purpose of research qualitative

Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images.  In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).   

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

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Qualitative research is a type of social science research that collects and works with non-numerical data and that seeks to interpret meaning from these data that help understand social life through the study of targeted populations or places.

People often frame it in opposition to quantitative research , which uses numerical data to identify large-scale trends and employs statistical operations to determine causal and correlative relationships between variables.

Within sociology, qualitative research is typically focused on the micro-level of social interaction that composes everyday life, whereas quantitative research typically focuses on macro-level trends and phenomena.

Key Takeaways

Methods of qualitative research include:

• observation and immersion
• open-ended surveys
• focus groups
• content analysis of visual and textual materials
• oral history

Qualitative research has a long history in sociology and has been used within it for as long as the field has existed.

This type of research has long appealed to social scientists because it allows the researchers to investigate the meanings people attribute to their behavior, actions, and interactions with others.

While quantitative research is useful for identifying relationships between variables, like, for example, the connection between poverty and racial hate, it is qualitative research that can illuminate why this connection exists by going directly to the source—the people themselves.

Qualitative research is designed to reveal the meaning that informs the action or outcomes that are typically measured by quantitative research. So qualitative researchers investigate meanings, interpretations, symbols, and the processes and relations of social life.

What this type of research produces is descriptive data that the researcher must then interpret using rigorous and systematic methods of transcribing, coding, and analysis of trends and themes.

Because its focus is everyday life and people's experiences, qualitative research lends itself well to creating new theories using the inductive method , which can then be tested with further research.

Qualitative researchers use their own eyes, ears, and intelligence to collect in-depth perceptions and descriptions of targeted populations, places, and events.

Their findings are collected through a variety of methods, and often a researcher will use at least two or several of the following while conducting a qualitative study:

• Direct observation : With direct observation, a researcher studies people as they go about their daily lives without participating or interfering. This type of research is often unknown to those under study, and as such, must be conducted in public settings where people do not have a reasonable expectation of privacy. For example, a researcher might observe the ways in which strangers interact in public as they gather to watch a street performer.
• Open-ended surveys : While many surveys are designed to generate quantitative data, many are also designed with open-ended questions that allow for the generation and analysis of qualitative data. For example, a survey might be used to investigate not just which political candidates voters chose, but why they chose them, in their own words.
• Focus group : In a focus group, a researcher engages a small group of participants in a conversation designed to generate data relevant to the research question. Focus groups can contain anywhere from 5 to 15 participants. Social scientists often use them in studies that examine an event or trend that occurs within a specific community. They are common in market research, too.
• In-depth interviews : Researchers conduct in-depth interviews by speaking with participants in a one-on-one setting. Sometimes a researcher approaches the interview with a predetermined list of questions or topics for discussion but allows the conversation to evolve based on how the participant responds. Other times, the researcher has identified certain topics of interest but does not have a formal guide for the conversation, but allows the participant to guide it.
• Oral history : The oral history method is used to create a historical account of an event, group, or community, and typically involves a series of in-depth interviews conducted with one or multiple participants over an extended period.
• Participant observation : This method is similar to observation, however with this one, the researcher also participates in the action or events to not only observe others but to gain the first-hand experience in the setting.
• Ethnographic observation : Ethnographic observation is the most intensive and in-depth observational method. Originating in anthropology, with this method, a researcher fully immerses themselves into the research setting and lives among the participants as one of them for anywhere from months to years. By doing this, the researcher attempts to experience day-to-day existence from the viewpoints of those studied to develop in-depth and long-term accounts of the community, events, or trends under observation.
• Content analysis : This method is used by sociologists to analyze social life by interpreting words and images from documents, film, art, music, and other cultural products and media. The researchers look at how the words and images are used, and the context in which they are used to draw inferences about the underlying culture. Content analysis of digital material, especially that generated by social media users, has become a popular technique within the social sciences.

While much of the data generated by qualitative research is coded and analyzed using just the researcher's eyes and brain, the use of computer software to do these processes is increasingly popular within the social sciences.

Such software analysis works well when the data is too large for humans to handle, though the lack of a human interpreter is a common criticism of the use of computer software.

Pros and Cons

Qualitative research has both benefits and drawbacks.

On the plus side, it creates an in-depth understanding of the attitudes, behaviors, interactions, events, and social processes that comprise everyday life. In doing so, it helps social scientists understand how everyday life is influenced by society-wide things like social structure , social order , and all kinds of social forces.

This set of methods also has the benefit of being flexible and easily adaptable to changes in the research environment and can be conducted with minimal cost in many cases.

Among the downsides of qualitative research is that its scope is fairly limited so its findings are not always widely able to be generalized.

Researchers also have to use caution with these methods to ensure that they do not influence the data in ways that significantly change it and that they do not bring undue personal bias to their interpretation of the findings.

Fortunately, qualitative researchers receive rigorous training designed to eliminate or reduce these types of research bias.

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Qualitative Study

Affiliations.

• 1 University of Nebraska Medical Center
• 2 GDB Research and Statistical Consulting
• 3 GDB Research and Statistical Consulting/McLaren Macomb Hospital
• PMID: 29262162
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Qualitative research is a type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

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What is Research? – Purpose of Research

• By DiscoverPhDs
• September 10, 2020

The purpose of research is to enhance society by advancing knowledge through the development of scientific theories, concepts and ideas. A research purpose is met through forming hypotheses, collecting data, analysing results, forming conclusions, implementing findings into real-life applications and forming new research questions.

What is Research

Simply put, research is the process of discovering new knowledge. This knowledge can be either the development of new concepts or the advancement of existing knowledge and theories, leading to a new understanding that was not previously known.

As a more formal definition of research, the following has been extracted from the Code of Federal Regulations :

While research can be carried out by anyone and in any field, most research is usually done to broaden knowledge in the physical, biological, and social worlds. This can range from learning why certain materials behave the way they do, to asking why certain people are more resilient than others when faced with the same challenges.

The use of ‘systematic investigation’ in the formal definition represents how research is normally conducted – a hypothesis is formed, appropriate research methods are designed, data is collected and analysed, and research results are summarised into one or more ‘research conclusions’. These research conclusions are then shared with the rest of the scientific community to add to the existing knowledge and serve as evidence to form additional questions that can be investigated. It is this cyclical process that enables scientific research to make continuous progress over the years; the true purpose of research.

What is the Purpose of Research

From weather forecasts to the discovery of antibiotics, researchers are constantly trying to find new ways to understand the world and how things work – with the ultimate goal of improving our lives.

The purpose of research is therefore to find out what is known, what is not and what we can develop further. In this way, scientists can develop new theories, ideas and products that shape our society and our everyday lives.

Although research can take many forms, there are three main purposes of research:

• Exploratory: Exploratory research is the first research to be conducted around a problem that has not yet been clearly defined. Exploration research therefore aims to gain a better understanding of the exact nature of the problem and not to provide a conclusive answer to the problem itself. This enables us to conduct more in-depth research later on.
• Descriptive: Descriptive research expands knowledge of a research problem or phenomenon by describing it according to its characteristics and population. Descriptive research focuses on the ‘how’ and ‘what’, but not on the ‘why’.
• Explanatory: Explanatory research, also referred to as casual research, is conducted to determine how variables interact, i.e. to identify cause-and-effect relationships. Explanatory research deals with the ‘why’ of research questions and is therefore often based on experiments.

Characteristics of Research

There are 8 core characteristics that all research projects should have. These are:

• Empirical  – based on proven scientific methods derived from real-life observations and experiments.
• Logical  – follows sequential procedures based on valid principles.
• Cyclic  – research begins with a question and ends with a question, i.e. research should lead to a new line of questioning.
• Controlled  – vigorous measures put into place to keep all variables constant, except those under investigation.
• Hypothesis-based  – the research design generates data that sufficiently meets the research objectives and can prove or disprove the hypothesis. It makes the research study repeatable and gives credibility to the results.
• Analytical  – data is generated, recorded and analysed using proven techniques to ensure high accuracy and repeatability while minimising potential errors and anomalies.
• Objective  – sound judgement is used by the researcher to ensure that the research findings are valid.
• Statistical treatment  – statistical treatment is used to transform the available data into something more meaningful from which knowledge can be gained.

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Types of Research

Research can be divided into two main types: basic research (also known as pure research) and applied research.

Basic Research

Basic research, also known as pure research, is an original investigation into the reasons behind a process, phenomenon or particular event. It focuses on generating knowledge around existing basic principles.

Basic research is generally considered ‘non-commercial research’ because it does not focus on solving practical problems, and has no immediate benefit or ways it can be applied.

While basic research may not have direct applications, it usually provides new insights that can later be used in applied research.

Applied Research

Applied research investigates well-known theories and principles in order to enhance knowledge around a practical aim. Because of this, applied research focuses on solving real-life problems by deriving knowledge which has an immediate application.

Methods of Research

Research methods for data collection fall into one of two categories: inductive methods or deductive methods.

Inductive research methods focus on the analysis of an observation and are usually associated with qualitative research. Deductive research methods focus on the verification of an observation and are typically associated with quantitative research.

Qualitative Research

Qualitative research is a method that enables non-numerical data collection through open-ended methods such as interviews, case studies and focus groups .

It enables researchers to collect data on personal experiences, feelings or behaviours, as well as the reasons behind them. Because of this, qualitative research is often used in fields such as social science, psychology and philosophy and other areas where it is useful to know the connection between what has occurred and why it has occurred.

Quantitative Research

Quantitative research is a method that collects and analyses numerical data through statistical analysis.

It allows us to quantify variables, uncover relationships, and make generalisations across a larger population. As a result, quantitative research is often used in the natural and physical sciences such as engineering, biology, chemistry, physics, computer science, finance, and medical research, etc.

What does Research Involve?

Research often follows a systematic approach known as a Scientific Method, which is carried out using an hourglass model.

A research project first starts with a problem statement, or rather, the research purpose for engaging in the study. This can take the form of the ‘ scope of the study ’ or ‘ aims and objectives ’ of your research topic.

Subsequently, a literature review is carried out and a hypothesis is formed. The researcher then creates a research methodology and collects the data.

The data is then analysed using various statistical methods and the null hypothesis is either accepted or rejected.

In both cases, the study and its conclusion are officially written up as a report or research paper, and the researcher may also recommend lines of further questioning. The report or research paper is then shared with the wider research community, and the cycle begins all over again.

Although these steps outline the overall research process, keep in mind that research projects are highly dynamic and are therefore considered an iterative process with continued refinements and not a series of fixed stages.

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Article contents

Use of qualitative methods in evaluation studies.

• Namita Ranganathan Namita Ranganathan University of Delhi
•  and  Toolika Wadhwa Toolika Wadhwa Shyama Prasad Mukherji College for Women
• https://doi.org/10.1093/acrefore/9780190264093.013.378
• Published online: 26 April 2019

Evaluation studies typically comprise research endeavors that are undertaken to investigate and gauge the effectiveness of a program, an institution, or individuals working in educational contexts, such as teachers, students, administrators, and other stakeholders in education. Usually, research studies in this genre use empirical methods to evaluate educational practices and systems. Alternatively, they may take up theoretical reflections on new policies, programs, and systems. An evaluation study requires a rigorous design and method of assessment to focus on the specific context and set of issues that it targets. In general, research studies that attempt to evaluate a program, an individual, or an institution place emphasis on checking their efficacy. They do not seek to find explanations that have led to the level of efficacy that the variables under study may have achieved. Thus, quite often, they are contested as not being full-fledged research.

Evaluation studies use a variety of methods. The choice of method depends on the area of study as well as the research questions. An evaluation study may thus fall within the qualitative or quantitative paradigms. Often, a mixed method approach is used. The purpose of the study plays a significant role in deciding the method of inquiry and analysis. Establishing the probability, plausibility, and adequacy of the program can be some of the main aims of evaluation studies. This implies as well that the programs, institutions, or individuals under study would have an impact on the course and direction of future programs and practices. An evaluation study is thus of vital importance to ensure that appropriate decisions can be made about efficacy, transferability to different contexts, and difficulties and challenges to be faced in subsequent applications.

Evaluation studies in India have been done in a vast range of areas that include program evaluation, impact studies, evaluations of specific interventions, performance outcome assessments, and the like. Some examples of studies undertaken by the government and the development sector in this regard are the following: assessment of interventions for adolescence education; impact studies of interventions, programs, and policies launched for education of minorities, including girls; and evaluation of performance outcomes stemming from programs for education of the marginalized.

The key challenges in evaluation studies are to gather accurate data in order to establish reliable outcomes, to establish clear relationships between the outcomes and the interventions being studied, and to safeguard against researcher bias.

• evaluation studies
• program evaluation
• qualitative evaluation
• outcome-based evaluation
• project evaluation
• inferring qualitative trends

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• Published: 21 May 2024

Tanzanian adolescents’ attitudes toward abortion: innovating video vignettes in survey research on health topics

• Anna Bolgrien   ORCID: orcid.org/0000-0002-1954-2403 1 &
• Deborah Levison   ORCID: orcid.org/0000-0002-3718-3432 2  

Reproductive Health volume  21 , Article number:  66 ( 2024 ) Cite this article

Metrics details

The purpose of this study was to pilot an innovative cartoon video vignette survey methodology to learn about young people’s perspectives on abortion and sexual relationships in Tanzania. The Animating Children’s Views methodology used videos shown on tablets to engage young people in conversations. Such conversations are complicated because abortion is highly stigmatized, inaccessible, and illegal in Tanzania.

The cartoon video vignette methodology was conducted as a part of a quantitative survey using tablet computers. Hypothetical situations and euphemistic expressions were tested in order to engage adolescents on sensitive topics in low-risk ways. Qualitative interviews and focus groups validated and further explored the perspectives of the young respondents.

Results indicate that 12–17 year-olds usually understand euphemistic expressions for abortion and are aware of social stigma and contradictory norms surrounding abortion from as young as age twelve. Despite the risks involved with abortion, this study finds adolescents sometimes view abortion as a reasonable solution to allow a girl to remain in school. Additional findings show that as adolescents wrestle with how to respond to a schoolgirl’s pregnancy, they are considering both the (un)affordability of healthcare services and also expectations for gender roles.

Conclusions

Digital data collection, such as the Animating Children’s Views cartoon video vignettes used in this study, allows researchers to better understand girls’ and boys’ own perspectives on their experiences and reproductive health.

Plain English Summary

The Animating Children’s Views project used cartoon video vignettes to collect quantitative and qualitative data on girls’ and boys’ (infrequently included) perspectives about this sensitive topic as these young people aged into and figured out how to navigate sexual maturity in rural and urban Tanzania. This novel survey technique leveraged digital technology to better engage young people’s perspectives about sensitive health topics. Despite the risks involved with abortion, this study finds adolescents sometimes view abortion as a reasonable solution to allow a girl to remain in school. Additional findings show that as adolescents wrestle with how to respond to a schoolgirl’s pregnancy, they are considering both the (un)affordability of healthcare services and also expectations for gender roles. We argue that digital data collection allows survey research to include girls and boys, to better understand how reproductive health outcomes are inextricably linked to their future lives.

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Introduction

“Sometimes bad luck happens, and a girl gets pregnant when she is still studying. And if the teacher knows about it, she might not attend school. And she can either abort the pregnancy or deliver and care for the baby. Some of the students are curious. They might know she is pregnant. It will be a shame on her. They can report her to the teacher, and she might be dismissed from school. The teachers will not understand her situation; they will not know it’s something that you did not plan for. They will feel you did it deliberately.” [girl, age 15, focus group, urban]

Approximately one-quarter of Tanzanian adolescents girls become pregnant between the ages of 15 to 19 years [ 43 ]. Many young people in Tanzania are sexually active from as young as 10–14 years of age or plan to become sexually active before marriage [ 27 ,  15 ]. Some girls have sex because boys are not expected to be abstinent, and they expect their girlfriends to have sex with them. In addition to seeking sexual relationships out of desire, girls may enter into consensual transactional sexual relationships with older boys or men as a way to secure financial stability [ 25 ,  46 ]. Peer pressure, lack of familial financial support, lack of information about health services, and poverty all strongly correlate with high rates of teenage pregnancy [  29 ]. Cultural barriers make it difficult for schools, non-governmental organizations, and parents to communicate appropriate and accurate reproductive health information to youth [ 34 ,  45 ]. Girls may face difficulties obtaining and paying for contraceptives [ 23 ] or for an abortion after an unplanned pregnancy.

Girls experience stigma at multiple levels of society when navigating teenage sexual relationships and their education [ 18 ,  33 ]. To surmount these and other challenges, Tanzanian girls and boys are convinced that “education is the key to life” ( Elimu ni ufunguo wa maisha. See Vavrus [ 44 ]). Becoming pregnant while in school puts a girl at risk of social isolation and being labeled a “bad girl” [ 11 ]. Additionally, at the time of this study the legal reality was that pregnant girls were expelled from school [ 8 ]. In 2021, the World Bank’s influence and change in Tanzanian leadership have led to changes in the government’s approach to schoolgirl pregnancy and motherhood (Reuters [ 35 ]). However, implementation of the revised policy requires separate schools for young mothers, which are unlikely to be accessible for much of the population any time soon.

What results is a culture of secrecy where young people hide their relationships from parents and peers alike. Abortion – illegal in Tanzania – may seem like a way of escaping a life-long penalty for premarital sexual activity. Yet, unsafe abortions account for a substantial fraction of maternal deaths in Tanzania [ 17 ]. Anti-abortion sentiment arises from religious objections; pro-choice discourse from public health aims to reduce maternal mortality rates due to unsafe illegal abortions; and human rights organizations call for women to have a choice in their reproductive health [ 36 ]. In the event of a pregnancy, secrecy can be maintained only through unsafe and potentially deadly abortion services, as the great majority of girls cannot raise the necessary funds for safer illegal abortions in private clinics [ 39 ].

Given the consequences of the lack of social support, accurate health information, and significant impacts to their lives, it is important to learn more about how young people are navigating the competing pressures of engaging in sexual relationships and staying in school if policy makers and researchers are to help improve outcomes for adolescents. While the overall study was methodologically driven and featured various topics and themes relating to the lives of adolescents in Tanzania, this paper focuses on how a cartoon video vignette methodology engaged young people in order to learn about how they weighed the risks and benefits of abortion in a context where teen pregnancy may be the end of education for girls.

In this paper, we present mixed-methods results using quantitative and qualitative data collected in response to a story about teen pregnancy. We find children and adolescents understood concerns about social stigma and were aware of contradictory norms surrounding abortion. They also shared their perceptions of inadequate health care services and views on gendered decision-making. Our results show that adolescents were considering complex social, medical, ethical, and pragmatic factors surrounding teenage pregnancy and abortion. In addition to the substantive findings, this paper also argues that a vignette methodology can be a useful way to collect survey data on children’s perspectives, made possible through advances in the usability and affordability of digital technology in field work. We describe two techniques – the use of euphemistic expressions and asking questions about hypotheticals – to learn children’s opinions about sensitive topics like abortion.

Methodology: using video vignettes in survey research

The relationship between high rates of teenage pregnancy and unknown rates of abortion – both sensitive topics – is examined primarily in qualitative research because researchers can take more time to establish rapport and build trust, thereby reducing risks to and vulnerability felt by participants [ 9 ]. Qualitative research is ideal for understanding nuances of how youth are interpreting cultural norms towards abortion and how they are thinking about access, effectiveness, and safety of abortion services in the event that they may at some point face an unplanned pregnancy. However, qualitative studies of youth’s experience and attitudes towards abortion across sub-Saharan Africa typically engage with older girls, most often between 15 and 24 years old, such as Bajoga et al. [ 3 ] and Otoide et al. [ 31 ] in Nigeria, Silburschmidt and Rasch [ 39 ] in Tanzania, Hall et al. [ 11 ] in Ghana, and Marlow et al. [ 22 ] in Kenya. Data on boys of all ages and younger girls are limited; one exception is Sommer et al. [ 40 ].

It can be difficult to gather quantitative data on experiences of abortion. Survey research on abortion in Tanzania and elsewhere generally focuses on adult women and occasionally men. While married or older women may feel less stigma associated with sexual behaviors, survey respondents may still feel uncomfortable responding to abortion-related topics that may be inappropriate to discuss in public, topics that would lead to admitting an illegal action, or topics where a truthful answer would be a violation of a social norm [ 42 ]. In the case of abortion, qualitative interviews with adult women in Tanzania and elsewhere who have experienced abortion frequently report that internalized stigma results in abortions being underreported or omitted from survey data (e.g., Astbury-Ward et al. [ 1 ] for the UK; Haws et al. [ 13 ] for Tanzania). Quantitative surveys typically avoid sensitive topics, particularly in contexts where privacy may be impossible. This is of high importance when engaging with vulnerable people. Adolescents may be particularly alert to sensitive topics and not feel comfortable disclosing their experiences in direct conversation [ 4 ]. If the children or adolescents are overheard saying anything that an adult deems inappropriate, they could be physically punished, have food withheld or be otherwise penalized. Quantitative studies of adolescents in Tanzania include a few examples of young people’s sexual experiences but these do not specifically discuss abortion [ 32 ,  28 ,  38 ].

Vignettes are one way that survey researchers can learn respondents’ views, by asking them about characters in a story instead of about personal experiences [ 10 , 30 , 14 ]. Vignettes can be written text, cartoons, read-aloud, or videos; respondents answer questions based on details in the story. Videos shown on tablets are similar to methods of communication that many young people in Tanzania are familiar with: 100% of our respondents had seen a video before. Instead of solely using a traditional question-answer format – which may feel to adolescents like an examination – videos creatively allowed participants to engage with stories.

Vignettes about abortion have been used in previous studies with adults (Sastre et al. [ 37 ] in France, Hans and Kimberly [ 12 ] in USA, Kavanaugh et al. [ 16 ] in Nigeria and Zambia). In a study in neighboring Kenya, Mitchell et al. [ 24 ] used vignettes to compare adolescents’ recommendations to a fictional couple, their own hypothetical future, and real examples of peers’ unplanned pregnancies and abortions. Their results suggest that respondents held different expectations for the vignette couple than for themselves or their peers.

The research presented in this paper fills a gap in the literature: young people’s perspectives – especially those of younger girls and of boys – are often excluded from research on abortion and sexual relationships. We show results from a novel methodology designed to illuminate the perspectives of children in low-income countries while reducing participation risks for young respondents.

Methodology: Animating Children’s Views (ACV)

The Animating Children’s Views (ACV) methodology developed by Levison and Bolgrien [ 21 ] used cartoon vignettes to present short stories to 12-to-17-year-olds in rural and urban northern Tanzania. While the use of tablet computers to collect survey data in the field is not a new technology, the ability to incorporate short videos during the survey allowed the field team to better engage young respondents during the interview. Respondents watched the cartoons and then responded to survey questions posed by interviewers about the situation and possible outcomes for characters in the stories. The innovation in using tablets to show videos establishes a way to create an experience where the respondent is expressing perspectives or opinions on a qualitative topic, but responses are coded as quantitative data collected during a survey.

In pilots of the ACV methodology, we developed several vignettes representing situations that are commonly understood by Tanzanian adolescents. As discussed above, the primary method of reducing risk was to present stories to young respondents on tablet computers, using audio heard privately through headphones. The stories were followed by questions about the stories conducted using a typical interviewer-led survey, but with reference to the videos that would be unlikely for nearby adults to understand (since they didn’t hear the videos). This, in turn, reduced the risk of participants being punished for responses viewed as inappropriate. Using free software and simple drawings, we created short cartoon videos with young protagonists along with recorded voice-overs in Swahili. The cartoon characters lack physical or contextual characteristics that would associate them with any particular ethnicity or socio-economic status. Figure  1 shows two of the images from the story about teen pregnancy.

Images of pregnant girl and “getting herbs or medicine” from ACV teen pregnancy vignette. Artist credit: Hillary Carter-Liggett

As described above, respondents watched a video and then answered survey questions about the dilemma it described. Some response options used a 5-point “Smiley Scale”: respondents could point at a face emoji (very sad/angry to very happy). Other questions required responses of a word or phrase. To better understand the quantitative results, some young respondents participated in brief qualitative interviews after the conclusion of the quantitative survey data collection, and some joined sex- and age-specific focus groups. All stories were validated in collaboration with the Tanzanian field team and through cognitive interviews with Tanzanian adolescents.

In the vignette analyzed in this paper, a schoolgirl with a boyfriend finds herself pregnant. The story explains that the girl would like children at some point, but now is not the right time. The girl recognizes that it is difficult for pregnant girls and mothers to remain in school. The cartoon girl thinks about several possible outcomes for the pregnancy, including getting an abortion, marrying the boy, or asking grandparents to care for the baby. Girls heard a female voice telling the story from the point of view of the cartoon girl. Boys were shown exactly the same video images but heard a male voice narrating from the point of view of the father of the fetus. No information about the cartoon couples’ exact ages, education levels, or family backgrounds was given, though our pretesting of the story suggests most respondents interpreted the characters as young people of similar ages to themselves.

Interviewer effects on survey data are a persistent concern for researchers especially when interviewing children and adolescents [ 19 ]. In an attempt to please interviewers, respondents may answer questions in ways that are consistent with a dominant social narrative; Morris [ 26 ] calls such responses “scripts” based on her research with adolescents in Zanzibar, Tanzania. For example, Mitchell et al. [ 24 ] found that children in Kenya often referenced textbook sentiments about abortions. In our study, survey questions following the vignette asked what the cartoon characters should do. The question wording allowed the respondent to keep the conversation firmly in the hypothetical third person (about the cartoon character) instead of asking respondents to share information about their personal opinions or experiences. Although Mitchell et al. [ 24 ] found that their respondents were more understanding of peers and of themselves than of vignette characters, in our focus groups young people often used local examples or even slipped into the first person when describing what the cartoon character should do in a difficult situation. This is a local example:

“I was studying with this girl. She got pregnant. The father of this girl came to school, and the teachers said, ‘we can’t accept this girl back because she is pregnant.’ The girl dropped out of school. But as her friends, we were not happy about the situation.” [boy, 17, focus group, rural].

Even though we explicitly did not request information about young people’s own experiences, these came up naturally in qualitative discussions. Similar to Mitchell et al.’s [ 24 ] conclusions, we demonstrate below that Tanzanian youth express opinions that sometimes conform to but also sometimes contradict social narratives or scripts, even when discussing hypothetical vignettes.

Some of the quotes presented in this paper may make it seem as if a child were asked directly about abortion or were asked to describe personal experiences. This was not the case. During interactions between field researchers and young respondents, we aimed to minimize any discussion using the word “abortion” in order to protect the adolescent from repercussions from conversing with a stranger about a sensitive topic. As corporal punishment is common in Tanzania, ethical protection of children as a vulnerable population necessitated extra caution on behalf of the research team to mitigate the potential of a child being punished by an adult who overheard the interview [ 41 ]. Instead of speaking directly about abortions, the euphemism “take herbs and medicine to get her period back” was used in Swahili. The results section will show that most young respondents understood this euphemism. If a child voluntarily used the word “abortion” or mentioned other sensitive topics, field researchers were trained to continue the conversation only if the location of the interview was private enough that there was no risk of being overheard by adults or other children. We conducted a small follow-up study with respondents in the pilot and none reported any risk or discomfort following the interview ([ 21 ], pg S152). We attribute our success to these precautions.

Data Collection

The vignette methodology was piloted in two locations in northern Tanzania in 2018 using a mixed-methods approach as shown in Fig.  2 . This project was approved on May 18, 2018, by the IRB of the University of Minnesota (STUDY00003131) and by the Commission for Science and Technology (COSTECH) on May 10, 2018, in Tanzania. Adult and child participants were given a small gift of sugar, school supplies or a small monetary payment based on recommendations by local collaborators. The first pilot location was a village in the Arusha District that was purposefully selected based on the diversity of ethnicities (predominantly Chagga and Iraqw), religions (Christian and Muslim) and occupations (farming, herding, and small businesses). Following the rural pilot, a second pilot was conducted in urban areas in Arusha District. We used a household-based instead of a school-based sample and did not require literacy to identify our study population. The pilots used a two-stage systematic random sampling of households in wards and neighborhoods drawn for the purpose of this study by the field team with support from local village and community leaders, as discussed in Bolgrien and Levison [ 6 ]. In each household, an adult answered a questionnaire about household demographics, and all available children ages 12–17 in the household were asked to participate in a face-to-face administered survey that included vignettes. Adults gave consent for household and child participation and children gave assent to the interviewer prior to the start of the survey. Survey teams were trained to conduct the survey in a public (visible) area but out of earshot of adults, to create privacy for the child respondents during in-person surveys and one-on-one interviews; training also included other methods to reduce perceived power disparities between adult interviewers and young interviewees [ 7 ]. Each pilot included teams of 4–6 experienced young Tanzanian interviewers; the authors and local staff conducted additional training in survey data collection and qualitative methods with adolescents.

Study development and pilot studies in Tanzania 2018

Table  1 shows sample characteristics for young survey respondents. In total, 327 children in 248 households were surveyed. Most came from relatively large households of about six people (including themselves). In each household, each available (and assenting) 12–17 year-old was included in the survey. In both samples, especially the rural village, the sample was skewed toward younger ages. Older children were often away in boarding school or had left home to work. The urban field research was conducted during the beginning of a school holiday so more older adolescents were available. Although all survey participants had attended school at some point, more than one-quarter of the rural children were no longer enrolled in school. The vignette about teen pregnancy was only one of several possible vignette topics the children watched. Children were asked between each video if they would like to continue participating. In the rural village, children were shown up to four videos in a random order. During the rural pilot, one-third of respondents did not watch all four vignette videos, but data on the reason for discontinuing – a child’s decision, a field team member determining the child was fatigued or distracted, or an adult interrupting the interview – was not collected. Based on feedback from the field team after the rural pilot, we modified the survey design for the urban pilot to present 3 videos in a set order to reduce respondent burden. In the urban pilot, only 4% of respondents did not complete the 3 videos. A subset of 291 out of the 327 surveyed adolescents watched the story about teen pregnancy and answered its follow-up questions.

To better interpret the results from the quantitative survey data collected from households and children, we also collected concurrent qualitative data from the child respondents. After participating in the survey, a subset of 152 children assented to participate in semi-structured interviews which took place directly following the child’s survey. Children were asked about their answers to some of the survey questions about one or more of the videos. Finally, children who participated in the survey were asked if they would like to participate in focus groups. Interested and available children were organized into focus group discussions of three to 10 participants, grouped by sex and similar ages, to have conversations about the vignettes. The aim of these short interviews and focus groups was to assess the understandability of the vignettes, the degree of personal connection the children felt in regard to each story, and to explore ideas children had about possible outcomes for the story. The focus group discussions and interviews were conducted, recorded, transcribed verbatim, translated from Swahili to English by the field team, and coded using ATLAS.ti 8 (Version 8.4.24.0) [ 2 ] in a collaborative and iterative effort by both authors and a project assistant. The story about teen pregnancy was discussed in 90 of the interviews and focus groups, and the topic of abortion was discussed 87 times. Language used in this paper will attempt to be true to the respondents’ language, e.g. referring to the cartoon boy as the “father” and saying “baby” instead of “fetus.”

Results and discussion about using a euphemism for abortion

As discussed above, we avoided using the term “abortion,” instead using the euphemism “the girl could take herbs or medicine to get her period back,” similar to other researchers’ use of euphemistic phrases like “sleep with someone” and “to make love” instead of “sexual intercourse” [ 33 ,  5 ]. During the preparation and training for the field work, this phrase was generally understood by respondents. We continued to validate that this phrase was understood during the qualitative interviews that followed the survey.

Based on the follow-up interviews, older respondents of both sexes understood the language around “herbs and medicine” to be referring to abortion. When abortion was discussed, 26 respondents used language that indicated their understanding that the situation implied abortion or terminating the pregnancy. For example:

Interviewer: And then she uses herbs or medicines to get her periods back, what do you think is going to happen?

Respondent: abortion

Interviewer: what are the effects of it?

Respondent: The unborn baby will die. [boy, 14, urban]

In another 13 interviews, the young respondent’s language indicated clearly that she or he understood the purpose of using herbs and medicine but did not refer to abortion directly. Instead, language such as “bringing back normal periods,” “losing the baby,” “grief,” and “negative effects” are examples of how respondents referenced the termination of a pregnancy. A 14-year-old girl indicated in the survey that the cartoon girl was somewhat happy to take herbs and medicine, and during the interview the respondent described happiness resulting from using the herbs. The interviewer asked, “what are other effects after she gets her period back?” and the girl replied, “abortion.” After this, the respondent became less talkative and responsive and changed the subject.

Seven interviewees (both genders, age 12–15) likely did not understand the nuanced language of “herbs and medicine” to imply abortion. One (boy, 13, rural) misunderstood that herbs or medicine referred to birth control or pre-natal care given at hospitals. Additionally, some younger boys and girls did not make the connection between menstruation and pregnancy. Education (formal or informal) about reproduction and reproductive health is very limited for younger children in Tanzania [ 27 ]. Whereas girls may be warned about the possibility of pregnancy when they begin menstruating, this may not happen for boys entering puberty. Several of the older boys incorrectly described female reproductive anatomy and how or when to use birth control.

Results and discussion on young people’s perspectives on abortion

A survey question about the teen pregnancy vignette asked respondents to identify what was most likely to happen to the cartoon kids. As shown in Table  2 , among the options presented, 18% of respondents reported that the girl would abort the baby; it was the third highest-ranking option out of the five options, behind getting married and taking the baby to the girl’s family. In an open-ended question (not shown) that asked the respondent to imagine the most likely outcome to the story if it happened “around here,” 11% chose abortion.

The relative popularity of the options about getting married or having parents of the girl or boy help to care for the baby is consistent with the qualitative findings from the interviews and focus groups. Respondents often described the cartoon girl and boy as considering possible outcomes in order of desirability: If it was unlikely the cartoon couple could marry or care for the baby themselves, they would next approach one or both sets of parents; if that was unsuccessful or undesirable, then an abortion was considered. For example,

She will feel happy because it’s something she did not really like and did not expect it. So, if he [presumably the cartoon boyfriend] goes to his parent, first if he goes to the parents of the girl. I mean they can reject [the pregnancy or baby] and they can hate him. So she was, I mean … that’s why I said she would feel happy. Because, I mean, she probably can’t afford it and she might need to reduce her responsibilities. Because if she used those herbs to abort the pregnancy, you will find that she can continue with her normal things. [boy, 14, urban, 5 on Smiley Scale]

When we asked young respondents how they felt about abortion using the Smiley Scale, 56% of them thought abortion was a negative outcome (sad/angry or very sad/angry) for the cartoon couple, as shown in Table  3 . An additional 18% reported a neutral feeling (3 on the Smiley Scale). 25% reported that abortion would be a positive outcome (happy or very happy). Girls were less likely to be very happy than boys and more likely to be very sad/angry, but a chi-square test for the Smiley Scale cross tabulation by gender was significant only at the 11% level. T-tests for differences in the specific Smiley Scale responses by gender were significant only for “very happy” ( P  = 0.012, not shown). The results from the qualitative analysis of interviews and focus groups helped us understand these quantitative results.

Of the respondents who indicated that abortion was a positive outcome, the primary reason mentioned was that an abortion would allow the cartoon girl to return to her normal life and possibly stay in school or go back to school.

She may feel happy because, if you have not got your periods for a while, it could be a problem. So, it is better to look for herbs/medicines that will help. She has to deal with that in order to get her periods back. [girl, 17, urban, 5 on Smiley Scale]

She has very big dreams in her life. She has dreams that will take her five years to reach: ‘I want to be a certain type of person later.’ The boy came and shortened her dream. She will make sure… she aborts the pregnancy so that she achieves her dreams… [girl, focus group ages 14-17-year-old, rural]

These positive reactions are consistent with strong social norms in Tanzania for children to complete their education before starting a family [ 44 ]. Based on the qualitative evidence, both girls and boys felt that the cartoon girl should be in school, and abortion was the mechanism that would allow that.

Many of the reasons given for a negative reaction to abortion were consistent with moral and ethical qualms associated with it. In our study, children said that ending the pregnancy will make the girl sad because “the baby will die” (multiple respondents). Other reasons for negative responses towards abortion reflected the dangers of illegal abortion services, particularly in rural areas where undergoing abortions may be especially risky for the mother. Mitchell et al. [ 24 ] noted that such dangers, while real, are greatly exaggerated in Kenyan schools and educational materials; this may also be true in Tanzania.

She feels sad because she might die in the process of abortion, that is why she will feel very sad. [girl, 14, urban, 2 on Smiley Scale]

Given the strong social norms of remaining in school and cultural stigmatization of teen pregnancy and abortion in Tanzania, the results of strong negative and strong positive opinions found in the quantitative smiley-scale and accompanying qualitative validation are not surprising. But why would a respondent feel neutrally about abortion? In follow-up interviews, some respondents described the complexity of a situation that could involve abortion. One older boy said:

When I said abortion, I assumed the boy denies the pregnancy and leaves the girl to decide on her own. The girl can abort the pregnancy so as to look like other girls…She can go to school and feel young as other girls. She will decide to abort the pregnancy so she can match with other girls of her age and also [have the abortion] when the pregnancy is not noticeable to other people. Most girls end up doing this when the boys deny the pregnancies. [boy, 17, urban, 3 on Smiley Scale]

The cartoon boy denying that the baby was his and abandoning his girlfriend seemed likely to this respondent, who chose abortion to spare the cartoon girl from stigma and other troubles. Because he saw both negatives (denying paternity, abandonment) and positives (being able to hide the pregnancy), he chose the middle Smiley emoji.

Results and discussion on healthcare access and gendered decision-making

Survey results show that there is variation in how children and adolescents are thinking about cultural norms, social stigma, and the choices about hypothetical, yet possible, decisions that they or their peers may face in their own communities. The findings from the ACV methodology show that young people understand and interpret teenage pregnancy as a complex situation with multiple overlapping expectations, including staying in school and abstaining from sex while in school. Two additional themes appeared during the qualitative conversations about abortion: unaffordable health care and gendered decision making. Both of these topics are central to broader conversations about sexual and reproductive health access and female empowerment in Tanzania.

Respondents were acutely aware of the life-threatening nature of illegal abortions, particularly using local medicine or witch doctors as opposed to costly private clinics. One girl (age 17, urban) spoke of hearing about a girl going to a witch doctor for an abortion, but it was unsuccessful and resulted in an infection. The expense of an abortion was often directly connected to discussions about who would decide whether the fetus would be carried to term.

In the quantitative survey respondents indicated whom they thought would be the decision maker in the vignette about pregnancy. Table  4 shows that almost half of surveyed participants (48%; including 50% of girls and 46% of boys) reported the cartoon boy would make the decision and only 17% thought it would be the cartoon girl; only 3% thought the boy and girl would make the decision together. Other young respondents thought that adults such as parents or leaders (31%) or a combination of adults and adolescents (1%) would make the decision.

Many conversations in the qualitative interviews and focus groups talked about gender roles and decision-making when considering the cost of abortion and safe access to the healthcare system. The father of the baby was typically expected to determine whether to abort, either via positive support (the contribution of funds to pay for the abortion) or negative coercion (abandoning the cartoon girl and forcing her to make a decision between single motherhood or abortion).

For example, here is an excerpt from a focus group discussion among boys ages 13 and 14 [rural]:

Boy 1: He [another boy in focus group] says that the girl is the one to decide about aborting the pregnancy because the pregnancy is within her body. She is the one with the decision of abortion because that boy, even if he can manage to tell her to abort the pregnancy, she is the one with the decision. She can make the decision to go to search for drugs, get them, and abort that pregnancy.

Boy 2: I think that will not be possible, because where will she get the money? And you might find that her parents are against her. She cannot do it. They [the girl and boy] will have to sit together and negotiate about the pregnancy…They have to say whether they are getting married, should get married. If they have to abort, then abort…But one of them cannot get the ideas [alone] because they will go into the wrong direction.

Other respondents described the father of the unborn baby – the cartoon boy – as being the head of the family. They felt it was therefore up to the cartoon boy to find money for the girl and to help the girl decide what to do about the pregnancy. Both girls and boys took this patriarchal position. For example:

The boy has the power to do anything and also he is the head of the family. Probably, this girl wouldn’t be able to raise the baby or provide the basic needs for the baby. [girl, 12, rural]

The cartoon boy is the one with decisions to abort the pregnancy because he is the one who knows how he will take care for the child or how he will raise it. [boy, focus group ages13-14, rural]

Conversely, many girls (and some boys) were more likely to assert that the cartoon girl had the final decision about what to do about the pregnancy since the girl was the one carrying the baby and the one who faced the most risks if the pregnancy or abortion went wrong. Conversations in some female focus groups described situations where the cartoon girl would be able to find the money from her parents or by working. Some girls were also acutely aware that the final decision would often be left to the cartoon girl if the boy abandoned her or decided to deny that the baby was his, as in this case:

She will have thought ‘Maybe this boy will reject me? Will I fail to raise my child?’ Maybe she will also go to people who will advise her to abort the pregnancy so that she can go back to how she used to be. [girl, 17, urban]

As shown in Table  4 , while half of the girls responded that the cartoon boy would make the decision about the outcome of the story, 23% of the female respondents reported that the cartoon girl would be the final decision maker. This was the second most popular result for female respondents whereas the cartoon girl’s parents was the second most popular option (16%) for male respondents. Excluding the cartoon girl from the decision regarding her own pregnancy reflects the strong patriarchal norms in Tanzanian society (Leshabari et al. [ 20 ]).

Both our study and Mitchell et al. [ 24 ] suggest that East African children and adolescents have complex understandings about pregnancy and abortion, with discourse that may be heavily influenced by religious or other teachings but with pragmatic, less-judgmental responses to actual situations. These results show that there is variation in how children and adolescents are thinking about cultural norms, social stigma, and the choices about hypothetical, yet possible, decisions that they or their peers may face in their own communities.

Before exploring the results on views on abortion, stigmatization, access, and decision making, we first needed to confirm that the majority of children in the study understood the phrase “take herbs and medicine to get her period back” to be a euphemism for having an abortion. A limitation in our study is that we did not test directly using the word “abortion” because that would have exposed young respondents to increased risk of harm. This methodological innovation was successful as young respondents’ use of language indicated an awareness about social norms when discussing a sensitive topic with researchers (adult strangers). Participants likely considered their comfort level about interacting with the field researcher, as well as the likelihood of others overhearing the conversation. While our team took many precautions to avoid increasing risk to respondents, including monitoring the environment during the interview for anyone who might be listening, respondents were also actively making decisions about what language they used and their levels of openness in their responses. We argue that the benefits of being able to ask vulnerable populations questions about a sensitive subject are worth potential misunderstandings by a small minority of participants.

The findings from the ACV methodology show that young people understand and interpret teenage pregnancy as a complex situation with multiple overlapping expectations, including staying in school and abstaining from sex while in school. Our findings on the mixed positive and negative perspectives of abortion in the quantitative survey would have been difficult to interpret without the qualitative interviews. The video vignette methodology in this study successfully engaged with young people about a complex and sensitive topic in ways that showed that adolescents could formulated complex and thoughtful opinions on such topics. Young people’s quantitative answers to survey questions and qualitative comments reflected the lack of safe and affordable options and services for youths. Even though abortion was clearly perceived as physical risky and socially stigmatized, both girls and boys promoted it as a solution that would leave the cartoon girl in school, where they felt she belonged. An early, secret abortion could protect the girl from being expelled from school. However, respondents indicated that the cartoon boy must participate in this scheme because girls on their own were not expected to have the resources to seek a lower-risk abortion.

Even at a young age, girls and boys are balancing the high risk of unsafe abortions against the benefits of keeping the pregnancy secret and avoiding social stigmatization for either pregnancy or early school-leaving. In our sample, respondents of all ages and both genders discussed abortion with maturity and understanding. Boys’ perspectives are infrequently included in studies about abortion or reproductive health care services, but the findings from this mixed methods study show that boys (and girls) are considering the nuanced role of boys and men in supporting or funding an illegal abortion. Framing the decision of an abortion as involving not only the pregnant girl but also other influential people such as the boyfriend or the girl’s parents can inform sexual and reproductive health policies to better support young people. However, the sample sizes in these pilot studies are too small to identify patterns correlated with demographic characteristics.

The secrecy and stigmatization of teen sexual relationships and illegality of abortion have made it very hard for researchers (let alone policymakers) to understand how adolescents are weighing trade-offs and navigating the competing pressures from peers, relationships, and familial expectations about education. Using the Animating Children’s View methodology, the sensitive topic of abortion was discussed with adolescents and children as young as 12 in a way that allowed them to share their perspectives without divulging personal information about sexual behaviors. Video cartoons engaged their attention leading to serious questions and sometimes conversations about hypothetical cartoon characters. In a context where pregnancy and motherhood mean the end of schooling for girls, respondents grappled with difficult decisions the cartoon couple faced regarding pregnancy and potential abortion. In future research, it will be imperative to explore adolescents’ perspectives regarding abortion for schoolgirls as it relates to increased access to education for pregnant girls. The ACV methodology can be used to engage adolescent girls and boys about pregnancy, abortion, contraceptive access, and cultural norms and stigma so their voices are included in such policy decisions.

Availability of data and materials

Participants of this study did not consent for their data to be shared publicly.

Abbreviations

Animating Children’s Views

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Acknowledgements

We are grateful to the Interdisciplinary Center for the Study of Global Change (ICGC) and the Humphrey School of Public Affairs at the University of Minnesota; also to Binu Sharma, and Deborah S. DeGraff for their assistance. We thank the field team members who collected the quantitative and qualitative data: Gloria Gerald, Haikael Mjema, Juliet Mongi, Masai Loreu, Rachel Gerald, Godfrey Rwiza, Nancy Laiser, Helen Urio, and David Mollel.

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This work was supported from the Human Rights Initiative Fund of the University of Minnesota 2018 and 2019; the University of Minnesota’s Grants-in-Aid of Research, Artistry and Scholarship 2018–2019; and the Minnesota Population Center, funded through a grant (P2C HD041023) from the Eunice Kennedy Shriver National Institute for Child Health and Human Development or NICHD. The funder had no role in the study design, data collection, analysis, interpretation, or reporting.

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Bolgrien, A., Levison, D. Tanzanian adolescents’ attitudes toward abortion: innovating video vignettes in survey research on health topics. Reprod Health 21 , 66 (2024). https://doi.org/10.1186/s12978-024-01809-x

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Envisaging challenges for the emerging medicinal Cannabis sector in Lesotho

• Regina M. Thetsane   ORCID: orcid.org/0000-0003-3666-0142 1  

Journal of Cannabis Research volume  6 , Article number:  23 ( 2024 ) Cite this article

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Cultivation of Cannabis and its use for medical purposes has existed for millennia on the African continent. The plant has also been widely consumed in the African continent since time immemorial. In particular, Lesotho has been largely growing Cannabis since approximately the 1550s and was illegally grown and unlawfully used for both medicinal and recreational purposes. It was only in 2017 when Lesotho started licensing Cannabis companies and regulating cultivation of Cannabis for medicinal purposes. However, the Lesotho Cannabis industry seems to have excluded the Small, Medium and Micro Enterprises (SMMEs) in the legalisation of Cannabis, the sector has the potential for small Cannabis enterprises in Lesotho.

This study attempts to examine challenges facing the evolving Cannabis sector in Lesotho as envisaged by Cannabis company managers with the aim of being proactive while addressing such challenges.

The qualitative descriptive method was employed using both primary and secondary data. For the selection of the three Cannabis managers exponential non-discriminative snowball sampling was adopted and interviews with the managers were recorded and transcribed verbatim. Thematic analysis was used to analyse the descriptive explanations of the Cannabis managers to determine the themes that were further consolidated into categories.

The implementation and compliance with the laws in the Lesotho medicinal Cannabis sector has proved very challenging, with long timeframes for finalising regulatory frameworks and not being applied objectively. The industry does not provide opportunities for Small, Medium and Micro Enterprises (SMMEs) to venture into the Cannabis business.

In Lesotho, the Cannabis sector appears to be faced with many challenges emanating from the implementation and enforcement of Cannabis laws. The Lesotho Government should review its Cannabis laws and regulations with a view to benefiting SMMEs and legalising Cannabis production so as to serve both the domestic and international markets.

Introduction

The production of medical Cannabis in Lesotho was previously regulated under the Dangerous Medicines Act of 1973 (Government of Lesotho, 1978 ), which was superseded in 2008 by the Drugs of Abuse Act (Government of Lesotho 2008 ). This initiative allowed the Government to provide access to specific drugs for medical and scientific purposes (Chatwin 2017 ). Lesotho became the first in African country to change an existing legislation and decriminalise the cultivation of Cannabis for medical use (Prohibition Partners, 2019 ). The new law came into effect through the Drug of Abuse (Cannabis) Regulations Act of 2018 (Phakela 2018 ). Following the Kingdom of Lesotho, some African countries which legalised cannabis include, Uganda, Malawi, Swaziland, Zimbabwe and Morocco (Mkhize 2018 ). Cannabis production, with the highest levels of production globally taking place in Africa, has existed for millennia (Duvall 2019 ). For instance, ten thousand five hundred metric tons or approximately 25% of the global production of Cannabis herb reportedly took place in Africa in 2005 (United Nation’s Office on Drugs and Crime’s (UNODC, 2022 )). While the highest rates have originated in West and Central Africa (13%) and in Southern Africa (8.5% (UNODC, 2022 )), such, countries as, Ghana, Lesotho, South Africa and eSwatini have largely been growing Cannabis for ages (Prohibition Partners, 2019 ). Further, despite its use for recreational and medicinal purposes, the greater percentage of the Lesotho Cannabis has been illegal, the 70% of which has also been smuggled into the neighbouring South Africa (Deon 2021 ). Generally, Cannabis, which came to be known esoterically by local various constructs, be they, matekoane, khomo ea fatše , likata and kakana ; elsewhere labelled marijuana, was found to be a more profitable crop that would enable Basotho to earn a better living than any other cash crops, such as, maize, sorghum and wheat. To date, many Basotho families have long been subsisting and collecting the extra income from selling Cannabis to both recreational and medicinal drug users to cover such additional costs as school fees for their children at different levels of schooling in Lesotho (Deon 2021 ).

Only in 2017 did Lesotho start licensing Cannabis companies and regulating the cultivation of Cannabis for medicinal purposes (Duvall 2019 ). Since then, the number of medicinal Cannabis businesses operating in Lesotho has grown rapidly following such a legislative change. In the same year, 2017, the first Lesotho company to be granted licences to produce Cannabis for medical and scientific purposes was the MG Health Limited Company. In the ensuing, the country has been experiencing an influx of foreign investment Cannabis companies. As Kabi ( 2018 ) stated that the Lesotho Ministry of Health (MoH) had granted thirty-three Cannabis licences across five licence categories: cultivation, processing, transport, retail and distribution in the same year.

Because of the influx of Cannabis companies, Lesotho has been projected to become a major source for medicinal Cannabis export into the markets of both Canada and the United Kingdom (UK), resulting in reducing poverty and unemployment in the country. This view is supported by Uwakonye ( 2020 ), who argues that in a resource-deficient country, for instance, Lesotho, the Cannabis industry may also upsurge the economy and become a solution to the high rate of youth unemployment (26.91%) (Aaron 2023 ). Considering the influx of medicinal Cannabis companies in Lesotho, the country’s economy, mainly driven by the construction industry, was projected to grow by 1.8 per cent in 2023, while the Cannabis industry was projected to contract (Central Bank of Lesotho, 2022 ), thereby rendering the future of this critically emerging sector rather oblique. Therefore, against this backdrop, this study set out to examine challenges facing the Cannabis sector in Lesotho.

Literature review

The most common Cannabis species grown around the world, including in Africa, and of course in Lesotho is Cannabis sativa , which can be traced to Asia (Government of Canada 2023 ). Cannabis sativa contains a complex mix of approximately 60 unique cannabinoids along with various chemical compounds (Western Cape Tourism, Trade and Investment Promotion Agency (Wessgro), ( 2021 ). The main active ingredient responsible for the production of Cannabis is delta-9-tetrahydrocannabinol (THC) (Wessgro), ( 2021 ). The National Institute on Drug Abuse (NIDA) ( 2019 ) also reported that the most commonly used parts of Cannabis sativa are dried leaves, flowers, stems and seeds and contain the mind-altering chemical THC and other similar compounds.

Medical Cannabis product

The name Medical Cannabis relates to the therapeutic activity of herbal Cannabis and its constituents (Whiting et al. 2015 ). For Wessgro ( 2021 ), medicinal Cannabis is a legal, high-quality and standardised product made from crude Cannabis. Having started in China, Asia, then the Middle East, and Africa, the use of Cannabis for medicinal purposes spread to the rest of the world (Lafaye et al. 2017 ). As Bridgeman and Abazia ( 2017 ) pointed out, the Cannabis plant contains more than 100 different chemicals, known as cannabinoids, while Delta-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are the main relevant chemicals used in medicine. The authors further argued that THC makes an individual euphoric when smoking Cannabis or eating foodstuffs with cannabis contents. For the purpose of this research, medicinal Cannabis refers to plant-derived Cannabis products prescribed by medical practitioners for treating specific conditions as in epilepsy and pain (Bridgeman & Abazia 2017 ).

Cannabis can include high CBD and low THC products, although CBD products also appear as consumer goods. Medical Cannabis products are currently prepared as plant materials, oils, tinctures, edibles or capsules (Prohibition Partners, 2019 ). Medicinal Cannabis is administered with the intention of alleviating pains caused by diseases and illnesses, such as, Multiple Sclerosis (MS), depression, anxiety, Human Immunodeficiency Virus ( HIV), nausea and vomiting, associated with chemotherapy, Posttraumatic Stress Disorder (PTSD), epilepsy or opioid addiction (National Academies of Sciences, Engineering, and Medicine (NASEM), 2017 ). However, medicinal Cannabis-related matters could be complicated in that, Cannabis is still an illegal drug and is legally constrained at the national and international levels in many countries (Mpela 2021 ). With some significant improvements in terms of legal imperatives by the industry, many challenges seem to lie ahead. Also noticeable worldwide is the increasing number of the Cannabis companies, making the industry highly competitive, something which has posed challenges for this particular industry. Doing business, coupled with observing the pertinent legal frameworks, using, distributing and growing Cannabis in such a legally multifaceted landscape, the Cannabis companies have encountered some difficulties (Matthew 2023 ).

The challenges facing the Cannabis sector

The complex legal landscape.

The medicinal Cannabis industry has been inhibited by regulatory restrictions for a long time. However, the legal market has emerged rapidly as many governments have started to legalise the production and use of medical Cannabis. For instance, many jurisdictions, especially in Europe, North America and South America, have liberalised control measures on Cannabis by decriminalising some instances of production, sales, possession and use. Some African countries, including Lesotho, have not been any exception to such a worldwide surge. Included in this industry are various activities, involving different professionals with direct, ancillary or tangential roles in the legal production, extraction, transport, sale and consumption or use of medical Cannabis, recreational Cannabis and any other related by-products (Duvall 2019 ). Further involve in cannabis industry are medical personnel, legal professionals, policy makers, dispensary owners and employees, cultivators and farmers, transport and handling personnel, and individuals as well as company manufacturing products as in oils and seeds for health and beauty products (Pacula and Smart 2017 ). However, with the industry being widely known for enforcing laws, some of which being clouded by ambiguous and contradictory regulations, Cannabis companies would end up operating with limited success (Bodwitch et al., 2019 ; Gianotti et al., 2017 ).

Cannabis cultivation methods

Medicinal Cannabis may grow either outdoors or indoors, thus differing from species to species as well as distinctive forms of produce, depending on different geographical situations. Outdoor cultivation is the traditional and original method of Cannabis cultivation that has been used for so long, mainly in African countries. Growing Cannabis outdoors exposes a crop to the elements, offering natural light and significantly reducing costs for growers. Nonetheless, the challenge is that Cannabis is exposed to harsh environmental conditions that may hinder an outdoor crop. For instance, prolonged heavy rains, insects and aggressive plants, such as, thistles, animals and extreme weather conditions are all potential crop killers. Improper soil and water resource management and pest control may also induce critical environmental hazards (Zheng et al. 2021 ). As a result, outdoor Cannabis growing could limit the growers’ control over environmental crossover from neighbouring fields.

In addition, medicinal Cannabis is mostly grown in green houses, mostly in developed countries. Joost ( 2019 ) reported that the intention is to mimic the elements of the outdoors that facilitate plant growth while maintaining full control over environmental parameters. The positive side of growing Cannabis in greenhouses is that the grower can detect how much carbon dioxide is in the air; how much moisture the plant needs; and even how well the soil conducts electricity (Bahji and Stephenson 2019 ). However, high upfront costs, including the building structures, equipment, water, electricity and other utilities, are the major downside of growing Cannabis indoors. Vaughan et al. ( 2021 ) argue that the light used indoors often reaches beyond greenhouses, causing some dissatisfaction on the part of the local communities and potentially disturbing ecosystem processes (Rich et al., 2020 ). Nonetheless, in 2019 and 2020, it was reported that growth in indoor Cannabis cultivation appeared to have overtaken growth in outdoor cultivation at the global level, with the overall net number of countries recording improved indoor cultivation being three times the net number of countries reporting a moribund outdoor cultivation (UNODC, 2022 ).

Competition

The common place increasing competition from Cannabis companies entering into the space is justifiably a major concern. The more countries legalise the medicinal Cannabis, the more companies enter into the Cannabis industry. For instance, on the African continent, Lesotho, Uganda, Malawi, Rwanda, Eswatini, Zimbabwe, Morocco and South Africa have already legalised the medicinal Cannabis. Such a series of legal frameworks in the Cannabis industry by the African countries may lead to a stiff competition among the Cannabis companies and across the African countries. A high competition may also threaten and push SMMEs Cannabis out of the emerging legal Cannabis industry (David et al. 2020 ).

Start-up costs

The Cannabis industry start-ups differ from traditional businesses with regard to the initial upfront costs. These are the expenses that Cannabis companies incur in the process of starting a new business venture. In many African countries, the expenses incurred include acquiring a licence fee for Cannabis production. The case in point is Lesotho where a licence fee for Cannabis production is approximately $350 000. In South Africa and Malawi, the production licence fee is approximately $1,465 and $10,000 respectively. In addition to the licence fee, setting up a medicinal Cannabis facility in South Africa, which cannot be afforded by many SMME Cannabis growers is estimated at $182,000 to $304 000. Adinoff and Reiman ( 2019 ) also argue that in the United States, economically disadvantaged individuals cannot participate in the legalised Cannabis market due to its high costs. In this view of this state of affairs, some researchers observe the participation of SMMEs Cannabis in the industry as crucial with potentially positive impact on the economy and citizens’ livelihoods in any given countries. This view is supported by Rusenga et al. ( 2022 ), who argue that legalising Cannabis production for medical purposes is extremely good. However, guaranteeing the involvement of ordinary citizens, SMMEs and local producers in the industry has to date proved challenging for many African countries.

The research capacity

In order to successfully inform health care decisions for a public policy, the research capacity of the Cannabis industry should be strengthened. Such policy-making decisions would require input from many stakeholders. These include clinical and public health Cannabis researchers; research methodologists; representatives from working groups who have developed research reporting guidelines; organisations engaged in standard development; representatives from scientific publications; and government agencies, with direct or indirect involvement in the research process (NASEM, 2017 ). In particular, institutions of higher learning should also come on board in advancing Cannabis research and offering courses geared towards the Cannabis industry.

Igiri et al. ( 2021 ) indicated that institutions of higher learning should offer courses, whose foci range from the business side of operations to growing and cultivating plants. Such courses could equip students with Cannabis consultancy, growing, technical extraction and dispensary operator skills. Establishing industry-focused universities for Cannabis research should be prioritised for the benefit of the country concerned. Besides, higher-learning institutions, particularly in Southern Africa, should be given funding for research, something has to date been a major barrier. Therefore, without adequate financial support, Cannabis research would hardly inform the health care and public health practice; nor would any initiatives for keeping pace with changes in Cannabis policy and patterns of Cannabis use make any headway. Supporting this view, Egbetokun et al. ( 2022 ) attribute low research output to poor funding and non-conducive and weak organisational climate in Africa. Some universities on the continent have few postgraduate programmes that further adversely affect their research output. Apart from lack of financial support for research and appropriate infrastructure, including laboratory facilities and equipment, the internet bandwidth required for collaboration with the global scholarly community, hence accessing more knowledge resources has been wanting (Igiri et al. 2021 ).

Research methodology

Based on the qualitative design, the methodology used aimed to explore Cannabis managers’ experiences with the challenges in the emerging Cannabis industry in Lesotho. For secondary data collection, the study thus critically reviewed relevant documentary sources, while for primary data collection, semi-structured interviews each of which lasted from 10 to 15 min were conducted on a one-on-one basis in the Board room of each individual organisation. With the participants’ consent, the interviews were audio-recorded and transcribed verbatim for analysis. Ethical Approval was granted on the 28th August, 2020 by the Ministry of Health and Ethics Committee and the National University of Lesotho Institutional Review Board (IRB) REF: ID 94-2020.

Respondents

The respondents for the study were the Cannabis companies’ managers, whose companies were registered, licenced and actively operated in Lesotho. There were eight registered and licenced Cannabis companies (Kabi 2018 ) which were all contacted for the interview. This information cannot be confirmed as the Chairperson of “Phekoane” (The Cannabis Association of Lesotho) could not provide the exact number of the registered Cannabis companies in Lesotho until the completion of the current study. The selection of the Cannabis managers adopted non-probability exponential non-discriminative snowball sampling, where the first manager, recruited to the sample group, provided multiple referrals, each of which was explored until the primary data from the adequate samples were collected (Mahin et al. 2017 ). This resulted in three Cannabis companies’ managers interviewed while five declined.

While it would be ideal to contact the entire target population for data collection, constrained resources, including time and access to certain participants became a factor. As such, sampling, particularly snowball sampling, was selected for this study. Snowball sampling is a purposeful method of data collection applied when samples with the target characteristics are not easily accessible (Vaughan et al. 2017 ). This technique was thus adopted for selecting the participant Cannabis managers from whom potentially rich data could be gathered for the study. The first Cannabis company manager contacted, provided multiple Cannabis managers who were followed up. Also, new referrals who accepted to participate pointed to more Cannabis managers, some of whose contact details were unavailable though. In the ensuing, the researcher arranged for the interview meetings with the readily available participants.

Data processing and analysis

Premised on the qualitative approach, the interviews were transcribed verbatim and analysed. In the process, a thematic analysis was chosen as the analytical instrument for preserving the descriptions and explanations of the Cannabis managers rather than analysing the actual content or raw data for in-depth meanings (Vaismoradi et al. 2013 ). The first step was to review transcripts comprehensively and ascribe them into themes. This was followed by the process of abstraction and coding to label meaningful units, with the codes being arranged according to categories throughout the analysis. The analysed report was discussed with the managers for confirmation and providing feedback.

The results

Company managers’ demographic profiles.

The data collection for this study drew on the participant managers, with the following demographic profiles: the managers’ gender, ages, current management positions, the highest qualifications and work experience in the management position. The summarised demographic profiles of each interviewed manager are presented in Table  1.1 .

As shown in Table  1.1 , the age of the three managers interviewed ranged from 25 to 64. All the participants were managers in the Cultivation Department. This might be because the three companies in which the managers agreed to be interviewed were at their initial stage of Cannabis production (cultivation). Regarding the level of education, the two managers each had a master’s degree, while one had a first degree. Further noted is that the closest master’s degree to Cannabis cultivation held by one of the respondents is Master’s in Agriculture. All the target managers had three years of experience in cultivation management.

Challenges for the emerging medicinal Cannabis sector

Challenges for the emerging medicinal Cannabis sector were reported as having varied categories. These include the ‘Legislation framework, interpretation and implementation’, ‘non-conformity to medical Cannabis regulations’, ‘Lack of accredited laboratories’ ‘Irrelevant skills’, ‘Accessibility of the Cannabis international markets’ and ‘Cannabis licence fees’. The responses, composed of verbatim statements made by the focal Cannabis cultivation managers are discussed below:

The legislation framework, interpretation and implementation

The respondents point to an array of limitations on the Lesotho Cannabis industry legislation, including its enforcement and implementation.

For example, as noted by Respondent 1 :

The legislation governing the Cannabis industry in Lesotho is unclear, difficult to comprehend, and it is not applied fairly.

Respondent 3 also commented :

I am wondering if these people who are in charge of the legal aspect of the Cannabis were ever exposed to some training on Cannabis laws and regulations under the auspices of the Ministry of Health. These people know nothing about Cannabis laws in the country.

This theme highlights the importance of careful interpretation and implementation of Cannabis laws and regulations in Lesotho.

Non-conformances to medical Cannabis regulations

The theme basically relates to non-conformity to medical rules and regulations. Crucial here is the first theme, legislation interpretation and implementation. The respondents observed the staff in the Ministry of Health as not complying with the rules and regulations of the industry. Such non-compliance may negatively impact on the industry, thus rendering the country at risk of being blacklisted by the International Narcotics Control Board (INCB).

In amplification of the above , Respondent 2 had this to say :

The staff in the Ministry do not have any interest in the industry. This is demonstrated by a lack of conformity to the industry regulations. As it stands, Lesotho is at risk of being blacklisted in the International Narcotics Control Board (INCB) because the Ministry have to date not being able to provide required annual reports.

Responded 3 remarked thus :

Those people in the Ministry are always sitting in offices; they do not go out to inspect and collect figures of the companies harvest. Nor do they know how much Cannabis Lesotho is producing. I won’t be surprised if people are still smuggling our Cannabis.

This theme suggests that the industry should adapt to a fast-changing, complex Cannabis legal landscape. Strict regulatory measures are required to protect both the domestic and international Cannabis markets and support the transition of small-scale illegal cultivators to the legal regime.

Lack of accredited laboratories

With the Cannabis industry finally in the legal realm in Lesotho, Cannabis testing has emerged as key to the emerging Cannabis sector. Cannabis testing enables growers, distributors and sellers to observe the Lesotho Cannabis regulations, while offering the highest quality, consistent and easy-to-dose products that are safely consumable to the customers. To this end, since Lesotho does not currently have its own testing laboratories, having all the companies take the samples to South Africa for Cannabis testing has been considered very expensive by the respondents.

Respondent 1 commented thus :

There are no accredited laboratories for testing the levels of Tetrahydrocannabinol (THC) and Cannabidiol (CBD) in our Cannabis products. Thus, the samples are taken to foreign countries for tests, something which turns out to be expensive for our companies.

Respondent 3 had this to say :

Some small Cannabis companies do not test their products at all because they cannot afford to take their Cannabis to South Africa. The laboratory that was located in the Letšeng Diamond Mining Company is not working. How could we have good cannabis produce while we do not have any testing laboratories?

Lack of relevant skills

The Cannabis industry in Lesotho is under the auspices of the Ministry of Health. The respondents observed that the employees attached to the Department of Cannabis in the Ministry do not have requisite skills and competencies.

In support of their views respondent 1 had this to say :

The Lesotho Health Ministry staff are very incompetent and do not have any interest and skills to run the sector. Neither are they willing to learn about the Cannabis industry, yet they are required to assist us with regulations related to licences, production, manufacturing, distribution and retailing of Cannabis. There is also a limited number of manufacturing pharmacists with comprehensive skills in the Cannabis industry, coupled with lack of compliance with Good Manufacturing Practices (GMP) and (GACP) Good Agricultural and Collection Practices and Good Manufacturing.

The other two respondents commented on the importance of training employees on Cannabis-related courses.

Respondent 1 stated as follows :

Our higher-learning institutions should introduce courses on Cannabis plants, including Cannabis short courses, targeting Cannabis employees who lack cannabis knowledge. Programme review should be done so that the country can provide Cannabis programmes needed by the country.

Respondent 2 remarked :

Cannabis companies should also offer their employees scholarships to further their studies, particularly in areas related to Cannabis production, Cannabis products and cultivation security. It could even be mandatory for all the Cannabis companies to provide hands-on experience for their employees in documenting the whole process, including growing the plant.

This theme suggests the importance of training employees to acquire requisite and relevant skills and competencies for the newly emerging Cannabis industry.

The international Cannabis markets

Currently, Lesotho has only one company producing and manufacturing Cannabis. It is the only one company which export the medicinal Cannabis flower as an active pharmaceutical ingredient (API) to the EU market. This means that the majority of the Lesotho Cannabis companies have, to date, not complied with the GMP requirements. As such, they cannot export the Lesotho Cannabis products to the international market.

Respondent 1 had this to say :

Without being granted the GMP (Good manufacturing practices and GACP (Good Agricultural and Collection Practices), Lesotho cannot sell anywhere in the world, nor can the country export to and access the international Cannabis markets.

This theme advocates for the improvement of the production of Cannabis in Lesotho in order to meet international standards for being granted the GMP and GACP. This theme relates to adhering and conforming to the rules and regulations governing the Cannabis industry.

Cannabis licence fees

The theme relating to the Cannabis licence fee is very important, as it affects the establishment of Cannabis companies in Lesotho. The Basotho people cannot venture into not afford operating in the Cannabis industry mainly because of the initial costly licencing. This indicates that although the 2008 legislation made it possible to grow Cannabis for medicinal purposes in Lesotho, growing it even for recreational purposes, without the licence from the Lesotho Ministry of Health still remains illegal in the country.

As Respondent 3 indicated :

It is not easy for the Basotho to establish their own Cannabis companies because the Cannabis licence fee is very expensive in Lesotho. Only the elite and multinationals have benefited from the Cannabis legislation that was heralded as something that would spread the economic gains amongst the Basotho.

This theme could be seen as the industry denying the local Basotho an opportunity to venture into the Cannabis business. Rather, the industry could be considered to be reserved for only few individuals with the potential or capacity to raise the required capital. The majority of the Basotho who have been cultivating Cannabis since time immemorial have apparently been excluded if not constrained by such Cannabis regulatory frameworks in Lesotho. Of the most favoured by the current or emerging Cannabis regulatory frameworks seem to be the large businesses over the smallholder farmers in the country.

Despite mixed experiences and limitations the Cannabis managers shared several challenges faced by the emerging Cannabis industry in Lesotho.

Industry legislation and compliance

The Cannabis industry in Lesotho is still at the rudimentary stage. Therefore, it is instructive to highlight, as reported by the respondents, that the legislation governing the industry is not yet refined nor fairly implemented. As observed globally, the scenario of Lesotho regarding the implementation of and compliance with the laws in the medicinal Cannabis sector has posed some challenges. Long timeframes for finalising regulatory frameworks have also met with problems of objective application (Rychert et al. 2021 ). However, due to the nature of this Cannabis products, the legality and regulation of the Cannabis industry is crucial. Regulatory bodies around the world have been instituting policies and guidelines to help to ensure safe and effective Cannabis production. Therefore, Lesotho is no exception as a member of the International Narcotics Control Board (INCB). The INCB responsibility is to administer a system of estimates for narcotic drugs and a voluntary assessment system for psychotropic substances, and to monitor licit activities involving drugs through a statistical returns system, with a view to assisting governments towards achieving, inter alia, a balance between supply and demand (INCB, 2011 ). Consequently, Lesotho is expected to enforce and adhere to the Cannabis laws, rules and regulations and duly submit regular reports regarding the Cannabis status for the INCB’s consideration.

The growing demand for medicinal Cannabis in Lesotho has created a booming industry that requires relevant and requisite skills. Taking the point further De Gobbi et al. ( 2022 ), highlights the Lesotho’s opportunity for the booming Cannabis sector for which requisite skills and knowledge could be inculcated among the Basotho for their vigorous involvement in the industry. Such skills could benefit the Basotho, including Cannabis cultivators and the Lesotho legal framework personnel. However, Letete ( 2023 ) reported that the Lesotho Cannabis industry has not lived up to the Basotho expectations. Small-scale growers are excluded from the emerging Cannabis industry, expatiating their illegal subsistence farming activities even more risky. As noted earlier, participation in the Cannabis sector, especially its licence fees, has become unaffordable for many Basotho interested in dealing in the Cannabis industry. Kabi ( 2018 ) attested that of the 33 people who had acquired licences to grow medical marijuana, only 13 had then paid M540, 000 ($28.18) for their operators’ licences. Concurring, Bloomer ( 2019 ) saw the current start-up costs for Cannabis production as being extremely high, thus excluding SMME participation in the industry in some African countries, including Lesotho and Malawi. This might be because, in particular, the Lesotho government has not done much to improve the possibilities of those who are already farming Cannabis inside the Lesotho legal framework.

Accredited testing laboratories

The Cannabis industry is a fast-paced industry, with the constantly changing job market, which requires different infrastructure and skill demands. One of the main requirements for effective Cannabis production are readily available and accredited test laboratories. With such test laboratories, determining potency of Cannabis products could be easily confirmed to avoid any harmful contaminants and ensure regulatory limits. Josh ( 2021 ) confirmed that Cannabis is predominantly tested for accurate labels and safety before consumption. On the other hand, Cannabis operators use testing results to improve their processes and to monitor the product quality versus state-specific regulatory requirements that could cause their products to pass or fail. It is, therefore, mandatory for countries, including Lesotho to provide Cannabis-testing infrastructure and ensure consumption of accurately labelled and uncontaminated products.

The industry-oriented skills

The Cannabis industry emanates from science-based to business-based careers, and the skills needed for each Cannabis job vary greatly (Fong, 2020 ). However, this fast-paced industry, with its constantly changing job market and varied skill demands, needs some of the most in-demand Cannabis skills as in basic Cannabis knowledge, reading and writing, basic computer and general skills. Jobs beyond an extractor require a bachelor’s degree in such areas as business, engineering, biology, chemistry, agriculture and horticulture, while scientific careers will require a master’s and doctorates. Careers related to law and policy, criminal justice and pharmacy are interconnected with Cannabis. Health professionals would especially need more education to ensure that they understand the medical benefits (Dattani 2018 ). On this basis, local institutions should introduce programmes that are geared towards the Cannabis industry skills. Cannabis SMMEs who may want to enter the Cannabis industry should also be provided with relevant training for participating in the industry.

Limitations of the study

As in any other study, some limitations have been noted in this particular study. This was all the more so, considering that the Cannabis industry was primarily in its infancy stage during the fieldwork for this study in the country. While the coming into being of the industry somewhat spurred this research study, at the time, some of the potentially relevant and information-rich participants could not come forward for providing data as expected. Neither could the precise number of the registered Cannabis companies be determined in the Kingdom of Lesotho at the time. Only a few companies appeared to have registered albeit not being fully operational. On the face of it, and of course, without necessarily undervaluing the phenomenon reported in this study, the snowball sampling technique, coupled with purposive sampling, were judiciously adopted for data collection. As such, from the purposively sampled target Cannabis managers, the study has been able to present, analyse and interpret the data which, as revealed, could shed light on the phenomena under study. Of course, with such a small sample, largely typical of the qualitative research adopted here, the findings may not be generalised to other contexts. Nevertheless, it is hoped that from the findings, conclusive remarks on the phenomenon of Cannabis production and its related legislative imperatives in the Kingdom of Lesotho could be made. From such conclusions, as noted below, future studies could carry over for further interrogating the Cannabis industry in Lesotho and possibly elsewhere.

Conclusions and recommendations

Considering the above findings, conclusions can be drawn based on the aim of the study. Conducting interviews with the Cannabis company managers, the study set out to identify challenges facing the Cannabis sector in Lesotho. The paper has found majority of the Lesotho Cannabis challenges as emanating from the legal framework governing the Cannabis sector in Lesotho. Inconsistencies in implementing and complying with the Cannabis laws and regulations by the Government Ministry of Health employees have also been noted. Issuing people with medicinal Cannabis licences has been done without any follow up on their use on the ground. At the time of study, Lesotho had thirty-three Cannabis companies, eight (8) of which were legally registered, and only one (1) had been granted Good Manufacturing Practices (GMP) certification. The GMP is a certification granted to producers who have stuck to the guidelines and regulations for dealing in Cannabis products according to GMP (Novak and Iguera 2019 ). This could indicate that Cannabis companies in Lesotho do not fully comply with the laws and regulations of the sector, resulting in only one Cannabis company being able to export Cannabis to EU markets. However, the export of medicinal Cannabis is necessary because not all countries have legalised medicinal Cannabis. However, the countries with legalised medicinal Cannabis apparently have limited domestic production capacity. For Lesotho to benefit from the Cannabis industry, strict compliance with the Cannabis laws is crucial.

The higher-learning institutions in Lesotho have the potential to support Cannabis career pathways by introducing and providing Cannabis-related programmes, thus assisting in producing a skilled and knowledgeable Cannabis workforce. However, also critical for the ultimate transfer of medicinal Cannabis skills and standards to the locals is the commercial knowledge of the international investors in the country. As such, the government should take measures to strengthen linkages with the medical Cannabis industry and promote economic activities so as to create low-skill jobs for small-scale farmers. With such newly created low-skill jobs, the locals should be retrained to work in the medical Cannabis industry, with the foreign workers being recruited largely or only for rare and/or special skills.

Cannabis production is increasingly becoming critical to Lesotho and to the international community. Therefore, the legalisation of the medicinal Cannabis sector should be reviewed so as to involve relevant stakeholders in Lesotho. In particular, the Lesotho Government should urgently spearhead such a review of the Cannabis laws and regulations for benefit of the entire Basotho nation, including the SMMEs, thus turning the extant illegal growers into legal growers who could also respond to the domestic marketing demands. As noted earlier, the Lesotho Government could thus formulate clear regulatory infrastructure to ensure responsive and sustainable Cannabis industry. Finally, liaising with higher-learning institutions, particularly in the country, the Government could develop requisite talents among the interested citizens, who would, in turn, be vigorously involved in the industry in Lesotho. Such strides could consolidate the Lesotho’s position as the leading trendsetter against which other African countries may benchmark.

Abbreviations

An Active Pharmaceutical Ingredient

Cannabidiol

Good Manufacturing Practices

High Pressure Sodium Light

International Narcotics Control Board

Light-emitting Diode

Ministry of Health

National Academies of Sciences, Engineering, and Medicine

National Institute on Drug Abuse

Doctor of Philosophy

Good Agricultural and Collection Practice

Small, Medium and Microenterprises

Tetrahydrocannabinol

United Nations Office on Drugs and Crime

United States of America

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The purpose of qualitative research

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Research fills a vital and important role in society: it is the means by which discoveries are made, ideas are confirmed or refuted, events controlled or predicted and theory developed or refined. All of these functions contribute to the development of knowledge. However, no single research approach fulfills all of these functions, and the contribution of qualitative research is both vital and unique to the goals of research in general. Qualitative research enables us to make sense of reality, to describe and explain the social world and to develop explanatory models and theories. It is the primary means by which the theoretical foundations of social sciences may be constructed or re-examined.

Research is to see what everybody has seen and to think what nobody has thought. (Albert Szent-Gyorgy)

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Atkinson, P. (1994) Some perils of paradigms. Qualitative Health Research , 5 (1).

Denzin, N.K. and Lincoln, Y.S. (eds) (1994) Part II: Major paradigms and perspectives, in Handbook of Qualitative Research , Sage, Thousand Oaks, CA, pp. 99–198.

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Morse, J.M. (ed.) (1992) Part I: The characteristics of qualitative research, in Qualitative Health Research , Sage, Newbury Park, CA, pp. 69–90.

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Noblit, G.W. and Engel, J.D. (1991/1992) The holistic injunction: an ideal and a moral imperative for qualitative research, in Qualitative Health Research , (ed. J.M. Morse), Sage, Newbury Park, CA, pp. 43–63.

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Smith, R.B. and Manning, P.K. (eds) (1982) A Handbook of Social Science Methods , Ballinger, Cambridge, MA.

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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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• Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Mar 5, 2024

Every day, drugs claim hundreds of lives. The Stop Overdose website educates drug users on fentanyl, naloxone, polysubstance use, and dealing with stigma.