health services research”; and “health”. These limits applied to the initial search (terms combined with AND) resulted in 205 hits in Medline and 100 hits in PsycINFO. Since this combination in CINAHL only limited the search results to 1017; a similar search was conducted but without using the search term triangulation to capture mixed methods papers; resulting in 237 hits. In CINAHL the search result on 1017 papers was further limited by using “interventions” as a keyword resulting in 160 papers also selected to be reviewed. Moreover; in Medline the mixed methods data set was limited by the MeSH term “research” resulting in 218 hits and in PsycINFO with “intervention” as keyword or MeSH term resulting in 178 hits.

When duplicates were removed the total numbers of papers identified were 843. The abstracts were then reviewed by each author and those identified as relevant to the review were selected to be retrieved and reviewed in full text. Papers were selected based on the following inclusion criteria: empirical studies; published in peer review journals; healthcare research (for the purpose of this paper defined as any study focussing on participants in receipt, or involved in the delivery, of healthcare or a study conducted within a healthcare setting, e.g. different kinds of care, health economics, decision making, and professionals’ role development); and using mixed methods (defined as a study in which both qualitative and quantitative data were collected and analysed ( Halcomb et al., 2009b ). To maintain rigour, a random sample (10%) of the full text papers was reviewed jointly by two authors. Any disagreements or uncertainties that arose between the reviewers regarding their inclusion or in determining the type of analytic approach used were resolved through discussion between the authors.

In addition to the criteria outlined above, papers were excluded if the qualitative element constituted a few open-ended questions in a questionnaire, as we would agree with previous authors who have argued such studies do not strictly constitute a mixed methods design ( Kroll and Neri, 2009 ). Papers were also excluded if they could not be retrieved in full text via the library services at the University of Edinburgh, Glasgow Caledonian University or the Karolinska Institutet, or did not adequately or clearly describe their analytic strategy, for example, failing to report how the qualitative and quantitative data sets were analysed individually and, where relevant, how these were integrated. See Table 1 for reasons for the exclusion of subsequent papers.

Reasons for exclusion.

A second search was conducted within the databases of Medline, PsychInfo and Cinahl to identify studies which have specifically used Erzberger and Kelle's (2003) triangulation metaphor to frame the description and interpretation of their findings. The term ‘triangulation metaphor’ (as keywords) and author searches on ‘Christian Erzberger’ and ‘Udo Kelle’ were conducted. Three papers, published by Christian Erzberger and Udo Kelle, were identified in the PsychInfo databases but none of these were relevant to the purpose of this review. There were no other relevant papers identified in the other two databases.

168 Papers were included in the final review and reviewed to determine the type of mixed analysis approach used, i.e. parallel, concurrent, or sequential mixed analysis. Four of these papers (identified from the first search on mixed methods studies and healthcare research) were also used to exemplify the use of the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ). Data was extracted from included papers accordingly in relation to these purposes.

In total, 168 papers were included in our review. The majority of these studies originated in the USA ( n  = 63), the UK ( n  = 39) and Canada ( n  = 19), perhaps reflecting the considerable interest and expertise in mixed methods research within these countries. The focus of the studies included in the review varied significantly and the populations studied included both patients and healthcare professionals.

3.1. Analytic approaches

Table 2 illustrates the types of analytic approaches adopted in each of the studies included in the review. The most widely used analytic approach ( n  = 98) was parallel analysis ( Creswell and Plano Clark, 2007 ). However, very few of the studies employing parallel analysis clearly articulate their purpose for mixing qualitative and quantitative data, the weighting (or priority) given to the qualitative and quantitative data or the expected outcomes from doing so, mirroring previous research findings ( O’Cathain et al., 2008 ). The weighting, or priority, of the qualitative and quantitative data in a mixed methods study is dependent upon various factors including; the aims of the study and whether the purpose is, for example, to contextualise quantitative data using qualitative data or to use qualitative data to inform a larger quantitative approach such as a survey. Nonetheless, the omission of this statement makes it difficult to determine which data set the conclusions have been drawn from and the role of, or emphasis on, each approach. Therefore, is of importance for authors to clearly state this in their papers ( Creswell and Plano Clark, 2007 ). A number of studies had also used sequential data analysis ( n  = 46), where qualitative approaches were visibly used to inform the development of both clinical tools (e.g. Canales and Rakowski, 2006 ) and research measures and surveys (e.g. Beatty et al., 2004 ) or where quantitative surveys were supplemented by and issues further explored using qualitative approaches (e.g. Abadia and Oviedo, 2009 , Cheng, 2004 , Halcomb et al., 2008 ).

Included papers illustrating their analytical approach and country of origin.

Most notably, with only 20 included studies using a concurrent approach to data analysis, this was the least common design employed. Compared to the studies using a parallel or sequential approach, the authors of concurrent studies more commonly provided an explanation for their purpose of using a mixed methods design in their study, e.g. how it addressed a gap or would facilitate and advance the state of knowledge (e.g. Bussing et al., 2005 , Kartalova-O’Doherty and Tedstone Doherty, 2009 ). Despite this, there remained a lack of clarity within these studies about the weighting given to, and priority of, each method. Consequently, the importance and relevance of the findings produced by each approach and how these have informed their conclusions and interpretation is lacking. In four of the included papers a combination of approaches to data analysis (i.e. sequential and concurrent, parallel and concurrent, or sequential and parallel) were used. In the next section, we have selected papers to illustrate the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ).

3.2. Using the methodological metaphor of triangulation

We have selected four papers from our review ( Lukkarinen, 2005 , Midtgaard et al., 2006 , Shipman et al., 2008 , Skilbeck et al., 2005 ) to illustrate how the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) can be applied to mixed methods studies. Each of these studies has been used to illustrate how the metaphor of triangulation can be applied to studies producing: (i) complementary findings, (ii) convergent findings, and (iii) divergent findings. In the following section, we demonstrate how the application of the metaphor can be used as a framework both to develop theory and to facilitate the interpretation of the findings from mixed methods studies and their conclusions in each of these scenarios, and how using the metaphor can help to promote greater clarity of the study's purpose, its theoretical propositions, and the links between data sets.

3.2.1. Triangulating complementary results

To exemplify the use of the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) for drawing inferences from complementary results, we have drawn on the results of a UK based study by Shipman et al. (2008) ( Fig. 2 ). In the UK, members of district nursing teams (DNs) provide most nursing care to people at home in the last year of life. Following concerns that inadequate education might limit the confidence of some DNs to support patients and their carers’ at home, and that low home death rates may in part be related to this, the Department of Health (DH) identified good examples of palliative care educational initiatives for DNs and invested in a 3-year national education and support programme in the principles and practice of palliative care. Shipman et al.’s study evaluates whether the programme had measurable effects on DN knowledge and confidence in competency in the principles and practice of palliative care. The study had two parts, a summative (concerned with outcomes) quantitative component which included ‘before and after’ postal questionnaires which measured effects on DNs’ ( n  = 1280) knowledge, confidence and perceived competence in the principles and practice of palliative care and a formative (concerned with process) qualitative component which included semi-structured focus groups and interviews with a sub-sample of DNs ( n  = 39).

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on complementary results in the study by Shipman et al. (2008) .

While their theoretical proposition may not be explicitly stated by the authors, there is clearly an implicit theoretical proposition that the educational intervention would improve DNs knowledge and confidence (theoretical proposition 1, Fig. 2 ). This was supported by the quantitative findings which showed significant improvement in the district nurses confidence in their professional competence post intervention. Qualitative results supported and complemented the quantitative findings as the district nurses described several benefits from the program including greater confidence in tackling complex problems and better communication with patient and carers’ because of greater understanding of the reasons for symptoms. Thus, a complementary theoretical proposition (theoretical proposition 2, Fig. 2 ) can be deduced from the qualitative findings: the DN's better understanding of factors contributing to complex problems and underlying reasons for symptoms led to improved confidence in competence raised from district nurses increased understanding.

Fig. 2 illustrates the theoretical propositions, the empirical findings from qualitative and quantitative data and the logical relationships between these. Theoretical proposition 1 is supported by the quantitative findings. From qualitative findings, a complementary theoretical proposition (theoretical proposition 2) can be stated explaining the process that led to the DNs improved confidence in competence.

3.2.2. Triangulating convergent results

To illustrate how the methodological metaphor of triangulation can be used to draw inferences from convergent findings, we have drawn on the example of a Danish study by Midtgaard et al. (2006) ( Fig. 3 ). This study was conducted to explore experiences of group cohesion and changes in quality of life (QoL) among people ( n  = 55) who participated in a weekly physical exercise intervention (for six weeks) during treatment for cancer. The study, conducted in a Danish hospital, involved the use of structured QoL questionnaires, administered at baseline and post intervention (at six weeks) to determine changes in QoL and health status, and qualitative focus groups, conducted post intervention (at six weeks), to explore aspects of cohesion within the group. With regards to the theoretical proposition of the study ( Fig. 3 ), group cohesion was seen as essential to understand the processes within the group that facilitated the achievement of desired outcomes and the satisfaction of affective needs as well as promoting a sense of belonging to the group itself.

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on convergent results in the study by Midtgaard et al. (2006) .

This proposition was deductively tested in an intervention where patients exercised in mixed gender groups of seven to nine members during a nine hour weekly session over a six week period and was supported by both the empirical quantitative and qualitative findings. The quantitative data showed significant improvements in peoples’ emotional functioning, social functioning and mental health. The qualitative data showed how the group setting motivated the individuals to pursue personal endeavors beyond physical limitations, that patients used each others as role models during ‘down periods’ and how exercising in a group made individuals feel a sense of obligation to train and to do their best. This subsequently helped to improve their social functioning which in turn satisfied their affective needs, improving their improved emotional functioning and mental health.

Fig. 3 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the logical relationships between these. Both the quantitative and qualitative findings, demonstrating improvements in participants’ emotional and social functioning and their mental health, can be attributed to the nature of group cohesion within the programme as expected.

3.2.3. Triangulating divergent results

Qualitative and quantitative results that seem to contradict each other are often explained as resulting from methodological error. However, instead of a methodological flaw, a divergent result could be a consequence of the inadequacy of the theoretical concepts used. This may indicate the need for changing or developing the theoretical concepts involved ( Erzberger and Kelle, 2003 ). The following example of using the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) for drawing inferences from divergent results is intended as an example rather than an attempt to change the theoretical concept involved. In a study by Skilbeck et al. (2005) ( Fig. 4 ), some results were found to be divergent which was explained as resulting from the use of inadequate questionnaires. We do not wish to critique their conclusion; rather we intend to simply offer an alternative interpretation for their findings.

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on divergent results using the study by Skilbeck et al. (2005) .

The study aimed to explore family carers’ expectations and experiences of respite services provided by one independent hospice in North England. This hospice provides inpatient respite beds specifically for planned respite admission for a two-week period. Referrals were predominated from general practitioners and patients and their carers were offered respite care twice a year, during the study this was reduced to once a year for each patient. Data was collected prior to respite admission and post respite care by semi-structured interviews and using the Relative Stress Scale inventory (RSSI), a validated scale to measure relative distress in relation to caring. Twenty-five carers were included but pre- and post-data were completed by 12 carers. Qualitative data was analysed by using a process of constant comparison and quantitative data by descriptive and comparative statistical analysis.

No clear theoretical proposition was stated by the authors, but from the definition of respite care it is possible to deduce that ‘respite care is expected to provide relief from care-giving to the primary care provider’ (theoretical proposition 1, Fig. 4 ). This proposition was tested quantitatively by pre- and post-test using the RSSI showing that the majority of carers experienced either a negative or no change in scores following the respite stay (no test of significance was stated). Accordingly, the theoretical proposition was not supported by the quantitative empirical data. The qualitative empirical results, however, were supportive in showing that most of the carers considered respite care to be important as it enabled them to have a break and a rest from ongoing care-responsibilities. From this divergent empirical data it could be suggested changing or developing the original theoretical proposition. It seems that respite care gave the carers relief from their care-responsibilities but not from the distress carers experienced in relation to caring (measured by the used scale). We would therefore suggest that in order to lessen distress related to caring, other types of support is also needed which would change the theoretical proposition as suggested (theoretical proposition 2).

Fig. 4 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the logical relationships between these. Theoretical proposition 1 was not supported by the quantitative findings (indicated in Fig. 4 by the broken arrow), but the qualitative findings supported this proposition. From these divergent empirical findings, the theoretical proposition could accordingly be changed and developed. Respite care seemed to provide relief from carers’ on-going care-responsibilities, but other types of support need to be added to provide relief from distress experienced (theoretical proposition 2).

3.2.4. Triangulation to produce theoretical propositions

Methodological triangulation has also been applied to illustrate how theoretical propositions can be produced by drawing on the findings from a Finnish study by Lukkarinen (2005) ( Fig. 5 ). The purpose of this longitudinal study was to describe, explain and understand the subjective health related quality of life (QoL) and life course of people with coronary artery disease (CAD). A longitudinal quantitative study was undertaken during the year post treatment and 19 individuals also attended thematic interviews one year after treatment. This study is one of the few studies that clearly defines theoretical underpinnings for both the selected methods and their purpose, namely “to obtain quantitatively abundant average information about the QoL of CAD patients and the changes in it as well as the patients’ individual, unique experiences of their respective life situations” ( Lukkarinen, 2005 :622).

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) to develop theory from the study by Lukkarinen (2005) .

The results of the quantitative analysis showed that the male and female CAD patients in the youngest age group had the poorest QoL. While patients’ QoL improved in the dimensions of pain, energy and mobility it deteriorated on dimensions of social isolation, sleep and emotional reactions. From the viewpoint of methodological triangulation used in the study the aim of the quantitative approach was to observe changes in QoL at the group level and also explore correlations of background factors to QoL. The qualitative approach generated information concerning both QoL in the individuals’ life situation and life course and the individuals’ rehabilitation. Both the quantitative and the qualitative analysis showed the youngest CAD patients to have the poorest psychosocial QoL. The results obtained using qualitative methods explained the quantitative findings and offered new insight into the factors related to poor psychosocial QoL, which could be used to help develop theoretical propositions around these. Patients at risk of poorer QoL were those with an acute onset of illness at a young age that led to an unexpected termination of career, resulting in financial problems, and worries about family. This group also experienced lack of emotional support (especially the females with CAD) and were concerned for the illness that was not alleviated by treatment. The interviews and the method of phenomenological psychology therefore helped to gain insight into the participants’ situational experience of QoL and life course, not detectable by the use of a questionnaire.

Fig. 5 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the relationships between these. The use of the mixed methods approach enabled a clearer understanding to emerge in relation to the lived experience of CAD patients and the factors that were related to poor QoL. This understanding allows new theoretical propositions about these issues to be developed and further explored, as depicted at the theoretical level.

4. Discussion

As the need for, and use of, mixed methods research continues to grow, the issue of quality within mixed methods studies is becoming increasingly important ( O’Cathain et al., 2008 , O’Cathain et al., 2007 ). Similarly, the need for guidance on the analysis and integration of qualitative and quantitative data is a prominant issue ( Bazeley, 2009 ). This paper firstly intended to review the types of analytic approaches (parallel, concurrent or sequential data analysis) that have been used in mixed methods studies within healthcare research. As identified in previous research ( O’Cathain et al., 2008 ), we found that the majority of studies included in our review employed parallel data analysis in which the different analyses are not compared or consolidated until the full analysis of both data sets have been completed. A trend to conduct separate analysis on quantitative and qualitative data is apparent in mixed methods healthcare studies, despite the fact that if the data were correlated, a more complete picture of a particular phenomenon may be produced ( Onwuegbuzie and Teddlie, 2003 ). If qualitative and quantitative data are not integrated during data collection or analysis, the findings may be integrated at the stage of interpretation and conclusion.

Although little pragmatic guidance exists within the wider literature, Erzberger and Kelle (2003) have published some practical advice, on the integration of mixed methods findings. For mixed methodologists, the ‘triangulation metaphor’ offers a framework to facilitate a description of the relationships between data sets and theoretical concepts and can also assist in the integration of qualitative and quantitative data ( Erzberger and Kelle, 2003 ). Yet despite the fact that the framework was published in 2003 within Tashakkori and Teddlie's (2003) seminal work, the Handbook for Mixed Methods in Social and Behavioural Research, our search revealed that it has received little application within the published body of work around mixed methods studies since its publication. This is surprising since mixed methodologists are acutely aware of the lack of guidance with regards to the pragmatics and practicalities of conducting mixed methods research ( Bryman, 2006 , Leech et al., 2010 ). Furthermore, there have been frequent calls to move the field of mixed methods away from the “should we or shouldn’t we” debate towards the practical application, analysis and integration of mixed methods and its’ findings and what we can learn from each other's work and advice. Consequently, we have a state of ambiguity and instability in the field of mixed methods in which mixed methodologists find themselves lacking appropriate sources or evidence to draw upon with which to facilitate the future design, conduct and interpretation of mixed methods studies. It is for these reasons that we, in this paper, also intended to identify and select studies that could be used as examples for the application of Erzberger and Kelle's (2003) triangulation metaphor.

When reviewing the studies it was clear that the majority of theoretical assumptions were implicit, rather than explicitly stated by authors. Wu and Volker (2009) previously acknowledged that while studies undoubtedly have a theoretical basis in their literature reviews and the nature of their research questions, they often fail to clearly articulate a particular theoretical framework. This is unfortunate as theory can help researchers to clarify their ideas and also help data collection, analysis and to improve the study's rigour ( Wu and Volker, 2009 ). When using triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ), researchers are encouraged to articulate their theoretical propositions and to validate their conclusions in relation to the chosen theories. Theory can also guide researchers when defining outcome measures . Should the findings not support the chosen theory, as shown in our examples on complementary and divergent results, researchers can modify or expand their theory accordingly and new theory may be developed ( Wu and Volker, 2009 ). It is therefore our belief that using triangulation as a methodological metaphor in mixed methods research can also benefit the design of mixed method studies.

Like other researchers ( O’Cathain et al., 2008 ), we have also found that most of the papers reviewed lacked clarity in whether the reported results primarily stemmed from qualitative or quantitative findings. Many of the papers were even less clear when discussing their results and the basis of their conclusions. The reporting of mixed methods studies is notoriously challenging, but clarity and transparency are, at the very least, crucial in such reports ( O’Cathain, 2009 ). Using triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ) may be one way of addressing this lack of clarity by explicitly showing the types of data that researchers have based their interpretations on. It may even help address some of the issues raised in the debate on the feasibility of integrating research methods and results stemming from different epistemological and ontological assumptions and paradigms ( Morgan, 2007 , Sale et al., 2002 ). In order to carry out methodological triangulation researchers also need to identify and observe the consistency and adequacy of the two methods, positivistic and phenomenological regarding the research questions, data collection, methods of analysis and conclusions.

While we used systematic principles in our search for mixed methods studies in healthcare research, we cannot claim to have included all such studies. In many cases, reports of mixed methods studies are subjected to ‘salami slicing’ by researchers and hence the conduct of, and findings from, individual approaches are addressed in separate papers. Since these papers are often not indexed as a ‘mixed method’ study, they are undoubtedly more difficult to identify. Furthermore, different terminologies are used to describe and index mixed methods studies within the electronic databases ( Halcomb and Andrew, 2009a ), making it challenging to be certain that all relevant studies were captured in this review. However, the studies included in this review should give a sufficient overview of the use of mixed analysis in healthcare research and most importantly, they enable us to make suggestions for the future design, conduct, interpretation and reporting of mixed methods studies. It is also important to emphasise that we have based our triangulation examples on the data published but have no further knowledge of the analysis and findings undertaken by the authors. The examples should thus be taken as examples and not alternative explanations or interpretations.

Mixed methods research within healthcare remains an emerging field and its use is subject to much debate. It is therefore particularly important that researchers clearly describe their use of the approach and the conclusions made to improve transparency and quality within mixed methods research. The use of triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ) can help researchers not only to present their theoretical propositions but also the origin of their results in an explicit way and to understand the links between theory, epistemology and methodology in relation to their topic area. Furthermore it has the potential to make valid inferences, challenge existing theoretical assumptions and to develop or create new ones.

Conflict of interest

None declared.

Ethical approval

Not required.

• Abadia C.E., Oviedo D.G. Bureaucratic itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems. Social Science & Medicine. 2009; 68 (6):1153–1160. [ PubMed ] [ Google Scholar ]
• Bazeley P. Analysing mixed methods data. In: Andrew S., Halcomb E.J., editors. Mixed Methods Research for Nursing and the Health Sciences. Wiley-Blackwell; Chichester: 2009. pp. 84–118. [ Google Scholar ]
• Beatty P.W., Neri M.T., Bell K., DeJong G. Use of outcomes information in acute inpatient rehabilitation. American Journal of Physical Medicine & Rehabilitation. 2004; 83 (6):468–478. [ PubMed ] [ Google Scholar ]
• Bernardi L., Kleim S., von der Lippe H. Social influences on fertility: a comparative mixed methods study in Eastern and Western Germany. Journal of Mixed Methods Research. 2007; 1 (1):23–47. [ Google Scholar ]
• Brannen J. Prologue: mixed methods for novice researchers: reflections and themes. International Journal of Multiple Research Approaches. 2009; 3 (1):8–12. [ Google Scholar ]
• Bryman A. University Press; Oxford: 2004. Social Research Methods. [ Google Scholar ]
• Bryman A. Integrating quantitative and qualitative research: how is it done? Qualitative Research. 2006; 6 (1):97–113. [ Google Scholar ]
• Bryman A. Barriers to integrating quantitative and qualitative research. Journal of Mixed Methods Research. 2007; 1 (1):8–22. [ Google Scholar ]
• Bussing R., Koro-Ljungberg M.E., Gary F., Mason D.M., Garvan C.W. Exploring help-seeking for ADHD symptoms: a mixed-methods approach. Harvard Review of Psychiatry. 2005; 13 (2):85–101. [ PubMed ] [ Google Scholar ]
• Canales M.K., Rakowski W. Development of a culturally specific instrument for mammography screening: an example with American Indian women in Vermont. Journal of Nursing Measurement. 2006; 14 (2):99–115. [ PubMed ] [ Google Scholar ]
• Cheng G.Y. A study of clinical questions posed by hospital clinicians. Journal of the Medical Library Association. 2004; 92 (4):445–458. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Clarke P.N., Yaros P.S. Research blenders: commentary and response. Transitions to new methodologies in nursing sciences. Nursing Science Quarterly. 1988; 1 (4):147–151. [ PubMed ] [ Google Scholar ]
• Cochrane, 2009. Cochrane Handbook for Systematic Reviews of Interventions. http://www.cochrane-handbook.org/ . The Cochrane Collaboration.
• Creswell J.W. Sage; Thousand Oaks: 2003. Research Design: Qualitative, Quantitative and Mixed Methods Approaches. [ Google Scholar ]
• Creswell J.W., Plano Clark V.L. Sage; Thousand Oaks: 2007. Designing and Conducting Mixed Methods Research. [ Google Scholar ]
• Erzberger C., Kelle U. Making inferences in mixed methods: The rules of integration. In: Tashakkori A., Teddlie C., editors. Handbook of Mixed Methods in Social & Behavioural Research. Sage; Thousand Oaks: 2003. pp. 457–488. [ Google Scholar ]
• Foss C., Ellefsen B. The value of combining qualitative and quantitative approaches in nursing research by means of method triangulation. Journal of Advanced Nursing. 2002; 40 (2):242–248. [ PubMed ] [ Google Scholar ]
• Halcomb E.J., Andrew A. Managing mixed methods projects. In: Andrew S., Halcomb E.J., editors. Mixed Methods Research for Nursing and the Health Sciences. Wiley-Blackwell; Chichester: 2009. pp. 50–64. [ Google Scholar ]
• Halcomb E.J., Andrew A., Brannen J. Introduction to mixed methods research for nursing and the health sciences. In: Andrew S., Halcomb E.J., editors. Mixed Methods Research for Nursing and the Health Sciences. Wiley-Blackwell; Chichester: 2009. pp. 3–12. [ Google Scholar ]
• Halcomb E.J., Davidson P.M., Griffiths R., Daly J. Cardiovascular disease management: time to advance the practice nurse role? Australian Health Review. 2008; 32 (1):44–53. [ PubMed ] [ Google Scholar ]
• Jick T.D. Mixing qualitative and quantitative methods: triangulation in action. Administrative Science Quarterly. 1979; 24 :602–611. [ Google Scholar ]
• Johnson R.B., Onquegbuzie A.J. Mixed methods research: a paradigm whose time has come. Educational Researcher. 2004; 33 (7):14–26. [ Google Scholar ]
• Kartalova-O’Doherty Y., Tedstone Doherty D. Satisfied carers of persons with enduring mental illness: who and why? The International Journal of Social Psychiatry. 2009; 55 (3):257–271. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kelle U. Sociological explanations between micro and macro and the integration of qualitative and quantitative methods. Forum: Qualitative Social Research. 2001; 2 (1):5. Art. [ Google Scholar ]
• Khan K.S. Centre for Review and Dissemination; York: 2001. Undertaking Systematic Reviews of Research on Effectiveness: CRD's Guidance for those Carrying Out or Commissioning Reviews. [ Google Scholar ]
• Kroll T., Neri M. Designs for mixed methods research. In: Andrew S., Halcomb E.J., editors. Mixed Methods Research for Nursing and the Health Sciences. Wiley-Blackwell; Chichester: 2009. pp. 31–49. [ Google Scholar ]
• Leech N.L., Dellinger A.M., Brannagan K.B., Tanaka H. Evaluating mixed research studies: a mixed methods approach. Journal of Mixed Methods Research. 2010; 4 (1):17–31. [ Google Scholar ]
• Lukkarinen H. Methodological triangulation showed the poorest quality of life in the youngest people following treatment of coronary artery disease: a longitudinal study. International Journal of Nursing Studies. 2005; 42 (6):619–627. [ PubMed ] [ Google Scholar ]
• Midtgaard J., Rorth M., Stelter R., Adamsen L. The group matters: an explorative study of group cohesion and quality of life in cancer patients participating in physical exercise intervention during treatment. European Journal of Cancer Care. 2006; 15 (1):25–33. [ PubMed ] [ Google Scholar ]
• Morgan D.L. Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods. Journal of Mixed Methods Research. 2007; 1 (1):48–76. [ Google Scholar ]
• O’Cathain A. Reporting mixed methods projects. In: Andrew S., Halcomb E.J., editors. Mixed Methods Research for Nursing and the Health Sciences. Wiley-Blackwell; Chichester: 2009. pp. 135–158. [ Google Scholar ]
• O’Cathain A., Murphy E., Nicholl J. Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study. BMC Health Services Research. 2007; 7 :85. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• O’Cathain A., Murphy E., Nicholl J. The quality of mixed methods studies in health services research. Journal of Health Services Research & Policy. 2008; 13 (2):92–98. [ PubMed ] [ Google Scholar ]
• Onwuegbuzie A., Teddlie C. A framework for analysing data in mixed methods research. In: Tashakkori A., Teddlie C., editors. Handbook of Mixed Methods in socIal & Behavioural Research. Sage; Thousands Oak: 2003. pp. 351–383. [ Google Scholar ]
• Onwuegbuzie A.J., Leech N.L. On becoming a pragmatic researcher: the importance of combining quantitative and qualitative methodologies. International Journal of Social Research Methodology. 2005; 8 (5):375–387. [ Google Scholar ]
• Sale J.E.M., Lohfeld L.H., Brazil K. Revisiting the quantitative-qualitative debate: implications for mixed methods research. Quality and Quantity. 2002; 36 :43–53. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Shipman C., Burt J., Ream E., Beynon T., Richardson A., Addington-Hall J. Improving district nurses’ confidence and knowledge in the principles and practice of palliative care. Journal of Advanced Nursing. 2008; 63 (5):494–505. [ PubMed ] [ Google Scholar ]
• Skilbeck J.K., Payne S.A., Ingleton M.C., Nolan M., Carey I., Hanson A. An exploration of family carers’ experience of respite services in one specialist palliative care unit. Palliative Medicine. 2005; 19 (8):610–618. [ PubMed ] [ Google Scholar ]
• Steckler A., McLeroy K.R., Goodman R.M., Bird S.T., McCormick L. Toward integrating qualitative and quantitative methods: an introduction. Health Education Quarterly. 1992; 19 (1):1–8. [ PubMed ] [ Google Scholar ]
• Tashakkori A., Creswell J.W. Editorial: the new era of mixed methods. Journal of Mixed Methods Research. 2007; 1 (1):3–7. [ Google Scholar ]
• Tashakkori A., Teddlie C. Sage; Thousands Oak: 2003. Handbook of Mixed Methods in Social & Behavioural Research. [ Google Scholar ]
• Wu H.L., Volker D.L. The use of theory in qualitative approaches to research: application in end-of-life studies. Journal of Advanced Nursing. 2009; 65 (12):2719–2732. [ PubMed ] [ Google Scholar ]

Is the worldview of qualitative inquiry a proper guide for psychological research?

Affiliation.

• 1 Purdue University, West Lafayette, IN 47907-1364, USA.
• PMID: 15989123

Qualitative methods are becoming increasingly popular in psychology. Although the distinction between qualitative and quantitative often is stated in terms of methods, the real distinction is between worldviews: that favored by most qualitative methodologists, which emphasizes subjective experience and multiple realities, and that commonly accepted in science. The worldview accepted by most adherents of qualitative inquiry suggests the exclusive use of methods that include verbal reports of lived experience. Qualitative methods serve an important function in psychology, but their use as recommended by their adherents is limited in 2 respects: The adherents use a narrow and unconventional approach to qualitative methods that differs from that normally understood, and they favor use of a restricted range of qualitative methods over other qualitative methods and quantitative methods. If qualitative inquiry is to make a greater contribution to psychology, researchers in that tradition must acquire a better understanding of contemporary science, correct their misunderstandings of the rationale for quantitative methods, and address the apparent limitations of their methods emphasizing reported experience.

• Psychology / methods*
• Qualitative Research*

Positivism and Realism

• Living reference work entry
• First Online: 16 January 2018
• Cite this living reference work entry

• Priya Khanna 2  

3862 Accesses

Theory and practice of research in health social sciences involves a unique synergy of a range of quantitative, qualitative, and hybrid methodologies derived from parent disciplines of medicine, nursing, and various other branches of social sciences such as sociology and psychology. While the methodological diversity enhances the scope of research and implications of research findings, it also renders the necessity for the investigator to explicitly address the implicit theoretical stances and philosophical assumptions underpinning the evidentiary claims. Still inherent among the investigators in health social sciences is to present their evidentiary claims in binary terms of whether an intervention/initiative worked or not, as opposed to why it worked and for whom. This tendency to gauge the strength of evidence in terms of objectivity and replicability seems to be emerging from the deep rooted desires for control and prediction of phenomena under investigation as opposed to meaning-making. While taking the readers on a brief journey through the emergence of history and philosophy of western science, this chapter aims to provide a deeper understanding of two major philosophical foundations of research methodologies: positivism, a theoretical stance underpinning rigor and objectivity in science and scientific method, and realism, an ontological perspective examining the truth of mind-independent reality. It is suggested that a closer inspection of emergence of scientific inquiry and its underpinnings will facilitate a better understanding of research designs and outcomes, especially for contemporary complex environments in which various initiatives in health social sciences operate.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Achinstein P. Science rules: a historical introduction to scientific methods. Baltimore: John Hopkins University Press; 2004.

Google Scholar  

Bernard HR. Research methods in anthropology: qualitative and quantitative approaches. Maryland: Rowman & Littlefield; 2011.

Bhaskar R. A realist theory of science. London: Routledge; 1975.

Bird A. Philosophy of science. London: Routledge; 2006.

Bourdeau M. Auguste comte. In: Zalta NE, editors. The stanford encyclopedia of philosophy (Winter 2015 Edition). 2008. Available at: https://plato.stanford.edu/archives/win2015/entries/comte/ .

Boyd RN. On the current status of the issue of scientific realism. In: Hempel CG, Putnam H, Essler WK, editors. Methodology, epistemology, and philosophy of science. Dordrech: Springer; 1983. p. 45–90.

Chapter   Google Scholar  

Cacioppo JT, Semin GR, Berntson GG. Realism, instrumentalism, and scientific symbiosis: psychological theory as a search for truth and the discovery of solutions. Am Psychol. 2004;59(4):214–23.

Article   Google Scholar  

Capra F. The turning point. London: Flamingo; 1982.

Capra F. The Tao of physics: an exploration of the parallels between modern physics and eastern mysticism. London: Flamingo; 1992.

Chakravartty A. Scientific realism. In: Zalta NE, editor. The stanford encyclopedia of philosophy (Summer 2017 Edition). 2011. Available at: https://plato.stanford.edu/archives/sum2017/entries/scientific-realism/ .

Cochran M. Deweyan pragmatism and post-positivist social science in IR. Millennium. 2002;31(3):525–48.

Crotty M. The foundations of social science research. Crow Nest: Allen & Unwin; 1998.

Dalkin SM, Greenhalgh J, Jones D, Cunningham B, Lhussier M. What’s in a mechanism? Development of a key concept in realist evaluation. Implement Sci. 2015;10(49):1–7.

Dardo M. Nobel laureates and twentieth-century physics. Cambridge: Cambridge University Press; 2004.

d’Espagnat B. On physics and philosophy, vol. 417. Princeton: Princeton University Press; 2006.

Evangelopoulos G. Scientific realism in the philosophy of science and international relations. Unpublished PhD thesis. London: The London School of Economics and Political Science (LSE); 2013.

Fox NJ. Post-positivism. In: Given LM, editor. The Sage encyclopaedia of qualitative research methods. London: SAGE; 2008. p. 661–664.

Grant BM, Giddings LS. Making sense of methodologies: a paradigm framework for the novice researcher. Contemp Nurse. 2002;13(1):10–28.

Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin N, Lincoln Y, editors. Handbook of qualitative research. Thousand Oaks: SAGE; 1994. p. 105–17.

Hjørland B. Empiricism, rationalism and positivism in library and information science. J Doc. 2005;61(1):130–55.

Kincaid H. Positivism in the social sciences. In: Edward JC, editor. Routledge encyclopedia of philosophy (Version 1.0). London: Routledge; 1998. p. 558–561.

Klee R. The Kuhnian model of science. In: Scientific inquiry: readings in the philosophy of science. Oxford: Oxford University Press; 1999. p. 199–201.

Lee AS. Integrating positivist and interpretive approaches to organizational research. Organ Sci. 1991;2(4):342–65.

Maxwell J. What is realism, and why should qualitative researchers care. In: Maxwell J, editor. A realist approach for qualitative research. London: SAGE; 2012. p. 3–14.

Moreau KA, Eady K. Connecting medical education to patient outcomes: the promise of contribution analysis. Med Teach. 2015;37(11):1060–2.

Norman G. Generalization and the qualitative-quantitative debate. Adv Health Sci Educ. 2017;22(5):1051–5.

Pawson R, Tilley N. Realist evaluation. London: SAGE; 1997.

Reichenbach M, Cohen R. Hans Reichenbach – selected writings, 1909–1953, vol. 1. Dordrecht: D. Reidel Publishing Company; 1978.

Richard C. Logical empiricism. In: Zalta EN, editors. The stanford encyclopedia of philosophy. 2017. Available at: https://plato.stanford.edu/archives/fall2017/entries/logical-empiricism/ .

Riley DJ. The paradox of positivism. Soc Sci Hist. 2007;31(1):115–26.

Ritzer G, Stepnisky J. Classical sociological theory. Thousand Oaks: Sage; 2017.

Russell B. History of Western philosophy: collectors edition. Abington: Routledge; 2013.

Sharrock WW. Kuhn: philosopher of scientific revolutions. Oxford: Polity Press; 2002.

Van Bavel J, Mende-Siedlecki P, Brady W, Reinero A. Contextual sensitivity in scientific reproducibility. Proc Natl Acad Sci. 2016;113(23):6454–9.

Van Fraassen B. The scientific image. Oxford: Oxford University Press; 1980.

Book   Google Scholar  

Wight C. Philosophy of social science and international relations. In: Walter C, Thomas R, Simmons B, editors. Handbook of international relations. Thousand Oaks: SAGE; 2002. p. 23–51.

Wong G, Westhorp G, Greenhalgh J, Jagosh J, Greenhalgh T. RAMESES II reporting standards for realist evaluations. BMC Med. 2016;14(96):1–18.

Download references

Author information

Authors and affiliations.

Sydney Medical Program, University of Sydney, Camperdown, NSW, Australia

Priya Khanna

You can also search for this author in PubMed   Google Scholar

Editor information

Editors and affiliations.

Health, Locked Bag 1797, CA.02.35, Western Sydney Univ, School of Science & Health, Locked Bag 1797, CA.02.35, Penrith, New South Wales, Australia

Pranee Liamputtong

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this entry

Cite this entry.

Khanna, P. (2018). Positivism and Realism. In: Liamputtong, P. (eds) Handbook of Research Methods in Health Social Sciences . Springer, Singapore. https://doi.org/10.1007/978-981-10-2779-6_59-1

Download citation

DOI : https://doi.org/10.1007/978-981-10-2779-6_59-1

Received : 27 December 2017

Accepted : 02 January 2018

Published : 16 January 2018

Publisher Name : Springer, Singapore

Print ISBN : 978-981-10-2779-6

Online ISBN : 978-981-10-2779-6

eBook Packages : Springer Reference Social Sciences Reference Module Humanities and Social Sciences Reference Module Business, Economics and Social Sciences

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• Search Menu
• Sign in through your institution
• Advance articles
• Author Guidelines
• Submission Site
• Open Access
• About Family Practice
• Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Self-Archiving Policy
• Dispatch Dates
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, what is general practice research, conducting general practice research, ‘how to do’ qualitative research in general practice, the philosophical underpinnings of qualitative research.

• < Previous

Doing qualitative research in general practice: methodological utility and engagement

• Article contents
• Figures & tables
• Supplementary Data

Chrystal Jaye, Doing qualitative research in general practice: methodological utility and engagement, Family Practice , Volume 19, Issue 5, October 2002, Pages 557–562, https://doi.org/10.1093/fampra/19.5.557

• Permissions Icon Permissions

Abstract. General practice uses an eclectic range of research methodology. This includes increasing reliance upon qualitative research methods. There seem to be two distinct treatments of qualitative research within primary care and, in particular, within general practice research. The first is characterized by a purely utilitarian and technical focus, using a qualitative method because it is the most appropriate means of realizing the aims of the research, while the second is characterized by in-depth engagement with the philosophical and paradigmatic aspects of qualitative methodology. In-depth engagement with methodology and theory, and theory building, is an important aspect of masterate and doctoral research within social sciences such as education and anthropology, and in the discipline of nursing, but has not been a feature of qualitative research in medicine. A practical difficulty encountered within postgraduate programmes such as the one in which the author teaches is that when innovative qualitative techniques are used by GPs in their postgraduate research dissertations and theses, it is often beyond GP examiners’ own knowledge and experience, yet it fails to measure up to standards established in social sciences, particularly in sociology and anthropology where in-depth reflexive engagement with the theory and philosophy of qualitative methodology is expected. This paper suggests that the value of in-depth engagement with methodology when conducting qualitative research results in creative and innovative ways of conducting research that are consonant with the nature of general practice itself, and strengthens research findings. Therefore, as teachers of research methods and supervisors of research theses, it is important to encourage students conducting qualitative research to engage fully with theoretical and methodological issues.

Jaye C. Doing qualitative research in general practice: methodological utility and engagement. Family Practice 2002; 19: 557–562.

The use of qualitative methods is increasing in general practice research. Thomas et al ., 1 for example, found in a review of publications on general practice research that around half of the studies surveyed had used qualitative methodologies. Interestingly, they also found that academic GPs and departments were more likely to use qualitative methodologies.

This trend is reflected in the research conducted by GPs participating in postgraduate programmes in the author’s department. The more traditional clinical topics researched using quantitative methods are still initiated, but there are increasing numbers of topics with a broader orientation around practice that are researched using a variety of qualitative methods. These topics include primary health care in rural settings, the reasons why patients change doctors, GPs’ experience of disciplinary complaints, GP supervision, the ‘sick role’ in pregnancy and the experiences of parents with chronically ill children. 2– 9

The theses listed above were researched using a variety of data collection and analytical methods that are part of the social science arsenal. An apt description of this genre is characterized by the term social general practice research . The idea of social general practice research reflects both the issues that interest GPs and the adaptation of social science methodologies to research these interests. These methodologies include various interview techniques, narrative and text analysis, qualitative and quantitative surveys, observation and ethnographic techniques, case studies and group discussion.

While these methods are adopted for their utility, there is a variable degree of engagement and reflection by thesis students in the philosophical issues inherent in qualitative methodology and in their application or utilization of it. Similarly, there is variability in the degree of engagement with theory building and the complexity of this process, as well as the results of this process. One reason for this, perhaps, is the implicit pragmatic and technical focus of medical training and practice. Another reason may lie in the teaching of research methods courses within general practice and emphasis on the utility of qualitative methods over methodological engagement.

While in-depth engagement with methodological and theoretical aspects of research are important tasks for masterate and doctorate research in social sciences and nursing, it does not appear to be such an integral task for equivalent research in general practice. This paper discusses the relationship between general practice and qualitative research, and argues that while a traditional pragmatic and applied approach to research has a primary focus on the utility of research methods, social general practice research would benefit greatly from in-depth engagement with methodology.

General practice research has been described as being fundamentally different from other types of medical research because of the nature or landscape of primary care, particularly the diversity inherent in the general practice environment, and the questions that arise from this context. 10, 11

There are varying opinions on what actually constitutes general practice research. For example, Herbert 12 advocates that primary care research be action oriented and community oriented. Tilyard and Dovey 13 suggest that general practice research is anything that arises from a question generated in practice and as such is critically dependent on the context of general practice. Crabtree and Miller describe general practice research as multilayered and complex, with legitimate focus on global, community, family and individual levels, as well as organ, genome and cellular levels. They suggest that the significance of general practice research is that it connects macro-level aspects of health and healing with micro-level aspects of specific primary care activities. 14 Similarly, Thomas et al . 1 found in a review of publications in general practice that general practice research ranges from clinical research to social problems, and the administration and organization of primary care.

There are obvious similarities between general practice and the social and behavioural sciences. Helman 15 asserts that primary care research is moving towards being an applied social science as well as an applied medical science. The common features of general practice and social science are implicit in Shapiro’s 16 description of general practice as an ecological science rather than as a reductionist science. Similarly, Stott 17 describes general practice research as socio-medical research.

Ultimately, Herbert suggests, 12 general practice research is generated and conducted in general practice or primary care settings, carried out by GPs, nurse practitioners and other affiliated academics who work in primary care settings such as epidemiologists, statisticians and social scientists, and above all has relevance to those conducting the research. It might or might not be action oriented, and could be pure or applied, interest driven or clinically driven.

Much of general practice and primary care research is based on the assumptions and perspectives of specialized biomedicine. However, biomedical researchers historically have given little attention to the relief of suffering, or to patients’ experiences of illness, treatment, and recovery—issues that are characteristic of general practice. 18 The development of research methodologies in general practice goes hand in hand with the development of the discipline itself. 14, 16 Specifically, research methods were developed in general practice that could capture the “richness of texture experienced in family practice”. 19 As a result, general practice research is highly eclectic and not limited by a defined set of tools and approaches. 10

Shapiro, in particular, argues for authenticity in general practice research. By this, she indicates that general practice must remain true to its own philosophical foundations and develop its own arsenal of research methodologies that are relevant and specific to the discipline, rather than attempting to gain legitimacy in the eyes of other biomedical disciplines by using traditional but inappropriate methods, and uncritically adopting the theoretical assumptions that frame research in other areas of medicine. 16

Considering the parallels that have been drawn between social and behavioural science and general practice, it is not surprising that general practice has adopted the research methods associated with these fields. 15, 17 Tilyard and Dovey go so far as to suggest that this merging of social science research methods with clinical research methods in general practice research has overcome the traditional quantitative/qualitative dichotomy. 13

There are several reasons why general practice research adopted qualitative methodologies. For example, Britten and Fisher suggested that general practice is open to qualitative methods because, like family practice, it involves listening to people and becoming involved in their world; something that is already a motivating force in many GPs’ work. 20 Similarly, Helman noted that qualitative methodologies provide the most useful means of understanding why people behave in certain ways and for exploring the relationship between beliefs and behaviour. 15 Qualitative methods are also very useful for researching previously unexplored topics, and for generating research questions and hypotheses. 21

While there is agreement that qualitative methods are useful in exploring issues that are unique to general practice settings, it is suggested that these need to be modified in order to be useful to general practice. 22 As in every research endeavour in every discipline, it is important that qualitative research methods are chosen because they are the most appropriate means of meeting the aims of the research.

In addition to publications reporting qualitative research undertaken within general practice settings, the last decade has seen an increasing number of publications on how to do qualitative research in general practice. Many of these are concerned with issues of technical utility and rigour. How can a researcher ensure that their findings are reliable and valid? 21, 23– 27

There is an important semantic distinction to be made concerning the use of the term methodology. Methodology in traditional quantitative biomedical research is used most often in a very narrow sense to describe research methods, and is no more than a descriptive term for data collection and analysis. Methodology, however, has a much broader meaning in many social science disciplines such as social anthropology, sociology and education. It refers to the philosophical and epistemological underpinnings of knowing about the world, and the problematics of conducting research. Methodology differs from methods because it concerns the logical and philosophical assumptions of particular research methods. 28 The volume by Crabtree and Miller 29 attempts to situate qualitative or social general practice research and methodology within its philosophical and paradigmatic context.

There appear to be two primary issues concerning qualitative research being conducted within general practice postgraduate programmes in New Zealand. The first concerns familiarity and training in qualitative research on two levels: both the technical utility of the methods, and the philosophical or methodological issues involved in conducting qualitative research. Current undergraduate and postgraduate medical training does not necessarily equip medical students with the skills necessary for conducting and writing up qualitative research. This means that postgraduate GPs’ first research projects are most often embarked upon without the benefit of undergraduate training in social science and the practical and theoretical grounding this confers.

Some have suggested that the nature of general practice gives GPs a ‘natural’ affinity and ability as qualitative researchers. For example, Whittaker 30 suggests that the experience of being a GP parallels the experience of being an ethnographer conducting qualitative research because the GP is based in the community over a long period of time and learns to understand local knowledge and many of the individuals in it. The interview has been likened to an ethnographic interview, coming to understand patients’ perspectives and understandings. Helman 15 also outlines a number of similarities between GPs and ethnographers, the use of the case history method, taking of personal and social medical histories, participant observation of the community in which the practice is situated, and treating the patient within the context of his or her own family. Britten et al . astutely suggest it is a mistake to consider GP consulting the equivalent of qualitative interviewing. They argue that the orientation of the clinician to the patient is fundamentally different from the orientation or relationship between interviewer and interviewee. While the doctor translates the patients’ experiences and words into concepts that are consonant with etic biomedical models, the interviewer attempts to understand the interviewee’s experiences from an emic perspective. 21

Britten et al . suggest that an apprenticeship model is useful in learning to do qualitative research, working alongside an experienced researcher. 21 This is similar to the models expounded by Lave and Wenger, and Brown et al ., who argue that authentic learning occurs within communities of practice. 31, 32 Ideally, the supervisory relationship within an academic department provides this. However, this form of apprenticeship works well when students are situated within a department. One feature of many postgraduate programmes for GPs in New Zealand is that they are distance taught. This means that the community of practice is dispersed and the legitimate peripheral participation within these communities to which Lave and Wenger refer is peripheral in a very literal sense!

The specialized training or apprenticeship that is required in order to conduct rigorous and methodologically informed qualitative research has significant implications in terms of time and resources. 26 Part-time distance study combines with a lack of expertise in qualitative methodologies among academic GP supervisors and examiners to result in a failure by many thesis students to engage with the theoretical foundations of qualitative paradigms and methodologies. While there might be varying degrees of reflexivity, the resultant time pressure often means that qualitative methods are used predominantly for their technical utility.

The second issue concerns the review of qualitative research, both by reviewers for medical journals and examiners of research theses. Britten et al . 21 argued in 1995 that there was a need for reviewers in journals who are familiar with qualitative research. Around this time, several guidelines on evaluating qualitative research were published. 21, 24, 27 While the amount of published qualitative research in general practice publications is increasing, and editors are ensuring that methodological rigour is demonstrated in these publications, the problem of adequate supervision and examination of qualitative social general practice dissertations and theses remains, certainly in New Zealand.

A recent publication has warned of uncritically adopting a ‘cookbook’ approach to qualitative research. Barbour 33 argues that while checklists have their place in conferring respectability on qualitative research and in convincing sceptics of its thoroughness and rigour, there is evidence that they are sometimes being used prescriptively without real engagement in the underlying methodological issues. In conducting qualitative research, it is a mistake to assume that one size fits all. She suggests that technical fixes (those enjoying greatest popularity are grounded theory, purposive sampling, multiple coding, triangulation and respondent validation) achieve little unless grounded in broader understanding of the rationale and assumptions behind qualitative research.

The value of methodological engagement in qualitative research lies not only in improved research standards, because they are defensible, but also in the continuing development of qualitative methodologies that are specific to general practice, and therefore contribute to the maturation of the discipline itself. Such engagement also fosters an attitude of creative problem solving in research rather than prescriptiveness.

The philosophical underpinnings of qualitative research are discussed in varying detail by a number of general practice academics and researchers and can be summarized briefly as follows.

The goals of qualitative research are the usual point of departure from traditional quantitative methods. While quantitative research explores the relationships between discreet measurable variables and outcomes, qualitative research is used to explore meanings and patterns, inconsistencies and conflicts in people’s thoughts and behaviours. 21, 27

The researcher is positioned very centrally in qualitative research. This positioning requires a high degree of reflexivity on the part of the researcher. They need to be aware of the way that their own position and their a priori knowledge and assumptions impact upon all aspects of the research: development and design, data collection and interpretation. Bias, in qualitative research, has a slightly different meaning and is dealt with in a different way from quantitative research. 27, 34

Qualitative research is explicitly interpretive. Researchers acknowledge that the analytical process involves interpreting the meanings, values, experiences, opinions and behaviours of other people. This process has been described as descriptive-inductive to distinguish it from the hypothetico-deductive means of drawing results in quantitative research. 30, 35 There are a variety of analytical frameworks within qualitative methodologies that range from being explicitly intuitive and non-fragmenting, such as immersion– crystallization, 36 to those that fragment and code data within strict frameworks, such as some types of discourse analysis and grounded theory techniques. 37, 38 However, the interpretive and interactive nature of the relationship between the researcher and that being researched means that the analytical process necessarily involves a high degree of researcher subjectivity. The variability of this subjectivity is often managed in qualitative research through various techniques that confer validity and reliability, such as triangulation, respondent feedback and peer review.

This interpretive and interactive quality of qualitative research is a reflection of ontological and epistemological assumptions that often differ from those of traditional quantitative research. Most quantitative, and some qualitative research is underpinned by positivist and post-positivist understandings about the nature of the world and its ‘facts’, that it exists a priori and is measurable. However, much qualitative research is informed by constructivist paradigms that view the world and its ‘facts’ as fundamentally interpreted and constructed by individuals within social groups. 39, 40 Murphy and Mattson argue that this perspective is entirely congruent with much of general practice. 35

There is growing recognition within general practice that the utility of qualitative methods should be accompanied by some degree of reflection and engagement in methodological issues. 17, 29, 41 Malterud, for example, is adamant that evidence of reflection upon the preconceptions and theoretical frames of reference that frame the research process must be accounted for in qualitative health research. 34 The value of reflexivity and engagement is practical in that the standard of qualitative research conducted in general practice is improved. It moves from being prescriptive and following a ‘cookbook’ approach, to being defensible and justifiable in terms of meeting research aims. 42 It also becomes an enterprise in creative problem solving that fosters methodological innovation. There is also the potential that, as in other health fields, notably nursing, this engagement will contribute to an academic debate that is continually extending the trans-disciplinary dialogue surrounding qualitative methodologies. Barbour suggests that this potential is somewhat limited by the lack of a clear vocabulary in general practice at present for talking about the processes involved in theorizing. 41

There is obviously a need for engagement with qualitative methodology to be generated within the discipline of general practice itself. The difficulty lies not only in the unfamiliarity of many general practice researchers with the theory that underlies qualitative research, but also in the relative recent emergence of general practice as a discipline. Crabtree and Miller problematize the paradigmatic underpinnings that general practice and primary care have inherited uncritically from other biomedical specialties. They argue that medicine has been reluctant to engage with theory because they have ‘Truth’. They point out that qualitative research adds a critical component to the discipline of general practice in that it challenges clinicians and researchers alike to critique the foundations of the scientific endeavour and to be reflexive and creative in practice and research. 14

It is apparent that much qualitative or social general practice research is certainly conducted within the philosophical and theoretical foundations and assumptions that underpin traditional biomedical quantitative research with its positivist orientation. The adoption of qualitative methods is no guarantee of researcher reflexivity or engagement with the methodological issues of qualitative research. Many questions answered using qualitative methods do not require paradigmatic and theoretical reflection. For example, Murphy and Mattson suggest that the choice of qualitative or quantitative methods is purely a technical matter, although they qualify this by noting that understanding the philosophical and epistemological aspects of methodology enables an informed decision to be made.

The demonstration of philosophical or methodological engagement is compounded by journal requirements that papers be structured in the SIMRAD model, and that word limits be strictly adhered to. There is often not the room to discuss methodological niceties in these publications. As a result, there often is an implicit assumption about methodology inherent within short publications. For example, the recent publication by Oppewel and Meyboom-de Jong is typical of this. These researchers interviewed family members about their experiences of autopsy. Although it might be assumed that this research was conducted within an interpretive framework, nothing about analytical frameworks is mentioned, nor is there any discussion about the philosophical framing of the research. 43 In a thesis, however, there are often different expectations by supervisors and/or examiners. To start with, there is much more room to develop ideas and to explicate the theoretical framework. However, if qualitative methods have been adopted as a utility only, then any discussion of methods is often quite limited and conducted in the more traditional style of quantitative research as a descriptive account of the methods of data collection and analysis. If examiners are expecting engagement with the philosophical and theoretical foundations that underlie qualitative methodologies, this technical utility style will fail to meet their expectations.

Is it legitimate to use qualitative methods in social general practice research without engaging in the methodological issues of research? The answer to this question might be yes, but the point of this paper has been to argue that some engagement is necessary in order to conduct quality social general practice and qualitative research. This moves it away from being prescriptive and means that well-informed research is done with careful consideration of design, collection and analysis aspects, as well as an attitude of creative and innovative problem solving. Perhaps the quality of this engagement will improve as general practice matures as a discipline.

What should this engagement look like? Other social sciences have a history of academic debate in methodology. The point of this paper is not to suggest that methodological discourses in general practice should imitate those in other disciplines. Far from it. The author anticipates that the developing methodological discourse within general practice will continue to grow, becoming more complex as it matures and also strengthening its own discipline-specific character.

How can we encourage postgraduate GPs to engage with methodological issues? The answer to this question lies in encouraging students to develop critical and reflective attitudes toward what they learn in general. We should provide opportunities for students to become familiar with a variety of qualitative research designs across disciplinary boundaries and challenge them to consider methodological issues in the broadest sense, as well as the technical utility of research methods. We should also model qualitative research within our academic communities of practice, and allow our postgraduate students the opportunity to learn by participating within these academic communities.

We need to emphasize the creative and innovative problem-solving aspects of conducting research and we need to stimulate our students to problematize methodological issues such as representation and cultural relativity, as well as validity, credibility, reliability and authenticity. Students learn best by being able to build upon what they already know and making connections and transforming what they learn. 44 However, in the process of engaging with methodological issues and the epistemology and ontology underlying these, students need to be challenged to explore fully their own epistemological and ontological assumptions about the world. Once explicated, these can be problematized, providing a base for transformative learning. In this way, social general practice research of the future may be truly innovative and creative, generated from within the discipline itself to meet its own needs.

Thomas T, Fahey T, Somerset M. The content and methodology of research papers published in three United Kingdom primary care journals. Br J Gen Pract 1998 ; 48 : 1229 –1232.

Henderson R. Why doctors leave rural practice. Thesis. Dunedin: University of Otago, 2000.

Koelmeyer M. The sick role in pregnancy: a study of Samoan women in South Auckland. Thesis. Dunedin: University of Otago, 2000.

Gunatunga S. Changes in after-hours general practice. Thesis. Dunedin: University of Otago, 2000.

Wilson H. Supervision and the culture of general practice. Thesis. Dunedin: University of Otago, 2000.

Cunningham W. The effects of disciplinary complaints. Thesis. Dunedin: University of Otago, 1999.

Stewart J. Parents’ understanding of their child’s chronic illness. Thesis. Dunedin: University of Otago, 2001.

Hanne T. Attention deficit hyperactivity disorder—best cared for in general practice. Thesis. Dunedin: University of Otago, 2001.

Nicholls W. Opting out: why patients change doctors. Thesis. Dunedin: University of Otago, 2001.

Dovey S. General practice research in New Zealand: a personal view. NZ Fam Physician 1994 ; 21 : 189 –190.

Jones R. Primary care research: ends and means. Fam Pract 2000 ; 17 : 1 –4.

Herbert C. How can quality research be done in primary care practice? In Bass M, Dunn E, Norton P, Stewart M, Tudiver F (eds). Conducting Research in the Practice Setting . Newbury Park (CA): Sage, 1993: 15–26.

Tilyard M, Dovey S. Research in general practice of general practice research. NZ Med J 2000 ; 113 : 150 –151.

Crabtree B, Miller W. Introduction. In Crabtree B, Miller W (eds). Doing Qualitative Research , 2nd edn. London: Sage, 1999: xi–xvii.

Helman C. Research in primary care: the qualitative approach. In Norton P, Stewart M, Tudiver F, Bass M, Dunn E (eds). Primary Care Research: Traditional and Innovative Approaches . Newbury Park (CA): Sage, 1991: 105–124.

Shapiro J. Goals and methods of research: the challenge for family medicine. Fam Pract 1992 ; 9 : 92 –97.

Stott N. A research strategy for family medicine: pure or applied? In Bass M, Dunn E, Norton P, Stewart M, Tudiver F (eds). Conducting Research in the Practice Setting . Newbury Park (CA): Sage, 1993: 3–14.

Nutting P. Introduction. In Bass M, Dunn E, Norton P, Stewart M, Tudiver F (eds). Conducting Research in the Practice Setting . Newbury Park (CA): Sage, 1993: vii–xi.

McWhinney I. Primary care research in the next twenty years. In Norton P, Stewart M, Tudiver F, Bass M, Dunn E (eds). Primary Care Research: Traditional and Innovative Approaches . Newbury Park (CA): Sage, 1991: 1–12.

Britten N, Fisher B. Qualitative research and general practice. Br J Gen Pract 1993 ; 43 : 270 –271.

Britten N, Jones R, Murphy E, Stacy R. Qualitative research methods in general practice and primary care. Fam Pract 1995 ; 12 : 104 –114.

Norton P, Stewart M, Tudiver F, Bass M, Dunn E. Introduction. In Norton P, Stewart M, Tudiver F, Bass M, Dunn E (eds). Primary Care Research: Traditional and Innovative Approaches . Newbury Park (CA): Sage, 1991: vii–ix.

Hamberg K, Johansson E, Lindgren G, Westman G. Scientific rigour in qualitative research—examples from a study of women’s health in family practice. Fam Pract 1994 ; 11 : 176 –181.

Mays N, Pope C. Rigour and qualitative research. Br Med J 1995 ; 311 : 109 –112.

Armstrong D. Measuring man: some problems of method. Fam Pract 1996 ; 13 Suppl 1: S6 –S9.

Jones R. Qualitative research: challenges for integration support and dissemination. Fam Pract 1996 ; 13 Suppl 1: S22 –S26.

Elder N, Miller W. Reading and evaluating qualitative research studies. J Fam Pract 1995 ; 41 : 279 –285.

Tolich M, Davidson C. Starting Fieldwork: An Introduction to Qualitative Research in New Zealand . Auckland: Oxford University Press, 1999.

Crabtree B, Miller W. Doing Qualitative Research , 2nd edn. London: Sage, 1999.

Whittaker A. Qualitative methods in general practice research: experience from the Oceanpoint Study. Fam Pract 1996 ; 13 : 310 –316.

Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation . Cambridge: Cambridge University Press, 1991.

Brown J, Collins A, Duguid S. Situation cognition and the culture of learning. Educ Researcher 1989 ; 18 : 32 –42.

Barbour R. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? Br Med J 2001 ; 322 : 1115 –1117.

Malterud K. Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract 1993 ; 10 : 201 –206.

Murphy E, Mattson B. Qualitative research and family practice: a marriage made in heaven? Fam Pract 1992 ; 9 : 85 –91.

Borkan J. Immersion/crystallisation. In Crabtree B, Miller W (eds). Doing Qualitative Research , 2nd edn. London: Sage, 1999: 179–194.

Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques . London: Sage, 1990.

Miles M, Huberman M. Qualitative Data Analysis: An Expanded Sourcebook , 2nd edn. Newbury Park (CA): Sage, 1994.

Miller W, Crabtree B. Clinical research: a multimethod typology and qualitative roadmap. In Crabtree B, Miller W (eds). Doing Qualitative Research , 2nd edn. London: Sage, 1999: 3–31.

Guba E, Lincoln Y. Competing paradigms in qualitative research. In Denzin N, Lincoln Y (eds). The Landscape of Qualitative Research: Theories and Issues . London: Sage; 1998: 195–220.

Barbour R, Members of WoReN. Acquiring qualitative skills for primary care research. Review and reflections on a three-stage workshop. Part 2: analysing interview data. Fam Pract 2000 ; 17 : 83 –89.

Richards L. Doing Qualitative Research? (Don’t). Paper presented at Association for Qualitative Research Annual Conference. Melbourne: 3–7th July, 2001.

Oppewel F, Meyboom-de Jong B. Family members’ experiences of autopsy. Fam Pract 2001 ; 18 : 304 –308.

Biggs J. Teaching for Quality Learning at University: What the Student Does . Buckingham: Society for Research into Higher Education and Open University Education, 1999.

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1460-2229
• Copyright © 2024 Oxford University Press
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.