questionnaire vs interview in qualitative research

Chapter 11. Interviewing

Introduction.

Interviewing people is at the heart of qualitative research. It is not merely a way to collect data but an intrinsically rewarding activity—an interaction between two people that holds the potential for greater understanding and interpersonal development. Unlike many of our daily interactions with others that are fairly shallow and mundane, sitting down with a person for an hour or two and really listening to what they have to say is a profound and deep enterprise, one that can provide not only “data” for you, the interviewer, but also self-understanding and a feeling of being heard for the interviewee. I always approach interviewing with a deep appreciation for the opportunity it gives me to understand how other people experience the world. That said, there is not one kind of interview but many, and some of these are shallower than others. This chapter will provide you with an overview of interview techniques but with a special focus on the in-depth semistructured interview guide approach, which is the approach most widely used in social science research.

An interview can be variously defined as “a conversation with a purpose” ( Lune and Berg 2018 ) and an attempt to understand the world from the point of view of the person being interviewed: “to unfold the meaning of peoples’ experiences, to uncover their lived world prior to scientific explanations” ( Kvale 2007 ). It is a form of active listening in which the interviewer steers the conversation to subjects and topics of interest to their research but also manages to leave enough space for those interviewed to say surprising things. Achieving that balance is a tricky thing, which is why most practitioners believe interviewing is both an art and a science. In my experience as a teacher, there are some students who are “natural” interviewers (often they are introverts), but anyone can learn to conduct interviews, and everyone, even those of us who have been doing this for years, can improve their interviewing skills. This might be a good time to highlight the fact that the interview is a product between interviewer and interviewee and that this product is only as good as the rapport established between the two participants. Active listening is the key to establishing this necessary rapport.

Patton ( 2002 ) makes the argument that we use interviews because there are certain things that are not observable. In particular, “we cannot observe feelings, thoughts, and intentions. We cannot observe behaviors that took place at some previous point in time. We cannot observe situations that preclude the presence of an observer. We cannot observe how people have organized the world and the meanings they attach to what goes on in the world. We have to ask people questions about those things” ( 341 ).

Types of Interviews

There are several distinct types of interviews. Imagine a continuum (figure 11.1). On one side are unstructured conversations—the kind you have with your friends. No one is in control of those conversations, and what you talk about is often random—whatever pops into your head. There is no secret, underlying purpose to your talking—if anything, the purpose is to talk to and engage with each other, and the words you use and the things you talk about are a little beside the point. An unstructured interview is a little like this informal conversation, except that one of the parties to the conversation (you, the researcher) does have an underlying purpose, and that is to understand the other person. You are not friends speaking for no purpose, but it might feel just as unstructured to the “interviewee” in this scenario. That is one side of the continuum. On the other side are fully structured and standardized survey-type questions asked face-to-face. Here it is very clear who is asking the questions and who is answering them. This doesn’t feel like a conversation at all! A lot of people new to interviewing have this ( erroneously !) in mind when they think about interviews as data collection. Somewhere in the middle of these two extreme cases is the “ semistructured” interview , in which the researcher uses an “interview guide” to gently move the conversation to certain topics and issues. This is the primary form of interviewing for qualitative social scientists and will be what I refer to as interviewing for the rest of this chapter, unless otherwise specified.

Types of Interviewing Questions: Unstructured conversations, Semi-structured interview, Structured interview, Survey questions

Informal (unstructured conversations). This is the most “open-ended” approach to interviewing. It is particularly useful in conjunction with observational methods (see chapters 13 and 14). There are no predetermined questions. Each interview will be different. Imagine you are researching the Oregon Country Fair, an annual event in Veneta, Oregon, that includes live music, artisan craft booths, face painting, and a lot of people walking through forest paths. It’s unlikely that you will be able to get a person to sit down with you and talk intensely about a set of questions for an hour and a half. But you might be able to sidle up to several people and engage with them about their experiences at the fair. You might have a general interest in what attracts people to these events, so you could start a conversation by asking strangers why they are here or why they come back every year. That’s it. Then you have a conversation that may lead you anywhere. Maybe one person tells a long story about how their parents brought them here when they were a kid. A second person talks about how this is better than Burning Man. A third person shares their favorite traveling band. And yet another enthuses about the public library in the woods. During your conversations, you also talk about a lot of other things—the weather, the utilikilts for sale, the fact that a favorite food booth has disappeared. It’s all good. You may not be able to record these conversations. Instead, you might jot down notes on the spot and then, when you have the time, write down as much as you can remember about the conversations in long fieldnotes. Later, you will have to sit down with these fieldnotes and try to make sense of all the information (see chapters 18 and 19).

Interview guide ( semistructured interview ). This is the primary type employed by social science qualitative researchers. The researcher creates an “interview guide” in advance, which she uses in every interview. In theory, every person interviewed is asked the same questions. In practice, every person interviewed is asked mostly the same topics but not always the same questions, as the whole point of a “guide” is that it guides the direction of the conversation but does not command it. The guide is typically between five and ten questions or question areas, sometimes with suggested follow-ups or prompts . For example, one question might be “What was it like growing up in Eastern Oregon?” with prompts such as “Did you live in a rural area? What kind of high school did you attend?” to help the conversation develop. These interviews generally take place in a quiet place (not a busy walkway during a festival) and are recorded. The recordings are transcribed, and those transcriptions then become the “data” that is analyzed (see chapters 18 and 19). The conventional length of one of these types of interviews is between one hour and two hours, optimally ninety minutes. Less than one hour doesn’t allow for much development of questions and thoughts, and two hours (or more) is a lot of time to ask someone to sit still and answer questions. If you have a lot of ground to cover, and the person is willing, I highly recommend two separate interview sessions, with the second session being slightly shorter than the first (e.g., ninety minutes the first day, sixty minutes the second). There are lots of good reasons for this, but the most compelling one is that this allows you to listen to the first day’s recording and catch anything interesting you might have missed in the moment and so develop follow-up questions that can probe further. This also allows the person being interviewed to have some time to think about the issues raised in the interview and go a little deeper with their answers.

Standardized questionnaire with open responses ( structured interview ). This is the type of interview a lot of people have in mind when they hear “interview”: a researcher comes to your door with a clipboard and proceeds to ask you a series of questions. These questions are all the same whoever answers the door; they are “standardized.” Both the wording and the exact order are important, as people’s responses may vary depending on how and when a question is asked. These are qualitative only in that the questions allow for “open-ended responses”: people can say whatever they want rather than select from a predetermined menu of responses. For example, a survey I collaborated on included this open-ended response question: “How does class affect one’s career success in sociology?” Some of the answers were simply one word long (e.g., “debt”), and others were long statements with stories and personal anecdotes. It is possible to be surprised by the responses. Although it’s a stretch to call this kind of questioning a conversation, it does allow the person answering the question some degree of freedom in how they answer.

Survey questionnaire with closed responses (not an interview!). Standardized survey questions with specific answer options (e.g., closed responses) are not really interviews at all, and they do not generate qualitative data. For example, if we included five options for the question “How does class affect one’s career success in sociology?”—(1) debt, (2) social networks, (3) alienation, (4) family doesn’t understand, (5) type of grad program—we leave no room for surprises at all. Instead, we would most likely look at patterns around these responses, thinking quantitatively rather than qualitatively (e.g., using regression analysis techniques, we might find that working-class sociologists were twice as likely to bring up alienation). It can sometimes be confusing for new students because the very same survey can include both closed-ended and open-ended questions. The key is to think about how these will be analyzed and to what level surprises are possible. If your plan is to turn all responses into a number and make predictions about correlations and relationships, you are no longer conducting qualitative research. This is true even if you are conducting this survey face-to-face with a real live human. Closed-response questions are not conversations of any kind, purposeful or not.

In summary, the semistructured interview guide approach is the predominant form of interviewing for social science qualitative researchers because it allows a high degree of freedom of responses from those interviewed (thus allowing for novel discoveries) while still maintaining some connection to a research question area or topic of interest. The rest of the chapter assumes the employment of this form.

Creating an Interview Guide

Your interview guide is the instrument used to bridge your research question(s) and what the people you are interviewing want to tell you. Unlike a standardized questionnaire, the questions actually asked do not need to be exactly what you have written down in your guide. The guide is meant to create space for those you are interviewing to talk about the phenomenon of interest, but sometimes you are not even sure what that phenomenon is until you start asking questions. A priority in creating an interview guide is to ensure it offers space. One of the worst mistakes is to create questions that are so specific that the person answering them will not stray. Relatedly, questions that sound “academic” will shut down a lot of respondents. A good interview guide invites respondents to talk about what is important to them, not feel like they are performing or being evaluated by you.

Good interview questions should not sound like your “research question” at all. For example, let’s say your research question is “How do patriarchal assumptions influence men’s understanding of climate change and responses to climate change?” It would be worse than unhelpful to ask a respondent, “How do your assumptions about the role of men affect your understanding of climate change?” You need to unpack this into manageable nuggets that pull your respondent into the area of interest without leading him anywhere. You could start by asking him what he thinks about climate change in general. Or, even better, whether he has any concerns about heatwaves or increased tornadoes or polar icecaps melting. Once he starts talking about that, you can ask follow-up questions that bring in issues around gendered roles, perhaps asking if he is married (to a woman) and whether his wife shares his thoughts and, if not, how they negotiate that difference. The fact is, you won’t really know the right questions to ask until he starts talking.

There are several distinct types of questions that can be used in your interview guide, either as main questions or as follow-up probes. If you remember that the point is to leave space for the respondent, you will craft a much more effective interview guide! You will also want to think about the place of time in both the questions themselves (past, present, future orientations) and the sequencing of the questions.

Researcher Note

Suggestion : As you read the next three sections (types of questions, temporality, question sequence), have in mind a particular research question, and try to draft questions and sequence them in a way that opens space for a discussion that helps you answer your research question.

Type of Questions

Experience and behavior questions ask about what a respondent does regularly (their behavior) or has done (their experience). These are relatively easy questions for people to answer because they appear more “factual” and less subjective. This makes them good opening questions. For the study on climate change above, you might ask, “Have you ever experienced an unusual weather event? What happened?” Or “You said you work outside? What is a typical summer workday like for you? How do you protect yourself from the heat?”

Opinion and values questions , in contrast, ask questions that get inside the minds of those you are interviewing. “Do you think climate change is real? Who or what is responsible for it?” are two such questions. Note that you don’t have to literally ask, “What is your opinion of X?” but you can find a way to ask the specific question relevant to the conversation you are having. These questions are a bit trickier to ask because the answers you get may depend in part on how your respondent perceives you and whether they want to please you or not. We’ve talked a fair amount about being reflective. Here is another place where this comes into play. You need to be aware of the effect your presence might have on the answers you are receiving and adjust accordingly. If you are a woman who is perceived as liberal asking a man who identifies as conservative about climate change, there is a lot of subtext that can be going on in the interview. There is no one right way to resolve this, but you must at least be aware of it.

Feeling questions are questions that ask respondents to draw on their emotional responses. It’s pretty common for academic researchers to forget that we have bodies and emotions, but people’s understandings of the world often operate at this affective level, sometimes unconsciously or barely consciously. It is a good idea to include questions that leave space for respondents to remember, imagine, or relive emotional responses to particular phenomena. “What was it like when you heard your cousin’s house burned down in that wildfire?” doesn’t explicitly use any emotion words, but it allows your respondent to remember what was probably a pretty emotional day. And if they respond emotionally neutral, that is pretty interesting data too. Note that asking someone “How do you feel about X” is not always going to evoke an emotional response, as they might simply turn around and respond with “I think that…” It is better to craft a question that actually pushes the respondent into the affective category. This might be a specific follow-up to an experience and behavior question —for example, “You just told me about your daily routine during the summer heat. Do you worry it is going to get worse?” or “Have you ever been afraid it will be too hot to get your work accomplished?”

Knowledge questions ask respondents what they actually know about something factual. We have to be careful when we ask these types of questions so that respondents do not feel like we are evaluating them (which would shut them down), but, for example, it is helpful to know when you are having a conversation about climate change that your respondent does in fact know that unusual weather events have increased and that these have been attributed to climate change! Asking these questions can set the stage for deeper questions and can ensure that the conversation makes the same kind of sense to both participants. For example, a conversation about political polarization can be put back on track once you realize that the respondent doesn’t really have a clear understanding that there are two parties in the US. Instead of asking a series of questions about Republicans and Democrats, you might shift your questions to talk more generally about political disagreements (e.g., “people against abortion”). And sometimes what you do want to know is the level of knowledge about a particular program or event (e.g., “Are you aware you can discharge your student loans through the Public Service Loan Forgiveness program?”).

Sensory questions call on all senses of the respondent to capture deeper responses. These are particularly helpful in sparking memory. “Think back to your childhood in Eastern Oregon. Describe the smells, the sounds…” Or you could use these questions to help a person access the full experience of a setting they customarily inhabit: “When you walk through the doors to your office building, what do you see? Hear? Smell?” As with feeling questions , these questions often supplement experience and behavior questions . They are another way of allowing your respondent to report fully and deeply rather than remain on the surface.

Creative questions employ illustrative examples, suggested scenarios, or simulations to get respondents to think more deeply about an issue, topic, or experience. There are many options here. In The Trouble with Passion , Erin Cech ( 2021 ) provides a scenario in which “Joe” is trying to decide whether to stay at his decent but boring computer job or follow his passion by opening a restaurant. She asks respondents, “What should Joe do?” Their answers illuminate the attraction of “passion” in job selection. In my own work, I have used a news story about an upwardly mobile young man who no longer has time to see his mother and sisters to probe respondents’ feelings about the costs of social mobility. Jessi Streib and Betsy Leondar-Wright have used single-page cartoon “scenes” to elicit evaluations of potential racial discrimination, sexual harassment, and classism. Barbara Sutton ( 2010 ) has employed lists of words (“strong,” “mother,” “victim”) on notecards she fans out and asks her female respondents to select and discuss.

Background/Demographic Questions

You most definitely will want to know more about the person you are interviewing in terms of conventional demographic information, such as age, race, gender identity, occupation, and educational attainment. These are not questions that normally open up inquiry. [1] For this reason, my practice has been to include a separate “demographic questionnaire” sheet that I ask each respondent to fill out at the conclusion of the interview. Only include those aspects that are relevant to your study. For example, if you are not exploring religion or religious affiliation, do not include questions about a person’s religion on the demographic sheet. See the example provided at the end of this chapter.

Temporality

Any type of question can have a past, present, or future orientation. For example, if you are asking a behavior question about workplace routine, you might ask the respondent to talk about past work, present work, and ideal (future) work. Similarly, if you want to understand how people cope with natural disasters, you might ask your respondent how they felt then during the wildfire and now in retrospect and whether and to what extent they have concerns for future wildfire disasters. It’s a relatively simple suggestion—don’t forget to ask about past, present, and future—but it can have a big impact on the quality of the responses you receive.

Question Sequence

Having a list of good questions or good question areas is not enough to make a good interview guide. You will want to pay attention to the order in which you ask your questions. Even though any one respondent can derail this order (perhaps by jumping to answer a question you haven’t yet asked), a good advance plan is always helpful. When thinking about sequence, remember that your goal is to get your respondent to open up to you and to say things that might surprise you. To establish rapport, it is best to start with nonthreatening questions. Asking about the present is often the safest place to begin, followed by the past (they have to know you a little bit to get there), and lastly, the future (talking about hopes and fears requires the most rapport). To allow for surprises, it is best to move from very general questions to more particular questions only later in the interview. This ensures that respondents have the freedom to bring up the topics that are relevant to them rather than feel like they are constrained to answer you narrowly. For example, refrain from asking about particular emotions until these have come up previously—don’t lead with them. Often, your more particular questions will emerge only during the course of the interview, tailored to what is emerging in conversation.

Once you have a set of questions, read through them aloud and imagine you are being asked the same questions. Does the set of questions have a natural flow? Would you be willing to answer the very first question to a total stranger? Does your sequence establish facts and experiences before moving on to opinions and values? Did you include prefatory statements, where necessary; transitions; and other announcements? These can be as simple as “Hey, we talked a lot about your experiences as a barista while in college.… Now I am turning to something completely different: how you managed friendships in college.” That is an abrupt transition, but it has been softened by your acknowledgment of that.

Probes and Flexibility

Once you have the interview guide, you will also want to leave room for probes and follow-up questions. As in the sample probe included here, you can write out the obvious probes and follow-up questions in advance. You might not need them, as your respondent might anticipate them and include full responses to the original question. Or you might need to tailor them to how your respondent answered the question. Some common probes and follow-up questions include asking for more details (When did that happen? Who else was there?), asking for elaboration (Could you say more about that?), asking for clarification (Does that mean what I think it means or something else? I understand what you mean, but someone else reading the transcript might not), and asking for contrast or comparison (How did this experience compare with last year’s event?). “Probing is a skill that comes from knowing what to look for in the interview, listening carefully to what is being said and what is not said, and being sensitive to the feedback needs of the person being interviewed” ( Patton 2002:374 ). It takes work! And energy. I and many other interviewers I know report feeling emotionally and even physically drained after conducting an interview. You are tasked with active listening and rearranging your interview guide as needed on the fly. If you only ask the questions written down in your interview guide with no deviations, you are doing it wrong. [2]

The Final Question

Every interview guide should include a very open-ended final question that allows for the respondent to say whatever it is they have been dying to tell you but you’ve forgotten to ask. About half the time they are tired too and will tell you they have nothing else to say. But incredibly, some of the most honest and complete responses take place here, at the end of a long interview. You have to realize that the person being interviewed is often discovering things about themselves as they talk to you and that this process of discovery can lead to new insights for them. Making space at the end is therefore crucial. Be sure you convey that you actually do want them to tell you more, that the offer of “anything else?” is not read as an empty convention where the polite response is no. Here is where you can pull from that active listening and tailor the final question to the particular person. For example, “I’ve asked you a lot of questions about what it was like to live through that wildfire. I’m wondering if there is anything I’ve forgotten to ask, especially because I haven’t had that experience myself” is a much more inviting final question than “Great. Anything you want to add?” It’s also helpful to convey to the person that you have the time to listen to their full answer, even if the allotted time is at the end. After all, there are no more questions to ask, so the respondent knows exactly how much time is left. Do them the courtesy of listening to them!

Conducting the Interview

Once you have your interview guide, you are on your way to conducting your first interview. I always practice my interview guide with a friend or family member. I do this even when the questions don’t make perfect sense for them, as it still helps me realize which questions make no sense, are poorly worded (too academic), or don’t follow sequentially. I also practice the routine I will use for interviewing, which goes something like this:

Introduce myself and reintroduce the study
Provide consent form and ask them to sign and retain/return copy
Ask if they have any questions about the study before we begin
Ask if I can begin recording
Ask questions (from interview guide)
Turn off the recording device
Ask if they are willing to fill out my demographic questionnaire
Collect questionnaire and, without looking at the answers, place in same folder as signed consent form
Thank them and depart

A note on remote interviewing: Interviews have traditionally been conducted face-to-face in a private or quiet public setting. You don’t want a lot of background noise, as this will make transcriptions difficult. During the recent global pandemic, many interviewers, myself included, learned the benefits of interviewing remotely. Although face-to-face is still preferable for many reasons, Zoom interviewing is not a bad alternative, and it does allow more interviews across great distances. Zoom also includes automatic transcription, which significantly cuts down on the time it normally takes to convert our conversations into “data” to be analyzed. These automatic transcriptions are not perfect, however, and you will still need to listen to the recording and clarify and clean up the transcription. Nor do automatic transcriptions include notations of body language or change of tone, which you may want to include. When interviewing remotely, you will want to collect the consent form before you meet: ask them to read, sign, and return it as an email attachment. I think it is better to ask for the demographic questionnaire after the interview, but because some respondents may never return it then, it is probably best to ask for this at the same time as the consent form, in advance of the interview.

What should you bring to the interview? I would recommend bringing two copies of the consent form (one for you and one for the respondent), a demographic questionnaire, a manila folder in which to place the signed consent form and filled-out demographic questionnaire, a printed copy of your interview guide (I print with three-inch right margins so I can jot down notes on the page next to relevant questions), a pen, a recording device, and water.

After the interview, you will want to secure the signed consent form in a locked filing cabinet (if in print) or a password-protected folder on your computer. Using Excel or a similar program that allows tables/spreadsheets, create an identifying number for your interview that links to the consent form without using the name of your respondent. For example, let’s say that I conduct interviews with US politicians, and the first person I meet with is George W. Bush. I will assign the transcription the number “INT#001” and add it to the signed consent form. [3] The signed consent form goes into a locked filing cabinet, and I never use the name “George W. Bush” again. I take the information from the demographic sheet, open my Excel spreadsheet, and add the relevant information in separate columns for the row INT#001: White, male, Republican. When I interview Bill Clinton as my second interview, I include a second row: INT#002: White, male, Democrat. And so on. The only link to the actual name of the respondent and this information is the fact that the consent form (unavailable to anyone but me) has stamped on it the interview number.

Many students get very nervous before their first interview. Actually, many of us are always nervous before the interview! But do not worry—this is normal, and it does pass. Chances are, you will be pleasantly surprised at how comfortable it begins to feel. These “purposeful conversations” are often a delight for both participants. This is not to say that sometimes things go wrong. I often have my students practice several “bad scenarios” (e.g., a respondent that you cannot get to open up; a respondent who is too talkative and dominates the conversation, steering it away from the topics you are interested in; emotions that completely take over; or shocking disclosures you are ill-prepared to handle), but most of the time, things go quite well. Be prepared for the unexpected, but know that the reason interviews are so popular as a technique of data collection is that they are usually richly rewarding for both participants.

One thing that I stress to my methods students and remind myself about is that interviews are still conversations between people. If there’s something you might feel uncomfortable asking someone about in a “normal” conversation, you will likely also feel a bit of discomfort asking it in an interview. Maybe more importantly, your respondent may feel uncomfortable. Social research—especially about inequality—can be uncomfortable. And it’s easy to slip into an abstract, intellectualized, or removed perspective as an interviewer. This is one reason trying out interview questions is important. Another is that sometimes the question sounds good in your head but doesn’t work as well out loud in practice. I learned this the hard way when a respondent asked me how I would answer the question I had just posed, and I realized that not only did I not really know how I would answer it, but I also wasn’t quite as sure I knew what I was asking as I had thought.

—Elizabeth M. Lee, Associate Professor of Sociology at Saint Joseph’s University, author of Class and Campus Life , and co-author of Geographies of Campus Inequality

How Many Interviews?

Your research design has included a targeted number of interviews and a recruitment plan (see chapter 5). Follow your plan, but remember that “ saturation ” is your goal. You interview as many people as you can until you reach a point at which you are no longer surprised by what they tell you. This means not that no one after your first twenty interviews will have surprising, interesting stories to tell you but rather that the picture you are forming about the phenomenon of interest to you from a research perspective has come into focus, and none of the interviews are substantially refocusing that picture. That is when you should stop collecting interviews. Note that to know when you have reached this, you will need to read your transcripts as you go. More about this in chapters 18 and 19.

Your Final Product: The Ideal Interview Transcript

A good interview transcript will demonstrate a subtly controlled conversation by the skillful interviewer. In general, you want to see replies that are about one paragraph long, not short sentences and not running on for several pages. Although it is sometimes necessary to follow respondents down tangents, it is also often necessary to pull them back to the questions that form the basis of your research study. This is not really a free conversation, although it may feel like that to the person you are interviewing.

Final Tips from an Interview Master

Annette Lareau is arguably one of the masters of the trade. In Listening to People , she provides several guidelines for good interviews and then offers a detailed example of an interview gone wrong and how it could be addressed (please see the “Further Readings” at the end of this chapter). Here is an abbreviated version of her set of guidelines: (1) interview respondents who are experts on the subjects of most interest to you (as a corollary, don’t ask people about things they don’t know); (2) listen carefully and talk as little as possible; (3) keep in mind what you want to know and why you want to know it; (4) be a proactive interviewer (subtly guide the conversation); (5) assure respondents that there aren’t any right or wrong answers; (6) use the respondent’s own words to probe further (this both allows you to accurately identify what you heard and pushes the respondent to explain further); (7) reuse effective probes (don’t reinvent the wheel as you go—if repeating the words back works, do it again and again); (8) focus on learning the subjective meanings that events or experiences have for a respondent; (9) don’t be afraid to ask a question that draws on your own knowledge (unlike trial lawyers who are trained never to ask a question for which they don’t already know the answer, sometimes it’s worth it to ask risky questions based on your hypotheses or just plain hunches); (10) keep thinking while you are listening (so difficult…and important); (11) return to a theme raised by a respondent if you want further information; (12) be mindful of power inequalities (and never ever coerce a respondent to continue the interview if they want out); (13) take control with overly talkative respondents; (14) expect overly succinct responses, and develop strategies for probing further; (15) balance digging deep and moving on; (16) develop a plan to deflect questions (e.g., let them know you are happy to answer any questions at the end of the interview, but you don’t want to take time away from them now); and at the end, (17) check to see whether you have asked all your questions. You don’t always have to ask everyone the same set of questions, but if there is a big area you have forgotten to cover, now is the time to recover ( Lareau 2021:93–103 ).

Sample: Demographic Questionnaire

ASA Taskforce on First-Generation and Working-Class Persons in Sociology – Class Effects on Career Success

Supplementary Demographic Questionnaire

Thank you for your participation in this interview project. We would like to collect a few pieces of key demographic information from you to supplement our analyses. Your answers to these questions will be kept confidential and stored by ID number. All of your responses here are entirely voluntary!

What best captures your race/ethnicity? (please check any/all that apply)

White (Non Hispanic/Latina/o/x)
Black or African American
Hispanic, Latino/a/x of Spanish
Asian or Asian American
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
Other : (Please write in: ________________)

What is your current position?

Grad Student
Full Professor

Please check any and all of the following that apply to you:

I identify as a working-class academic
I was the first in my family to graduate from college
I grew up poor

What best reflects your gender?

Transgender female/Transgender woman
Transgender male/Transgender man
Gender queer/ Gender nonconforming

Anything else you would like us to know about you?

Example: Interview Guide

In this example, follow-up prompts are italicized. Note the sequence of questions. That second question often elicits an entire life history , answering several later questions in advance.

Introduction Script/Question

Thank you for participating in our survey of ASA members who identify as first-generation or working-class. As you may have heard, ASA has sponsored a taskforce on first-generation and working-class persons in sociology and we are interested in hearing from those who so identify. Your participation in this interview will help advance our knowledge in this area.

The first thing we would like to as you is why you have volunteered to be part of this study? What does it mean to you be first-gen or working class? Why were you willing to be interviewed?
How did you decide to become a sociologist?
Can you tell me a little bit about where you grew up? ( prompts: what did your parent(s) do for a living? What kind of high school did you attend?)
Has this identity been salient to your experience? (how? How much?)
How welcoming was your grad program? Your first academic employer?
Why did you decide to pursue sociology at the graduate level?
Did you experience culture shock in college? In graduate school?
Has your FGWC status shaped how you’ve thought about where you went to school? debt? etc?
Were you mentored? How did this work (not work)? How might it?
What did you consider when deciding where to go to grad school? Where to apply for your first position?
What, to you, is a mark of career success? Have you achieved that success? What has helped or hindered your pursuit of success?
Do you think sociology, as a field, cares about prestige?
Let’s talk a little bit about intersectionality. How does being first-gen/working class work alongside other identities that are important to you?
What do your friends and family think about your career? Have you had any difficulty relating to family members or past friends since becoming highly educated?
Do you have any debt from college/grad school? Are you concerned about this? Could you explain more about how you paid for college/grad school? (here, include assistance from family, fellowships, scholarships, etc.)
(You’ve mentioned issues or obstacles you had because of your background.) What could have helped? Or, who or what did? Can you think of fortuitous moments in your career?
Do you have any regrets about the path you took?
Is there anything else you would like to add? Anything that the Taskforce should take note of, that we did not ask you about here?

Qualitative study design: Surveys & questionnaires

Qualitative study design
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Surveys & questionnaires
Study Designs Home

Surveys & questionnaires

Qualitative surveys use open-ended questions to produce long-form written/typed answers. Questions will aim to reveal opinions, experiences, narratives or accounts. Often a useful precursor to interviews or focus groups as they help identify initial themes or issues to then explore further in the research. Surveys can be used iteratively, being changed and modified over the course of the research to elicit new information.

Structured Interviews may follow a similar form of open questioning.

Qualitative surveys frequently include quantitative questions to establish elements such as age, nationality etc.

Qualitative surveys aim to elicit a detailed response to an open-ended topic question in the participant’s own words. Like quantitative surveys, there are three main methods for using qualitative surveys including face to face surveys, phone surveys, and online surveys. Each method of surveying has strengths and limitations.

Face to face surveys

Researcher asks participants one or more open-ended questions about a topic, typically while in view of the participant’s facial expressions and other behaviours while answering. Being able to view the respondent’s reactions enables the researcher to ask follow-up questions to elicit a more detailed response, and to follow up on any facial or behavioural cues that seem at odds with what the participants is explicitly saying.
Face to face qualitative survey responses are likely to be audio recorded and transcribed into text to ensure all detail is captured; however, some surveys may include both quantitative and qualitative questions using a structured or semi-structured format of questioning, and in this case the researcher may simply write down key points from the participant’s response.

Telephone surveys

Similar to the face to face method, but without researcher being able to see participant’s facial or behavioural responses to questions asked. This means the researcher may miss key cues that would help them ask further questions to clarify or extend participant responses to their questions, and instead relies on vocal cues.

Online surveys

Open-ended questions are presented to participants in written format via email or within an online survey tool, often alongside quantitative survey questions on the same topic.
Researchers may provide some contextualising information or key definitions to help ‘frame’ how participants view the qualitative survey questions, since they can’t directly ask the researcher about it in real time.
Participants are requested to responses to questions in text ‘in some detail’ to explain their perspective or experience to researchers; this can result in diversity of responses (brief to detailed).
Researchers can not always probe or clarify participant responses to online qualitative survey questions which can result in data from these responses being cryptic or vague to the researcher.
Online surveys can collect a greater number of responses in a set period of time compared to face to face and phone survey approaches, so while data may be less detailed, there is more of it overall to compensate.

Qualitative surveys can help a study early on, in finding out the issues/needs/experiences to be explored further in an interview or focus group.

Surveys can be amended and re-run based on responses providing an evolving and responsive method of research.

Online surveys will receive typed responses reducing translation by the researcher

Online surveys can be delivered broadly across a wide population with asynchronous delivery/response.

Limitations

Hand-written notes will need to be transcribed (time-consuming) for digital study and kept physically for reference.

Distance (or online) communication can be open to misinterpretations that cannot be corrected at the time.

Questions can be leading/misleading, eliciting answers that are not core to the research subject. Researchers must aim to write a neutral question which does not give away the researchers expectations.

Even with transcribed/digital responses analysis can be long and detailed, though not as much as in an interview.

Surveys may be left incomplete if performed online or taken by research assistants not well trained in giving the survey/structured interview.

Narrow sampling may skew the results of the survey.

Example questions

Here are some example survey questions which are open ended and require a long form written response:

Tell us why you became a doctor?
What do you expect from this health service?
How do you explain the low levels of financial investment in mental health services? (WHO, 2007)

Example studies

Davey, L. , Clarke, V. and Jenkinson, E. (2019), Living with alopecia areata: an online qualitative survey study. British Journal of Dermatology, 180 1377-1389. Retrieved from https://onlinelibrary-wiley-com.ezproxy-f.deakin.edu.au/doi/10.1111%2Fbjd.17463
Richardson, J. (2004). What Patients Expect From Complementary Therapy: A Qualitative Study. American Journal of Public Health, 94(6), 1049–1053. Retrieved from http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=13270563&site=eds-live&scope=site
Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., ... & Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370(9593), 1164-1174. Retrieved from https://www-sciencedirect-com.ezproxy-f.deakin.edu.au/science/article/pii/S014067360761263X?via%3Dihub

Below has more detail of the Lancet article including actual survey questions at:

World Health Organization. (2007.) Expert opinion on barriers and facilitating factors for the implementation of existing mental health knowledge in mental health services. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/44808
Green, J. 1961-author., & Thorogood, N. (2018). Qualitative methods for health research. SAGE. Retrieved from http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cat00097a&AN=deakin.b4151167&authtype=sso&custid=deakin&site=eds-live&scope=site
JANSEN, H. The Logic of Qualitative Survey Research and its Position in the Field of Social Research Methods. Forum Qualitative Sozialforschung, 11(2), Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/1450/2946
Neilsen Norman Group, (2019). 28 Tips for Creating Great Qualitative Surveys. Retrieved from https://www.nngroup.com/articles/qualitative-surveys/
<< Previous: Documents
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Last Updated: Apr 8, 2024 11:12 AM
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Qualitative Research Questions

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How to write qualitative research questions.

11 min read Here’s how to write effective qualitative research questions for your projects, and why getting it right matters so much.

What is qualitative research?

Qualitative research is a blanket term covering a wide range of research methods and theoretical framing approaches. The unifying factor in all these types of qualitative study is that they deal with data that cannot be counted. Typically this means things like people’s stories, feelings, opinions and emotions , and the meanings they ascribe to their experiences.

Qualitative study is one of two main categories of research, the other being quantitative research. Quantitative research deals with numerical data – that which can be counted and quantified, and which is mostly concerned with trends and patterns in large-scale datasets.

What are research questions?

Research questions are questions you are trying to answer with your research. To put it another way, your research question is the reason for your study, and the beginning point for your research design. There is normally only one research question per study, although if your project is very complex, you may have multiple research questions that are closely linked to one central question.

A good qualitative research question sums up your research objective. It’s a way of expressing the central question of your research, identifying your particular topic and the central issue you are examining.

Research questions are quite different from survey questions, questions used in focus groups or interview questions. A long list of questions is used in these types of study, as opposed to one central question. Additionally, interview or survey questions are asked of participants, whereas research questions are only for the researcher to maintain a clear understanding of the research design.

Research questions are used in both qualitative and quantitative research , although what makes a good research question might vary between the two.

In fact, the type of research questions you are asking can help you decide whether you need to take a quantitative or qualitative approach to your research project.

Discover the fundamentals of qualitative research

Quantitative vs. qualitative research questions

Writing research questions is very important in both qualitative and quantitative research, but the research questions that perform best in the two types of studies are quite different.

Quantitative research questions

Quantitative research questions usually relate to quantities, similarities and differences.

It might reflect the researchers’ interest in determining whether relationships between variables exist, and if so whether they are statistically significant. Or it may focus on establishing differences between things through comparison, and using statistical analysis to determine whether those differences are meaningful or due to chance.

How much? This kind of research question is one of the simplest. It focuses on quantifying something. For example:

How many Yoruba speakers are there in the state of Maine?

What is the connection?

This type of quantitative research question examines how one variable affects another.

For example:

How does a low level of sunlight affect the mood scores (1-10) of Antarctic explorers during winter?

What is the difference? Quantitative research questions in this category identify two categories and measure the difference between them using numerical data.

Do white cats stay cooler than tabby cats in hot weather?

If your research question fits into one of the above categories, you’re probably going to be doing a quantitative study.

Qualitative research questions

Qualitative research questions focus on exploring phenomena, meanings and experiences.

Unlike quantitative research, qualitative research isn’t about finding causal relationships between variables. So although qualitative research questions might touch on topics that involve one variable influencing another, or looking at the difference between things, finding and quantifying those relationships isn’t the primary objective.

In fact, you as a qualitative researcher might end up studying a very similar topic to your colleague who is doing a quantitative study, but your areas of focus will be quite different. Your research methods will also be different – they might include focus groups, ethnography studies, and other kinds of qualitative study.

A few example qualitative research questions:

What is it like being an Antarctic explorer during winter?
What are the experiences of Yoruba speakers in the USA?
How do white cat owners describe their pets?

Qualitative research question types

questionnaire vs interview in qualitative research

Marshall and Rossman (1989) identified 4 qualitative research question types, each with its own typical research strategy and methods.

Exploratory questions

Exploratory questions are used when relatively little is known about the research topic. The process researchers follow when pursuing exploratory questions might involve interviewing participants, holding focus groups, or diving deep with a case study.

Explanatory questions

With explanatory questions, the research topic is approached with a view to understanding the causes that lie behind phenomena. However, unlike a quantitative project, the focus of explanatory questions is on qualitative analysis of multiple interconnected factors that have influenced a particular group or area, rather than a provable causal link between dependent and independent variables.

Descriptive questions

As the name suggests, descriptive questions aim to document and record what is happening. In answering descriptive questions , researchers might interact directly with participants with surveys or interviews, as well as using observational studies and ethnography studies that collect data on how participants interact with their wider environment.

Predictive questions

Predictive questions start from the phenomena of interest and investigate what ramifications it might have in the future. Answering predictive questions may involve looking back as well as forward, with content analysis, questionnaires and studies of non-verbal communication (kinesics).

Why are good qualitative research questions important?

We know research questions are very important. But what makes them so essential? (And is that question a qualitative or quantitative one?)

Getting your qualitative research questions right has a number of benefits.

It defines your qualitative research project Qualitative research questions definitively nail down the research population, the thing you’re examining, and what the nature of your answer will be.This means you can explain your research project to other people both inside and outside your business or organization. That could be critical when it comes to securing funding for your project, recruiting participants and members of your research team, and ultimately for publishing your results. It can also help you assess right the ethical considerations for your population of study.
It maintains focus Good qualitative research questions help researchers to stick to the area of focus as they carry out their research. Keeping the research question in mind will help them steer away from tangents during their research or while they are carrying out qualitative research interviews. This holds true whatever the qualitative methods are, whether it’s a focus group, survey, thematic analysis or other type of inquiry.That doesn’t mean the research project can’t morph and change during its execution – sometimes this is acceptable and even welcome – but having a research question helps demarcate the starting point for the research. It can be referred back to if the scope and focus of the project does change.
It helps make sure your outcomes are achievable

Because qualitative research questions help determine the kind of results you’re going to get, it helps make sure those results are achievable. By formulating good qualitative research questions in advance, you can make sure the things you want to know and the way you’re going to investigate them are grounded in practical reality. Otherwise, you may be at risk of taking on a research project that can’t be satisfactorily completed.

Developing good qualitative research questions

All researchers use research questions to define their parameters, keep their study on track and maintain focus on the research topic. This is especially important with qualitative questions, where there may be exploratory or inductive methods in use that introduce researchers to new and interesting areas of inquiry. Here are some tips for writing good qualitative research questions.

1. Keep it specific

Broader research questions are difficult to act on. They may also be open to interpretation, or leave some parameters undefined.

Strong example: How do Baby Boomers in the USA feel about their gender identity?

Weak example: Do people feel different about gender now?

2. Be original

Look for research questions that haven’t been widely addressed by others already.

Strong example: What are the effects of video calling on women’s experiences of work?

Weak example: Are women given less respect than men at work?

3. Make it research-worthy

Don’t ask a question that can be answered with a ‘yes’ or ‘no’, or with a quick Google search.

Strong example: What do people like and dislike about living in a highly multi-lingual country?

Weak example: What languages are spoken in India?

4. Focus your question

Don’t roll multiple topics or questions into one. Qualitative data may involve multiple topics, but your qualitative questions should be focused.

Strong example: What is the experience of disabled children and their families when using social services?

Weak example: How can we improve social services for children affected by poverty and disability?

4. Focus on your own discipline, not someone else’s

Avoid asking questions that are for the politicians, police or others to address.

Strong example: What does it feel like to be the victim of a hate crime?

Weak example: How can hate crimes be prevented?

5. Ask something researchable

Big questions, questions about hypothetical events or questions that would require vastly more resources than you have access to are not useful starting points for qualitative studies. Qualitative words or subjective ideas that lack definition are also not helpful.

Strong example: How do perceptions of physical beauty vary between today’s youth and their parents’ generation?

Weak example: Which country has the most beautiful people in it?

Related resources

Qualitative research design 12 min read, primary vs secondary research 14 min read, business research methods 12 min read, qualitative research interviews 11 min read, market intelligence 10 min read, marketing insights 11 min read, ethnographic research 11 min read, request demo.

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Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

P. Gill 1 &
J. Baillie 2

British Dental Journal volume 225 , pages 668–672 ( 2018 ) Cite this article

28k Accesses

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

You have full access to this article via your institution.

Interviews in the social sciences

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Key Differences

Know the Differences & Comparisons

Difference Between Questionnaire and Interview

Once the research problem is defined and research design is laid out, the task of data collection begins. There are two types of data, i.e. primary data and secondary data. The data collection methods of these two types of data differ, because, in the case of primary data, the collection of data must be original, while in secondary data, data collection is much like a compilation.

The different methods of collecting primary data, like observation, interview, questionnaire, schedule and so on. Many think that questionnaire and interview are one and the same thing, but there are a lot of differences between these two.

Content: Questionnaire Vs Interview

Comparison chart, definition of questionnaire.

Questionnaire refers to a research instrument, in which a series of question, is typed or printed along with the choice of answers, expected to be marked by the respondents, used for survey or statistical study. It consists of aformalisedd set of questions, in a definite order on a form, which are mailed to the respondents or manually delivered to them for answers. The respondents are supposed to read, comprehend and give their responses, in the space provided.

A ‘Pilot Study’ is advised to be conducted to test the questionnaire before using this method. A pilot survey is nothing but a preliminary study or say rehearsal to know the time, cost, efforts, reliability and so forth involved in it.

Definition of Interview

The interview is a data collection method wherein a direct, in-depth conversation between interviewer and respondent takes place. It is carried out with a purpose like a survey, research, and the like, where both the two parties participate in the one to one interaction. Under this method, oral-verbal stimuli are presented and replied by way of oral-verbal responses.

It is considered as one of the best methods for collecting data because it allows two way exchange of information, the interviewer gets to know about the respondent, and the respondent learns about the interviewer. There are two types of interview:

Personal Interview : A type of interview, wherein there is a face to face question-answer session between the interviewer and interviewee, is conducted.
Telephonic Interview : This method involves contacting the interviewee and asking questions to them on the telephone itself.

Key Differences Between Questionnaire and Interview

The difference between questionnaire and interview can be drawn clearly on the following grounds:

A form consisting of a series of written or printed multiple choice questions, to be marked by the informants, is called questionnaire. A formal conversation between the interviewer and respondent wherein the two participates in the question-answer session is called interview
The questionnaire method of collecting data involves emailing questionnaire to respondents in a written format. On the contrary, interview method is one wherein the interviewer communicates to the respondent orally.
The questionnaire is objective while the nature of the interview is subjective.
In an interview, open-ended questions are asked by the interviewer to the respondent. As against this, closed-ended questions are asked through a questionnaire.
The questionnaire provides fact-based information to the respondents. Conversely, analytical information can be gathered through interviews.
As question are written in a proper manner in a questionnaire, the order cannot be changed. Unlike interview, wherein the order of questions can be changed as per needs and preferences.
The collection of data through questionnaire is relatively cheap and economical, as money is spent only on the preparation and mailing of the questionnaire to the respondent. In contrast, an interview is a little expensive method, because, to provide data either the respondents have to come to the interviewer or the interviewer has to visit the respondents individually.
Questionnaire method is more time consuming than an interview, as in an interview, the responses are spontaneous, while the informant takes his own time to reply, in the case of the questionnaire.
In questionnaire method, a single questionnaire is mailed to many respondents. However, only one person at a time can be interviewed in a case interview.
The probability of non-responses is very high in case of the questionnaire, as many people avoid answering it and so they return the questionnaire with providing their responses. On the other hand, the chances of non-responses are almost nil in case of an interview, because of direct interaction between interviewer and respondent.
In the questionnaire, it is not known, as to who replies it, which is not in the case of an interview.

So, whatever method you use for your research project, to collect information, it must fulfil your requirements. As both the methods have their pros and cons, it cannot be said which method is best, i.e. while questionnaire method takes more time, interview method requires high investment. So, you can choose any of the two, considering your needs and expectations from the data collected.

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March 20, 2018 at 5:40 pm

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Excellent explanation and very helpful. Thank you.

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February 15, 2019 at 3:04 pm

Very useful resource, thank you.

Michael Saka Darkwah says

March 2, 2019 at 3:40 pm

Can a researcher use both questionnaire and interview in his or her study

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March 5, 2019 at 9:44 am

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Helpful information

The qualitative pretest interview for questionnaire development: outline of programme and practice

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Christina Buschle ORCID: orcid.org/0000-0002-1848-7254 1 ,
Herwig Reiter ORCID: orcid.org/0000-0003-4577-3376 2 &
Arne Bethmann ORCID: orcid.org/0000-0002-7649-0371 3

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Good survey research depends on asking the right questions; it is the only way to ensure that the information collected from respondents is suitable for providing good answers to our research questions. The article discusses and advocates a comprehensive consideration of qualitative-interpretive methodology in open forms of pretesting for the evaluation of draft survey questionnaires. We outline an approach we call Qualitative Pretest Interview (QPI) . It transfers the idea of negotiated common understanding in everyday communication to the clarification of meaning in draft survey questions and similar stimuli. The QPI involves ascribing interview partners the role of co-experts in this process and employing methodically integrated communication strategies. This paper focusses on how QPIs are conducted. Using an example interview, we illustrate how the particular way of qualitative pretest interviewing aims at a dialogic clarification of meaning in order to reach intersubjective understanding between participant and interviewer. In the process, we gain detailed insights into how and why a certain questionnaire might not work as intended, and ideally how this might be alleviated. QPIs pursue similar goals as Cognitive Interviews but rely more systematically on qualitative-interpretive methodology.

A worked example of Braun and Clarke’s approach to reflexive thematic analysis

Qualitative Inhaltsanalyse

How to use and assess qualitative research methods

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1 Introduction

Surveys require researchers to have a precise idea of the theoretical constructs they want to investigate and of their presumed connectedness. Furthermore, it is necessary to measure these constructs validly by means of a questionnaire. In other words, good survey research depends on asking the right questions; it is the only way to ensure that the information collected from respondents is suitable for providing good answers to our research questions. In this article, we will essentially deal with a specific issue of valid measurement: How can we formulate questions in such a way that they are understood adequately and produce answers that we can consider valid? The paper is intended as a contribution to a pragmatic-professional consideration and integration of qualitative-interpretive perspectives in the preparation of standardised surveys.

Based on the works of Tourangeau and colleagues on “Cognitive Aspects of Survey methodology” (CASM), in-depth evaluation of questionnaires is often structured along the lines of the “Response Process Model” (Tourangeau et al. 1984 , 2000 ). It describes the respondents’ way of processing and answering questions as a four-step procedure: comprehension of the intended meaning; retrieval of an answer from memory; judging the answer e.g. whether memory is complete; and formulating a response that fits the format of the question. Each of these steps poses its own potential source of measurement error, e.g. lack of comprehension, problems remembering an answer, or socially desirable answering. There is by now extensive literature providing suggestions on how to alleviate these problems when designing standardised questionnaires (e.g., Bradburn et al. 2004 ; Faulbaum et al. 2009 ; Groves et al. 2009 ; Gobo and Mauceri 2014 ; Porst 2014 ; Schnell 2012 ; Wolf et al. 2016 ).

Since the challenges faced in designing a questionnaire and the resulting potential sources of measurement error depend to a large degree on the particular study at hand, general recommendations are not sufficient to ensure high quality. It is therefore advisable to make extensive use of pretest-procedures to evaluate and improve questionnaires before the main fieldwork (cf. e.g., Bradburn et al. 2004 ; Schnell 2012 ). Some common approaches include the inspection of non-response patterns or unexpected distributions across response categories quantitatively, or the use of even more complex approaches like the testing of psychometric properties.

While these techniques help to identify problematic questions, it is often more useful to employ open forms of pretesting in order to get a deeper understanding of how and why certain questions might not work as originally intended. These open forms of pretesting are particularly relevant as soon as a general concept of the questionnaire, regarding e.g. topics and concepts, has been decided upon and the next step consists in developing and refining individual questions. Already in the 1940s there was a debate about the potential of open forms of interaction between interviewer and respondent for providing more valid answers to research questions (Beatty 1995 ). Today, standardised procedures dominate primary data collection due to efficiency issues and concerns about interviewer bias. At the same time, the use of open techniques and the benefits of reactivity for the validation of survey questionnaires are largely undisputed. Since the 1980s cognitive techniques have been an important part of the process of developing, testing, reviewing, and evaluating standardised questionnaires and individual survey questions. With their origin in the tradition of cognitive psychology (Ericsson and Simon 1980 ) they help identify, together with participants, problems with the questionnaire and correct them if necessary.

Over the last decades, Cognitive Interviewing (CI) as developed by Gordon Willis (e.g., Willis 2005 , 2015 ) has emerged as the main approach to conducting in-depth evaluations of survey questionnaires. The original challenge of the design of the CI consisted in reducing response and measurement errors by “identifying and correcting problems with survey questions” through, as (Beatty and Willis 2007 , p. 287) define the CI in practical terms, “the administration of draft survey questions while collecting additional verbal information about the survey responses, which is used to evaluate the quality of the response or to help determine whether the question is generating the information that its author intends.” Over the past 30 years the CI has been elaborated continuously as a method and refined into what has become one of the most effective tools for improving survey research.

The starting point of our contribution to advancing this very effort is the observation of a somewhat ambiguous relationship of the CI to qualitative-interpretive research (Bethmann et al. 2019 ; Buschle et al. 2020 ). Over the course of the past decades its authors and advocates moved the CI ever closer to the purposes and sphere of qualitative research—from the mere proposition that cognitive interviewing is “designed to help researchers understand how respondents interpret questions” (Beatty 1995 , p. 1052) to the more recent textbook about the analysis of CIs published in the Series in Understanding Qualitative Research of Oxford University Press (Willis 2015 ). The textbook—“in seeking a theory of method to apply to the cognitive interview as an alternative to cognitive theory” (ibid., p. 29)—suggests rudimentary links to qualitative research theory. This is an important step in the ongoing development of the CI that is corroborated by other contributions (Miller 2014 ; Collins 2015 ). Yet this ‘qualification’ of the CI is done ex post, for the origin of the method as a practical solution to reducing measurement error is rooted in debates about cognitive approaches in psychology and survey research in the 1980s (e.g., Willis et al. 1991 ; Willis 2005 , chapter 3). At the current point in its development a few decades later the CI appears as a methodological hybrid, at least in conceptual terms: “cognitive interviewing can be viewed as either a psychological procedure, or as a special case of qualitative interviewing” (Willis 2015 , p. 16).

Against this background, we take sides and advocate the more comprehensive consideration of qualitative-interpretive aspects characterising the process of exchanging meaning in interview encounters. Our starting point is the notion of intersubjective understanding as the conceptual pillar of interpretive interview research. While we do not contest the practical objectives addressed with CI-techniques our initial formulation of the underlying challenge is, in contrast, rather conceptual. Our point of departure is social-scientific and sociological. Thus, our argument and conclusions arrive at labelling the method in a way that does not reproduce traditions and connotations associated with the term ‘cognitive’. We propose to call it Qualitative Pretest Interview (QPI), a genuinely qualitative technique of interviewing for the purpose of improving survey questions and their delivery.

To put it more succinctly, there are large and obvious overlaps between the CI and the QPI methodology, namely employing a “think-aloud” approach and encouraging interview partners to say everything that comes to their minds when reading the question. Furthermore, both approaches underline, that the aim of the pretest interview is not to collect data to answer a substantive research question, but rather that the interviewer and the participant work together to identify sources of difficulty and vagueness in survey items. That being said, there are a few important distinctions between the proposed QPI and the traditional CI. Firstly, the QPI emphasizes the participant more explicitly as an equal partner in the discussion, resulting in specific interviewing techniques, e.g. a more extensive briefing sequence to establish this work relation. It also has a stronger focus on discussing the question’s intended meaning, including a more thorough deliberation of potential improvements to the questions already vis-à-vis the participant. These results can then be used as a qualified input for further discussion of revisions to the survey instrument among the researchers.

Compared to the above definition of the CI our conceptual rather than practical starting point is reflected in our development of the working definition of the QPI. It is provided in the following chapter 2 together with an outline of the methodological programme of the QPI and its key communication strategies. Chapter 3 illustrates and synthesises the practical implementation of these programmatic aspects of the QPI based on a concrete example from pretesting an add-on questionnaire to the German sub-study of the Survey of Health, Ageing and Retirement in Europe (SHARE, http://share-eric.eu ). In addition to exemplifying the joint production of understanding with regard to one particular item, we discuss the important steps of briefing and debriefing interview partners for the particular challenge of participating in a QPI. The conclusion reviews the argument and connects it to survey methodological practice.

2 Outline of the methodological background and programme of the QPI

The QPI has its roots in methodology debates that provide particular perspectives on the issue of producing mutual understanding in research encounters. They informed the development of our approach to pretest interviewing and are discussed in the following.

2.1 Indexical expressions and intersubjective understanding

Already more than four decades ago, Kohli ( 1978 ) contributed a fundamental discussion of differences and similarities between unstructured and standardised interviews. He argues that situativity, interactivity and reactivity characterise both open and closed interview techniques. The validity of all kinds of interview data crucially depends on the equal understanding of the meaning communicated in questions and answers, pre-formulated or not, by all participants—i.e. at least researchers, interviewers, and respondents. In the direction of standardised procedures, Kohli ( 1978 , p. 9; own translation) finally writes: “Communication always means intersubjective understanding (albeit to varying degrees).” According to their origin in the French term ‘entrevue’ interviews are arranged encounters for verbal exchange and understanding based on mutual expectations (see also Kvale and Brinkmann 2009 , pp. 1–2). Participants in all types of interviews face the challenge of understanding inevitably vague and ‘indexical expressions’ that, according to Garfinkel ( 1984 /1967), are constitutive of human communication and mutual understanding (Schutz 1967 /1932). Following Garfinkel’s ethnomethodological approach, expressions are potentially ambiguous references to meanings that are best understood in their context of origin. Thus, intersubjective understanding ( Fremdverstehen ) of meaning requires the consideration of these origins and contexts of expressions.

The various approaches in the social sciences subscribe to different ways of dealing with this vagueness and indexicality described by Garfinkel (Przyborski and Wohlrab-Sahr 2008 , pp. 28–31). Qualitative-interpretive approaches recognise that expressions ( within everyday frames of interpretation ) always refer to everyday meanings that are specific for the very context of their articulation. Accordingly, social scientists can only reconstruct these meanings ( within scientific-theoretical frames of interpretation ) in a valid and appropriate way if some of the original context of expression is preserved during data collection. Ideally, the very context that is unfolded by the participants themselves constitutes the background against which expressions are interpreted, for this is the context, in which these expressions originally ‘made sense’. On the contrary, and in line with its very own programme, standardised research tries to predefine the context of collecting responses and to eliminate the risks (and chances) of achieving an embedded understanding of expressions and ‘answers’. It claims to neutralise the indexicality of expressions (i.e. their potentially unclear reference) by attempting to standardise the semantic content. In practice, standardisation should ensure that all participants within an artificial-scientific context (i.e. the standardised situation, procedure, and contents of data collection) understand formulations of questions and answers in the same way (ibid.).

2.2 Fabricated versus negotiated common understanding

Standardised survey interviewing must rely on fabricated common understanding for the sake of measurement throughout the whole chain of participants involved in meaning making and taking like, for instance, in secondary analysis (Suchman and Jordan 1990 ). Qualitative interviews, on the other hand, generate what could be called negotiated common understanding . They do not attempt to bypass the requirement of intersubjective understanding by artificially neutralising indexicality or by re-contextualising expressions in a scientific perspective. Rather, qualitative-interpretive approaches suggest various strategies to capture expressions within context, thus preserving their indexical quality. In other words, in qualitative-interpretive approaches, the inevitable process of intersubjective understanding is “methodically controlled in so far as the difference between the frames of interpretation of the researchers and those of the researched is systematically accounted for” (cf. Przyborski and Wohlrab-Sahr 2008 , p. 31, own translation).

The qualitative interview is one of those methods that provide the opportunity to clarify the meaning of indexical expressions together with our research subjects. It can be characterised as “a fundamentally asymmetrical form of communication, which, however, is always co-produced and maintained by both participants, because, for example, during the interview situation both cannot help but find out what the other 'actually wants' (what his actual interests are, how he sees the situation, how he assesses his counterpart, etc.)” (Honer et al. 2006 , p. 95f, emphases in the original, own translation). Despite this asymmetry—i.e. it is initiated (and usually compensated for) by the researcher with certain knowledge interests—the qualitative interview is not a role-playing game where one person asks questions and the other provides answers. As discussed above, in order to achieve intersubjective understanding as qualitative researchers we need to decipher the relation between indexical expressions and their original context. The genuine advantage of qualitative interviews consists in the fact that we have the chance do that under the guidance of our interview partners.

The goal of generating negotiated common understanding requires both participants to meet each other as partners in an encounter where researchers consider interviewees as experts with specific knowledge that is otherwise not accessible. This knowledge can be substantial. Alternatively, and of importance for our discussion of pretest interviews, it can be semantic in the sense that it clarifies the links between utterances and their context of origin. This helps us to comprehend how the respondent’s expressions and intended implications should be understood (i.e. how he or she wants it to be interpreted) in the context of what has been said—in contrast to how it could be understood in terms of possible interpretations researchers can come up with. Footnote 1 In order for both participants to be able to contribute equally to the challenge of handling potentially ambiguous expressions the research event of the qualitative interview needs to revert to the taken-for-granted rules of everyday communication. Deviations from these familiar and unquestioned rules, which are necessary due to the specific nature and dynamic of research encounters in general and pretest interviews in particular, require explanation that is delivered in the frame of extensive briefing at the beginning of the conversation.

2.3 Towards a definition of the QPI

The programme and practice of the QPI follows elaborate methods of qualitative interviewing that translate these requirements of intersubjective understanding into principles and techniques for research communication. Within the diverse landscape of qualitative interviewing methods originating in the particular German methodology discourse in the tradition of intersubjective understanding ( Fremdverstehen ; Schutz 1967 /1932; Cicourel 1964 ), the Problem-centred Interview (PCI) stands out in that it programmatically promotes active understanding (in addition to active listening). The PCI (Witzel 1982 ; Witzel and Reiter 2012 ; Reiter and Witzel 2019 ) conceptualises the situation of data collection explicitly as a research encounter for the discursive-dialogical clarification of (implied) meanings. Researchers and respondents exchange views in everyday language on topics (‘problems’) that interest the former scientifically and the latter from a practical perspective (Witzel and Reiter 2012 ). In view of the ambiguity and indexicality of expressions, the PCI proposes to make good use of the distinct interpretive competence of the interview partners. They are not just respondents providing information that is collected and later analysed. The PCI recognises their participation, presence, and readiness to clarify meaning and involves interview partners as temporary research assistants in the co-construction of interpretations and comprehension.

The QPI inherits these aspects of the PCI’s programme of joint production of understanding. It is a method of pretest interviewing for quality improvement of questionnaires by conceptualising the clarification of comprehension as a social process of negotiating meaning through intersubjective understanding. It involves interview partners as co-experts for this process in a dialogic clarification, in everyday language, of manifest and implied meanings and understanding of formulations and expressions used in draft survey questions and other standardised stimuli.

2.4 Communication strategies—active listening and active understanding

The QPI adopts from the PCI the idea of applying two sets of methodologically integrated communication strategies of general and specific exploration for collecting information and for directly negotiating implied meaning (Bethmann et al. 2019 ; Buschle et al. 2020 ; Witzel and Reiter 2012 ; Reiter and Witzel 2019 ). Together they constitute an integrated portfolio of techniques that allow the interviewer, depending on the course of the conversation, to change back and forth between active listening and active understanding. A first set of communication strategies of general exploration are dedicated to generating self-perpetuating accounts; the respondent’s point of view should be able to unfold gradually and mainly inductively. In terms of methodology and in line with the above discussion, these communication strategies of general exploration pursue the goal of eliciting contextualised expressions—i.e. expressions that are best interpreted from within their context of origin. For example, in addition to having each survey question first read out by the interview partner this set of strategies combines open and ad-hoc questions with comparative probing and repeated prompts and invitations to specify what was said (see next chapter). The interviewer’s attention is occupied mostly with active listening and making up his or her mind about what is being said. Analytically, these communication strategies of general exploration follow exactly the purpose of providing the ‘material’ basis for the subsequent specific exploration and stepwise reduction of the ambiguity of communication that Garfinkel ( 1984 /1967, p. 41) calls “the occasionality of expressions, the specific vagueness of references.”

The second set of communication strategies of specific exploration introduce a deductive moment into the conversation by identifying interconnections between statements, by clarifying possible misunderstandings and pre-interpretations, and by validating attributions of meaning. In this way, the conversation becomes much more dialogic. The stronger involvement of the interviewers reflects their effort to engage in active understanding of what is being said and of establishing intersubjective understanding. Comprehension questions are used to clarify evasive and hidden answers in an unobtrusive manner. Mirroring is a prime strategy for achieving communicative validation of ideas and hypotheses about possible improvements of formulations that emerge during the conversation. Thereby, interviewers summarise and rephrase statements of the participants, and in this way put their re-contextualised interpretations of what has been said up for discussion.

Experienced interviewers pursue the QPI’s goal of intersubjective understanding by deliberately combining these communication strategies. The flow of the QPI dialogue is then characterised by shifting back and forth between the two reference systems of the interviewer (i.e. research) and the interview partner (i.e. everyday world). It is the task of the interviewer to make sure that this shift is performed by both parties. Experience in previous studies shows that interview partners appreciate these dialogical elements (Witzel and Reiter 2012 ). They feel taken seriously by the active negotiation, appropriation, and critical consideration of their contributions as research participants. With the appropriate briefing interview partners will not be irritated even by confrontations (e.g. with contradictions) that go beyond mere clarification or when interviewers doubt, question or even reject their suggested amendments. The purpose of confrontations and critical discussions of contradictory aspects is solely the joint identification of the appropriate, comprehensible and, in this sense, valid wording of questions and answers. And that is a step that can have features of a struggle beyond negotiation. Yet once this purpose is explicated and its necessity ratified by the interview partners, they should be able to understand that opposition and even conflict over interpretations and suggestions are productive and benefit clarification. Interviewers need to be trained and equipped with the required qualifications and communication skills (e.g., Roulston et al. 2003 ; Kvale 2007 ; Mann 2016 ). They need to be prepared to deal with alternative perspectives, insinuations of meaning and provocations in a way that a confrontational situation, despite its asymmetrical orientation, does not resemble an interrogation. This includes the appropriate briefing of the participants, the creation and maintenance of a trusting atmosphere, and the careful and flexible handling of the dynamics of difficult communication situations.

3 Practical aspects of the QPI

The following chapter is dedicated to practical examples of conducting QPIs. They illustrate how the interplay of the programmatic aspects of QPI methodology (c.f. chapter 2) translates into practice. In this paper our focus is on the three key steps of (1) briefing the interview partner before or at the beginning of the conversation, (2) the use of communication strategies, and (3) the final step of debriefing and concluding the research encounter. The commonalities and differences between the QPI and the CI mentioned in the introduction become apparent here.

The following examples were collected in the frame of a university seminar at the Ludwig-Maximilians-University of Munich/Germany in the winter semester 2019/2020. All excerpts are taken from the same interview and were translated into English by the authors. The aim of the seminar was to discuss different techniques of pretesting in the context of questionnaire development. The course introduced students to the procedure and to different communication techniques. One of their tasks was to conduct QPIs to test an already developed paper and pencil drop-off questionnaire, Footnote 2 which was part of the German sub-study in Wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE, http://share-eric.eu ) investigating the problem of income non-response. The students had detailed information about the background and development of the questionnaire and the task was to test it in its entirety. The questionnaire consists of seven printed pages (incl. instructions on the first two pages) and 31 items with separate instructions. A block of nine items, which were irrelevant in terms of contents for this step, was excluded; thus, altogether 22 items had to be tested.

In general, the length of QPIs varies because they are always unique encounters resulting from the confrontation of two individuals and their priorities and perspectives. There is no default requirement to discuss all aspects of the questionnaire in equal detail, and the process may be faster in case the wording or contents of some items do not require clarification. Nevertheless, researchers can obviously also decide in advance, that certain items need to be tested more thoroughly than others.

3.1 Briefing and opening the conversation

Like any conversation, QPIs are ideally embedded within a pleasant social situation based on trust. However, as a research encounter they are different from everyday conversations in many ways (due to the required recording alone). Some of the special features of the QPI need to be introduced accordingly in the frame of a separate briefing before the interview, and the opening of the conversation follows certain conventions (incl. the compliance with interview norms such as a proper welcome and expressing thanks for participation, etc.).

Researchers need to explain what the interview is about and how it will proceed. Some of the information included in the cover letter for the recruitment are repeated orally, like project description (background, purpose and utilisation of the interview), and research-ethical aspects (e.g. voluntary participation, data protection, declaration of consent). In addition, some conversational instructions should be included (e.g. the possibility of interrupting the interview etc.) and open questions clarified. Furthermore, some basics regarding situation, duration, participation, recording etc. need to be addressed. All these preparatory steps set the stage for the research conversation. In the case of the QPI they also clarify the goal of the interview and establish the interview partners as co-experts for achieving this goal and to underline their key role in improving draft survey questions and exploring and struggling for alternative formulations. This process can vary in terms of length as it depends on both participants. In the case of our example, it took about four minutes.

3.1.1 Goal of the QPI

First of all, it is important to familiarise the interview partner with the peculiarities of this encounter. As described above, the QPI is a discursive exchange based on a working relationship at eye level. It follows rules of engagement that are different from those suggested by the question–answer scheme that may usually be associated with a (survey) ‘interview’. The common goal of the pretest situation is the improvement of a draft survey question or similar stimuli. We need to emphasise that the QPI is not about collecting and analysing answers to the substantive survey questions that could possibly be provided to certain questions. To put it differently: we are not interested in what answer participants give to the survey question, but rather why they answer the way they do. Even if interviewees do actually provide answers to the questions, they are not analysed in terms of substance. The purpose of the exchange is the mutual clarification of the meaning of the contents (e.g. items) and of formal aspects (e.g. design) of the draft survey questionnaire (including cover letter, instructions, formulations, response categories and scales etc.). The following excerpt illustrates how the interviewer (I) introduces purpose and procedure to the interview partner (IP) in the context of briefing Footnote 3 :

I: The whole thing that we are having here now is not a classical interview, that you may know from television, or that you may have done yourself at some point, that is, I ask questions and you answer. Instead, you can imagine this as a conversation between the two of us [IP: Ok.] . Because in a nutshell it's not about you answering these questions from the questionnaire and I sit and nod, but it's really about us looking at this sheet together, step by step, page by page, question by question, and so on... [Interview 1, 00:21-00:51]

3.1.2 Interview partners as co-experts

Another purpose of the briefing is to underline that it is a joint process and that both participants are working together on an unfinished document. This includes asking critical questions on both sides, discussing and arguing, and making suggestions for improvement:

...and I depend on your support, that means, first I would like you to say everything that you notice, [IP: Uhm.] to talk about everything that comes to your mind when you read each of the questions, when you look at the individual pages. And I depend on that, that’s why I say support, uhm, that you are welcome to put your finger on it and say: ‘The term is not clear to me now.’ [IP: Ok.] ... [Interview 1, 00:52-01:20]

The QPI constitutes an unusual situation for both participants. The briefing provides an opportunity for creating a space for close collaboration with a previously unknown person and for talking freely about substantial issues as well as problematic formulations. On the one side, researchers need to put aside their research knowledge and distance themselves from the ambition of having constructed a somehow ‘perfect’ questionnaire. They must dismiss the idea of non-reactivity and need to be aware of the weak spots of the draft questionnaire and disclose them. Interview partners, on the other side, need to realise that they are in a position of temporary research assistance. Their interpretive competence is equally important in this situation, and it is essentially their contribution that will advance the improvement of the questionnaire. This clarification of roles and status are key to a productive QPI and should therefore be done very thoughtfully and depending on the circumstances. These aspects are illustrated in the following excerpt that continues where the previous one ended:

I: ... background is that we are quite aware of the fact that we sometimes have such a ‘researcher speak’, which is perhaps not at all used in everyday life in this way. IP: Ok, am I everyday speak or am I researcher speak? I: Uhm, for me it is important that you just tell me how you understand it. IP: Ok, so how I understand it now. I: Exactly. And that we just look at it together, maybe even ‘How could we formulate something differently?’ [IP: Uhm.] Because we are currently in the middle of the development phase with this drop-off questionnaire, so we are in the middle of it, we still have the chance to adjust some things, ask questions differently or maybe use different terms [IP: Ok.] ... [Interview 1, 01:20-02:04]

3.1.3 General exploration and thinking aloud

The briefing should pay particular attention to the introduction of the communication strategy of thinking aloud that is also used in forms of cognitive interviewing (Bethmann et al. 2019 ; Buschle et al. 2020 ). Footnote 4 The QPI exploits the idea of thinking aloud that is used as a strategy of general exploration at the beginning of the review of each item. The discussion of each draft question starts by handing over to the interview partners as co-experts. They are invited to articulate what comes to mind while the interviewer assumes the role of the active listener that develops ideas for follow-up probing. Thinking aloud may not be an obvious thing to do for interview partners. Freely articulating one’s flow of thoughts can be unusual and exhausting and needs some preparation and introduction. For instance, in this example the interviewer adds: “What makes this situation so special is the fact that I am actually encouraging you to express everything that comes to your mind.” Our experiences indicate that the best way of getting used to this form of exchange and of handling the interview partners’ possible uncertainties consists in trying it out together— “This is not as simple as that. [IP: laughs.] And it means that we will still practise it together now. [IP: Uhm, good.] ”.

3.1.4 Anticipation of unusual interventions

The briefing should also indicate how the interviewer intends to participate in the conversation, which part he or she will play, and what kind of interventions can be expected—e.g. “I will interrupt you from time to time to follow up on things.” Addressing spontaneous interruptions and inquiries in the frame of briefings is particularly important due to their significance for the goal of clarification. Interruptions create pauses and produce space for reflection; they may even take the form of confrontations and (polite!) controversies when contradictions need explanation. As part of the briefing, objections and confrontations are introduced as forms of constructive irritation and invitations to join the struggle for clarification. They demonstrate that in this unusual encounter called QPI it is socially desirable not to settle for easy compromises but to be ready, if necessary, to contest and dispute each other’s proposals. Both parties are welcome to do that. With the proper briefing, the QPI can be a method of negotiating controversial aspects as long as the conversation remains at the factual level. Productive interruptions and ad-hoc questions also have the positive side-effect of demonstrating that this kind of conversation breaks with the question–answer-scheme of conventional interviews. In this respect QPIs resemble dialogic everyday conversations where the thoughts, contributions, questions, doubts etc. of two participants are more closely intertwined than in conventional research communication.

The following section illustrates the practical steps of general and specific exploration in QPIs as well as the interviewer’s shift between active listening and active understanding.

3.2 Communication in QPIs—an example

The following segment is taken from the same interview quoted in the previous section. The interview has a total length of about 50 min. The example refers to item 11 on page 4 of the questionnaire. The item is part of a set of items dealing with the question of how respondents handle their own privacy protection. 30 min and 55 s into the interview, the general exploration of item 11 starts with the interviewee first reading the question out loud and expressing any thoughts that come to his mind.

3.2.1 Reading the item out loud & thinking aloud

This first step of reading out loud is the same for every item.

IP: How concerned are your relatives, friends or your partner that you provide too much personal information (.) to people you don’t know very well? (.) So, now I don't know what it is that relatives, friends or partners should be worried about. (.) Is it simply about my, are they worried that I make my own information available to others that I use smartphones. That’s how I understand that. [I: Yes.] Or, uh, is it about (.) that they (.) are concerned that the information I have about the relatives. (.) So, [I: Ah.] yes. [Interview 1, 30:55–31:43]

After reading out the item the interview partner follows the instruction of thinking aloud and immediately expresses his confusion about its precise meaning. The short pause within indicates that it is related to the term ‘information’. He leans towards one interpretation but offers a second one that is also conceivable. His uninterrupted thoughts conclude with a Coda ( “(.) So, yes.” ). This is when the interviewer realises that there is a problem in the formulation ( “Ah.” ). It is her turn to take over and she shifts from active listening to a dialogue of active understanding.

3.2.2 Stepwise clarification and active understanding

In the following interview excerpt, the researcher first responds to the interviewee’s thinking aloud with an explicit affirmative statement ( “totally exciting” ). While this is unusual in qualitative interviews because it might introduce bias towards social desirability (in terms of contents), it serves here as a strong motivational intervention. This is followed by the disclosure of the intention behind the question ( “To explain what we had in mind…” ) initiating a stepwise dialogical process of clarifying understanding at eye level by using different communication strategies.

I: That is totally exciting. To explain what we had in mind: that too much of your own, of course personal information from you, so to speak, that you report what you do and that then your relatives, friends or so, that they are worried that you pass on information. IP: From myself? I: Exactly. But of course, this is also a point that they might be worried that, uh, [IP: Yes.] by you passing on information… IP: that something about them will also come out. I: That also something about them, that also something about them would be found out. OK. That means, when we now say that we are actually interested in your information [IP: Uhm.] , that is, that friends are concerned about you [IP: Uhm.] , would it be possible for us to say: “How concerned are your relatives, friends or your partner that too much personal information about you, even more so, own personal information (.) or (.) personal information about oneself…” IP: Yes, about oneself, that would be so with me (..) personal information about oneself. I: About oneself? IP: About oneself, exactly. I: Exactly, so that we specify this once again. That would be one possibility [IP: Yes, totally.] , so that you would know what we want? [IP: Totally, totally.] Yes, ok. IP: And that's what it's about, isn't it? I: Yes exactly, that would be the point. [Interview 1, 31:44–32:58]

The interviewer’s disclosure of the intended purpose of the questionnaire item is a first substantial contribution that actively initiates the process of clarifying meaning. It provides the interview partner with the opportunity to understand and agree with the interviewer’s proposal ( “From myself?” ). By paraphrasing and mirroring the interview partner’s second interpretation ( “…they might be worried that … by you passing on information…” ) the interviewer both acknowledges it and asks him to confirm that she got it right. This kind of response of the researcher inviting validation is a step of active understanding. The interview partner confirms the researcher’s statement and even completes her sentence ( “… that something about them will also come out” ). In turn, she repeats it in similar words and concludes this first part of negotiating agreement ( “OK” ).

3.2.3 Negotiating indexicality and joint adjustment of the wording

Once common ground is established, they can move on to the next step of working together on an adjustment of the wording of the item. The interviewer’s suggestion ( “personal information about oneself” ) is accepted and verbally ratified repeatedly by the interview partner; he can “totally” agree that such a specification would help to reduce the ambiguity of the original wording. This segment illustrates the significance of listening to each other: the full appreciation of the perspective of the interviewer, and at times its redundant confirmation (like in this example), is equally important for building consensus. This capability of the two interlocutors to agree on an interpretation is crucial for the next part of the sequence:

IP: Yes, and then it's just that, it's such a mishmash, then I would just say "rather not like that", four. [i.e. the answer category 4; authors] I: Mishmash, because? IP: Yes, maybe my mother is totally worried and, uh, all my friends are just not worried, that’s just how it was now. I: Ok, so because now we simply packed all [I: Yes.] contacts [I: Yes, all.] into this question [I: Uhm.] , so that it is difficult to name exactly [I: Exactly.] who is worried. [I: Yes.] That means, if we wanted to, so if we were interested in what your partner or friends were saying and if we wanted to separate that, we would have to list them separately. [I: Uhm.] Do I understand that correctly? IP: Totally. Exactly like that. I: Ok. [Interview 1, 32:58-33:37]

The interview partner addresses another flaw (“ it's such a mishmash” ) that he notices as he tries to select an appropriate answer category. The problem is that relatives, friends, and partner are all lumped together in the item. Even if one of these three categories would deserve the highest rating of 1 ( “maybe my mother is totally worried” ) he would still have to mark the second lowest rating of 4 because all the others would not be concerned ( “all my friends are just not worried” ).

This sequence underlines the interview partner’s commitment to his status as diligent co-expert: of his own accord he addresses another inconsistency by continuing to think aloud. The interviewer shifts from active listening to active understanding by interposing a simple detailing question that explores the contextuality of the term “mishmash” ( “Mishmash, because?” ). This question triggers an explication, which is then followed by a longer sequence of active understanding through paraphrasing and mirroring accompanied by several affirmations of the interview partner. In this way the indexicality of what he has said is gradually dissolved and replaced by genuine understanding. Again, the interviewer initiates the conclusion of this process by suggesting an adjustment of the item based on a compromise between research interest ( “if we were interested in…” ) and the now resolved irritation of the interview partner ( “Exactly like that.” ).

However, the interview partner is not quite finished yet. He once again assumes his responsibility as co-expert and submits his very own alternative formulation of the item.

IP: Yes. Otherwise, there might perhaps be the option to simplify it by saying "environment" or so. I: Uh, "your personal environment", something like that? [IP: Uhm.] Okay. (...) Thank you very much. [IP: Uhm.] [Interview 1, 33:38–33:51] Footnote 5

The researcher adapts his proposal and seeks one final agreement for her suggested clarification of understanding. At this point, the discussion of this item is finalised because all the suggestions and adjustments of the wording are fully acceptable for both sides. If this were not the case, the debate would continue. In the example it could then, hypothetically, evolve along the suggested notion of “environment” that is, in fact, just as indistinct as a list of potentially important members of this ‘environment’. Instead of concluding the negotiation, the interviewer could have initiated further clarification by confronting the interview partner with this contradiction. An open probe would be appropriate to obtain the interview partner’s notion of ‘environment’. In case he sticks with such a vague term, she could question its usefulness for improving the item. She could finally indicate her inclination to reject the suggestion and would provide arguments underlining her decision with the aim of finding out whether she would be able to convince the interview partner as co-expert. In any case, each proposal made by the interview partner enters the further discussion and questionnaire development among the researchers as a qualified contribution.

3.2.4 Summary

This short interview sequence demonstrates that with all these instructive shifts between the researcher’s and the interviewee’s reference systems (of research and everyday knowledge) intersubjective understanding can be accomplished in a very effective and highly indexical way. It requires careful briefing of the interview partner and an interviewer that is able to handle the idiosyncrasies of an open conversation and channel them towards negotiated agreement. In summary, these examples show different strategies of clarifying meaning and establishing mutual understanding in QPIs:

Active listening to the interview partner’s thinking aloud is the most subtle form of general exploration with the least risk of introducing reactivity to the conversation. With its foundation in thorough briefing it encourages most authentic expressions and preserves their indexicality . They constitute the basis for active understanding.

Active understanding through specific exploration is dedicated to the exploration and negotiation of contextual meanings and interpretations of these expressions. It is done through the strategic and repeated use of summaries, by paraphrasing and mirroring (of contradictions, if necessary) and by carefully employing interpretive confrontations that emphasise the QPI’s purpose of clarifying misunderstandings.

The joint discussion and adjustment of the wording of draft survey questions and items contributes significantly to the active clarification of understanding. Concrete suggestions by the interview partner are indicators for his or her degree of involvement and for the overall progress of the specific exploration of interpretations.

The identification of the interviewee's point of view provides valuable information about the range of possible interpretations and for determining appropriate alternative formulations. By adjusting sampling and analysis, the characteristic features of particular target groups can be established as well as possible divergences in their understanding of the relations between question, answer, and conceptual background.

The choice and use of certain communication strategies depends on the researcher’s interest in specific aspects of the draft questionnaire or other survey material (e.g., cover letter, instructions, items, answer categories), the various possible goals in the process of intersubjective understanding as well as the kind of course the conversation should take. Thus, researchers need to consider in advance the potential and advantages of certain kinds of communication and probing strategies with regard to active understanding and active listening. It is worthwhile figuring out for which parts of the questionnaire or which types of draft questions these strategies might be most suitable. All this can be documented in an interview guide. However, as the example indicates, interviewers need to remain flexible and should not just work through the interview guide without considering the previous part of the conversation (Hopf 1978 ). They need to remain open to the perspective of the interview partner for true conversations can be full of surprising turns and opportunities.

Interviewers must be trained carefully in general conversation techniques as well as the particular QPI strategies. Ideally, in addition to their QPI training they have some practical experience as well as comprehensive training in qualitative methods in general and beyond interviewing. The latter can help to understand exactly why it is so important for intersubjective understanding in QPIs to reflect both their own and the interview partner’s possible interpretations: it is the necessary precondition for improving the quality of questionnaires through an exchange and alignment of everyday knowledge and research knowledge. This article does not cover the analysis of QPIs; we need to postpone this to a different occasion. Depending on purpose, time, and resources the same data can be analysed in many different ways (e.g., Flick 2014 ). This applies also to the QPI, which can, in principle, equally utilise the full potential of available approaches.

3.3 Debriefing

The exit sequence is about concluding the social encounter appropriately, by recognising their status as co-experts. In the procedure described so far, the importance of uncovering the interviewees’ point of view and using their interpretive competence as co-experts was repeatedly emphasised. This aspect becomes relevant once again in the frame of debriefing.

In addition to expressing one’s thanks for their time, interest and commitment, the final appreciation of their participation should address the importance of their contribution (e.g. practical perspective, specific expertise and background) as well as the information provided (e.g. substance of their comments and significance for the improvement of the questionnaire). One part of this closing ritual consists in inviting the interview partners to address issues that have remained open so far or that are still missing. Their answers can hold valuable remarks like in the next example. Following the concluding recapitulation of the whole questionnaire, the interview partner emphasises, after a long pause for thought of six seconds, the importance of the briefing for this unusual QPI encounter in one of his final comments:

IP: It was a lot of fun. I found it very interesting, because (……) yes, I actually found it, I found it much more interesting to say everything that comes to my head. [I: laughs] Completely crazy this situation. [Interview 1, 47:35–47:52]

The final sequence illustrates that debriefing can be used for a summary and reflection of the background and purpose of the conversation. It highlights the researcher’s take-away conclusions and emphasises that the contribution of the interviewee will lead to adjustments in the questionnaire:

I: Now I would like to thank you very much for being ready to participate here. As you have noticed in many places, there were a few [IP: laughs] points where I noticed, “OK, here we could differentiate a bit more, there we could put things differently”, [IP: Uhm.] or maybe some things are not so clear yet. I can tell you now from my side, there were some things I was worried about, “Oops, I hope that's clear”, where I noticed, “OK, that's totally clear, you're really good with that.” [IP: Uhm, ok.] That was also very nice. [IP: Cool.] But above all there were some points where I thought we could make some improvements. [IP: Uhm.] That's very valuable for us. [IP: Yes.] Many, many thanks for being willing to do this. [Interview 1, 48:04–48:44].

Finally, debriefing addresses the next steps and informs, for instance, about how comments will be processed and considered, and what will likely need to be adjusted. Interview partners are also informed about how they could participate further and, if interested, who to contact for further information.

4 Summary and conclusion

The discussion about the degree of openness of the interaction between interviewers and interview partners has existed since at least the 1940s (Beatty 1995 ); more than 75 years after Lazarsfeld's ( 1944 ) first conciliatory intervention it is still ongoing (e.g., West et al. 2018 ). Both parties involved in this debate provide reasonable arguments that are highly relevant for interview practice. The proponents of a strong standardisation on the one side emphasise the necessity of using an efficient and coherent protocol of data collection to generate adequate data for the analysis of statistical distributions. Advocates of open interviewing on the other side argue that the validity of the answers of participants depends essentially on a shared understanding of questions. They consider the possibility of reflecting on this understanding and clarifying it in the interview interaction a key element in reducing bias and error in surveys (Suchman and Jordan 1990 ). At the same time, more intensive interaction implies the danger of interviewer influence and thus the distortion of answers. Ongoing comparative research into the techniques of “conversational” and “standardised” interviews (e.g., Schober and Conrad 1997 ) sheds light on the trade-off between the two main sources of measurement error—i.e. wrong understanding of the question by the respondents and distorted answers due to the influence of the interviewer.

One area, in which the use of open interviewing techniques does not cause much controversy, is questionnaire development. It is possible to increase the validity of answers by preponing the open exchange about the meaning of questions and moving it from the primary survey to the process of questionnaire development. The “cognitive turn” in survey research in the 1980s resulted in a systematisation of open pretesting techniques, especially through the development of methods that are now subsumed under the label of ‘Cognitive Interviews’ (Willis 2005 , 2015 ). These methods were developed to identify and, ideally, remedy problems in the respondents’ understanding already in the process of designing the wording of questions.

This paper discusses and advocates a comprehensive consideration of qualitative-interpretive aspects in open forms of pretesting survey questionnaires. More specifically, we start out from the notion of intersubjective understanding as the conceptual pillar of interpretive interview research. Borrowing from the well-developed methodology and techniques of Problem-centred Interviews (PCI) (Witzel and Reiter 2012 ; Reiter and Witzel 2019 ; Bethmann et al. 2019 ), we propose an approach we call Qualitative Pretest Interviews (QPI), which focuses on a joint production of understanding. The QPI can be described as a method of pretest interviewing that involves interview partners as co-experts in a joint discursive clarification of meaning in draft survey questions and other standardised stimuli.

The QPI shares its practical objectives with the Cognitive Interview (CI) developed by Willis (e.g., Willis 2005 , 2015 ), in aiming at reducing response and measurement errors due to problematic survey questions. While the QPI also takes an open approach to pretest interviewing it is conceptually rooted in qualitative-interpretive methodology, as opposed to the CI’s heritage of cognitive psychology. In a sense, we accept Willis’ ( 2015 ) invitation to elaborate the qualitative potential of pretest interviewing by fleshing it out in the QPI’s methodology.

In the course of the paper, we outline the QPI’s background in interpretive interview research and elaborate on the value of the concept of intersubjective understanding for the purpose of evaluating survey questions. Namely, it helps to identify and explicate ambiguous meanings of survey stimuli between participants, interviewers and (ideally) researchers by discussing them in their contexts of origin. Eventually, this dialog should lead to shared understanding of meaning and in turn yield suggestions for improvement of the questionnaire.

Regarding practical interviewing techniques, we borrow from the PCI and its particular qualitative interviewing methodology developed for the joint clarification of meanings related to topics, which, like in the QPI, have been identified in advance. Translating the concept of intersubjective understanding into actionable communication strategies, the QPI promotes strategies of active listening for general exploration and strategies of active understanding for specific exploration. We further differentiate this approach and show its practical application in an example interview discussing items in a paper-and-pencil questionnaire on income non-response developed as an add-on for the Survey of Health, Ageing and Retirement in Europe (SHARE, http://share-eric.eu ). We explain the concepts of general and specific exploration for the discursive-dialogical clarification of (implied) meaning, using straight-forward examples like encouragement to think aloud and paraphrasing by the interviewer, as well as more complex sequences of making and discussing suggestions to improve the questionnaire. We also point out the importance of briefing and debriefing in order to create a relaxed and professional atmosphere, as well as a relationship between participant and interviewer that is friendly and appreciative, but also sober enough to debate disagreements about the questionnaire critically. In order for a QPI to work, it is vital that the participant’s role of a co-expert is thoroughly understood and accepted by the participant him- or herself as well as the interviewer.

While rooting open pretesting techniques in qualitative-interpretive methodology, as we have done with the QPI, seems to be a fruitful approach, this paper can only give a first impression of what has to be further developed into a proper framework of the methodology and practice of QPIs in the future. Apart from further refining the interviewing techniques themselves, a second equally significant topic we were not able to cover here, is the discussion of methods to analyse the rich and complex material collected during the QPI. Also, a thorough comparison of priorities, procedures, and results with other pretesting methods like the CI needs to be postponed to another publication.

The task of pretesting standardised instruments of data collection with QPIs is at the intersection of quantitative and qualitative research; and only people or teams that are familiar with both approaches will really be able to accomplish it. One thing that becomes clear when looking at the implementation of QPIs in practical questionnaire pretesting is the substantial demand it poses on the training of interviewers. The techniques of QPIs are rather involved, and interviewers would benefit from comprehensive prior training in qualitative interviewing methods. In contrast to other forms of pretests, QPIs cannot be standardised very well as they rely heavily on the interviewer being able to react flexibly during the interaction with the participant. This leads to the need for a specific set of skills, rather than a simple list of prescriptions, which have to be learned through a substantial amount of practice.

QPIs allow for a very thorough investigation of how and why survey questions might not be understood and answered as intended. In our view, employing the methods described above provides a good way of making use of the potential that lies within the direct social interaction during an open pretest situation. By recognising the participants as co-experts, it is possible to tap into their knowledge and ability to discuss and interpret the meanings of questionnaire items as they understand them themselves or as is brought forward by the interviewer. Depending on the specific survey project, this might be very helpful indeed to mitigate important risks to survey quality.

At the same time, QPIs are very resource intensive, as they require well-trained interviewers and a considerable amount of time and money for conducting and processing the interviews, as well as their analysis. In direct comparison with CIs, we would assume that QPIs would require even more training and experience on the side of the interviewers, especially regarding qualitative interviewing techniques. The same will probably hold true for the analysis of the interview material, as the conversations will presumably be more complex due to the higher degree of dialogic interaction. For the same reasons it is likely harder to ensure high quality for a QPI. One could argue that the QPI allows for more degrees of freedom in interview and analysis, putting the result more at risk if done inaptly. The traditional CI, while still one of the most involved pretesting approaches available, might be—at least to some extent—easier to standardise than the QPI, reducing its margin for error. Or, to put it differently: the QPI puts more responsibility for the end result on the well-trained interviewer, rather than on the process. Whether these costs and quality risks are outweighed by the benefits of a potentially higher quality of the questionnaire needs to be decided for each survey project individually.

Finally, even open forms of pretesting will always have their limitations. Even the most elaborate procedure will not result in question wordings that produce equally valid answers for all different, heterogeneous groups of respondents. Conducting pretests with a variety of different types of respondents seems indicated. Still there will be cases where we are only able to find that some respondents may understand a specific question wording, while others do not. Standardisation across all groups of respondents will not at all be possible in some cases, and even open pretest procedures such as the proposed QPI will not be able to resolve these contradictions. Nevertheless, they can provide a nuanced basis for identifying group-differences in the comprehension of questions and for recognising the fundamental necessity of reflecting the concepts in the survey. Sometimes, QPIs might even be instrumental in determining that the study would benefit from an altogether more open approach to interviewing (e.g., Conversational Interviewing, cf. Schober and Conrad 1997 ). With regard to the decision whether to spend a considerable amount of time and money on thorough pretesting at all, be that QPIs, CIs, or other, maybe less elaborate strategies, we would like to close the discussion with a reminder put forward by Sudman and Bradburn already in 1982 (p. 283): “It is even more important for researchers with limited resources to pilot-test their questionnaires before spending all their money. If you do not have the resources to pilot-test your questionnaire, don’t do the study.”

The former comprehension of manifest and implied meaning in the tradition of pragmatism is required for situational intersubjective understanding in pretest interviews; the latter discovery of possible latent meanings and of unconscious generative structures behind utterances is characteristic of reconstructive qualitative research in the German hermeneutic tradition that applies sophisticated techniques of data analysis and interpretation (Reichertz 2016 ).

The final, German version, fielded in SHARE Wave 8, can be found here: http://www.share-project.org/fileadmin/pdf_questionnaire_wave_8_preliminary/Wave_8_DropOffs/DE_DE_SHAREw8_Main_dropoff.pdf .

The interview was audio-recorded, transcribed following simple standards, and anonymised. Underlined text indicates emphasis. “(.)” signifies pauses and their length (one point per second). “…” indicate that the account is continued. The end of each quotation includes time markers.

The paradigms of thinking aloud and probing in Cognitive Interviews described by Willis ( 2005 ), Beatty and Willis ( 2007 ), Willis ( 2015 ) have their origin in psychological laboratory analyses of short-term memory and information processing (Ericsson and Simon 1980 ). In the QPI these means of collecting data are combined with communication strategies in the context of an altogether different methodological frame (c.f. chapters 2 and 3.2).

This item was problematic for similar reasons for most of the interview partners in the other QPIs that were conducted.

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Acknowledgements

We want to thank the anonymous reviewers for their constructive critique and discussion that greatly helped us to improve the argument in terms of both substance and structure. We also thank the participants of our university seminar “Pretest-Interviews in der Entwicklung standardisierter Fragebögen” at the Ludwig-Maximilians-University of Munich/Germany in the winter semester 2019/2020 for providing us valuable feedback in the frame of developing the QPI.

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Buschle, C., Reiter, H. & Bethmann, A. The qualitative pretest interview for questionnaire development: outline of programme and practice. Qual Quant 56 , 823–842 (2022). https://doi.org/10.1007/s11135-021-01156-0

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Qualitative Methods in Health Care Research

Vishnu renjith.

School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain

Renjulal Yesodharan

1 Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Judith A. Noronha

2 Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Elissa Ladd

3 School of Nursing, MGH Institute of Health Professions, Boston, USA

Anice George

4 Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Introduction

Healthcare research is a systematic inquiry intended to generate trustworthy evidence about issues in the field of medicine and healthcare. The three principal approaches to health research are the quantitative, the qualitative, and the mixed methods approach. The quantitative research method uses data, which are measures of values and counts and are often described using statistical methods which in turn aids the researcher to draw inferences. Qualitative research incorporates the recording, interpreting, and analyzing of non-numeric data with an attempt to uncover the deeper meanings of human experiences and behaviors. Mixed methods research, the third methodological approach, involves collection and analysis of both qualitative and quantitative information with an objective to solve different but related questions, or at times the same questions.[ 1 , 2 ]

In healthcare, qualitative research is widely used to understand patterns of health behaviors, describe lived experiences, develop behavioral theories, explore healthcare needs, and design interventions.[ 1 , 2 , 3 ] Because of its ample applications in healthcare, there has been a tremendous increase in the number of health research studies undertaken using qualitative methodology.[ 4 , 5 ] This article discusses qualitative research methods, their significance, and applicability in the arena of healthcare.

Qualitative Research

Diverse academic and non-academic disciplines utilize qualitative research as a method of inquiry to understand human behavior and experiences.[ 6 , 7 ] According to Munhall, “Qualitative research involves broadly stated questions about human experiences and realities, studied through sustained contact with the individual in their natural environments and producing rich, descriptive data that will help us to understand those individual's experiences.”[ 8 ]

Significance of Qualitative Research

The qualitative method of inquiry examines the 'how' and 'why' of decision making, rather than the 'when,' 'what,' and 'where.'[ 7 ] Unlike quantitative methods, the objective of qualitative inquiry is to explore, narrate, and explain the phenomena and make sense of the complex reality. Health interventions, explanatory health models, and medical-social theories could be developed as an outcome of qualitative research.[ 9 ] Understanding the richness and complexity of human behavior is the crux of qualitative research.

Differences between Quantitative and Qualitative Research

The quantitative and qualitative forms of inquiry vary based on their underlying objectives. They are in no way opposed to each other; instead, these two methods are like two sides of a coin. The critical differences between quantitative and qualitative research are summarized in Table 1 .[ 1 , 10 , 11 ]

Differences between quantitative and qualitative research

Qualitative Research Questions and Purpose Statements

Qualitative questions are exploratory and are open-ended. A well-formulated study question forms the basis for developing a protocol, guides the selection of design, and data collection methods. Qualitative research questions generally involve two parts, a central question and related subquestions. The central question is directed towards the primary phenomenon under study, whereas the subquestions explore the subareas of focus. It is advised not to have more than five to seven subquestions. A commonly used framework for designing a qualitative research question is the 'PCO framework' wherein, P stands for the population under study, C stands for the context of exploration, and O stands for the outcome/s of interest.[ 12 ] The PCO framework guides researchers in crafting a focused study question.

Example: In the question, “What are the experiences of mothers on parenting children with Thalassemia?”, the population is “mothers of children with Thalassemia,” the context is “parenting children with Thalassemia,” and the outcome of interest is “experiences.”

The purpose statement specifies the broad focus of the study, identifies the approach, and provides direction for the overall goal of the study. The major components of a purpose statement include the central phenomenon under investigation, the study design and the population of interest. Qualitative research does not require a-priori hypothesis.[ 13 , 14 , 15 ]

Example: Borimnejad et al . undertook a qualitative research on the lived experiences of women suffering from vitiligo. The purpose of this study was, “to explore lived experiences of women suffering from vitiligo using a hermeneutic phenomenological approach.” [ 16 ]

Review of the Literature

In quantitative research, the researchers do an extensive review of scientific literature prior to the commencement of the study. However, in qualitative research, only a minimal literature search is conducted at the beginning of the study. This is to ensure that the researcher is not influenced by the existing understanding of the phenomenon under the study. The minimal literature review will help the researchers to avoid the conceptual pollution of the phenomenon being studied. Nonetheless, an extensive review of the literature is conducted after data collection and analysis.[ 15 ]

Reflexivity

Reflexivity refers to critical self-appraisal about one's own biases, values, preferences, and preconceptions about the phenomenon under investigation. Maintaining a reflexive diary/journal is a widely recognized way to foster reflexivity. According to Creswell, “Reflexivity increases the credibility of the study by enhancing more neutral interpretations.”[ 7 ]

Types of Qualitative Research Designs

The qualitative research approach encompasses a wide array of research designs. The words such as types, traditions, designs, strategies of inquiry, varieties, and methods are used interchangeably. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research.[ 1 , 7 , 10 ]

Narrative research

Narrative research focuses on exploring the life of an individual and is ideally suited to tell the stories of individual experiences.[ 17 ] The purpose of narrative research is to utilize 'story telling' as a method in communicating an individual's experience to a larger audience.[ 18 ] The roots of narrative inquiry extend to humanities including anthropology, literature, psychology, education, history, and sociology. Narrative research encompasses the study of individual experiences and learning the significance of those experiences. The data collection procedures include mainly interviews, field notes, letters, photographs, diaries, and documents collected from one or more individuals. Data analysis involves the analysis of the stories or experiences through “re-storying of stories” and developing themes usually in chronological order of events. Rolls and Payne argued that narrative research is a valuable approach in health care research, to gain deeper insight into patient's experiences.[ 19 ]

Example: Karlsson et al . undertook a narrative inquiry to “explore how people with Alzheimer's disease present their life story.” Data were collected from nine participants. They were asked to describe about their life experiences from childhood to adulthood, then to current life and their views about the future life. [ 20 ]

Phenomenological research

Phenomenology is a philosophical tradition developed by German philosopher Edmond Husserl. His student Martin Heidegger did further developments in this methodology. It defines the 'essence' of individual's experiences regarding a certain phenomenon.[ 1 ] The methodology has its origin from philosophy, psychology, and education. The purpose of qualitative research is to understand the people's everyday life experiences and reduce it into the central meaning or the 'essence of the experience'.[ 21 , 22 ] The unit of analysis of phenomenology is the individuals who have had similar experiences of the phenomenon. Interviews with individuals are mainly considered for the data collection, though, documents and observations are also useful. Data analysis includes identification of significant meaning elements, textural description (what was experienced), structural description (how was it experienced), and description of 'essence' of experience.[ 1 , 7 , 21 ] The phenomenological approach is further divided into descriptive and interpretive phenomenology. Descriptive phenomenology focuses on the understanding of the essence of experiences and is best suited in situations that need to describe the lived phenomenon. Hermeneutic phenomenology or Interpretive phenomenology moves beyond the description to uncover the meanings that are not explicitly evident. The researcher tries to interpret the phenomenon, based on their judgment rather than just describing it.[ 7 , 21 , 22 , 23 , 24 ]

Example: A phenomenological study conducted by Cornelio et al . aimed at describing the lived experiences of mothers in parenting children with leukemia. Data from ten mothers were collected using in-depth semi-structured interviews and were analyzed using Husserl's method of phenomenology. Themes such as “pivotal moment in life”, “the experience of being with a seriously ill child”, “having to keep distance with the relatives”, “overcoming the financial and social commitments”, “responding to challenges”, “experience of faith as being key to survival”, “health concerns of the present and future”, and “optimism” were derived. The researchers reported the essence of the study as “chronic illness such as leukemia in children results in a negative impact on the child and on the mother.” [ 25 ]

Grounded Theory Research

Grounded theory has its base in sociology and propagated by two sociologists, Barney Glaser, and Anselm Strauss.[ 26 ] The primary purpose of grounded theory is to discover or generate theory in the context of the social process being studied. The major difference between grounded theory and other approaches lies in its emphasis on theory generation and development. The name grounded theory comes from its ability to induce a theory grounded in the reality of study participants.[ 7 , 27 ] Data collection in grounded theory research involves recording interviews from many individuals until data saturation. Constant comparative analysis, theoretical sampling, theoretical coding, and theoretical saturation are unique features of grounded theory research.[ 26 , 27 , 28 ] Data analysis includes analyzing data through 'open coding,' 'axial coding,' and 'selective coding.'[ 1 , 7 ] Open coding is the first level of abstraction, and it refers to the creation of a broad initial range of categories, axial coding is the procedure of understanding connections between the open codes, whereas selective coding relates to the process of connecting the axial codes to formulate a theory.[ 1 , 7 ] Results of the grounded theory analysis are supplemented with a visual representation of major constructs usually in the form of flow charts or framework diagrams. Quotations from the participants are used in a supportive capacity to substantiate the findings. Strauss and Corbin highlights that “the value of the grounded theory lies not only in its ability to generate a theory but also to ground that theory in the data.”[ 27 ]

Example: Williams et al . conducted a grounded theory research to explore the nature of relationship between the sense of self and the eating disorders. Data were collected form 11 women with a lifetime history of Anorexia Nervosa and were analyzed using the grounded theory methodology. Analysis led to the development of a theoretical framework on the nature of the relationship between the self and Anorexia Nervosa. [ 29 ]

Ethnographic research

Ethnography has its base in anthropology, where the anthropologists used it for understanding the culture-specific knowledge and behaviors. In health sciences research, ethnography focuses on narrating and interpreting the health behaviors of a culture-sharing group. 'Culture-sharing group' in an ethnography represents any 'group of people who share common meanings, customs or experiences.' In health research, it could be a group of physicians working in rural care, a group of medical students, or it could be a group of patients who receive home-based rehabilitation. To understand the cultural patterns, researchers primarily observe the individuals or group of individuals for a prolonged period of time.[ 1 , 7 , 30 ] The scope of ethnography can be broad or narrow depending on the aim. The study of more general cultural groups is termed as macro-ethnography, whereas micro-ethnography focuses on more narrowly defined cultures. Ethnography is usually conducted in a single setting. Ethnographers collect data using a variety of methods such as observation, interviews, audio-video records, and document reviews. A written report includes a detailed description of the culture sharing group with emic and etic perspectives. When the researcher reports the views of the participants it is called emic perspectives and when the researcher reports his or her views about the culture, the term is called etic.[ 7 ]

Example: The aim of the ethnographic study by LeBaron et al . was to explore the barriers to opioid availability and cancer pain management in India. The researchers collected data from fifty-nine participants using in-depth semi-structured interviews, participant observation, and document review. The researchers identified significant barriers by open coding and thematic analysis of the formal interview. [ 31 ]

Historical research

Historical research is the “systematic collection, critical evaluation, and interpretation of historical evidence”.[ 1 ] The purpose of historical research is to gain insights from the past and involves interpreting past events in the light of the present. The data for historical research are usually collected from primary and secondary sources. The primary source mainly includes diaries, first hand information, and writings. The secondary sources are textbooks, newspapers, second or third-hand accounts of historical events and medical/legal documents. The data gathered from these various sources are synthesized and reported as biographical narratives or developmental perspectives in chronological order. The ideas are interpreted in terms of the historical context and significance. The written report describes 'what happened', 'how it happened', 'why it happened', and its significance and implications to current clinical practice.[ 1 , 10 ]

Example: Lubold (2019) analyzed the breastfeeding trends in three countries (Sweden, Ireland, and the United States) using a historical qualitative method. Through analysis of historical data, the researcher found that strong family policies, adherence to international recommendations and adoption of baby-friendly hospital initiative could greatly enhance the breastfeeding rates. [ 32 ]

Case study research

Case study research focuses on the description and in-depth analysis of the case(s) or issues illustrated by the case(s). The design has its origin from psychology, law, and medicine. Case studies are best suited for the understanding of case(s), thus reducing the unit of analysis into studying an event, a program, an activity or an illness. Observations, one to one interviews, artifacts, and documents are used for collecting the data, and the analysis is done through the description of the case. From this, themes and cross-case themes are derived. A written case study report includes a detailed description of one or more cases.[ 7 , 10 ]

Example: Perceptions of poststroke sexuality in a woman of childbearing age was explored using a qualitative case study approach by Beal and Millenbrunch. Semi structured interview was conducted with a 36- year mother of two children with a history of Acute ischemic stroke. The data were analyzed using an inductive approach. The authors concluded that “stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles”. [ 33 ]

Sampling in Qualitative Research

Qualitative researchers widely use non-probability sampling techniques such as purposive sampling, convenience sampling, quota sampling, snowball sampling, homogeneous sampling, maximum variation sampling, extreme (deviant) case sampling, typical case sampling, and intensity sampling. The selection of a sampling technique depends on the nature and needs of the study.[ 34 , 35 , 36 , 37 , 38 , 39 , 40 ] The four widely used sampling techniques are convenience sampling, purposive sampling, snowball sampling, and intensity sampling.

Convenience sampling

It is otherwise called accidental sampling, where the researchers collect data from the subjects who are selected based on accessibility, geographical proximity, ease, speed, and or low cost.[ 34 ] Convenience sampling offers a significant benefit of convenience but often accompanies the issues of sample representation.

Purposive sampling

Purposive or purposeful sampling is a widely used sampling technique.[ 35 ] It involves identifying a population based on already established sampling criteria and then selecting subjects who fulfill that criteria to increase the credibility. However, choosing information-rich cases is the key to determine the power and logic of purposive sampling in a qualitative study.[ 1 ]

Snowball sampling

The method is also known as 'chain referral sampling' or 'network sampling.' The sampling starts by having a few initial participants, and the researcher relies on these early participants to identify additional study participants. It is best adopted when the researcher wishes to study the stigmatized group, or in cases, where findings of participants are likely to be difficult by ordinary means. Respondent ridden sampling is an improvised version of snowball sampling used to find out the participant from a hard-to-find or hard-to-study population.[ 37 , 38 ]

Intensity sampling

The process of identifying information-rich cases that manifest the phenomenon of interest is referred to as intensity sampling. It requires prior information, and considerable judgment about the phenomenon of interest and the researcher should do some preliminary investigations to determine the nature of the variation. Intensity sampling will be done once the researcher identifies the variation across the cases (extreme, average and intense) and picks the intense cases from them.[ 40 ]

Deciding the Sample Size

A-priori sample size calculation is not undertaken in the case of qualitative research. Researchers collect the data from as many participants as possible until they reach the point of data saturation. Data saturation or the point of redundancy is the stage where the researcher no longer sees or hears any new information. Data saturation gives the idea that the researcher has captured all possible information about the phenomenon of interest. Since no further information is being uncovered as redundancy is achieved, at this point the data collection can be stopped. The objective here is to get an overall picture of the chronicle of the phenomenon under the study rather than generalization.[ 1 , 7 , 41 ]

Data Collection in Qualitative Research

The various strategies used for data collection in qualitative research includes in-depth interviews (individual or group), focus group discussions (FGDs), participant observation, narrative life history, document analysis, audio materials, videos or video footage, text analysis, and simple observation. Among all these, the three popular methods are the FGDs, one to one in-depth interviews and the participant observation.

FGDs are useful in eliciting data from a group of individuals. They are normally built around a specific topic and are considered as the best approach to gather data on an entire range of responses to a topic.[ 42 Group size in an FGD ranges from 6 to 12. Depending upon the nature of participants, FGDs could be homogeneous or heterogeneous.[ 1 , 14 ] One to one in-depth interviews are best suited to obtain individuals' life histories, lived experiences, perceptions, and views, particularly while exporting topics of sensitive nature. In-depth interviews can be structured, unstructured, or semi-structured. However, semi-structured interviews are widely used in qualitative research. Participant observations are suitable for gathering data regarding naturally occurring behaviors.[ 1 ]

Data Analysis in Qualitative Research

Various strategies are employed by researchers to analyze data in qualitative research. Data analytic strategies differ according to the type of inquiry. A general content analysis approach is described herewith. Data analysis begins by transcription of the interview data. The researcher carefully reads data and gets a sense of the whole. Once the researcher is familiarized with the data, the researcher strives to identify small meaning units called the 'codes.' The codes are then grouped based on their shared concepts to form the primary categories. Based on the relationship between the primary categories, they are then clustered into secondary categories. The next step involves the identification of themes and interpretation to make meaning out of data. In the results section of the manuscript, the researcher describes the key findings/themes that emerged. The themes can be supported by participants' quotes. The analytical framework used should be explained in sufficient detail, and the analytic framework must be well referenced. The study findings are usually represented in a schematic form for better conceptualization.[ 1 , 7 ] Even though the overall analytical process remains the same across different qualitative designs, each design such as phenomenology, ethnography, and grounded theory has design specific analytical procedures, the details of which are out of the scope of this article.

Computer-Assisted Qualitative Data Analysis Software (CAQDAS)

Until recently, qualitative analysis was done either manually or with the help of a spreadsheet application. Currently, there are various software programs available which aid researchers to manage qualitative data. CAQDAS is basically data management tools and cannot analyze the qualitative data as it lacks the ability to think, reflect, and conceptualize. Nonetheless, CAQDAS helps researchers to manage, shape, and make sense of unstructured information. Open Code, MAXQDA, NVivo, Atlas.ti, and Hyper Research are some of the widely used qualitative data analysis software.[ 14 , 43 ]

Reporting Guidelines

Consolidated Criteria for Reporting Qualitative Research (COREQ) is the widely used reporting guideline for qualitative research. This 32-item checklist assists researchers in reporting all the major aspects related to the study. The three major domains of COREQ are the 'research team and reflexivity', 'study design', and 'analysis and findings'.[ 44 , 45 ]

Critical Appraisal of Qualitative Research

Various scales are available to critical appraisal of qualitative research. The widely used one is the Critical Appraisal Skills Program (CASP) Qualitative Checklist developed by CASP network, UK. This 10-item checklist evaluates the quality of the study under areas such as aims, methodology, research design, ethical considerations, data collection, data analysis, and findings.[ 46 ]

Ethical Issues in Qualitative Research

A qualitative study must be undertaken by grounding it in the principles of bioethics such as beneficence, non-maleficence, autonomy, and justice. Protecting the participants is of utmost importance, and the greatest care has to be taken while collecting data from a vulnerable research population. The researcher must respect individuals, families, and communities and must make sure that the participants are not identifiable by their quotations that the researchers include when publishing the data. Consent for audio/video recordings must be obtained. Approval to be in FGDs must be obtained from the participants. Researchers must ensure the confidentiality and anonymity of the transcripts/audio-video records/photographs/other data collected as a part of the study. The researchers must confirm their role as advocates and proceed in the best interest of all participants.[ 42 , 47 , 48 ]

Rigor in Qualitative Research

The demonstration of rigor or quality in the conduct of the study is essential for every research method. However, the criteria used to evaluate the rigor of quantitative studies are not be appropriate for qualitative methods. Lincoln and Guba (1985) first outlined the criteria for evaluating the qualitative research often referred to as “standards of trustworthiness of qualitative research”.[ 49 ] The four components of the criteria are credibility, transferability, dependability, and confirmability.

Credibility refers to confidence in the 'truth value' of the data and its interpretation. It is used to establish that the findings are true, credible and believable. Credibility is similar to the internal validity in quantitative research.[ 1 , 50 , 51 ] The second criterion to establish the trustworthiness of the qualitative research is transferability, Transferability refers to the degree to which the qualitative results are applicability to other settings, population or contexts. This is analogous to the external validity in quantitative research.[ 1 , 50 , 51 ] Lincoln and Guba recommend authors provide enough details so that the users will be able to evaluate the applicability of data in other contexts.[ 49 ] The criterion of dependability refers to the assumption of repeatability or replicability of the study findings and is similar to that of reliability in quantitative research. The dependability question is 'Whether the study findings be repeated of the study is replicated with the same (similar) cohort of participants, data coders, and context?'[ 1 , 50 , 51 ] Confirmability, the fourth criteria is analogous to the objectivity of the study and refers the degree to which the study findings could be confirmed or corroborated by others. To ensure confirmability the data should directly reflect the participants' experiences and not the bias, motivations, or imaginations of the inquirer.[ 1 , 50 , 51 ] Qualitative researchers should ensure that the study is conducted with enough rigor and should report the measures undertaken to enhance the trustworthiness of the study.

Conclusions

Qualitative research studies are being widely acknowledged and recognized in health care practice. This overview illustrates various qualitative methods and shows how these methods can be used to generate evidence that informs clinical practice. Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes. Hence, qualitative methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

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Open access
Published: 22 May 2024

Preparedness for a first clinical placement in nursing: a descriptive qualitative study

Philippa H. M. Marriott 1 ,
Jennifer M. Weller-Newton 2 nAff3 &
Katharine J. Reid 4

BMC Nursing volume 23 , Article number: 345 ( 2024 ) Cite this article

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A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students’ perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students’ emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews ( n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants’ feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students’ expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

Conclusions

This unique study of first-year postgraduate entry-to-practice nursing students’ perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students’ narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Peer Review reports

First clinical placements enable nursing students to develop their professional identity through initial socialisation, and where successful, first clinical placement experiences can motivate nursing students to persist with their studies [ 1 , 2 , 3 , 4 ]. Where the transition from the tertiary environment to learning in the healthcare workplace is turbulent, it may impact nursing students’ learning, their confidence and potentially increase attrition rates from educational programs [ 2 , 5 , 6 ]. Attrition from preregistration nursing courses is a global concern, with the COVID-19 pandemic further straining the nursing workforce; thus, the supply of nursing professionals is unlikely to meet demand [ 7 ]. The COVID-19 pandemic has also impacted nursing education, with student nurses augmenting the diminishing nursing workforce [ 7 , 8 ].

The first clinical placement often triggers immense anxiety and fear for nursing students [ 9 , 10 ]. Research suggests that among nursing students, anxiety arises from perceived knowledge deficiencies, role ambiguity, the working environment, caring for ‘real’ people, potentially causing harm, exposure to nudity and death, and ‘not fitting in’ [ 2 , 3 , 11 ]. These stressors are reported internationally and often relate to inadequate preparation for entering the clinical environment [ 2 , 10 , 12 ]. Previous research suggests that high anxiety before the first clinical placement can be related to factors likely to affect patient outcomes, such as self-confidence and efficacy [ 13 ]. High anxiety during clinical placement may impair students’ capacity to learn, thus compromising the value of the clinical environment for learning [ 10 ].

The first clinical placement often occurs soon after commencing nursing training and can challenge students’ beliefs, philosophies, and preconceived ideas about nursing. An experience of cultural or ‘reality’ shock often arises when entering the healthcare setting, creating dissonance between reality and expectations [ 6 , 14 ]. These experiences may be exacerbated by tertiary education providers teaching of ‘ideal’ clinical practice [ 2 , 6 ]. The perceived distance between theoretical knowledge and what is expected in a healthcare placement, as opposed to what occurs on clinical placement, has been well documented as the theory-practice gap or an experience of cognitive dissonance [ 2 , 3 ].

Given the pivotal role of the first clinical placement in nursing students’ trajectories to nursing practice, it is important to understand students’ experiences and to explore how the placement experience shapes initial perceptions. Existing research focusses almost entirely either on describing nursing students’ projected emotions and perceptions prior to undertaking a first clinical placement [ 3 ] or examines student perceptions of reflecting on a completed first placement [ 15 ]. We wished to examine consistency and change in student perception of their first clinical placement by tracking their experiences longitudinally. We focused on a first clinical placement undertaken in a Master of Nursing Science. This two-year postgraduate qualification provides entry-to-practice nursing training for students who have completed any undergraduate qualification. The first clinical placement component of the course aimed to orient students to the clinical environment, support students to acquire skills and develop their clinical reasoning through experiential learning with experienced nursing mentors.

This paper makes a significant contribution to understanding how nursing students’ perceptions might develop over time because of their clinical placement experiences. Our research addresses a further gap in the existing literature, by focusing on students completing an accelerated postgraduate two-year entry-to-practice degree open to students with any prior undergraduate degree. Thus, the current research aimed to understand nursing students’ emotional responses and expectations and their perceptions of preparedness before attending their first clinical placement and to contrast these initial perceptions with their end-of-placement perspectives.

Study design

A descriptive qualitative study was undertaken, utilising a pre- and post-design for data collection. Focus groups with first-year postgraduate entry-to-practice nursing students were conducted before the first clinical placement, with individual semi-structured interviews undertaken during the first clinical placement.

Setting and participants

All first-year students enrolled in the two-year Master of Nursing Science program ( n = 190) at a tertiary institution in Melbourne, Australia, were eligible to participate. There were no exclusion criteria. At the time of this study, students were enrolled in a semester-long subject focused on nursing assessment and care. They studied the theoretical underpinnings of nursing and science, theoretical and practical nursing clinical skills and Indigenous health over the first six weeks of the course. Students completed a preclinical assessment as a hurdle before commencing a three-week clinical placement in a hospital setting, a subacute or acute environment. Overall, the clinical placement aimed to provide opportunities for experiential learning, skill acquisition, development of clinical reasoning skills and professional socialisation [ 16 , 17 ].

In total, sixteen students participated voluntarily in a focus group of between 60 and 90 min duration; ten of these students also participated in individual interviews of between 30 and 60 min duration, a number sufficient to reach data saturation. Table 1 shows the questions used in the focus groups conducted before clinical placement commenced and the questions for the semi-structured interview questions conducted during clinical placement. Study participants’ undergraduate qualifications included bachelor’s degrees in science, arts and business. A small number of participants had previous healthcare experience (e.g. as healthcare assistants). The participants attended clinical placement in the Melbourne metropolitan, Victorian regional and rural hospital locations.

Data collection

The study comprised two phases. The first phase comprised six focus groups prior to the first clinical placement, and the second phase comprised ten individual semi-structured interviews towards the end of the first clinical placement. Focus groups (with a maximum of four participants) and individual interviews were conducted by the lead author online via Zoom and were audio-recorded. Capping group size to a relatively small number considered diversity of perceptions and opportunities for participants to share their insights and to confirm or contradict their peers, particularly in the online environment [ 18 , 19 ].

Focus groups and interview questions were developed with reference to relevant literature, piloted with volunteer final-year nursing students, and then verified with the coauthors. All focus groups and interviewees received the same structured questions (Table 1 ) to ensure consistency and to facilitate comparison across the placement experience in the development of themes. Selective probing of interviewees’ responses for clarification to gain in-depth responses was undertaken. Nonverbal cues, impressions, or observations were noted.

The lead author was a registered nurse who had a clinical teaching role within the nursing department and was responsible for coordinating clinical placement experiences. To ensure rigour during the data collection process, the lead author maintained a reflective account, exploring her experiences of the discussions, reflecting on her interactions with participants as a researcher and as a clinical educator, and identifying areas for improvement (for instance allowing participants to tell their stories with fewer prompts). These reflections in conjunction with regular discussion with the other authors throughout the data collection period, aided in identifying any researcher biases, feelings and thoughts that possibly influenced the research [ 20 ].

To maintain rigour during the data analysis phase, we adhered to a systematic process involving input from all authors to code the data and to identify, refine and describe the themes and subthemes reported in this work. This comprehensive analytic process, reported in detail in the following section, was designed to ensure that the findings arising from this research were derived from a rigorous approach to analysing the data.

Data analysis

Focus groups and interviews were transcribed using the online transcription service Otter ( https://otter.ai/ ) and then checked and anonymised by the first author. Preliminary data analysis was carried out simultaneously by the first author using thematic content analysis proposed by Braun and Clarke [ 21 ] using NVivo 12 software [ 22 ]. All three authors undertook a detailed reading of the first three transcripts from both the focus groups and interviews and independently identified major themes. This preliminary coding was used as the basis of a discussion session to identify common themes between authors, to clarify sources of disagreement and to establish guidelines for further coding. Subsequent coding of the complete data set by the lead author identified a total of 533 descriptive codes; no descriptive code was duplicated across the themes. Initially, the descriptive codes were grouped into major themes identified from the literature, but with further analysis, themes emerged that were unique to the current study.

The research team met frequently during data analysis to discuss the initial descriptive codes, to confirm the major themes and subthemes, to revise themes on which there was disagreement and to identify any additional themes. Samples of quotes were reviewed by the second and third authors to decide whether these quotes were representative of the identified themes. The process occurred iteratively to refine the thematic categories, to discuss the definitions of each theme and to identify exemplar quotes.

Ethical considerations

The lead author was a clinical teacher and the clinical placement coordinator in the nursing department at the time of the study. Potential risks of perceived coercion and power imbalances were identified because of the lead author’s dual roles as an academic and as a researcher. To manage these potential risks, an academic staff member who was not part of the research study informed students about the study during a face-to-face lecture and ensured that all participants received a plain language statement identifying the lead author’s role and how perceived conflicts of interest would be managed. These included the lead author not undertaking any teaching or assessment role for the duration of the study and ensuring that placement allocations were completed prior to undertaking recruitment for the study. All students who participated in the study provided informed written consent. No financial or other incentives were offered. Approval to conduct the study was granted by the University of Melbourne Human Research Ethics Committee (Ethics ID 1955997.1).

Three main themes emerged describing students’ feelings and perceptions of their first clinical placement. In presenting the findings, before or during has been assigned to participants’ quotes to clarify the timing of students’ perspectives related to the clinical placement.

Major theme 1: Adjusting and managing a raft of feelings

The first theme encompassed the many positive and negative feelings about work-integrated learning expressed by participants before and during their clinical placement. Positive feelings before clinical placement were expressed by participants who were comfortable with the unknown and cautiously optimistic.

I am ready to just go with the flow, roll with the punches (Participant [P]1 before).

Overwhelmingly, however, the majority of feelings and thoughts anticipating the first clinical placement were negatively oriented. Students who expressed feelings of fear, anxiety, lack of knowledge, lack of preparedness, uncertainty about nursing as a career, or strong concerns about being a burden were all classified as conveying negative feelings. These negative feelings were categorised into four subthemes.

Subtheme 1.1 I don’t have enough knowledge

All participants expressed some concerns and anxiety before their first clinical placement. These encompassed concerns about knowledge inadequacy and were linked to a perception of under preparedness. Participants’ fears related to harming patients, responsibility for managing ‘real’ people, medication administration, and incomplete understanding of the language and communication skills within a healthcare setting. Anxiety for many participants merged with the logistics and management of their life during the clinical placement.

I’m scared that they will assume that I have more knowledge than I do (P3 before). I feel quite similar with P10, especially when she said fear of unknown and fear that she might do something wrong (P9 before).

Subtheme 1.2 Worry about judgment, being seen through that lens

Participants voiced concerns that they would be judged negatively by patients or healthcare staff because they perceived that the student nurse belonged to specific social groups related to their cultural background, ethnicity or gender. Affiliation with these groups contributed to students’ sense of self or identity, with students often describing such groups as a community. Before the clinical placement, participants worried that such judgements would impact the support they received on placement and their ability to deliver patient care.

Some older patients might prefer to have nurses from their own background, their own ethnicity, how they would react to me, or if racism is involved (P10 before). I just don’t want to reinforce like, whatever negative perceptions people might have of that community (P16 before).

Participants’ concerns prior to the first clinical placement about judgement or poor treatment because of patients’ preconceived ideas about specific ethnic groups did not eventuate.

I mean, it didn’t really feel like very much of a thing once I was actually there. It is one of those things you stress about, and it does not really amount to anything (P16 during).

Some students’ placement experiences revealed the positive benefits of their cultural background to enhancing patient care. One student affirmed that the placement experience reinforced their commitment to nursing and that this was related to their ability to communicate with patients whose first language was not English.

Yeah, definitely. Like, I can speak a few dialects. You know, I can actually see a difference with a lot of the non-English speaking background people. As soon as you, as soon as they’re aware that you’re trying and you’re trying to speak your language, they, they just open up. Yeah, yes. And it improves the care (P10 during).

However, a perceived lack of judgement was sometimes attributed to wearing the full personal protective equipment required during the COVID-19 pandemic, which meant that their personal features were largely obscured. For this reason, it was more difficult for patients to make assumptions or attributions about students’ ethnic or gender identity based on their appearance.

People tend to assume and call us all girls, which was irritating. It was mostly just because all of us were so covered up, no one could see anyone’s faces (P16 during).

Subtheme 1.3 Is nursing really for me?

Prior to their first clinical placement experience, many participants expressed ambivalence about a nursing career and anticipated that undertaking clinical placement could determine their suitability for the profession. Once exposed to clinical placement, the majority of students were completely committed to their chosen profession, with a minority remaining ambivalent or, in rare cases, choosing to leave the course. Not yet achieving full commitment to a nursing career was related to not wishing to work in the ward they had for their clinical placement, while remaining open to trying different specialities.

I didn’t have an actual idea of what I wanted to do after arts, this wasn’t something that I was aiming towards specifically (P14 before). I think I’m still not 100%, but enough to go on, that I’m happy to continue the course as best as I can (P11 during).

Subtheme 1.4 Being a burden

Before clinical placement, participants had concerns about being burdensome and how this would affect their clinical placement experiences.

If we end up being a burden to them, an extra responsibility for them on top of their day, then we might not be treated as well (P10 before).

A sense of burden remained a theme during the clinical placement for participants for the first five to seven days, after which most participants acknowledged that their role became more active. As students contributed more productively to their placement, their feelings of being a burden reduced.

Major theme 2: Sinking or swimming

The second major theme, sinking or swimming, described participants’ expectations about a successful placement experience and identified themes related to students’ successes (‘swimming’) or difficulties (‘sinking’) during their placement experience. Prior to clinical placement, without a realistic preview of what the experience might entail, participants were uncertain of their role, hoped for ‘nice’ supervising nurses and anticipated an observational role that would keep them afloat.

I will focus on what I want to learn and see if that coincides with what is expected, I guess (P15 before).

During the clinical placement, the reality was very different, with a sense of sinking. Participants discovered, some with shock, that they were expected to participate actively in the healthcare team.

I got the sense that they were not going to muck around, and, you know, they’re ‘gonna’ use the free labour that came with me (P1 during).

Adding to the confusion about the expected placement experience, participants believed that healthcare staff were unclear about students’ scope of practice for a postgraduate entry-to-practice degree, creating misalignment between students’ and supervising nurses’ expectations.

It seems to me like the educators don’t really seem to have a clear picture of what the scope is, and what is actually required or expected of us (P10 during).

In exploring perceived expectations of the clinical placement and the modifying effect of placement on initial expectations, three subthemes were identified: translation to practice is overwhelming, trying to find the rhythm or jigsaw pieces, and individual agency.

Subtheme 2.1 Translation to practice is overwhelming

Before clinical placement, participants described concerns about insufficient knowledge to enable them to engage effectively with the placement experience.

If I am doing an assessment understanding what are those indications and why I would be doing it or not doing it at a certain time (P1 before).

Integrating and applying theoretical content while navigating an unfamiliar clinical environment created a significant gap between theory and practice during clinical placement. As the clinical placement experience proceeded and initial fears dissipated, students became more aware of applying their theoretical knowledge in the clinical context.

We’re learning all this theory and clinical stuff, but then we don’t really have a realistic idea of what it’s like until we’re kind of thrown into it for three weeks (P10 during).

Subtheme 2.2 Trying to find the rhythm or the jigsaw pieces

Before clinical placement, participants described learning theory and clinical skills with contextual unfamiliarity. They had the jigsaw pieces but did not know how to assemble it; they had the music but did not know the final song. When discussing their expectations about clinical placement, the small number of participants with a healthcare background (e.g. as healthcare assistants) proposed realistic answers, whereas others struggled to answer or cited stories from friends or television. With a lack of context, feelings of unpreparedness were exacerbated. Once in the clinical environment, participants further emphasised that they could not identify what they needed to know to successfully prepare for clinical placement.

It was never really pieced together. We’ve learned bits and pieces, and then we’re putting it together ourselves (P8 during). On this course I feel it was this is how you do it, but I did not know how it was supposed to be played, I did not know the rhythm (P4 during).

Subtheme 2.3 Individual agency

Participants’ individual agency, their attitude, self-efficacy, and self-motivation affected their clinical placement experiences. Participant perceptions in advance of the clinical placement experience remained consistent with their perspectives following clinical placement. Before clinical placement, participants who were highly motivated to learn exhibited a growth mindset [ 23 ] and planned to be proactive in delivering patient care. During their clinical placement, initially positive students remained positive and optimistic about their future. Participants who believed that their first clinical placement role would be largely observational and were less proactive about applying their knowledge and skills identified boredom and a lack of learning opportunities on clinical placement.

A shadowing position, we don’t have enough skills and authority to do any work, not do any worthwhile skills (P3 before). I thought it would be a lot busier, because we’re limited with our scope, so there’s not much we can do, it’s just a bit slower than I thought (P12 during).

Individual agency appears to influence a successful first clinical placement; other factors may also be implicated but were not the focus of this study. Further research exploring the relationships between students’ age, life experience, resilience, individual agency, and the use of coping strategies during a first clinical placement would be useful.

Major theme 3: The reality of navigating placement relationships

The third main theme emphasised the reality of navigating clinical placement relationships and explored students’ relationships with healthcare staff, patients, and peers. Before clinical placement, many participants, especially those with healthcare backgrounds, expressed fears about relationships with supervising nurses. They perceived that the dynamics of the team and the healthcare workplace might influence the support they received. Several participants were nervous about attending placement on their own without peers for support, especially if the experience was challenging. Participants identified expectations of being mistreated, believing that it was unavoidable, and prepared themselves to not take it personally.

For me it’s where we’re going to land, are we going to be in a supportive, kind of nurturing environment, or is it just kind of sink or swim? (P5 before). If you don’t really trust them, you’re nervous the entire time and you’ll be like what if I get it wrong (P16 before).

Despite these concerns, students strongly emphasised the value of relationships during their first clinical placement, with these perceptions unchanged by their clinical placement experience. Where relationships were positive, participants felt empowered to be autonomous, and their self-confidence increased.

You get that that instant reaction from the patients. And that makes you feel more confident. So that really got me through the first week (P14 during). I felt like I was intruding, then as I started to build a bit of rapport with the people, and they saw that I was around, I don’t feel that as much now (P1 during).

Such development hinged on the receptiveness and support of supervising nurses, the team on the ward, and patients and could be hindered by poor relationships.

He was the old-style buddy nurse in his fifties, every time I questioned him, he would go ssshh, just listen, no questions, it was very stressful (P10 during). It depends whether the buddy sees us as an extra pair of hands, or we’re learners (P11 during).

Where students experienced poor behaviour from supervising nurses, they described a range of emotional responses to these interactions and also coping strategies including avoiding unfriendly staff and actively seeking out those who were more inclusive.

If they weren’t very nice, it wouldn’t be very enjoyable and if they didn’t trust you, then it would be a bit frustrating, that like I can do this, but you won’t let me (P12 during). If another nurse was not nice to me, and I was their buddy, I would literally just not buddy with them and go and follow whoever was nice to me (P4 during).

Relationships with peers were equally important; students on clinical placement with peers valued the shared experience. In contrast, students who attended clinical placement alone at a regional or rural hospital felt disconnected from the opportunities that learning with peers afforded.

Our research explored the emotional responses and perceptions of preparedness of postgraduate entry-to-practice nursing students prior to and during their first clinical placement. In this study, we described how the perceptions of nursing students remained consistent or were modified by their clinical placement experiences. Our analysis of students’ experiences identified three major themes: adjusting and managing a raft of feelings; sinking or swimming; and the reality of navigating placement relationships. We captured similar themes identified in the literature; however, our study also identified novel aspects of nursing students’ experiences of their first clinical placement.

The key theme, adjusting and managing a raft of feelings, which encapsulates anxiety before clinical placement, is consistent with previous research. This theme included concerns in communicating with healthcare staff and managing registered nurses’ negative attitudes and expectations, in addition to an academic workload [ 11 , 24 ]. Concerns not previously identified in the literature included a fear of judgement or discrimination by healthcare staff or patients that might impact the reputation of marginalised communities. Fortunately, these initial fears largely dissipated during clinical placement. Some students discovered that a diverse cultural background was an asset during their clinical placement. Although these initial fears were ameliorated by clinical placement experiences, evidence of such fears before clinical placement is concerning. Further research to identify appropriate support for nursing students from culturally diverse or marginalised communities is warranted. For example, a Finnish study highlighted the importance of mentoring culturally diverse students, creating a pedagogical atmosphere during clinical placement and integrating cultural diversity into nursing education [ 25 ].

Preclinical expectations of being mistreated can be viewed as an unavoidable phenomenon for nursing students [ 26 ]. The existing literature highlights power imbalances and hierarchical differences within the healthcare system, where student nurses may be marginalised, disrespected, and ignored [ 9 , 27 , 28 ]. During their clinical placement, students in our study reported unintentional incivility by supervising nurses: feeling not wanted, ignored, or asked to remain quiet by supervising nurses who were unfriendly or highly critical. These findings were similar to those of Thomas et al.’s [ 29 ] UK study and were particularly heightened at the beginning of clinical placement. Several students acknowledged that nursing staff fatigue from a high turnover of students on their ward and the COVID-19 pandemic could be contributing factors. In response to such incivility, students reported decreased self-confidence and described becoming quiet and withdrawing from active participation with their patients. Students oriented their behaviour towards repetitive low-level tasks, aiming to please and help their supervising nurse, to the detriment of learning opportunities. Fortunately, these incidents did not appear to impact nursing students’ overall experience of clinical placement. Indeed, students found positive experiences with different supervising nurses and their own self-reflection assisted with coping. Other active strategies to combat incivility identified in the current study that were also identified by Thomas et al. [ 29 ] included avoiding nurses who were uncivil, asking to work with nurses who were ‘nice’ to them, and seeking out support from other staff as a coping strategy. The nursing students in our study were undertaking a postgraduate entry-to-practice qualification and already had an undergraduate degree. The likely greater levels of experience and maturity of this cohort may influence their resilience when working with unsupportive supervising nurses and identifying strategies to manage challenging situations.

The theory-practice gap emerged in the theme of sinking or swimming. A theory-practice gap describes the perceived dissonance between theoretical knowledge and expectations for the first clinical placement, as opposed to the reality of the experience, and has been reported in previous studies (see, for instance, 24 , 30 , 31 , 32 ). Existing research has shown that when the first clinical placement does not meet inexperienced student nurses’ expectations, a disconnect between theory and practice occurs, creating feelings of being lost and insecure within the new environment, potentially impacting students’ motivation and risk of attrition [ 19 , 33 ]. The current study identified further areas exacerbating the theory-practice gap. Before the clinical placement, students without a healthcare background lacked context for their learning. They lacked understanding of nurses’ shift work and were apprehensive about applying clinical skills learned in the classroom. Hence, some students were uncertain if they were prepared for their first clinical placement or even how to prepare, which increased their anxiety. Prior research has demonstrated that applying theoretical knowledge more seamlessly during clinical placement was supported when students knew what to expect [ 6 ]. For instance, a Canadian study exposed students as observers to the healthcare setting before starting clinical placement, enabling early theory to practice connections that minimised misconceptions and false assumptions during clinical placement [ 34 ].

In the current study, the theory-practice gap was further exacerbated during clinical placement, where healthcare staff were confused about students’ scope of practice and the course learning objectives and expectations in a postgraduate entry-to-practice nursing qualification. The central booking system for clinical placements classifies first-year nursing students who participated in this study as equivalent to second-year undergraduate nursing students. Such a classification could create a misalignment between clinical educators’ expectations and their delivery of education versus students’ actual learning needs and capacity [ 3 , 31 ]. Additional communication to healthcare partners is warranted to enhance understanding of the scope of practice and expectations of a first-year postgraduate entry-to-practice nursing student. Educating and empowering students to communicate their learning needs within their scope of practice is also required.

Our research identified a link between students’ personality traits or individual agency and their first clinical placement experience. The importance of a positive orientation towards learning and the nursing profession in preparedness for clinical placement has been highlighted in previous studies [ 31 ]. Students’ experience of their first clinical placement in our study appeared to be strongly influenced by their mindset [ 23 ]. Some students demonstrated motivation to learn, were happy to ‘roll with the punches’, yet remain active in their learning requirements, whereas others perceived their role as observational and expected supervising nurses to provide learning opportunities. Students who anticipated a passive learning approach prior to their first clinical placement reported boredom, limited activity, and lack of opportunities during their first clinical placement. These students could have a lowered sense of self-efficacy, which may lead to a greater risk of doubt, stress, and reduced commitment to the profession [ 35 ]. Self-efficacy theory explores self-perceived confidence and competence around people’s beliefs in their ability to influence events, which is associated with motivation and is key to nursing students progressing in their career path confidently [ 35 , 36 ]. In the current study, students who actively engaged in their learning process used strategies such as self-reflection and sought support from clinical educators, peers and family. Such active approaches to learning appeared to increase their resilience and motivation to learn as they progressed in their first clinical placement.

Important relationships with supervising nurses, peers, or patients were highlighted in the theme of the reality of navigating placement relationships. This theme links with previous research findings about belongingness. Belongingness is a fundamental human need and impacts students’ behaviour, emotions, cognitive processes, overall well-being, and socialisation into the profession [ 37 , 38 ]. Nursing students who experience belongingness feel part of a team and are more likely to report positive experiences. Several students in the current study described how feeling part of a team improved self-confidence and empowered work-integrated learning. Nonetheless, compared with previous literature (see for instance, 2), working as a team and belongingness were infrequent themes. Such infrequency could be related to the short duration of the clinical placement. In shorter clinical placements, nursing students learn a range of technical skills but have less time to develop teamwork skills and experience socialisation to the profession [ 29 , 39 ].

Positive relationships with supervising nurses appeared fundamental to students’ experiences. Previous research has shown that in wards with safe psycho-social climates, where the culture tolerates mistakes, regarding them as learning opportunities, a pedagogical atmosphere prevails [ 25 , 39 ]. Whereas, if nursing students experience insolent behaviours or incivility, this not only impacts learning it can also affect career progression [ 26 ]. Participants who felt safe asking questions were given responsibility, had autonomy to conduct skills within their scope of practice and thrived in their learning. This finding aligns with previous research affirming that a welcoming and supportive clinical placement environment, where staff are caring, approachable and helpful, enables student nurses to flourish [ 36 , 40 , 41 , 42 ]. Related research highlights that students’ perception of a good clinical placement is linked to participation within the community and instructor behaviour over the quality of the clinical environment and opportunities [ 27 , 28 ]. Over a decade ago, a large European study found that the single most important element for students’ clinical learning was the supervisory relationship [ 39 ]. In our study, students identified how supervising nurses impacted their emotions and this was critical to their experience of clinical placement, rather than how effective they were in their teaching, delivery of feedback, or their knowledge base.

Students’ relationships with patients were similarly important for a successful clinical placement. Before the clinical placement, students expressed anxiety and fears in communicating and interacting with patients, particularly if they were dying or acutely unwell, which is reflective of the literature [ 2 , 10 , 11 ]. However, during clinical placement, relationships with patients positively impacted nursing students’ experiences, especially at the beginning when they felt particularly vulnerable in a new environment. Towards the end of clinical placement, feelings of incompetence, nervousness and uncertainty had subsided. Students were more active in patient care, which increased self-confidence, empowerment, and independence, in turn further improving relationships with patients and creating a positive feedback loop [ 36 , 42 , 43 ].

Limitations

This study involved participants from one university and a single course, thus limiting the generalisability of the results. Thus, verification of the major themes identified in this research in future studies is needed. Nonetheless, the purpose of this study was to explore in detail the way in which the experiences of clinical placement for student nurses modified initial emotional responses towards undertaking placement and their perceptions of preparedness. Participants in this study undertook their clinical placement in a variety of different hospital wards in different specialties, which contributed to the rigour of the study in identifying similar themes in nursing students’ experiences across diverse placement contexts.

This study explored the narratives of first-year nursing students undertaking a postgraduate entry-to-practice qualification on their preparedness for clinical placement. Exploring students’ changing perspectives before and during the clinical placement adds to extant knowledge about nursing students’ emotional responses and perceptions of preparedness. Our research highlighted the role that preplacement emotions and expectations may have in shaping nursing students’ clinical placement experiences. Emerging themes from this study highlighted the importance students placed on relationships with peers, patients, and supervising nurses. Significant anxiety and other negative emotions experienced by nursing students prior to the first clinical placement suggests that further research is needed to explore the impact of contextual learning to scaffold students’ transition to the clinical environment. The findings of this research also have significant implications for educational practice. Additional educational support for nursing students prior to entering the clinical environment for the first time might include developing students’ understanding of the clinical environment, such as through increasing students’ understanding of the different roles of nurses in the clinical context through pre-recorded interviews with nurses. Modified approaches to simulated teaching prior to the first clinical placement would also be useful to increase the emphasis on students applying their learning in a team-based, student-led context, rather than emphasising discrete clinical skill competencies. Finally, increasing contact between students and university-based educators throughout the placement would provide further opportunities for students to debrief, to receive support and to manage some of the negative emotions identified in this study. Further supporting the transition to the first clinical placement could be fundamental to reducing the theory-practice gap and allaying anxiety. Such support is crucial during their first clinical placement to reduce attrition and boost the nursing workforce.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the conditions of our ethics approval but may be available from the corresponding author on reasonable request and subject to permission from the Human Research Ethics Committee.

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Acknowledgements

The authors wish to thank the first-year nursing students who participated in this study and generously shared their experiences of undertaking their first clinical placement.

No funding was received for this study.

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Jennifer M. Weller-Newton

Present address: School of Nursing and Midwifery, University of Canberra, Kirinari Drive, Bruce, Canberra, ACT, 2617, Australia

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Department of Nursing, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

Philippa H. M. Marriott

Department of Rural Health, The University of Melbourne, Grattan St, Shepparton, VIC, 3630, Australia

Present address: Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

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All authors made a substantial contribution to conducting the research and preparing the manuscript for publication. P.M., J.W-N. and K.R. conceptualised the research and designed the study. P.M. undertook the data collection, and all authors were involved in thematic analysis and interpretation. P.M. wrote the first draft of the manuscript, K.R. undertook a further revision and all authors contributed to subsequent versions. All authors approved the final version for submission. Each author is prepared to take public responsibility for the research.

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The research was undertaken in accordance with the National Health and Medical Research Council of Australia’s National Statement on Ethical Conduct in Human Research and the Australian Code for the Responsible Conduct of Research. Ethical approval to conduct the study was obtained from the University of Melbourne Human Research Ethics Committee (Ethics ID 1955997.1). All participants received a plain language statement that described the requirements of the study. All participants provided informed written consent to participate, which was affirmed verbally at the beginning of focus groups and interviews.

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Marriott, P.H.M., Weller-Newton, J.M. & Reid, K.J. Preparedness for a first clinical placement in nursing: a descriptive qualitative study. BMC Nurs 23 , 345 (2024). https://doi.org/10.1186/s12912-024-01916-x

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Interviews are more resource-intensive but can provide great depth to your research. Meanwhile, surveys are quick and easy to get off the ground and to analyse—especially with SurveyMonkey's survey templates and suite of tools—and bring an excellent breadth to your findings. Create a successful survey in 10 easy steps.
Questionnaire Design
Questionnaires vs. surveys. A survey is a research method where you collect and analyze data from a group of people. A questionnaire is a specific tool or instrument for collecting the data.. Designing a questionnaire means creating valid and reliable questions that address your research objectives, placing them in a useful order, and selecting an appropriate method for administration.
(PDF) Interviews and Questionnaires
Interviews and Questionnaires. March 2009. DOI: 10.1002/9781444301120.ch9. In book: The Blackwell Guide to Research Methods in Bilingualism and Multilingualism (pp.158 - 176) Authors: Eva Codó ...
PDF Asking the Right Question: Qualitative Research Design and Analysis
Limitations of Qualitative Research. Lengthy and complicated designs, which do not draw large samples. Validity of reliability of subjective data. Difficult to replicate study because of central role of the researcher and context. Data analysis and interpretation is time consuming. Subjective - open to misinterpretation.
Qualitative Methods in Health Care Research
Qualitative Research Questions and Purpose Statements. Qualitative questions are exploratory and are open-ended. A well-formulated study question forms the basis for developing a protocol, guides the selection of design, and data collection methods. Qualitative research questions generally involve two parts, a central question and related ...
Qualitative vs. Quantitative Research
Common qualitative methods include interviews with open-ended questions, observations described in words, and literature reviews that explore concepts and theories. Qualitative research is also at risk for certain research biases including the Hawthorne effect, observer bias, recall bias, and social desirability bias.
Preparedness for a first clinical placement in nursing: a descriptive
The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing ...
Training Needs of In-Service Bilingual Teachers: A study of Taiwan
Through mixed methods consisting of individual interviews and questionnaires, this study sought to answer the following questions (cf. Pérez Cañado, 2016a, 2016b, 2017): 1. ... which means understanding of quantitative and qualitative research, ability of using action research methods, familiarity with journals and books on CLIL, and ...
Artificial Intelligence vs. Human Coaches: A Mixed Methods Randomized
Quantitative data were captured through three surveys and qualitative input was captured through open-ended survey questions and 27 debrief interviews. The study utilized a Wizard of Oz technique from human-computer interaction research, ingeniously designed to sidestep the rapid obsolescence of technology by simulating an advanced AI coaching ...
ERIC
Sixteen participants provided in-depth responses to open ended interview questions related to the study's two research questions. The first research question was; how do K-2 teachers describe their use of technology resources? The themes emerged from research question one were lack of consistent training, lack of technology training, and lack ...
About Stop Overdose
Through preliminary research and strategic workshops, CDC identified four areas of focus to address the evolving drug overdose crisis. Stop Overdose resources speak to the reality of drug use, provide practical ways to prevent overdoses, educate about the risks of illegal drug use, and show ways to get help.

Chapter 11. Interviewing

Types of Interviews

Creating an Interview Guide

Type of Questions

Background/Demographic Questions

Temporality

Question Sequence

Probes and Flexibility

The Final Question

Conducting the Interview

How Many Interviews?

Your Final Product: The Ideal Interview Transcript

Final Tips from an Interview Master

Sample: Demographic Questionnaire

Example: Interview Guide

Further Readings

Qualitative study design: Surveys & questionnaires

Surveys & questionnaires

Limitations

Example questions

Example studies

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What is qualitative research?

What are research questions?

Quantitative vs. qualitative research questions

Quantitative research questions

Qualitative research questions

Qualitative research question types

Why are good qualitative research questions important?

Developing good qualitative research questions

1. Keep it specific

2. Be original

3. Make it research-worthy

4. Focus your question

4. Focus on your own discipline, not someone else’s

5. Ask something researchable

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Interviews and focus groups in qualitative research: an update for the digital age

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Professionalism in dentistry: deconstructing common terminology

Overview of qualitative research

Types of interview

Conducting an interview

Box 1: Example of a topic guide

Focus groups

Focus group considerations

Focus group management

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Corresponding author

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Difference Between Questionnaire and Interview

Content: Questionnaire Vs Interview

Definition of Interview

Key Differences Between Questionnaire and Interview

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The qualitative pretest interview for questionnaire development: outline of programme and practice

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A worked example of Braun and Clarke’s approach to reflexive thematic analysis

Qualitative Inhaltsanalyse

How to use and assess qualitative research methods

1 Introduction

2 Outline of the methodological background and programme of the QPI

2.1 Indexical expressions and intersubjective understanding

2.2 Fabricated versus negotiated common understanding

2.3 Towards a definition of the QPI

2.4 Communication strategies—active listening and active understanding

3 Practical aspects of the QPI

3.1 Briefing and opening the conversation

3.1.1 Goal of the QPI